Mean Wound Size Research Articles

The profunda artery perforator free flap for lower extremity reconstruction.

The profunda artery perforator (PAP) flap has been reported in several types of reconstructions. This report aims to evaluate the usefulness and the clinical outcome of patients who underwent the PAP free flap for lower limb reconstruction. Between February 2018 and February 2020, nine patients with injury at lower third of the leg, foot dorsum or foot plant (eight acute injuries and one chronic ulcer) were selected. Mean wound size was 12.5 × 6.3cm (9 × 5-14.5 × 6.5). Inclusion criteria consisted in patient's request to hide the donor site scar and the absence of previous traumas or surgery in the donor site. Patients considered unable to bear prolonged surgery were excluded. Patients underwent preoperative CT angiography and peri-operative Doopler, for perforator selection. All flaps were designed with pinch test, in elliptical shape. Microvascular anastomosis was performed to the tibialis anterior/posterior or medial plantar vessels. Outcomes were evaluated in terms of wound coverage success and patient's quality of life through Lower Extremity Functional Scale (LEFS) questionnaire. The mean size of the harvested skin paddle was 13.5 × 7.4cm (9 × 6-15 × 8) and mean pedicle length was 8.5cm. Mean flap harvest time was 43.5min (35-55). Flap survival rate was 100%, with one re-exploration with minimal partial flap loss. Mean follow-up was 13.5months . Reconstructive results were successful in wound coverage and function. All patients reported satisfaction with their result by LEFS questionnaire (score:64.7). With proper patient selection, there was 100% flap survival rate with no major complication. According to our data, the PAP free flap could be a valuable option for lower extremity reconstruction.

Arteriovenous Vascular Loops in Latissimus Free Flap Reconstruction of Cervical and Cervicothoracic Spine Wounds

Introduction Wound dehiscence is the most common complication after spinal fusion procedures, resulting in an increase in mortality rate and hospital length of stay. Reconstruction of these wounds presents a challenge, as the spine is dependent on these implants for stability and must be maintained throughout the wound dehiscence treatment protocol. We describe a method for extending the thoracodorsal pedicle with an arteriovenous loop to permit an increased excursion of the latissimus dorsi muscle in patients with exposed implants and present the results of this procedure.Materials and Methods A retrospective review of patients treated with a latissimus free flap with saphenous vein pedicle extension for posterior spinal wounds from 2010 to 2020 were reviewed. Patient charts were reviewed for demographic information including comorbidities, previous spine operations, wound size and location, and postoperative complications including total flap loss, flap dehiscence, and need for secondary surgery.Results Six patients were identified who underwent a total of eight extended pedicle free flaps. Mean age was 64.8 years with a mean follow-up of 12.3 months (range, 6–20 months). Four wounds were in the cervicothoracic region with two wounds in the cervical region. Mean number of previous spine surgeries was 3.5 (range, 2–4). Mean wound size was 189 cm2 with a mean vein graft length of 28 cm. Wound coverage was successful in five of six patients. Major complications occurred in five of six patients. Total flap loss occurred in two patients (33%) and both underwent a second extended latissimus flap from the contralateral side. Three patients developed postoperative flap dehiscence which resolved with regular dressing changes.Conclusion Extended pedicle latissimus flaps are an effective treatment for posterior spine wounds but are associated with a high complication rate, secondary to medically complex patients with multiple prior surgeries. Careful patient selection is critical for success.

Ultrasonography-Guided Minimally Invasive Surgery for Achilles Sleeve Avulsions.

Achilles sleeve avulsion, a relatively rare disorder, is characterized by sleeve-shaped injury extending from the calcaneus, located near the tendon insertion site. Unlike midsubstance tears of the Achilles tendon, end-to-end repair is difficult because less soft tissue is preserved distally. Open repair with transosseous sutures or suture anchors is currently favored. The purpose of this study was to evaluate the technical feasibility and functional outcomes of ultrasonography-guided Achilles sleeve avulsion repair. From November 2009 to April 2018, 21 patients with Achilles sleeve avulsions (mean age, 57.8 years; range, 25-82 years) who underwent repair by the same surgeon were retrospectively reviewed. The repair was achieved through a stab wound under ultrasonographic guidance. Two parallel Bunnell-type sutures were crossed over the proximal stump and tied with sutures from suture anchors fixed in the calcaneal tuberosity. The mean operative time was 44 minutes, and the mean wound size was 1.5 cm. The patients were allowed to walk freely on postoperative week 6 with using high-ankle shoes. At postoperative 2 years' follow-up, the American Orthopaedic Foot & Ankle Society score significantly improved from 70.9 to 97.1 (P < .05); similarly, their 12-item Short Form Health Survey scores improved significantly (P < .05). Only 2 patients had superficial wound infections, which resolved with wound care and oral antibiotics. Our ultrasonography-guided surgical technique for Achilles sleeve avulsions provided excellent soft tissue visualization and availability as well as minimized the wound length to achieve good postsurgical outcomes. Level IV, retrospective case series.

Clinical outcome and cost analysis of negative pressure wound therapy in extremity wounds: a comparison to conventional wound management

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Open fractures and traumatic wounds constitute a major health problem. Amongst the armamentarium of wound care products available, negative pressure wound therapy (NPWT) is a modality that has transformed wound care and has been recommended for treating all kinds of acute and chronic wounds.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective randomised comparative study was conducted at a tertiary care hospital in Northeast India. 30 patients were included in this study over a period of 24 months commencing from January 2018. The patients consisted of two groups of 15 each, the first group comprised patients who underwent treatment using NPWT and the second group was treated using standard wound therapy (SWT). The endpoint taken was a granulated wound or a wound ready for split skin grafting (SSG).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean wound size difference between the NPWT group and the SWT group on day nine was 13±7.17 mm and 4.53±0.99 mm, respectively. Likewise, on day nine, 11 (73.3%) patients in the group treated using NPWT had no positive bacterial cultures compared to 8(53.3%) patients on SWT. The estimated cost of materials for each NPWT dressing change was roughly INR₹ 3446 (US$ 45.57).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; NPWT is not a magic bullet and will not replace the basic methods of wound treatment such as wound debridement, infection control and ensuring adequate blood supply. Nevertheless, NPWT remains an integral part of the current scenario in wound care management and is cost effective under the condition that it accelerates wound healing when compared to traditional treatment.&lt;/p&gt;

Moxibustion burns: wound characteristics and clinical manifestation

Moxa treatment (moxibustion) is a herbal treatment and based on the theories of traditional Chinese medicine, which has been practiced for over 2500 years. In East Asia, moxibustion has been performed on a variety of diseases and conditions for therapeutic purposes. Traditional moxibustion works by using the heat generated from burning herbal materials. During the process, burning herbs come in contact with the skin directly or indirectly. Because the skin is heated during moxibustion, we supposed that there would be a risk of burn injuries. To date, there have been no reports about burn injuries from moxibustion. We report the wound characteristics of burns by moxibustion. We retrospectively reviewed the charts of 35 inpatients and outpatients who had been treated for burns after moxibustion from January 2017 to December 2019. The data reviewed were gender, age, reason for using moxibustion, burned lesion and size, type of treatment for burn, underlying disease/condition, period between the day of the burn injury and the day treatment began, and the location of the burn injury on the patients’ body. The mean age of the patients was 64.46 years, 71% were women, and the most common reason for moxibustion was joint pain. The most common region of the burn injury was the lower extremities (50%), and the mean wound size was 7.81 cm2. The lengths and widths of the wounds were similar in many cases. The average period from burn onset to the start of treatment was 22.6 days, and the type of treatment was mainly local flap (65.7%). Despite moxibustion burns often being severe, such a side effect has not been investigated. We recommend that patients be informed about the risk of burns when being treated with moxibustion. This potentially severe side effect should be further researched. Level of evidence: Level IV, Risk/Prognostic study.

Heal or no heel: Outcomes of ischaemic heel ulcers following lower limb revascularization from a multi-ethnic Asian Cohort in Singapore.

Ischaemic diabetic heel ulcers are difficult to treat and prognosis is often guarded. The aim was to document our outcome of treating heel ulcers following revascularization in a predominantly diabetic Asian cohort presenting with chronic limb threatening ischaemia from Singapore. Retrospective cohort study (n = 66, 66 limbs) over a 5‐year period. Data were collected from hospital electronic health records. Outcomes included time to healing, amputation free survival (AFS), and mortality. Minimum follow‐up period was 6 months. Multivariate regression analysis was performed to look for factors associated with poor outcome. Mean age was 67.4 ± 8.8 years. 62/66 (93.9%) were diabetics. Mean wound size at presentation was 3.6 ± 2.3 cm. Mean Wound, Ischaemia, Foot Infection (WIFI) score was 5 ± 1.6. 12/66 (18%) patients had a patent posterior tibial artery pre‐operatively. Straight line flow was restored in only 31/66 (46.9) patients but 47/66 (71.2%) had successful limb salvage. Median time to wound healing was 90.0 (IQR 60‐180) days. A median of 1 (IQR 0‐2) wound debridement was required. Patients who underwent negative pressure dressing (23/66; 34.8%) required a median of 26 (IQR 13‐33) cycles to achieve healing. Amputation free survival (AFS) was 72% and 68% at 6‐ and 12‐months, respectively. Mortality rate was 16.7% and 19.7% at 6‐ and 12‐months, respectively. Low albumin level and initial Rutherford class were independent predictors of worse 6‐month AFS. Outcomes of heel ulcers post revascularisation may not be as poor as previously described. Persistent attention to wound care with multidisciplinary effort is needed for optimal healing.

Outcome of honey dressing on pain relief and re-epithelization of donor site wound of split thickness skin graft.

Objectives: To determine the frequency of pain relief and re-epithelization of the donor site wound of split thickness skin graft with the use of honey dressing. Study Design: Descriptive Case Series. Setting: Plastic Surgery Department, Jinnah Burn and Reconstructive Surgery Centre Lahore. Period: From 1st January, 2019 to 30th November, 2019. Material &amp; Methods: A total of 100 patients with healthy granulating wound were included in the study. All patients undergone operations under general anaesthesia by the same surgeon. The dressing was done by a layer of honey on gauze piece, wrapped around the donor wound site of split thickness skin graft. Patients were followed at the 7th post-operative day and outcome measures were noted. Pain was scored by the use of Visual analogue score (VAS) and re-epithelization was complete healing of the wound. Results: A total of 100 patients were enrolled with mean age of 33.11±9.72 years and there were 45% (45) females and 55% (55) male patients. Mean wound size was 7.70±1.83 cm2. At the 7th post-operative day follow up; pain relief was seen in 74% patients and re-epithelization was seen in 78% of patients. Both the outcome measures i.e. pain relief and re-epithelialization was effectively controlled with the use of honey dressing. Conclusion: Honey dressing is useful and effective on split thickness skin graft donor site in terms of pain relief and re-epithelization.

Novel Cross-Linked Ocular Bandage Gel Improves Reepithelialization After Photorefractive Keratectomy: A Randomized, Masked Prospective Study

Purpose: To compare, in a masked manner, a novel cross-linked hyaluronic acid ocular bandage gel (OBG) versus standard-of-care bandage contact lens (BCL) plus artificial tears with respect to safety and effectiveness in healing epithelial defects created for photorefractive keratectomy (PRK). Methods: This was a randomized, reading center-masked, exploratory study. Forty-five patients (myopic without significant anisometropia) scheduled for bilateral PRK (9-mm epithelial defect) were randomized post-PRK to treatment with OBG 8 times daily for 3 days, followed by 4 times daily for 11 days (Group 1); OBG 4 times daily for 14 days (Group 2); or BCL and artificial tears (Control). A masked reading center used image analysis of digital slit lamp photos of the fluorescein-stained cornea to evaluate defect size during the 14-day postoperative follow-up period. Effectiveness endpoints were (1) time to complete closure of the corneal defect and (2) proportion of patients with complete healing on day 3 postoperatively, whose defect remained closed. Safety assessments included findings for adverse events and vision, Standard Patient Evaluation of Eye Dryness (SPEED™) Questionnaire, slit lamp, intraocular pressure, and fundus examinations. Results: The proportion of patients with complete healing at 3 days was 73.3%, 86.7%, and 66.7% of patients in Groups 1, 2, and Control, respectively. On day 2, the mean wound size was 6%-26% smaller in Groups 1 and 2 compared with Control. No safety concern arose. SPEED scores were not significantly different across groups. Conclusion: OBG offers a well-tolerated and effective therapy for quickly reepithelializing the cornea following trauma, disease, or surgery.

One year randomized controlled trial to compare the effectiveness of honey dressing versus povidone iodine dressing for diabetic foot ulcer at Dr. Prabhakar Kore Hospital and MRC, Belagavi

Background: The objective of the study is to find out the effect of honey dressing versus povidone iodine dressing for reduction of wound size in diabetic foot ulcer.Methods: This randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital, Belagavi from January 2017 to December 2017. 64 patients were randomized into 32 group each undergoing unprocessed honey dressing and other group undergoing povidone iodine dressing.Results: The mean wound size in honey dressing was 23.16 cm2 and 23.03 cm2 in povidone dressings at baseline, 23.16 cm2 and 22.94 cm2 at 1st day follow up, 23.16 cm2 and 22.94 cm2 at 3rd day follow up, 19.38 cm2 and 20.28 cm2 at 5th day follow up, 16.13 cm2 and 17.06 cm2 at 7th day follow up, 12.44 cm2 and 16.13 cm2 at 10th day follow up and the end of 15th day, it was 10.69 cm2 and 15.06 cm2 respectively in honey dressing group and povidone dressing group. The difference in the wound size in honey dressing group and povidone dressing group at 1st day, 3rd day, 5th day, 7th day, 10th day follow up period were statistically not significant (p&gt;0.05). The difference in the wound size in honey dressing group at 15th day follow up period were statistically significant (p&lt;0.05).Conclusions: This study shows more favorable results with honey dressing for reduction of wound size in diabetic foot ulcers.

The Effect of Autologous Blood Patch Treatment Among Patients With Hard-to-heal Wounds; A Clinical Perspective

Introduction: The aim of the project is to describe the effect of treatment with an autologous blood patch[1] among patients with hard-to-heal wounds, including both diabetics and non-diabetics. Growth factors and concentration of leucocytes and thrombocytes are harvested from the patient's own blood. The blood is concentrated and layered by centrifuging making it into a gelatinous blood-patch. Growth factors mediate macrophage migration, neovascularization, collagen synthesis, fibroblast proliferation and epithelization, while leucocytes fight infection and thrombocytes are blood-clotting agents. After the centrifuging, the blood-patch is placed directly into the wound bed and fastened by appropriate bandages. Methods: The treatment is implemented in a multi-disciplinary outpatient clinic specialized in advanced wound treatment, as a supplement to standard care (off-loading, compression, debridement, infection control etc.). Only patients with hard-to-heal wounds (wound duration>6 weeks) are included. The indication for blood patch treatment is set after clinical assessment by a consultant wound specialist. We administer the autologous blood patch [1] weekly, and measure the wound size at the beginning and at the end of treatment. Furthermore, we register time to healing and potential adverse events. Results: From June 2016 to October 2018, 26 patients were included. Wound-categories were: diabetic foot ulcer(n=4), pressure ulcer(n=7), related to surgical incision(n=9) venous(n=3) and other(n=3). The mean age was 65 years (SD 13.6), 58%(n=15) were males. Median pre-treatment time before inclusion was 21.5 weeks (IQR 28). The median number of blood patch[1] treatments were three ranging from 1-19 treatments per patient. The median time to healing was 73 days (IQR 156). 54 %(14/26) healed < 20 weeks, 27%(7/26) healed >20 weeks, and 19%(5/32) did not heal. A reduction in mean wound size was seen, from 2.75 cm2(SD 3.55) at the start of treatment versus 1.62 cm2(SD 2.48) after completion of treatment, (95%CI 1.29;4.22) versus (95%CI 0.59;2.64) p=0.0058. In all cases with pain prior to treatment, the patients reported less pain after treatment start. All patients had weekly controls and treatment was stopped ahead of time for 3/26 patients: one because of difficulties obtaining the blood sample, one had an infection and one was amputated. Conclusion: Autologous blood patch[1] , as a supplement to standard wound treatment, among patients with hard-to-heal wounds treated in a highly specialized clinic, seemed to expedite wound healing and reduce pain, without any negative side effects. Disclosure: [1] Leukopatch by Reapplix

An Open-Label Study of Low-Level Laser Therapy Followed by Autologous Fibroblast Transplantation for Healing Grade 3 Burn Wounds in Diabetic Patients.

Introduction: Low-level laser therapy (LLLT) has been used as an effective therapeutic modality since the mid-1960s. Although there have been several clinical studies using LLLT in wound healing, especially diabetic, pressure and venous ulcers, there are few reports of using this technique in burn ulcers. Autologous fibroblast transplantation is a novel treatment for patients with burns or venous ulcers. In this study for the first time, we used LLLT along with autologous fibroblast skin transplantation to treat grade 3 burn ulcers in diabetic patients. This case series describes the successful management of grade 3 burn ulcers in 10 diabetic patients using autologous fibroblast transplantation along with LLLT. Methods: After the approval of the Tehran University Ethics Committee (IR.TUMS.REC.1394.1683) and the Iran Registry of Clinical Trials (IRCT2016050226069N3), 10 diabetic patients with 10 grade 3 burn ulcers, who were a candidate for skin graft surgery, entered the study. Donor skin was biopsied using a 3 mm punch. Fibroblasts were extracted and cultured in vitro in the GMP Technique laboratory. The patients were treated using LLLT in 3-4 weeks during the time that fibroblast cultures became ready to use. Laser irradiation was done using red light, 650 nm, 150 mW, 1 J/cm2 for the bed of the ulcer and infra-red light 808 nm, 200 mW, 6 J/cm2 for the margins every other day for 10 sessions. Results: The mean wound size before treatment was 16.28 cm2 . All patients' burn wounds healed completely after 10-12 weeks. Conclusion: We conclude that this method can be used as an effective method for treating large wounds, especially in complicated patients including the diabetics.

Outcomes of the Recombinant Human Epidermal Growth Factor Addition to Chloramphenicol Ointment for Facial Burn Wound Healing

Objective: Delayed healing of facial burns can result in scarring and psychological morbidity. Epidermal growth factor may promote wound granulation and angiogenesis to enhance wound healing. &nbsp;We compared the effect of Chloramphenicol ointment alone with Recombinant Human Epidermal Growth Factor (rhEGF) plus chloramphenicol on facial burn wound healing.Methods: A randomized controlled trial was conducted in patients admitted to the Burn Unit. Subjects aged 18 to 65 years with acute second-degree facial burn wounds that did not require surgical treatment were enrolled. Subjects were divided equally and randomized to receive either topical chloramphenicol ointment twice daily (control) or rhEGF ointment once daily and chloramphenicol ointment twice daily. Wounds were assessed at frequent intervals. Wound size, complete healing day, pain score, infection, side effects, Vancouver Scar Scale and the cost of treatment were recorded.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Results: Twenty-six wounds were enrolled. The mean wound size was similar in both groups (rhEGF plus chloramphenicol treated group 38.5±18.2 cm2 vs control group 42.1±19.4 cm2). Burn wounds in the rhEGF group healed more rapidly, though the difference was not statistically significant (8.5 ± 3.4 days vs 9.3 ± 4.4 days, p=0.3). No difference was observed in the Vancouver scar scale. Mean post-treatment pain scores were the same in both groups. There were no infections or side effects in either group. The rhEGF-treated group was more expensive (1463.1 ± 142.6 vs 19.2 ± 1.9 baht).Conclusion: &nbsp;There are no difference in outcomes of acute facial burn wound healing treated with rhEGF and chloramphenical ointment compared to chloramphenicol treatment alone. The further study to evaluate the effect of rhEGF in patients who have some factors that delay wound healing should be done.

External validity of randomized controlled trials of interventions in venous leg ulceration: A systematic review.

We set out to evaluate quality of reporting of data related to external validity from randomized controlled trials (RCTs) assessing treatment interventions for active venous leg ulcers. Using a systematic review study design, we identified 144 full-text RCTs of treatment interventions, where the wound was assessed and published in English from 1998 to 2018. We found that the median study sample size was 75.5. Weighted mean wound size was 13.22 cm2 and weighted mean wound duration was 22.20 months. Forty-six (32%) reported numbers screened for eligibility and 27 (19%) reported the number who declined to participate; 19 (13%) reported on patient ethnicity; 60 (42%) reported comorbidities; and 5 (4%) reported current medication use. When reported, 60/102 (59%) excluded patients with an ankle-brachial pressure index <0.8; 68/135 (50%) were conducted in Europe, 6/135 (4%) in Asia, and 74/104 (71%) were conducted in outpatient facilities; 3 (2%) reported socioeconomic factors and 88 (61%) reported on adverse events. We concluded that there is inadequate reporting of data related to external validity in reports of RCTs assessing venous leg ulcers treatment interventions. Significant variability exists in the ankle-brachial pressure index cutoff point for inclusion or exclusion, making generalizability difficult to assess.

Biologics and immunoglobulins in the treatment of pyoderma gangrenosum - analysis of 52 patients.

Corticosteroids and cyclosporine A are frequently ineffective as first-line therapies in the treatment of pyoderma gangrenosum (PG) and associated with a number of adverse effects. The objective of the present study was to analyze the effectiveness and safety of biologics and intravenous immunoglobulins (IVIGs). Retrospective, dual-center cohort study analyzing the treatment outcome in patients with PG who received biologics and IVIGs. Fifty-two patients (mean age: 58.4 years) with 75 wound episodes (mean wound size: 53.2cm²) were included in the study. Overall, 92.3% of patients initially received corticosteroids (CSs; 48/52); 51.9% cyclosporine A (CSA; 27/52). In 275 therapeutic attempts, complete remission or improvement were achieved in 63.6% (21/33) of patients on infliximab; 57.1% (16/28) on adalimumab; 71.4% (5/7) on etanercept; 66.6% (6/9) on ustekinumab and 66.7% (10/15) of patients who were given IVIGs. That figure was 48.8% (38/78) for those treated with CSs and 20.0% (7/35) for individuals on CSA. On average, adverse events occurred in 18.5% (15/81) of cases treated with biologics in 20% (3/15) of patients receiving IVIGs, in 40% (14/35) of individuals on CSA and in 10.4% of those treated with CSs (5/48). The present retrospective analysis suggests that both biologics - especially TNFα antagonists - and IVIGs are well-tolerated and safe options in the treatment of PG. Data from prospective comparative studies would be highly desirable.

Comparative study of wound healing effect of topical Acacia catechu extract and silver sulfadiazine on excisional wound model in guinea pigs

Background: Impaired and aberrant wound healing imposes a huge financial burden and places an enormous drain in health care resources in the developed world and an insurmountable problem in the developing countries too. In this study, authors have compared the wound healing effect of topical application of Acacia catechu extract with silver sulfadiazine in excisional wound model in guinea pigs.Methods: Twelve guinea pigs were randomly divided into two groups (n=6). The wound healing was observed in excision model. The standard group is treated with silver sulfadiazine (group 1) and the test group with Acacia catechu extract (group 2). The mean wound size expressed in mm2 and the mean percentage of the wound healed was measured on day 0, 4, 8, 12, 16 and 19. Biopsy was done on day 21 for histopathological examination (HPE).Results: Statistical analysis was done by using unpaired t test for between the groups comparison and by using paired t test for within the group comparison. The mean percentage of the wound healed with-in the groups was found to be statistically highly significant (p value &lt;0.001) and in between the groups was found to be statistically non-significant (p value &gt;0.05). A comparable increase in collagen content and granulation tissue was found on HPE in both the groups on day 21.Conclusions: Wound healing effect of the Acacia catechu extract is equal to and comparable with that of silver sulfadiazine.

Long-Term Outcomes of Pedicled Gastrocnemius Flaps in Total Knee Arthroplasty.

Deficient soft tissue following total knee arthroplasty (TKA) can jeopardize outcome. The gastrocnemius flap is an important means of providing coverage of a knee with deficient soft tissue. There is a paucity of long-term studies on the use of the gastrocnemius flap in the setting of TKA. The purpose of this study was to review the outcomes after the use of pedicled gastrocnemius flaps for coverage of a soft-tissue defect at the time of TKA. Eighty-three patients in whom a gastrocnemius flap had been used to cover the site of a primary (n = 18) or revision (n = 65) TKA over a 25-year period were identified. There were 48 women (58%) and 35 men (42%) with a mean age and body mass index (BMI) of 65 years and 32.6 kg/m. The mean wound size was 49 cm, and the wound was most commonly located over the anterior aspect of the knee/patellar tendon (n = 33). Patients were followed to the time of implant or flap revision, amputation, or death or for a minimum of 2 years (mean, 8 years). Clinical outcomes were assessed using the Knee Society Score (KSS) for pain and the KSS for function. The Kaplan-Meier method was used to assess revision and amputation-free survival. Risk factors for amputation and revision were identified with Cox regression. The 10-year revision and amputation-free survival rates following gastrocnemius flap coverage were 68% and 79%, respectively. The risk of implant failure was increased by morbid obesity (BMI of ≥40 kg/m) (hazard ratio [HR] = 2.82, 95% confidence interval [CI] = 1.09 to 7.32, p = 0.03) and ≥5 prior surgical procedures on the knee (HR = 2.68, 95% CI = 1.04 to 6.88, p = 0.04). The risk of amputation was increased in patients with ≥5 prior surgical procedures (HR = 10.76, 95% CI = 2.38 to 48.58, p = 0.002), an age of ≥65 years (HR = 4.94, 95% CI = 1.10 to 22.09, p = 0.03), and a wound size of ≥50 cm (HR = 3.29, 95% CI = 1.14 to 9.53, p = 0.02). Preoperatively the mean KSSs for pain and function were 46 and 28, and these scores significantly (p < 0.05) improved to 78 and 43, respectively, at the time of follow-up. The gastrocnemius flap reliably provides coverage of components used in complex knee reconstruction. A history of multiple surgical procedures on the knee and larger soft-tissue defects increase the risk of revision TKA and of amputation. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effect of ultrasound-assisted debridement on wound healing and infection outcomes in diabetic foot

Objective The objective of this study was to determine the efficacy of low-frequency ultrasound (LFU) in chronic wound healing and infection outcome in diabetic foot ulcers. Background Around 15% of patients with diabetes will develop foot ulcers at some point in their life, making them 30–40 times more likely to undergo amputation due to a nonhealing foot ulcer than the nondiabetic population. Debridement plays a significant role in the healing of diabetic foot ulcers. Patient and methods This randomized clinical trial was conducted on 46 patients with diabetes, recruited from the Diabetic Foot Clinic at Mansoura and Menoufia Universities, Egypt. All patients with diabetes (type I and type II) who had chronic diabetic foot ulcers without severe arterial insufficiency, with ankle brachial indices of at least 0.6, and without severe limb-threatening infections were included. Results Patients were divided into two groups – group 1 received ultrasound-assisted wound (UAW) therapy in conjunction with standard wound care (n = 23), and the other group received only standard wound care. Patients were followed-up for 3 months. The complete healing rate in the present study population was 30.34% (control group = 17.39%, UAW group = 43.47%). The mean wound size reduction was significantly higher in the UAW group only in the second-week and third-month follow-ups. The number of infected ulcers was reduced by ultrasound debridement more than surgical debridement (control group = 5, UAW group = 11) at the end of the study, but with no significant difference (P = 0.148). A significant difference in healing ratio was found in patients with ultrasound debridement and initial wound culture (P = 0.01). Conclusion In diabetic foot ulcers, LFU debridement accompanied by standard wound care has a beneficial effect on wound healing and wound infection. LFU debridement can initially accelerate ulcer healing; however, there was no significant difference between the two modalities in the healing rate after 3 months.

Effectiveness of viable cryopreserved placental membranes for management of diabetic foot ulcers in a real world setting.

In a multicenter randomized controlled trial (RCT), the use of viable cryopreserved placental membrane (vCPM) for chronic diabetic foot ulcers (DFUs) resulted in a higher proportion of wound closure in comparison to good wound care: 62% versus 21% (p < 0.01). However, patients in RCTs are not representative of daily physician practice. Healthcare databases serve as a valuable tool to evaluate therapy effectiveness and to supplement evidence from RCTs. The objective of this study was to evaluate the effectiveness of vCPM for DFU management using Net Health's WoundExpert® electronic health records (EHR). The primary endpoint was the proportion of DFUs that achieved complete closure. Other endpoints included time and number of grafts to closure, probability of wound closure by week 12, and the number of wound-related infections and amputations. De-identified EHR data for 360 patients with 441 wounds treated with vCPM were extracted from the database. Average patient age was 63.7 years with a mean wound size of 5.1 cm2 and an average wound duration of 102 days prior to vCPM treatment. For evaluation of clinical outcomes, 350 DFUs larger than 0.25 cm2 at baseline were analyzed. Closure at the end of treatment was achieved in 59.4% of wounds with a median treatment duration of 42.0 days and 4 applications of vCPM. The probability of wound closure at week 12 was 71%, and the number of amputations and wound-related infections was 13 (3.0%) and 9 (2.0%), respectively. Data also demonstrated a correlation between wound size and closure rate as well as a correlation between > 50% wound area reduction by week 4 and wound closure by week 12. The results of this study mirror previous RCT efficacy data, supporting the benefits of vCPM for DFU management. These results can also influence policy and treatment decisions regarding advanced vCPM technology.

Combined use of modulated ultrasound and electric current stimulation for diabetic foot ulcers: a case series.

Diabetic foot ulcers (DFUs) are a significant challenge in wound care practice. Our aim was to evaluate the combined use of of two therapies, ultrasound and electrostimulation, in the treatment of DFUs. This study employed a prospective, non-comparative, case series design, undertaken in a podiatry-led diabetic foot clinic, in an acute hospital setting, in an urban location in Ireland. We recruited patinets with hard-to-heal DFUs who were treated twice a week with combined modulated ultrasound and electric current stimulation. We recruited seven patients with eight chronic DFUs. A mean wound size reduction of 71% was achieved and there were no adverse reactions to the therapy. The results of this small case series indicate that combined modulated ultrasound and electric current stimulation offers promise as an adjunct therapy for DFUs. Further large scale trials are now warranted.

The effect of color type on early wound healing in farmed mink (Neovison vison)

BackgroundIndividual differences of mink, including color type, are speculated to affect the course of wound healing, thereby impacting wound assessment and management on the farms, as well as the assessment of wounds in forensic cases. In this study, we examined the effect of color type on early wound healing in farmed mink. Full thickness excisional wounds (2 × 2 cm) were made on the back in 18 mink of the color types Brown, Silverblue and Blue Iris. Gross and microscopic pathology of the wounds was evaluated 2 days post-wounding together with degree of wound size reduction, presence of bacteria and blood analyses.ResultsPathological examination on day 2 showed the greatest mean wound size reduction in Brown mink (11.0%) followed by Blue Iris (7.9%) and Silverblue (1.6%). Bacteria were cultured from all wounds, and predominantly Staphylococcus species were recovered in mixed or pure culture. Histopathology from day 2 wounds showed a scab overlying necrotic wound edges, which were separated from underlying vital tissue by a demarcation zone rich in polymorphonuclear leukocytes. Fibroblasts and plump endothelial cells were more numerous in the deeper tissues. Complete blood count parameters were within normal ranges in most cases, however, the mink showed mildly to markedly decreased hematocrit and six mink of the color types Silverblue and Blue Iris showed moderately elevated numbers of circulating segmented neutrophils on day 2. There was a marked increase in concentration of serum amyloid A from day 0 to day 2 in all color types.ConclusionsWe have described differences in early wound healing between mink of the color types Brown, Silverblue and Blue Iris by use of an experimental wound model in farmed mink. The most pronounced difference pertained to the degree of wound size reduction which was greatest in Brown mink, followed by Blue Iris and Silverblue, respectively.