Moist Wound Care Research Articles

Wound care practices following in-office cutaneous surgery among family physicians in Canada.

Family physicians (FPs) in Canada routinely perform in-office cutaneous surgery. There is strong evidence to support a moist wound healing environment, resulting in faster healing times and improved cosmesis. However, the wound care practices of FPs have not been previously studied. We aimed to examine the postoperative wound care practices of FPs after in-office cutaneous surgery. An online survey was distributed to Canadian FPs to determine post-surgical wound care practices. The survey examined moist versus dry wound healing and the reasons for these recommendations were explored. Additional wound care practices were also studied. Appropriate statistical analyses were undertaken. A total of 573 (91.5%) FPs completed the survey. Just under half (49.2%) of FPs recommended moist wound healing to their patients, while the remaining respondents (50.8%) recommended dry wound healing. The most endorsed reason for both moist and dry wound care recommendations was prior training (63.1% and 65.3%, respectively). Most physicians (57.2%) recommended the use of a cream or ointment postoperatively. While there appeared to be consensus on recommending sun avoidance after cutaneous surgery (77.7%), additional wound care practices varied, including: the use of dressings; cleansing practices; smoking cessation; reduction in physical activity; photoprotection; water exposure; and scar treatment/cosmetic use. Almost half of FPs in Canada responding to the survey did not recommend moist wound healing despite strong evidence to support this practice. We also noted a diverse range of postoperative wound care practices after in-office cutaneous surgery. Therefore, these results highlight a critical need for consistent wound care recommendations following cutaneous surgery for FPs in Canada.

Negative Pressure Wound Therapy With and Without Instillation in Necrotizing Soft Tissue Infections.

Background: Necrotizing soft tissue infections (NSTIs) are rare but deadly infections that require early and often extensive surgical debridement. After debridement, patients frequently have substantial morbidity because of large, open wounds. Hypothesis: Negative pressure wound therapy with instillation (NPWTi) results in higher wound closure rates compared with traditional negative pressure wound therapy (NPWT) or wet to dry dressings (moist wound care dressing). Patients and Methods: A prospectively maintained Acute and Critical Care Surgery database spanning 2008-2018 was queried for patients with a diagnosis of necrotizing fasciitis, Fournier gangrene, or gas gangrene. Data were collected on patient comorbidities, operative management, and clinical outcomes. Patients were stratified by use of moist wound care dressing, traditional NPWT, or NPWTi. Data were analyzed using analysis of variance (ANOVA), χ2, and logistic regression. Results: During the 10-year study period, patients were treated for NSTI; 173 were managed with moist wound care dressing, 150 with NPWT, and 48 with NPWTi. Patients were similar in terms of demographics, body mass index (BMI), diabetes mellitus, and smoking rates. Overall, complication rates were not substantially different, but mortality was higher in the moist wound care dressing group (16.2% vs. 10.7% NPWT vs. 2.1% NPWTi; p = 0.02). In the moist wound care dressing group, 81.5% of patients had an open wound at discharge compared with 52.7% of the NPWT group and only 14.6% of the NPWTi group (p < 0.001). On multivariable regression, NPWTi was associated with closure rates five times higher than the NPWT group (odds ratio [OR], 5.28; 95% confidence interval [CI], 2.40-11.61; p < 0.001) after controlling for smoking status, intravenous drug use, number of operations, and involvement of the most common region of the body. Conclusions: Negative pressure wound therapy with instillation is associated with higher rates of wound closure without increasing complication rates in patients with NSTI compared with traditional NPWT or moist wound care dressing. Although prospective studies are needed, this indicates the potential to improve patient quality of life through reduced pain and outpatient home health needs.

Development and Characterization of Nano-Chitosan-Polyvinyl Alcohol-Glycerol -Chlorhexidine Films for Wound Healing Applications

The process of wound healing is intricate and dynamic, requiring advanced medical care for a speedy recovery. Currently available semi-permeable wound dressings fall short in efficiently absorbing excess wound exudates to facilitate moist wound care, a crucial factor for promoting effective wound healing. Additionally, efforts have been made to enhance the antibacterial properties of wound dressings by incorporating antimicrobials into films. In this study, films were development using nanochitosan-polyvinyl alcohol-glycerol-chlorhexidine (NC-PVA-GLY-CLX) for applications in wound healing. The dressings were subjected to various characterizations, including UV-Visible spectrometry, Fourier Transform Infrared Spectroscopy, Scanning Electron Microscopy, Thermogravimetric analysis, and X‑ray diffraction pattern. Furthermore, the resulting film dressings underwent evaluation for their bactericidal properties. The findings indicated that the incorporation of chlorhexidine into the films has positively influenced the fluid holding capacity and the active period of the dressing, creating a favourable environment for effective wound healing.

The effectiveness of negative pressure wound therapy compared to the traditional method in the treatment of diabetic foot

Introduction and objective: Diabetes is one of the most common metabolic diseases in the world. Diabetic foot ulcers, which are often the result of the disease, are undoubtedly a nursing challenge. Negative pressure wound therapy (NPWT) is a new therapeutic method supporting wound healing, which has been useful in patients with diabetic foot. The purpose of this study is to compare the effectiveness of negative pressure therapy in comparison to the standard method in the treatment of diabetic foot. Review methods: In February 2023, articles found in the Medline (Pubmed) and Google Scholar databases were selected by using the following keywords: negative pressure wound therapy; VAC therapy; traditional dressing; standard moist wound care; diabetic foot. Brief description of the state of knowledge: NPWT has been proven to be associated with reduced healing time and faster appearance of granulation tissue, which is a sign of wound healing. Patients using this method require fewer dressing changes and surgical cleanings. Negative pressure therapy reduces the time to rehospitalisation and the risk of amputation or resection of the diabetic foot. Summary: Negative pressure wound therapy is more effective in the treatment of diabetic foot ulcers than traditional therapy. Despite the costs associated with NPWT being higher, the method proves to be more profitable. It is important to remember about good therapy technique and proper selection of patients.

A Rare Case of Recurrent Pyoderma Gangrenosum

Introduction: Pyoderma gangrenosum (PG) is a rare non-infectious disorder, and presents as solitary or multiple, fragile papules that progresses to ulcer and necrotic tissue. Autoimmune is the favored pathophysiology associated with this chronic inflammatory skin disease. Systemic disease such as inflammatory bowel disease, rheumatoid arthritis, and haematological disorders often accompany PG. We report a case of recurred PG in 60 year old male with no evidence of associated systemic condition. Case Presentation: A 60 year-old male complained of 1 month-long painful ulceration on his left chest. The lesion started as a pustule which gradually increased in size and broke into painful ulcer. The patient had similar skin lesion, five and three years prior to this admission on the lower abdomen and lower limbs respectively. Both episodes healed more than a year. The diagnosis of ulcerative PG was established based on the physical and histopathological examination. The patient was treated with prednisone and moist wound care. The ulceration responded rapidly. Discussion: Pyoderma gangrenosum is associated with underlying disease in up to two-thirds of case. It occurs typically in adults between 40 and 60 years of age. Although PG predilection is typically lower extremities, any body site can be affected, especially following a trauma. Our patient presented with recurred PG but showed no other systemic condition. Autoinflammatory disease are clinically characterized by recurrent episode and the treatment is quite challenging for its tendency to become chronic, relapsing, or reversible ulcer. Conclusion. We report a rare case of recurred ulcerative PG with no symptom of associated systemic disease who responded rapidly with oral steroid treatment and moist wound care. Keywords: Pyoderma gangrenosum, ulcerative, autoimmune, case report, steroid.

Minor Skin Injuries at School: The Role of the School Nurse.

School nurses routinely provide simple wound care for minor injuries in the school health office. Simple wound care is centered on the principles of moist wound care and only requires a few supplies to be on hand. This article outlines the steps for simple wound care for minor abrasions, cuts, blisters, and burns. Recommendations for referral of more complicated wounds are also provided. Student encounters for minor wound care can also be used by school nurses to provide education on first aid and to teach students, parents, and caregivers about infection prevention and control of the wound.

Comparative assessment of commercially available wound gels in ex vivo human skin reveals major differences in immune response-modulatory effects

Wound healing is a crucial process for maintaining the function of human skin as a protective barrier to pathogens and other external stress factors. Hydrogels—in combination with antimicrobials—are often used, as moist wound care has been widely accepted as standard therapy. Recently, we reported about immune response-modulatory effects of an octenidine-based hydrogel, however little is known about the mechanism of action of other hydrogels including antiseptic molecules or chlorine-based and chlorine-releasing agents, respectively. The aim of this study was the comparative assessment of commercially available wound gels (octenilin®, Prontosan®, Lavanid®, Betadona®, ActiMaris®, Microdacyn60®, VeriforteTMmed) with regard to their effects on the secretion of distinct cytokines (IL-6, IL-8, IL-10), matrix-metalloproteinases as well as their potential to cause alterations in skin structure and apoptosis. Hence, tape-stripped human ex vivo skin biopsies were treated topically with wound gels and cultured for 48 h. Enzyme-linked immunosorbent assays and an enzyme activity assay of culture supernatants revealed that octenilin® demonstrates significantly broader anti-inflammatory and protease-inhibitory capacities than other wound gels. Further, haematoxylin & eosin as well as caspase-3 staining of treated biopsies showed that octenilin® does not alter skin morphology and shows the least interfering effect on human epidermal cells compared to untreated controls. Overall, this study clearly demonstrates totally different effects for several commercially available hydrogels in our wound model, which gives also new insight into their tissue compatibility and mode of action.

Comparison of negative pressure wound therapy and moist wound care in patients with diabetic foot ulcers: A protocol for systematic review and meta-analysis of randomized controlled trials.

Background:This study conducted a meta-analysis to compare the effectiveness and safety of the negative pressure wound therapy (NPWT) with the moist wound care (MWC) in the treatment of diabetic foot ulcers (DFUs).Methods:The PubMed, EMBASE, and CENTRAL were searched by 2 of the authors, to identify randomized controlled trials comparing the clinical outcomes of patients treated with NPWT versus MWC for DFUs. Meta-analyses were performed for several outcomes, including wound healing results, amputation or resection incidence, and risk of adverse events, utilizing the “meta” package of R language version 4.0.3.Results:A total of 10 trials (619 patients in NPWT group and 625 in MWC group) and 8 trials were included for the qualitative and quantitative syntheses, respectively. As a result, significantly lower risk of non-closure of the wound (risk ratio [RR] = 0.74, 95% confidence interval [CI]: 0.63–0.87; P = .001), lower average wound area (standard mean difference = −0.80, 95% CI: −1.54 to −0.06; P = .034), more wound area decrease (standard mean difference = 0.81, 95% CI: 0.36–1.26; P = .001), increased appearance rate of granulation tissue (RR = 1.61, 95% CI: 1.07–2.41; P-0.021), and lower risk of amputation or resection (RR = 0.70, 95% CI: 0.50–0.99; P = .045), were demonstrated for the NPWT group when compared to MWC group. However, no statistically significant difference was found for the disappearance rate of wound discharge at 8 weeks, the rate of blood culture positivity, VAS-pain score, and the overall frequency of adverse events between the 2 treatment groups (P = .05).Conclusion:NPWT could accelerate process of the wound healing, and decrease the risk of post-treatment amputation or resection, without any additional frequency of adverse events, when compared with MWC, in patients with DFUs.

NPWT resource use compared with standard moist wound care in diabetic foot wounds: DiaFu randomized clinical trial results

BackgroundDiabetic foot ulcers not only have a negative impact on patient mortality, morbidity and quality of life, but also require high resource utilization to achieve complete wound healing. The aim of this evaluation was to compare resource utilization of negative pressure wound therapy (NPWT) and standard moist wound care (SMWC) for diabetic foot wounds after amputation, surgical debridement or wound cleansing.MethodsThe multicenter clinical DiaFu study enrolled 368 adults with diabetic foot ulcers between December 23, 2011 and October 21, 2014. Patients were randomly assigned to NPWT and SMWC. Evaluation of direct resource use comprised inpatient and outpatient treatment time, and personnel and material for wound treatment within 16 weeks. This resource use analysis was primarily based on the per protocol population (NPWT 44; SMWC 110).ResultsTreatment duration was 16 days shorter with NPWT (mean (SD) 82.8 (31.6), SMWC 98.8 (24.6); U test, p = 0.001) with 14.9 days shorter outpatient treatment (mean (SD) NPWT 68.3 (31.1), SMWC 83.2 (29.7)). The number of dressing changes per study participant was lower with NPWT (mean (SD) 35.1 (18.6), SMWC (42.9 (21.4); U test, p = 0.067). Time per dressing change was significantly lower with SMWC (mean (SD) 19.7 (12.8), NPWT (16.5 (8.2) minutes; U test, p < < 0.0001). Time for surgical debridements per study participant was 23.3 minutes shorter with NPWT (mean (SD) 20.5 (20.5), SMWC (43.8 (46.7); U test, p = 0.395).ConclusionsResource use was lower for NPWT, which may be an efficient treatment alternative to SMWC for diabetic foot wounds, to be demonstrated in subsequent cost analyses.Trial registrationclinicaltrials.govNCT01480362 on November 28, 2011

A Multicenter, Blinded, Randomized Controlled Clinical Trial Evaluating the Effect of Omega-3-Rich Fish Skin in the Treatment of Chronic, Nonresponsive Diabetic Foot Ulcers.

Omega-3-rich fish skin grafts have been shown to accelerate wound healing in full-thickness wounds. The goal of this study was to compare the fish skin graft with standard of care (SOC) using collagen alginate dressing in the management of treatment-resistant diabetic foot ulcers (DFUs), defined as superficial ulcers not involving tendon capsule or bone. Patients with DFUs who were first treated with SOC (offloading, appropriate debridement, and moist wound care) for a 2-week screening period were then randomized to either receiving SOC alone or SOC plus fish skin graft applied weekly for up to 12 weeks. The primary endpoint was the percentage of wounds closed at 12 weeks. Forty-nine patients were included in the final analysis. At 12 weeks, 16 of 24 patients' DFUs (67%) in the fish skin arm were completely closed, compared with 8 of 25 patients' DFUs (32%) in the SOC arm (P value = .0152 [N = 49]; significant at P < .047). At 6 weeks, the percentage area reduction was 41.2% in the SOC arm and 72.8% in the fish skin arm. The application of fish skin graft to previously nonresponsive DFUs resulted in significantly more fully healed wounds at 12 weeks than SOC alone. The study findings support the use of fish skin graft for chronic DFUs that do not heal with comprehensive SOC treatment.

Wet-spun bi-component alginate based hydrogel fibers: Development and in-vitro evaluation as a potential moist wound care dressing

In this study, bi-component alginate-hyaluronic acid (AHA) fibers were developed by using two different routes. In the first method, sodium alginate dope solution was extruded into a coagulation bath containing CaCl2 and subsequently dip-coated with hyaluronic acid (HA) whereas, in the second method, hyaluronic acid-containing sodium alginate dope solution was directly extruded into CaCl2 bath. The resulting AHA fibers were then dehydrated in 25–100% v/v acetone solutions and dried in air. The fibers were characterized by surface morphology, physicochemical analysis, mechanical performance, swelling percentage, and total liquid absorption (g/g), cell viability, and release behavior. The results showed that AHA fibers produced by the second method have better mechanical performance, high liquid absorption, and swelling percentage with a more controlled release of hyaluronic acid. The AHA fibers showed high biocompatibility toward nHDF cell line in in-vitro testing, and the MVTR values (650–800 g/m2/day) are in a suitable range for maintaining a moist wound surface proving to be appropriate for promoting wound healing.

Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German DiaFu-RCT

ObjectivesThe aim of the DiaFu study was to evaluate effectiveness and safety of negative pressure wound therapy (NPWT) in patients with diabetic foot wounds in clinical practice.DesignIn this controlled clinical...

Matched-cohort study comparing bioactive human split-thickness skin allograft plus standard of care to standard of care alone in the treatment of diabetic ulcers: A retrospective analysis across 470 institutions.

This retrospective, matched‐cohort study analyzed 1,556 patients with diabetic ulcers treated at 470 wound centers throughout the United States to determine the effectiveness of a cryopreserved bioactive split‐thickness skin allograft plus standard of care when compared to standard of care alone. There were 778 patients treated with the graft in the treatment cohort, who were paired with 778 patients drawn from a pool of 126,864 candidates treated with standard of care alone (controls), by using propensity matching to create nearly identical cohorts. Both cohorts received standard wound care, including surgical debridement, moist wound care, and offloading. Logistic regression analysis of healing rates according to wound size, wound location, wound duration, volume reduction, exposed deep structures, and Wagner grade was performed. Amputation rates and recidivism at 3 months, 6 months, and 1 year after wound closure were analyzed. Diabetic ulcers were 59% more likely to close in the treatment cohort compared to the control cohort (p = 0.0045). The healing rate with the graft was better than standard of care across multiple subsets, but the most significant improvement was noted in the worst wounds that had a duration of 90‐179 days prior to treatment (p = 0.0073), exposed deep structures (p = 0.036), and/or Wagner Grade 4 ulcers (p = 0.04). Furthermore, the decrease in recidivism was statistically significant at 3 months, 6 months, and 1 year, with and without initially exposed deep structures (p < 0.05). The amputation rate in the treatment cohort was 41.7% less than that of the control cohort at 20 weeks (0.9% vs. 1.5%, respectively). This study demonstrated that diabetic ulcers treated with a cryopreserved bioactive split‐thickness skin allograft were more likely to heal and remain closed compared to ulcers treated with standard of care alone.

MODERN WOUND CARE MANAGEMENT IN GENERAL HOSPITAL CUT NYAK DIEN LANGSA

Introduction: The concept of moist wound care based (moisture balance) has long been known in the world, because it has advantages such as speeding up the re-epitalisasi, retain moisture, decrease infection, the wound bed moist spending can stimulate growth factors that accelerate the wound healing process. This research aims to produce modern wound care management protocols that will run on General Hospital Langsa Cut Nyak Dien, and can be a guide to wound care by nurses in RSUCND. Method: The design used in this study was action research with one cycle. The number of participants involved were 12 people assigned to the purposive sampling method. Data collection methods are focus groups discuss, self-report (questionnaire wound care nurses' knowledge about modern and caring, nurse and patient satisfaction levels), and observation (checklist). Data collection was conducted from 26 April to 28 September 2013. Data obtained were analyzed by analysis wilcoxon. Results: Result test conducted between the pre and post show significant changes. Discussion: The recommendations can be made based on the results of this study, which has been composed POS can be run by RSUCND and this research can be continued on the next cycle. Keywords: wound care with moisture balance concepts, operational procedures

Health economic evaluation of moist wound care in chronic cutaneous leishmaniasis ulcers in Afghanistan

BackgroundThe present health economic evaluation in Afghanistan aims to support public health decision makers and health care managers to allocate resources efficiently to appropriate treatments for cutaneous leishmaniasis (CL) elicited by Leishmania tropica or Leishmania major.MethodsA decision tree was used to analyse the cost and the effectiveness of two wound care regimens versus intra-lesional antimony in CL patients in Afghanistan. Costs were collected from a societal perspective. Effectiveness was measured in wound free days. The incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (NMB) were calculated. The model was parameterized with baseline parameters, sensitivity ranges, and parameter distributions. Finally, the model was simulated and results were evaluated with deterministic and probability sensitivity analyses. Final outcomes were the efficiency of the regimens and a budget impact analysis in the context of Afghanistan.ResultsAverage costs per patients were US$ 11 (SE = 0.016) (Group I: Intra-dermal Sodium Stibogluconate [IL SSG]), US$ 16 (SE = 7.58) (Group II: Electro-thermo-debridement [ETD] + Moist wound treatment [MWT]) and US$ 25 (SE = 0.48) (Group III: MWT) in patients with a single chronic CL ulcer. From a societal perspective the budget impact analysis shows that the regimens’ drug costs are lower than indirect disease cost. Average effectiveness in wound free days are 177 (SE = 0.36) in Group II, 147 (SE = 0.33) in Group III, and 129 (SE = 0.27) in Group I. The ICER of Group II versus Group I was US$ 0.09 and Group III versus Group I US$ 0.77, which is very cost-effective with a willingness-to-pay threshold of US$ 2 per wound free day. Within a Monte-Carlo probabilistic sensitivity analysis Group II was cost-effective in 80% of the cases starting at a willingness-to-pay of 80 cent per wound free day.ConclusionsGroup II provided the most cost-effective treatment. The non-treatment alternative is not an option in the management of chronic CL ulcers. MWT of Group III should at least be practiced. The cost-effectiveness of Group III depends on the number of dressings necessary until complete wound closure.

Aseptically Processed Placental Membrane Improves Healing of Diabetic Foot Ulcerations: Prospective, Randomized Clinical Trial.

Background:Allogeneic grafts derived from amnion/chorion are known to be efficacious in healing chronic diabetic foot ulcerations (DFUs). The goal of this study was to compare aseptically processed dehydrated human amnion and chorion allograft (dHACA) versus standard of care (SOC) in facilitating wound closure in nonhealing DFUs.Methods:Patients with DFUs treated with SOC (off-loading, appropriate debridement, and moist wound care) after a 2-week screening period were randomized to either SOC or wound-size-specific dHACA (AmnioBand, Musculoskeletal Transplant Foundation, Edison, N.J.) applied weekly for up to 12 weeks plus SOC. Primary endpoint was the percentage of wounds healed at 6 weeks between groups.Results:At 6 weeks, 70% (14/20) of the dHACA-treated DFUs healed compared with 15% (3/20) treated with SOC alone. Furthermore, at 12 weeks, 85% (17/20) of the DFUs in the dHACA group healed compared with 25% (5/20) in the SOC group, with a corresponding mean time to heal of 36 and 70 days, respectively. At 12 weeks, the mean number of grafts used per healed wound for the dHACA group was 3.8 (median 3.0), and mean cost of the tissue to heal a DFU was $1400. The mean wastage at 12 weeks was 40%. One adverse event and 1 serious adverse event occurred in the dHACA group; neither was graft related. Three adverse events and 1 serious adverse event occurred in the SOC group.Conclusion:Aseptically processed dHACA heals diabetic foot wounds significantly faster than SOC at 6 and 12 weeks with minimal graft wastage.

Wound management with enzyme alginogels : Expert consensus

The challenges of modern wound management, such as the treatment of chronic wounds and their phase-specific handling, are demanding and require optimally adapted therapeutic measures. The principles of moist wound care as well as an adequate debridement have priority here. To support these necessary measures, different options are available, e.g., anew product group operating across several wound phases. Anew treatment principle in modern wound management based on an expert consensus is presented. On the basis of clinical experience reports and published evidence, the current and new principles of wound treatment were discussed in apanel of experts and formulated as aconsensus statement. Enzyme alginogels represent acombination of agents that allow phase-specific wound care. They exhibit autolytic, absorbent, and antimicrobial properties and simultaneously cover three components of wound management based on the TIME framework. Thus, according to the experts, they differ from other wound healing products and can be classified in adistinct product group. Clinical studies, as well as clinical experiences, provide evidence for the efficacy of enzyme alginogels. According to the experts, the potential of enzyme alginogels used considering the principles of moist wound care, comprises the three-fold effect (continuous and significantly simplified debridement, maintaining amoist wound environment and antimicrobial effect without cytotoxicity), the ease of use, and the flexible application. In addition, the flexibility of the product class regarding frequency of application, duration of treatment and combinability with secondary dressings, are of economic benefit in the health care sector.

Prospective, Randomized, Controlled, Comparative Effectiveness Trial Examining Healing, of Acellular-Reticular Human-Dermis Versus Standard Care in Treatment of Diabetic Foot Ulcers

Category: Diabetes Introduction/Purpose: One sequitur of prolonged diabetes is the development of diabetic foot ulcers (DFUs), which are often complicated by lower extremity amputation (LEA). The annual incidence of DFUs and LEAs calculated from the Medicare population is approximately 6% and 0.4% respectively. Many acellular dermal matrices have been shown to successfully heal these wounds. In this study, we examined a novel, human, acellular reticular dermis with an open, porous, uniform framework aseptically processed to retain endogenous matrix protein versus standard of care in non healing diabetic foot wounds. Methods: This study was a multicenter, randomized controlled trial in which diabetic patients having at least one non-healing neuropathic foot ulcer that failed at least 4 weeks of documented conservative care with adequate blood flow and a lack of renal failure were screened for a 2-week period. Those meeting inclusion and exclusion criteria, after 2-weeks of offloading and moist wound care if the diabetic foot ulcer (DFU) failed to reduce in area by 20% were randomized 1:1 to standard of care (SOC) or human acellular dermal tissue (HADT) applied weekly plus SOC for up to 12 weeks Results: At 6 weeks, 65% of the HADT–treated wounds had healed (13/20) compared to 5% (1/20) of the wounds that received SOC alone (adjusted p=.00028). At 12 weeks, 80% of the HADT–treated wounds (16/20) had healed compared to 20% (4/20) of the DFUs in the SOC group (adjusted p=.00036). Mean time to heal within 12 weeks was 39.6 days for the HADT group compared to 77.0 days for the SOC group (adjusted p=.00014). There was no incidence of increased adverse or serious adverse events between groups, nor adverse events related to the graft. The mean and median costs to closure in the HADT group were $1475.00 and $963.00, respectively, per healed wound Conclusion: These findings demonstrate that weekly application of acellular human reticular dermis is an effective treatment for non-healing diabetic foot wounds. Wound-size-specific pieces may allow for decreased cost to closure and wastage.

Prevention of Surgical Site Infection After Ankle Surgery Using Vacuum-Assisted Closure Therapy in High-Risk Patients With Diabetes

Patients with diabetes have a high risk of surgical site infection (SSI) after ankle surgery. The aim of the present study was to investigate the efficacy of vacuum-assisted closure (VAC) in the prevention of SSI after ankle surgery compared with the efficacy of standard moist wound care (SMWC). A retrospective study was performed of unstable ankle fractures for surgical fixation in patients with diabetes from January 2012 to December 2014. VAC and SMWC were used for surgical incision coverage. The primary outcome was the incidence of SSI, and the secondary outcomes were the length of hospital stay and crude hospital costs. The data from 76 patients were analyzed, with 22 (28.95%) in the VAC group and 54 (71.05%) in the SMWC group. The incidence of SSI was 4.6% in the VAC group compared with 27.8% in the SMWC group (chi-square 5.076; p = .024), and the crude odds ratio for SSI in the VAC group was 0.124 (95% confidence interval 0.002 to 0.938). The length of hospital stay was lower in the VAC group than in the SMWC group (12.6 ± 2.7 days and 15.2 ± 3.5 days, respectively; t = 3.122, p = .003). The crude hospital costs were also lower in the VAC group than in the SMWC group (Chinese yuan 8643.2 ± 1195.3 and 9456.2 ± 1106.3, respectively; t = 2.839, p = .006). After logistic regression analysis, the adjusted odds ratio for the total SSI rate comparing VAC and SMWC was 0.324 (95% confidence interval 0.092 to 0.804; p = .021). Compared with SMWC, VAC can decrease the SSI rate after ankle surgery in patients with diabetes. This finding should be confirmed by prospective, randomized controlled clinical trials.

Development and preclinical evaluation of a new galactomannan-based dressing with antioxidant properties for wound healing.

We describe a novel wound dressing (HR006) with two components: a lyophilized matrix of the galactomannan from locust bean gum (LBG) and an antioxidant hydration solution (AHsol) containing curcumin and N-acetyl-L-cysteine (NAC). Physico-structural analyses of the LBG matrix revealed homogeneous interconnected pores with high absorbing capacity showing excellent properties for moist wound care (MWC). In an in vitro oxidative stress fibroblast injury model, the AHsol showed relevant protective effects reducing intracellular reactive oxygen species (ROS) production, rescuing cell viability, and regulating expression of inflammation-related genes (COX-2, TNF-α, IL-1α, IL-1β). The new dressing showed good biocompatibility profile as demonstrated by cytotoxicity, hemocompatibility, and skin irritation tests. Moreover, in an in vivo skin wound model in pigs, this dressing enhanced the production of healthy and organized granulation tissue and re-epithelization. In summary, HR006 exhibits significant antioxidant activity, good biocompatibility, and excellent repair capabilities improving tissue remodeling and the healing of wounds.