Increased Healing Rate Research Articles

Efficacy and safety of allogeneic platelet-rich plasma in chronic wound treatment: a meta-analysis of randomized controlled trials

Allogeneic platelet-rich plasma (al-PRP) is gaining attention in clinical practice for treating chronic refractory wounds, though research results remain controversial. To assess the clinical efficacy of al-PRP for chronic refractory wounds. Databases including PubMed, Cochrane Library, Embase, CNKI, SinoMed, VIP, and WFPD were searched for randomized controlled trials comparing al-PRP with conventional treatments up to October 2023. Two researchers independently screened studies, extracted data, and assessed quality. Statistical analysis was conducted using RevMan 5.4, and potential publication bias was assessed and corrected using funnel plots and Egger’s test. Twelve studies with 717 cases were included. Meta-analysis showed al-PRP significantly improved outcomes compared to non-al-PRP treatments: increased healing rate (RR 2.72, 95% CI 1.77–4.19, p < 0.00001), shortened healing time (SMD − 1.03, 95% CI -1.31 to -0.75, p < 0.00001), improved efficacy rate (RR 1.19, 95% CI 1.10–1.28, p < 0.00001), increased wound shrinkage (MD 35.65%, 95% CI 21.65–49.64, p < 0.00001), and reduced hospital stays (MD -2.62, 95% CI -4.35 to -0.90, p = 0.003). Al-PRP is a feasible, effective, and safe biological therapy for chronic refractory wounds.Trial registration: PROSPERO Identifier CRD42022374920.

Nitric oxide-based treatments improve wound healing associated with diabetes mellitus.

Non-healing wounds are long-term complications of diabetes mellitus (DM) that increase mortality risk and amputation-related disability and decrease the quality of life. Nitric oxide (NO·)-based treatments (i.e., use of both systemic and topical NO· donors, NO· precursors, and NO· inducers) have received more attention as complementary approaches in treatments of DM wounds. Here, we aimed to highlight the potential benefits of NO·-based treatments on DM wounds through a literature review of experimental and clinical evidence. Various topical NO·-based treatments have been used. In rodents, topical NO·-based therapy facilitates wound healing, manifested as an increased healing rate and a decreased half-closure time. The wound healing effect of NO·-based treatments is attributed to increasing local blood flow, angiogenesis induction, collagen synthesis and deposition, re-epithelization, anti-inflammatory and anti-oxidative properties, and potent broad-spectrum antibacterial effects. The existing literature lacks human clinical evidence on the safety and efficacy of NO·-based treatments for DM wounds. Translating experimental favors of NO·-based treatments of DM wounds into human clinical practice needs conducting clinical trials with well-predefined effect sizes, i.e., wound reduction area, rate of wound healing, and hospital length of stay.

P272 Healing of Perineal Wounds after Proctectomy for Crohn's Disease: A Systematic Review and Meta-Analysis

Abstract Background Non-healing perineal wounds are common in patients undergoing proctectomy for Crohn’s disease. We systematically reviewed the literature and performed a meta-analysis to estimate the pooled proportion of perineal wound healing after proctectomy for Crohn’s disease. Methods A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases to identify relevant studies reporting perineal wound healing after proctectomy in patients with Crohn’s disease from 2010 to 2023. Articles were screened and those reporting perineal wound healing rates after proctectomy were included. Data on the study characteristics and proportion of healed wounds were extracted. Random effects meta-analysis was performed to estimate the pooled proportion and 95% confidence intervals using the ‘meta’ package in R. Heterogeneity was assessed using the I2 statistic. Results The literature search yielded 501 articles, of which 252 articles remained after removing duplicates. After screening the titles and abstracts, four retrospective cohort studies involving 332 patients with Crohn’s who underwent proctectomy were included in the meta-analysis. Across the four studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%) and at 12 months was 70% (95% CI 60%-83%). Significant heterogeneity was found between studies (I2=86% at 6 months). Only one study examined the predictors of impaired healing after proctectomy. Factors such as age, sex, BMI, smoking, steroid use, presence of high fistula-in-ano, and surgical technique were not significantly associated with impaired healing in univariate and multivariate analyses in this study. However, preoperative perineal sepsis was independently associated with impaired healing in the univariate and multivariate analyses in this study (p = 0.001). Study 4 included both Crohn's disease (n=54) and ulcerative colitis (n=20) patients who underwent proctectomy and reported fewer overall perineal complications in patients with UC than in those with Crohn’s disease (15% vs. 46.3%, p=0.01). Conclusion This meta-analysis revealed complete perineal healing in 70% of patients with Crohn's 12 months after proctectomy. Significant heterogeneity was observed between the studies. This review highlights the gaps in the best practices for optimizing perineal wound healing after proctectomy. These findings suggest the need to study techniques, such as vacuum-assisted closure and flap reconstruction. Further research is needed to identify modifiable factors to increase healing rates and develop evidence-based protocols for surgical approach, wound closure, and postoperative care in Crohn's disease patients.

Use of a Novel Human Keratin Matrix Improves Healing Rates in Diabetic Lower Extremity Wounds

Background. Lower extremity wounds in patients with diabetes are difficult to heal due to an overabundance of pro-inflammatory M1 macrophages, reduced phagocytosis of necrosed cells, and circulatory issues. Keratin biomaterials have been shown to address some of these concerns by encouraging the proliferation of anti-inflammatory M2 macrophages, thereby creating more favorable conditions for wound healing resembling those of patients without diabetes. Objective. To investigate the effect of a novel human keratin matrix (HKM) on wound healing. Materials and Methods. Ten patients with diabetes with lower extremity wounds at risk for delayed healing underwent wound debridement and application of HKM. Patients received weekly follow-up care and reapplication of HKM until healing occurred; wound size at each visit was used to calculate healing rate. Results. Increased healing rates were noted with HKM compared with standard of care (SOC), including debridement and collagen treatment in all 8 patients who had received SOC prior to HKM treatment. When HKM treatment was alternated with SOC in 2 patients due to other medical conditions, healing rates decreased with SOC and then increased after reintroduction of HKM applications. Conclusions. These results suggest that HKM may help regulate the pathological processes that contribute to wound chronicity to “kick-start” wound healing. This case series demonstrates that HKM is a promising technology to improve healing rates in nonhealing lower extremity wounds in patients with diabetes.

Diagnosis of exclusion in Burning Mouth Syndrome (BMS)

Internationally, relatively few studies have been undertaken regarding research on non-specific oral burning pain, especially regarding the identification of possible causal factors. Knowledge in this field from a physiopathological and therapeutic perspective is recent, which supports the need for further study and the definition of the disease as an interdisciplinary syndrome. Deepening the research on the etiopathogenesis of burning mouth syndrome (BMS) would be beneficial to medical practice, as it would allow for appropriate therapy and an increased healing rate.

101-OR: Systematic Intraoperative Bone Sampling Increases Healing Chances in Diabetic Foot Osteomyelitis

Aim: We aimed to evaluate if a proactive multidisciplinary diagnostic program could improve outcomes in the management of multidrug resistant (MDR) diabetic foot (DF) osteomyelitis (OM). Methods: We evaluated all the consecutive patients undergoing surgical procedure for OM July-December 2021 in our department (Group A). Intraoperative bone specimens were collected for microbiological and histological analysis on whose results antibacterial therapy was decided. Controls were patients admitted January-June 2021 with same indications (Group B) but with no systematic intraoperative bone sampling. Clinical and demographic characteristics, procedures, healing rate (HR) and healing time (HT), were compared between the groups. Results: We derived data from 89 patients: 46 in Group A [51.7%; age 68.8±13.5 yrs; diabetes duration (DD) 19.6±11.6 yrs Hba1c 8.7±4.8%] and 43 in Group B [48.3%; age 70.4±12.9 yrs; DD 18.8±12.1 yrs; Hba1c 8.4±5.1%]. No differences in demographic and clinical features, i.e. chronic kidney disease (39.1% vs 37.2%, p=ns), ischemic cardiac disease (41.3% vs 39.5%, p=ns), peripheral arterial disease (65.2% vs 67.4%, p=ns) and peripheral revascularizations (56.5% vs 53.4%, p=ns). Group A had a higher healing rate (80.4% vs 60.4%, p=0.0021) and a shorter healing time (67±41 days vs 134±92 days, p=0.020) compared to Group B. Conclusions: Systematic intraoperative bone sampling for culture and histology, and consequent antibiotic adjustment, increases healing rates and reduces healing times in DF patients undergoing surgical debridement for OM. Disclosure E.Iacopi: None. G.Naccarato: None. A.Piaggesi: None. F.Giangreco: None. A.Leonildi: None. V.Ortenzi: None. L.Suardi: None. L.Pieruzzi: None. C.Goretti: None. S.Barnini: None. M.Falcone: None.

Cost-effectiveness of two reduced pressure compression systems in treating newly diagnosed venous leg ulcers.

To assess the clinical outcomes and cost-effectiveness of using two different reduced pressure compression systems in treating newly diagnosed venous leg ulcers (VLUs) in clinical practice, from the perspective of the UK's National Health Service (NHS). This was a modelling study based on a retrospective cohort analysis of the case records of patients with a newly diagnosed VLU, randomly extracted from The Health Improvement Network (THIN) database, who were initially treated with a two-layer cohesive compression bandage (TLCCB Lite; Coban 2 Lite, 3M, US) or a two-layer compression system (TLCS Reduced; Ktwo Reduced, Urgo, France). No significant differences were detected between the groups. Nevertheless, analysis of covariance (ANCOVA) was performed to enable differences in patients' outcomes between the groups to be adjusted for any heterogeneity in baseline covariates. Clinical outcomes and cost-effectiveness of the alternative compression systems were estimated over 12 months after starting treatment. Time from wound onset to starting compression was a mean of two months. The probability of healing at 12 months was 0.59 in the TLCCB Lite group and 0.53 in the TLCS Reduced group. Patients in the TLCCB Lite group experienced a marginally better health-related quality of life (HRQoL) of 0.02 quality-adjusted life years (QALYs) per patient compared to those in the TLCS Reduced group. The 12-month NHS wound management cost was £3883 per patient treated with TLCCB Lite and £4235 per patient treated with TLCS Reduced. When the analysis was repeated without ANCOVA, the findings from the base case analysis remained unchanged (i.e., use of TLCCB Lite improved outcomes at lower cost). Within the study's limitations, treating newly diagnosed VLUs with TLCCB Lite instead of TLCS Reduced potentially affords a cost-effective use of NHS-funded resources in clinical practice, since it is expected to result in an increased healing rate, better HRQoL and a lower NHS wound management cost.

The combined effect of the human umbilical cord blood with chitosan scaffold on the full-thickness wound healing process in rats

This studyaimed to investigate the role of a low dose of human umbilical cord blood mesenchymal stem cells (HUCB-MSCs) with chitosan scaffold (ChSc) on the progress of the cutaneous wound healing process in male Albino rats. A full-thickness cutaneous wound with a circular shape with a diameter of about 2 cm was induced on the dorsum of thirty-six Albino male rats, divided into four groups: the first group, the wounds were left without treatment as a control group. In the second group, the wounds were covered by freeze-dried ChSc. While in the third group, the wounds were treated through injection of the HUCB-MSCs intradermally, and in the fourth group, the ChSc seeded with HUCB-MSCs were used together to treat the wounds. The progress of wound healing was monitored by histological, immunohistochemical, and biochemical assays for all experimental groups at 3, 8, and 21 postoperative days. Both ChSc and the low dose of HUCB-MSCs alone performed moderate healing progress.The (HUCB-MSCs) ChSc group exhibited an increased healing rate more than the other groups and reported an appropriate collagen deposition without scarring signs, effective mast cell regulation, and well vascularization. In conclusion, the fourth group (the HUCB-MSCs with ChSc) improved the healing process, revealing the highest healing rate and performance without complications.

One-Pot Synthesis of Bioadhesive Double-Network Hydrogel Patch as Disposable Wound Dressing.

Inventions of materials to achieve biocompatibility, bioadhesion, and easy manufacturing are the urgent demand for promoting wound healing in clinical treatment. Hyaluronic acid (HA) is probably the ideal candidate for current dressing materials due to its well-known biocompatibility. However, the unavoidable problem for HA dressings is their inherent low adhesiveness to wounds, which severely impairs their treatment efficacy, especially during body movement. Here, we report a one-pot facile fabrication of hybrid double-network polydopamine-HA (PDA-HA) hydrogel with significantly enhanced adhesiveness compared to the HA hydrogel. Besides the easy manufacturing and promoted effectiveness, the PDA-HA hydrogel could be vacuum-dried to form a patch, further benefitting from the convenience for storage and distribution. When applied on the wound, the PDA-HA patch quickly rehydrated by absorbing exudate and stuck tightly to the wound. The applied PDA-HA patches keep the wounds covered for more than 7 days against strenuous exercise. Thus, mouse full-thickness wounds treated with the PDA-HA patches exhibited increased healing rates, where epithelization was finished within 14 days. Moreover, the hydrogel dressing exhibited promoting effects on vascularization and cell proliferation/migration. Together with the easy manufacturing procedure, good adhesion/adaptation, and promotion of wound healing, the PDA-HA patch holds great potential for future clinical translation.

Driving Outcomes and Improving Documentation with Long-Wave Infrared Thermography in a Long-term Acute Care Hospital.

Hospital-acquired pressure injuries (HAPIs) have been increasing nationally, and unfortunately, long-term acute care hospitals (LTACHs) continue to report the highest prevalence and incidence. 1,2 To help reduce HAPI rates and to increase healing rates of all pressure injuries (PIs), including those that are present on admission, a 23-bed LTACH implemented a HAPI prevention and treatment protocol using new technology as a tool for patient skin assessments. A 75-day evaluation using long-wave infrared thermography (LWIT) was conducted for all patients admitted to the facility in conjunction with new PI treatment and prevention bundles that were created by the skin care team. Every PI was imaged using LWIT, which provided a photographic image of the PI, as well as a thermal image of the subcutaneous tissue underneath. This enabled staff to implement treatment and prevention measures as soon as possible. After the 75-day evaluation, the LTACH decided to make LWIT a permanent tool in their HAPI treatment and prevention program. For 10 months, the LTACH sustained a zero HAPI rate using the new treatment and prevention program including LWIT. The LTACH demonstrated that LWIT technology was an invaluable tool in the prevention and treatment of PIs. The use of LWIT has become common practice in this facility. The LTACH facility maintained a zero HAPI rate for 10 months after implementation of LWIT.

E2F1-Deficient Adipose-Derived Stem Cells Improve Wound Closure in Mice by Up-Regulating Expression of VEGF and TGF-β1.

Wound healing is a widespread health problem that imposes a financial burden on health systems. Cell therapy with genetically modified adipose-derived stem cells (ADSCs) is a promising strategy for dysregulated wound repair. E2F transcription factor 1 (E2F1) is a bidirectional regulator of cytokines. Here, the authors aimed to investigate the impact and potential mechanism of E2F1 -/- ADSCs in promoting the wound healing process. Forty-five C57BL/6 mice (specific pathogen-free, male) with 10-mm full-thickness wounds were randomly treated with subcutaneous injection of 2 × 10 6 wild-type ADSCs, 2 × 10 6 E2F1 -/- ADSCs, or phosphate-buffered saline. The wound closure rate was monitored at days 0, 3, 7, 10, and 14 after treatment. The collagen synthesis, angiogenesis, and wound contraction were calculated by Masson, immunohistochemistry, and immunofluorescent staining (CD31 and KI67), Western blotting (α-smooth muscle actin, collagen I, vascular endothelial growth factor, and transforming growth factor-β1) separately at day 14. In vitro, the conditioned media (CM) of wild-type ADSCs and E2F1 -/- ADSCs were collected to evaluate the impact on proliferation, migration, and angiogenesis. In vivo, the E2F1 -/- ADSC group exhibited increased healing rate, proliferating vessels, and collagen synthesis compared with control at day 14 ( P < 0.05). Moreover, E2F1 -/- ADSCs showed enhanced vascular endothelial growth factor and transforming growth factor-β1 expression in the wound site and CM, and the CM from E2F1 -/- ADSCs promoted the proliferation, migration, and tube formation of co-cultured cells in vitro ( P < 0.05). The E2F1 -/- ADSCs exhibited a strong paracrine ability to improve the vascularization process and collagen deposition, thereby accelerating wound healing in the rodent model. These findings show that targeting transcription factor E2F1 could regulate the paracrine function of ADSCs, developing E2F1-modified ADSCs as an effective therapeutic option for wound healing and regeneration.

Clinical Effect of Photobiomodulation on Wound Healing of Diabetic Foot Ulcers: Does Skin Color Needs to Be Considered?

Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes. DFUs impede patients' quality of life and are known to be unresponsive to conventional therapy. Photobiomodulation (PBM) is a pain-free, noninvasive treatment method that has been shown to promote chronic wound healing and has been successfully used for the treatment of DFUs. Since skin tone and color can affect the way light interacts with tissue, studies should take this into consideration when determining protocols for the use of PBM. This review is aimed at critically evaluating data of existing studies conducted to evaluate the clinical effect of PBM on DFUs, taking skin color into consideration. A literature search was conducted and resulted in articles on cell studies, animal studies, and clinical trials. Only 13 clinical trials and 2 clinical case studies were adopted and used in this review. All the clinical trials adopted for this review show evidence that PBM together with conventional treatment results in an increased healing rate of DFUs; however, only one study adjusted their protocol according to skin color. There are not enough studies conducted on people of color to determine the safety and efficacy of PBM therapy in such ethnic groups. Future randomized, placebo-controlled clinical trials are necessary on PBM and DFUs and should take skin color into consideration.

The Discovery and Development of Natural-Based Biomaterials with Demonstrated Wound Healing Properties: A Reliable Approach in Clinical Trials.

Current research across the globe still focuses strongly on naturally derived biomaterials in various fields, particularly wound care. There is a need for more effective therapies that will address the physiological deficiencies underlying chronic wound treatment. The use of moist bioactive scaffolds has significantly increased healing rates compared to local and traditional treatments. However, failure to heal or prolonging the wound healing process results in increased financial and social stress imposed on health institutions, caregivers, patients, and their families. The urgent need to identify practical, safe, and cost-effective wound healing scaffolding from natural-based biomaterials that can be introduced into clinical practice is unequivocal. Naturally derived products have long been used in wound healing; however, clinical trial evaluations of these therapies are still in their infancy. Additionally, further well-designed clinical trials are necessary to confirm the efficacy and safety of natural-based biomaterials in treating wounds. Thus, the focus of this review is to describe the current insight, the latest discoveries in selected natural-based wound healing implant products, the possible action mechanisms, and an approach to clinical studies. We explore several tested products undergoing clinical trials as a novel approach to counteract the debilitating effects of impaired wound healing.

34. The effect of screw length on single-level anterior cervical fusion using finite element

<h3>BACKGROUND CONTEXT</h3> Anterior cervical discectomy fusion and plating (ACDFP) is one of the most common neurosurgical procedures performed. Early in the use of plates to minimize postoperative orthosis duration and to increase healing rates, there was an attempt to use a bicortical screw purchase. Over time, we have typically converted to a lesser screw length to decrease any additional risks from the bicortical technique. Our study looks at the biomechanical effect of screw length at a single-level ACDFP and the effect on adjacent levels in flexion and extension using finite element modeling. <h3>PURPOSE</h3> To determine the effect of screw length on single-level anterior cervical discectomy, fusion and plating, and its clinical application. <h3>STUDY DESIGN/SETTING</h3> Finite element model. <h3>METHODS</h3> A previously validated three-dimensional osteoligamentous finite element model (FEM) of the cervical spine column (C2-T1) was used. The FEM simulated the vertebra of the body, posterior elements, intervertebral disc and ligaments. Each vertebral body consisted of a thin cortical shell, a softer cancellous bone, endplate, and a posterior bony structure. The cortical bone was modeled as a linear isotropic material of 0.5mm thick shell surrounding the cancellous bone and a 0.2mm thick endplate was placed on the superior and inferior surface of the intervertebral disc. Each single motion segment of the FEM consists of vertebral bodies, intervertebral disc and five major vertebral ligaments. The intervertebral disc was modeled and composed of the nucleus pulposus, annulus ground substance and annulus fibrosus. Material property parameters from literature were used as definitions in the model. The intact spine was modified at the C5-C6 functional spine unit level to simulate the biomechanics of ACDF with different screw lengths (12mm, 14mm, 16mm, 18mm). The standard surgical procedure was used to simulate ACDFP with different length screws at the C5-C6 level. The ALL was removed. The disc properties were altered at the surgical level to simulate the trabecular bone, and this represented complete fusion. The plate was placed at the C5-C6 level, and 4 titanium screws were simulated. All FEM were fixed at the first thoracic vertebra in all degrees of freedom, and load was applied at the C2 superior endplate vertebra. Bending moment (1.5 Nm) combined with a follower load (75N) magnitude under flexion and extension was applied to the intact model. The ROM was measured at each level and across the C3-C7 levels. The variable moment loading protocol (otherwise known as hybrid loading) was next applied. The bending moment was varied until the ACDF with different length screw models displayed the same total range of motion across the C3-C7 levels (although individual segments could have different range of motion). The ROM was obtained at the segmental levels under the same loading mode. <h3>RESULTS</h3> The C5-6 area of fusion demonstrated the least flexion (0.17°) and extension (0.36°) with the 18mm screw and the most flexion (0.75°) and extension (1.06°) with the 12 mm screws. The length of the screw effects the adjacent levels of the spine throughout with the largest increase in ROM in flexion (11.51° -11.98° with 12mm and 18mm screw length respectively) and extension (6.71°- 7.71° with 12mm and 18mm screw length respectively occurring at the cephalad C4-5 level. The caudal C6-7 adjacent level was more pronounced with an increase in flexion ROM with 12mm screws with 12.04° vs 11.88° with 18mm screws and increased but less pronounced ROM in extension with 6.34° with 18mm screws and 5.72° with 12mm screws. <h3>CONCLUSIONS</h3> Increased screw length results in higher flexion ROM at the C4-5 level. An inverse relationship is noted with 12mm screws at the C6-7 adjacent levels demonstrating more ROM than the 18mm screws in flexion. In extension both C4-5 and C6-7 demonstrate that increasing screw length results in increased ROM as compared to 12mm screws. This increased ROM would be expected to increase adjacent segment degeneration more prominently at the C4-5 level as compared to C6-7. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

OBESTATIN ACCELERATES THE HEALING OF GINGIVAL ULCERS IN SALIVARY INTACT AND SIALOADENECTOMIZED RATS

<h3>Objectives</h3> There are numerous strategies for the prevention or treatment of oral mucositis. However, their effectiveness is limited and does not correspond to expectations. Recent studies have shown that obestatin exhibits protective effects and accelerates the healing of gastrointestinal mucosa. The aim of the present study was to examine the influence of obestatin administration on oral ulcers in rats. <h3>Study Design</h3> Studies were performed on salivary-intact and sialoadenectomized rats. Gingival ulcers were induced by the use of acetic acid. Rats were treated intraperitoneally twice a day with saline or obestatin (4, 8, or 16 nmol/kg/dose) for 6 days. The study determined the oral mucosa morphology, cell proliferation, mucosal blood flow, and mucosal pro-inflammatory IL-1β level. <h3>Results</h3> In animals with intact salivary glands without induction of oral ulcers, treatment with obestatin was without any effect. Obestatin administration in rats with gingival ulcersbut with intact salivary glands significantly increased healing rate of these ulcers. Obestatin given at a dose of 8 or 16 nmol/kg/dose caused the strongest and similar therapeutic effects. This result was associated with a significant increase in blood flow and cell proliferation in gingival mucosa, as well as a significant decrease in IL-1β level. Sialoadenectomy caused a reduction in cell proliferation and an increase in IL-1β level. Administration of obestatin reversed this effect. In sialoadenectomized rats, the healing rate of ulcers was reduced. As in rats without induction of ulcers, this effect was associated with a reduction in blood flow and cell proliferation in oral mucosa, as well as an increase in mucosal IL-1β concentration. In these rats, obestatin reversed the effect of sialoadenectomy and doses of 8 or 16 nmol/kg increased the healing rate of oral ulcers above a value observed in control rats with intact salivary glands. <h3>Conclusions</h3> Obestatin accelerates the healing of gingival ulcers in both sialoadenectomized and non-sialoadenectomized rats. This therapeutic effect is well correlated with an increase in blood flow and cell proliferation in oral mucosa, as well as decrease of pro-inflammatory IL-1β level. Obestatin is potentially useful candidate for the prevention and treatment of oral mucositis.

Autologous platelet-rich plasma vs conventional dressing in the management of chronic diabetic foot ulcers.

Diabetic foot ulcers (DFUs) are a major complication of diabetes. Recently, considerable progress has been achieved in techniques that promote wound healing. Autologous platelet-rich plasma (PRP) is one such technique that is gaining popularity. Platelet-rich plasma is thought to stimulate wound healing by releasing growth factors essential for healing. This research aimed to study the efficacy of PRP in managing chronic DFUs. Seventy-two patients with chronic DFUs were equally divided into 2 groups. The first group was treated with activated PRP injection and gel on the surface of the ulcer, and the second group was treated with conventional dressing using normal saline to irrigate the wound, followed by coverage with petrolatum gauze and sterile dressing. Both methods of treatment improved healing, but there was a significant increase in healing rate among the PRP group compared with the conventional dressing group (31/36 patients [86.11%] vs 23/36 patients [63.89%]; P =.029). Additionally, the healing duration was shorter in the PRP group than in the conventional dressing group (10.90 weeks ± 3.40 standard deviation vs 13.48 weeks ± 3.37, respectively; P =.01). The use of autologous PRP results in a higher rate of wound healing in less time compared with conventional wound care in managing DFUs. Platelet-rich plasma is an effective and promising treatment for chronic DFUs; PRP enables healing in less time. This is expected to positively affect the individual's performance and minimize long-term health care expenditure on foot ulcers.

Impact of topical oxygen therapy on diabetic foot ulcer healing rates: a systematic review.

The aim of this systematic review was to determine the impact of topical oxygen therapy (TOT) on diabetic foot ulcer (DFU) healing. Using systematic review methodology, we considered randomised controlled trials (RCTs), controlled trials, pilot studies and observational studies. The search was conducted in January 2019, using PubMed, CINAHL, Ovid, Cochrane, Web of Science and EMBASE databases. Data analysis was undertaken using RevMan and a narrative synthesis. The article titles were assessed by two authors independently, and the abstracts (when available) of the studies identified by the search strategy were screened for their eligibility, according to the inclusion and exclusion criteria. The full-text version of potentially relevant studies was obtained and two authors independently screened this against the inclusion criteria. Data were extracted using a predesigned extraction tool and all included studies were quality appraised using the Evidence-Based Librarianship checklist. The search returned 565 records of which eight met the inclusion criteria. Of the included studies, three were set in single centre outpatient wound clinics, two studies were set in an outpatient wound care research clinic and three studies were multisite. Meta-analysis of four studies was undertaken. DFUs are >2 times more likely to heal with TOT than with standard care alone. The odds ratio (OR)=2.49 (95% confidence interval (CI): 1.59-3.90, p=0.00001). The remaining four studies also showed that using TOT increased healing rates. An included study reported that time to 50% DFU closure was significantly shorter in participants who received the TOT, mean 18.4 days versus 28.9 days in the sham therapy group (p=0.001). However, the validity of 65.5% of the eight studies was assessed as low. The findings suggest that TOT enhances healing for patients with hard-to-heal DFUs when used with standard care. The results from the trials reviewed also indicate a benefit for patients over standard care alone. However, the sample sizes in the studies were generally small, thus, more RCTs are warranted to further validate these findings. The authors have no conflicts of interest to declare.

High-energy extracorporeal shockwave therapy in humeral delayed and non-unions.

Within the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions. A retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT. A total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5mm (p = 0.002). The findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions.

Electrical Stimulation to Enhance Wound Healing.

Electrical stimulation (ES) can serve as a therapeutic modality accelerating the healing of wounds, particularly chronic wounds which have impaired healing due to complications from underlying pathology. This review explores how ES affects the cellular mechanisms of wound healing, and its effectiveness in treating acute and chronic wounds. Literature searches with no publication date restrictions were conducted using the Cochrane Library, Medline, Web of Science, Google Scholar and PubMed databases, and 30 full-text articles met the inclusion criteria. In vitro and in vivo experiments investigating the effect of ES on the general mechanisms of healing demonstrated increased epithelialization, fibroblast migration, and vascularity around wounds. Six in vitro studies demonstrated bactericidal effects upon exposure to alternating and pulsed current. Twelve randomized controlled trials (RCTs) investigated the effect of pulsed current on chronic wound healing. All reviewed RCTs demonstrated a larger reduction in wound size and increased healing rate when compared to control groups. In conclusion, ES therapy can contribute to improved chronic wound healing and potentially reduce the financial burden associated with wound management. However, the variations in the wound characteristics, patient demographics, and ES parameters used across studies present opportunities for systematic RCT studies in the future.

Controlling pH by electronic ion pumps to fight fibrosis

Fibrosis and scar formation is a medical condition observed under various circumstances, ranging from skin wound healing to cardiac deterioration after myocardial infarction. Among other complex interdependent phases during wound healing, fibrosis is associated with an increased fibroblast to myofibroblast transition. A common hypothesis is that decreasing the pH of non-healing, alkaline wounds to a pH range of 6.0 to 6.5 increases healing rates. A new material-based strategy to change the pH by use of electronic ion pumps is here proposed. In contrast to passive acidic wound dressings limited by non-controlled delivery kinetics, the unique electronic ion pump design and operation enables a continuous regulation of pH by H+ delivery over prolonged durations. In an in vitro model, fibroblast to myofibroblast differentiation is attenuated by lowering the physiological pH to an acidic regime of 6.62 ± 0.06. Compared to differentiated myofibroblasts in media at pH 7.4, gene and protein expression of fibrosis relevant markers α-smooth muscle actin and collagen 1 is significantly reduced. In conclusion, myofibroblast differentiation can be steered by controlling the pH of the cellular microenvironment by use of the electronic ion pump technology as new bioelectronic drug delivery devices. This technology opens up new therapeutic avenues to induce scar-free wound healing.