Management Of Chronic Nonhealing Wounds Research Articles

Role of Bovine Colostrum Dressing on Chronic Non-Healing Wounds in Comparison to Conventional Dressing: A Case-Control Study.

Colostrum has been shown to be suitable for oral and/or topical applications. Colostrum decreases the amount of discharge from wounds and also accelerates healing, leading to a decrease in the number of dressings. In this study, 40 patients with chronic non-healing wounds were divided into two groups, considering the inclusion and exclusion criteria. Group I included 15 patients with conventional dressings, and Group II included 25 patients with added topical colostrum dressings. All patients were assessed at the time of presentation and after 21 days. The results of the present study indicate that colostrum powder dressings may be used as an adjunct in the management of chronic non-healing wounds.

Current applications of platelet gels in wound healing-A review.

Human platelets play important roles in several physiologic and pathologic processes. Platelet concentrates are activated with thrombin or calcium, resulting in a viscous coagulum (platelet gel [PG]), composed of 95% platelets at least. PG is increasingly used for the treatment of a variety of soft and hard tissue defects, most notably in the management of chronic non-healing wounds. During wound healing, platelets not only play a critical role in primary hemostasis and thrombosis, but also release growth factors and cytokines to promote tissue regeneration, enhance collagen synthesis, and trigger an immune response. This review addresses a variety of aspects relevant to the functions of well-known platelet growth factors, animal and clinical studies of PG in the last decade, and different sources of platelets for PG. PG is used for non-healing chronic wounds, such as oral ulcerations related to epidermolysis bullosa and chronic graft-versus-host disease, for those, the traditional treatment effect is poor. PG maybe provide a new therapeutic direction for these diseases. Nevertheless, some uncertainty is present, the number of clinical studies is not enough. Hence, randomized controlled trials are still required to study the potential of the use of PG in the near future.

VAC (Vacuum assisted closure) in the management of chronic non-healing wounds: Institutional study

Background: The management of chronic non- healing wounds has always been a cause of concern for the patients and treating team as well. There had been a marked increase in patients presenting with chronic non -healing wounds of varied etiology. The conventional methods of treatment have been in use traditionally include different medicated dressing application since the long-time yet desired results are not achievable always and some other applications like collagen are mostly not affordable to the poor local population. Vacuum-assisted closure using negative pressure being considered as a suitable alternative management for treating chronic non-healing wounds and the results are comparatively better in relatively lesser time than the conventional techniques. Objective: To assess the impact of (VAC) in the management of non-healing Ulcers To compare the advantage of VAC over conventional dressings in ulcer management Methods: Prospective controlled study of 60 patients aged between 40 and 60 were randomly divided into two groups (Wagner grade 2-5) VAC dressing was kept for over 2-5 weeks. Ulcers were treated until the wound closed spontaneously, surgically or until completion of the 50 days, whichever was earlier. Results: By the seventh week, discharge disappeared in 94 % in VAC and only 56 % in conventional dressing group. Granulation tissue appeared in 100 % of patients in the VAC group and only 63 % in the conventional dressing group. The patients treated with VAC dressing in our study showed comparable wound reduction capabilities with an average wound size reduction of 58 % in comparison to conventional dressing group which had an average wound size reduction of 26 %. Majority of wounds in the VAC group got closed in 7 weeks. Patient satisfaction was very good in the VAC group compared to those patients managed with conventional dressing group. Conclusion: The application of VAC is feasible, reliable and affordable with a better outcome in the management of chronic non-healing ulcers.

Drug-eluting wound dressings having sustained release of antimicrobial compounds

Wound healing is a complex and costly public health problem that should be timely addressed to achieve a rapid and adequate tissue repair avoiding or even eliminating potential pathogenic infection. Chronic infected non-healing wounds represent a serious concern for health care systems. Efficient wound dressings with tailored therapy having the best response and highest safety margin for the management of chronic non-healing wounds are still needed. The use of novel wound dressing materials has emerged as a promising tool to fulfil these requirements. In this work, asymmetric electrospun polycaprolactone (PCL)-based nanofibers (NFs) were decorated with electrosprayed poly(lactic-co-glycolic acid) microparticles (PLGA MPs) containing the natural antibacterial compound thymol (THY) in order to obtain drug eluting antimicrobial dressings having sustained release. The synthesized dressings successfully inhibited the in vitro growth of Staphylococcus aureus ATCC 25923, showing also at the same doses cytocompatibility on human dermal fibroblasts and keratinocyte cultures after treatment for 24 h, which was not observed when using free thymol. An in vivo murine excisional wound splinting model, followed by the experimental infection of the wounds with S. aureus and their treatment with the synthesized dressings, pointed to the reduction of the bacterial load in wounds after 7 days, though the total elimination of the infection was not reached. The findings indicated the relevance of the direct contact between the dressings and the bacteria, highlighting the need to tune their design considering the wound surface and the nature of the antimicrobial cargo contained.

Role of Collagen in Management of Chronic Non-Healing Wounds

Background A chronic wound does not heal in an orderly set of stages. The healing in such a wound is unpredictable in relation to time contrary to the way most wounds heal. The type of wounds that do not heal within three months are often and should be considered chronic wounds. Aim To study the efficacy of topical use of collagen granules in wound healing. Material and method In this prospective study one hundred cases with chronic non-healing wounds were selected and treated with collagen granules topically. The effect on the chronic wounds was studied for three months. The collagen granules were made from 100% bovine collagen. Observation and result all the wounds were observed for three months in terms of disappearance of slough, appearance of healthy granulation tissue and complete or incomplete healing. Conclusion The use of collagen granules dressing accelerated the wound healing in chronic wounds/ulcers. In our study we found that the rate of wound healing was significantly better in using collagen granules.

Role of Collagen in Management of Chronic Non-Healing Wounds

Background A chronic wound does not heal in an orderly set of stages. The healing in such a wound is unpredictable in relation to time contrary to the way most wounds heal. The type of wounds that do not heal within three months are often and should be considered chronic wounds. Aim To study the efficacy of topical use of collagen granules in wound healing. Material and method In this prospective study one hundred cases with chronic non-healing wounds were selected and treated with collagen granules topically. The effect on the chronic wounds was studied for three months. The collagen granules were made from 100% bovine collagen. Observation and result all the wounds were observed for three months in terms of disappearance of slough, appearance of healthy granulation tissue and complete or incomplete healing. Conclusion The use of collagen granules dressing accelerated the wound healing in chronic wounds/ulcers. In our study we found that the rate of wound healing was significantly better in using collagen granules.

Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds.

Despite a growing consensus that biofilms contribute to a delay in the healing of chronic wounds, conflicting evidence pertaining to their identification and management can lead to uncertainty regarding treatment. This, in part, has been driven by reliance on in vitro data or animal models, which may not directly correlate to clinical evidence on the importance of biofilms. Limited data presented in human studies have further contributed to the uncertainty. Guidelines for care of chronic wounds with a focus on biofilms are needed to help aid the identification and management of biofilms, providing a clinical focus to support clinicians in improving patient care through evidence-based medicine. A Global Wound Biofilm Expert Panel, comprising 10 clinicians and researchers with expertise in laboratory and clinical aspects of biofilms, was identified and convened. A modified Delphi process, based on published scientific data and expert opinion, was used to develop consensus statements that could help identify and treat biofilms as part of the management of chronic nonhealing wounds. Using an electronic survey, panel members rated their agreement with statements about biofilm identification and treatment, and the management of chronic nonhealing wounds. Final consensus statements were agreed on in a face-to-face meeting. Participants reached consensus on 61 statements in the following topic areas: understanding biofilms and the problems they cause clinicians; current diagnostic options; clinical indicators of biofilms; future options for diagnostic tests; treatment strategies; mechanical debridement; topical antiseptics; screening antibiofilm agents; and levels of evidence when choosing antibiofilm treatments. This consensus document attempts to clarify misunderstandings about the role of biofilms in clinical practice, and provides a basis for clinicians to recognize biofilms in chronic nonhealing wounds and manage patients optimally. A new paradigm for wound care, based on a stepped-down treatment approach, was derived from the consensus statements.

Biomedical evaluation of a novel nitrogen oxides releasing wound dressing

Chronic wounds are a major cause for both suffering and economical losses. Management of chronic non-healing wounds requires multipronged approach. They are polymicrobial and agonizing for the patient due to associated pain. Moist dressing providing antimicrobial action is a highly desirable chronic wound management option. Here we report a hydrogel based dressing that possesses the antimicrobial properties of acidified sodium nitrite and the homeostatic property of a hydrogel. The dressing was developed by combining citric acid cross-linked cotton gauze and sodium nitrite loaded gelatin. The cotton gauze was cross-linked with citric acid by pad-dry-curing in presence of nano-titania catalyst. The cotton gauze-gelatin hydrogel combination was gamma-irradiated and freeze-dried. At the time of application, the freeze-dried dressing is wetted by sodium nitrite solution. The dressing has a fluid uptake ability of 90 % (w/v) and the water vapour evaporation rate was estimated to be 2,809 ± 20 g/m(2)/day. The dressing showed significant antimicrobial activity against both planktonic and biofilm forms and was effective during consecutive re-uses. Cytotoxicity study showed inhibition of fibroblasts, but to a lesser extent than clinically administered concentrations of antiseptic like povidone iodine. Storage at 37 °C over a 3 month period resulted in no significant loss of its antimicrobial activity.

MiRNA in Wound Inflammation and Angiogenesis

Chronic wounds represent a rising health and economic burden to our society. Emerging studies indicate that miRNAs play a key role in regulating several hubs that orchestrate the wound inflammation and angiogenesis processes. Of interest to wound inflammation are the regulatory loops where inflammatory mediators elicited following injury are regulated by miRNAs, as well as regulate miRNA expression. Adequate angiogenesis is a key determinant of success in ischemic wound repair. Hypoxia and cellular redox state are among the key factors that drive wound angiogenesis. We provided first evidence demonstrating that miRNAs regulate cellular redox environment via a NADPH oxidase-dependent mechanism in human microvascular endothelial cells (HMECs). We further demonstrated that hypoxia-sensitive miR-200b is involved in induction of angiogenesis by directly targeting Ets-1 in HMECs. These studies point toward a potential role of miRNA in wound angiogenesis. miRNA-based therapeutics represent one of the major commercial hot spots in today's biotechnology market space. Understanding the significance of miRs in wound inflammation and angiogenesis may help design therapeutic strategies for management of chronic nonhealing wounds.

The use of autologous PRP gel as an aid in the management of acute trauma wounds

Autologous platelet-rich plasma (PRP) gel is increasingly used in the treatment of a variety of soft and bony tissue defects, such as accelerating bone formation and in the management of chronic non-healing wounds. We performed this study to assess the benefits of using autologous PRP gel in the treatment of acute limb soft tissue wounds. 59 patients with acute wounds (open fractures, closed fractures with skin necrosis and friction burns) were randomised into two groups. Group A (32 patients) were treated with conventional dressings and Group B (27 patients) were managed with local application of PRP gel. Gustillo grade IIIb or IIIc open fractures were not included in this study, as these injuries required coverage with flap. The clinical endpoints were the healing rate and/or the time required to bring about adequate tissue regeneration in order to undergo reconstructive plastic surgery. The rate of wound healing rate was significantly faster in Group B at week 1, 2 and 3 (p=0.003, p<0.001 and p<0.001, respectively). The mean time to plastic reconstruction in Group B was 21.26 days, S.D.=1.35 vs 40.6 days in Group A, S.D.=5.27 (p<0.001). This study has shown that PRP gel treatment can be a valuable and effective aid in the management of acute trauma wounds.

Modelling the cost-utility of bio‑electric stimulation therapy compared to standard care in the treatment of elderly patients with chronic non-healing wounds in the UK

ABSTRACTObjective: To estimate the cost-utility of bio-electric stimulation therapy (Posifect) compared to standard care in elderly patients with chronic, non-healing wounds of > 6 months duration, from the perspective of the National Health Service (NHS) in the UK.Methods: Clinical and resource use data from a 16 week clinical evaluation of bio-electric stimulation therapy among patients who had recalcitrant wounds were combined with utility data obtained from a standard gamble analysis to construct a 16 week Markov model. The model considers the decision by a clinician to continue with a patient's previous care plan or treat with bio-electric stimulation therapy. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the cost-utility of bio-electric stimulation therapy compared to standard care to be estimated. The acquisition cost of Posifect had not been decided at the time of performing this study. Hence, the base case analysis used a cost of £50 per dressing.Results: 33% of all wounds are expected to heal within 16 weeks after the start of bio-electric stimulation therapy. Consequently, using bio-electric stimulation therapy is expected to lead to a 51% decrease in the number of domiciliary clinician visits, from 4.7 to 2.3 per week. The model also showed that using bio-electric stimulation therapy instead of patients’ standard care is expected to reduce the NHS cost of managing them by 16% from £2287 (95% CI: £1838; £2735) to £1921 (95% CI: £1609; £2233) and result in a health gain of 0.023 QALYs over 16 weeks. Hence, bio-electric stimulation therapy was found to be a dominant treatment. Sensitivity analyses demonstrated that the cost-utility of using bio-electric stimulation therapy relative to standard care is very sensitive to the acquisition cost of the therapy, the acquisition cost of patients’ drugs and the number of clinician visits and less sensitive to utility values and the acquisition cost of other dressings.Conclusion: Within the limitations of the model, bio-electric stimulation therapy is expected to afford the NHS a cost-effective dressing compared to standard care in the management of chronic non-healing wounds of > 6 months duration. Bio-electric stimulation therapy's acquisition cost is expected to be offset by a reduction in the requirement for domiciliary clinician visits, leading to a release of NHS resources for use elsewhere in the system, thereby generating an increase in NHS efficiency.