Wound Outcomes Research Articles

Role of ultrathin skin graft in early healing of diabetic foot ulcers: a randomized controlled trial in comparison with conventional methods.

Diabetic foot ulcers (DFUs) are a global burden on health care systems. Despite the availability of various treatment modalities, many DFUs do not heal. Nonhealing wounds can lead to various complications, which add to significant morbidity in terms of the degree of moisture retained in the dressing, pain, foul order, and restriction of daily activities. A different treatment modality that can promote the wound healing process earlier (and is cost-effective, easy to use, and readily available) may be necessary to consider. The purpose of the current study was to demonstrate the efficacy of ultrathin skin grafting (UTSG) in the early healing of DFUs in terms of cost-effectiveness, reduced total number of hospital visits, and final wound outcome (ie, limb salvage rate). A randomized controlled trial was conducted in which 52 patients were treated with either UTSG (test group) or conventional dressing (control group). Both groups were compared by time to healing, number of hospital visits, cost, and final outcome of the wound. By the end of the 12-week study period, 84.61% of wounds managed with UTSG healed completely, whereas only 53.84% of wounds managed with conventional methods achieved complete healing. The test group achieved a more than 50% wound size reduction within 6 weeks after grafting. There were fewer hospital visits for the test group, indicating this grafting technique was more cost-effective than the control group. As demonstrated in this study, UTSG appears to be beneficial in achieving faster healing of DFUs and improving the final outcome of the wound.

Chronic Wound Telemedicine Models Before and During the COVID-19 Pandemic: A Scoping Review.

To present the results of a scoping review exploring chronic wound care telemedicine before and during the pandemic, including the characteristics of the models implemented. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Identify the characteristics of the studies the authors examined for their scoping review of chronic wound care telemedicine.2. Choose the electronic methods commonly used for wound care telemedicine in the studies the authors examined.3. Recognize the implications for the patients who participated in chronic wound care telemedicine in the studies the authors examined. OBJECTIVETo explore different chronic wound telemedicine models and identify current research on this topic.METHODSThe authors searched the MEDLINE and EMBASE databases on August 10, 2021 and identified 58 articles included in the analysis.RESULTSIncluded studies were published between 1999 and 2021, with more than half of the studies published between 2015 to 2019 (25.9%, n = 15/58) and 2020 to 2021 (25.9%, n = 15/58). There were 57 models identified, of which 87.7% (n = 50/57) used a blended model of care. Image assessment was the most common element in blended care (66.0%, n = 33/50), followed by video consultation (46.0%, n = 23/50), text (44.0%, n = 22/50), and telephone consultation (22.0%, n = 11/50). Purely virtual care was used in 12.3% (n = 7/57) of models, 85.7% (n = 6/7) of which were implemented during the COVID-19 pandemic. Most studies conducted a quantitative analysis (62.1%, n = 36/58); 20.7% (n = 12/58) conducted a qualitative analysis, and 17.2% (n = 10/58) conducted both. The most frequently assessed results were wound outcomes (53.4%, n = 31/58) and patient opinions (25.9%, n = 15/58).CONCLUSIONSChronic wound care-related telemedicine has common elements: image assessment, video and telephone consultation, and text-based information that can be combined in a variety of ways with unique implementation barriers. Blended care models are more common than purely virtual alternatives. Heterogeneity among outcomes and reporting methods make the results difficult to synthesize.

Preparation of pro-angiogenic, antibacterial and EGCG-modified ZnO quantum dots for treating bacterial infected wound of diabetic rats

The complex wound environment and abnormalities in self-metabolism of diabetic skin defects lead to impaired angiogenesis, which can easily lead to bacterial infection and increased inflammation. Therefore, there is an urgent need for multifunctional composites with antimicrobial and pro-angiogenic properties to improve the current therapeutic outcomes of diabetic wounds. In this study, we described an EGCG-modified zinc oxide quantum dots (ZnO QDs) hydrogel (ZnO-EGCG@H) for the treatment of delayed diabetic wounds. In vitro antimicrobial assays showed that ZnO-EGCG@H effectively cleared 95.6% of MRSA and 97% of AmprE. coli with good bactericidal activity. Western blotting assay analysis showed that ZnO-EGCG@H downregulated trauma inflammatory factors (TNF-α, IL-6) by 46.9% and 57%, respectively, while upregulating 1.7-fold VEGF and 2-fold EGF, accelerating wound healing by reducing inflammatory response and promoting proliferation of vascular endothelial cells and skin epidermal cells. After 15 days of ZnO-EGCG@H treatment, the rate of skin lesion closure in rats was 96.3%, which was much better than that of 65.4% in the control group. Safety experiments showed that ZnO-EGCG@H was reassuringly biocompatible and harmless to vital organs. The obtained results suggested that ZnO-EGCG@H had the potential to be a safe and effective treatment method with a promising future as a diabetic wound treatment material.

Acellular fish skin grafts for the management of wounds in dogs and cats: 17 cases (2019-2021).

To report the clinical outcomes of the use of acellular fish skin grafts (FSGs) for the management of complex soft tissue wounds of various etiologies in dogs and cats. 13 dogs and 4 cats with complex wounds treated with FSGs between February 2019 and March 2021. Medical records were reviewed for information regarding cause, location, size of the wound, management techniques, complications, and clinical outcomes. In dogs, the number of FSG applications ranged from 1 to 4 (median, 2 graft applications). The time between each application ranged from 4 to 21 days (median, 9.5 days). Time to application of the first FSG ranged from 9 to 210 days (median, 19 days). Wounds closed by second-intention healing following the first fish skin application between 26 and 145 days (median, 71 days; n = 12). In cats, 1 or 2 FSGs were used, and the wounds of 3 of 4 cats healed completely by secondary intention. The wounds of 1 dog and 1 cat did not heal. There were no adverse events attributed to the use of the FSGs. For dogs and cats of the present study, complete healing of most wounds occurred with the use of FSGs, the application of which did not require special training, instruments, or bandage materials.

Impact of Quilting Sutures on Surgical Outcomes After Mastectomy: A Systematic Review and Meta-Analysis.

Seroma after mastectomy and/or axillary lymph node dissection (ALND) is among the most common issue surgeons have to face in the early postoperative management of breast cancer. Using quilting sutures (QS) to aid in tissue approximation and decrease dead space is proposed as a simple technique to reduce seroma rate. We aimed to perform a systematic review, and analyse, in a meta-analytical model, the role of QS in improving wound outcomes and decrease volume, duration of drainage, and length of stay in hospital. The study was registered with PROSPERO. A systematic search of the PubMed, EMBASE, and SCOPUS databases was performed for all comparative studies examining surgical outcomes in patients who underwent QS versus conventional closure (CC) after mastectomy ± ALND. Twenty-one studies with a total of 3473 patients (1736 in the study group and 1737 in the control group) were included based on the selection criteria. The study group showed significantly lower rates of seroma (p<0.00001), total volume of drainage (p<0.0001), days to drain removal (p<0.00001), and length of stay (p<0.00001) compared with the control group, while wound complication rates (surgical site infection, flap necrosis, hematoma, skin dimpling) were comparable between the two groups. QS are a reliable intraoperative technique that decrease seroma formation, volume of postoperative drainage, duration of drainage and length of hospital stay, and should be considered in mastectomies with or without ALND.

Experience of small tissue bites with conventional tissue bites in emergency setting for midline abdominal wound closure

Background: Midline incision provides excellent access to the abdominal cavity. However, wound infection following a laparotomy can increase morbidity as well as burden on health care system. Wound prognosis can be influenced by the type of incisions, suture material and the method of closure. This study aimed to assess the outcome of midline abdominal wound closure using two different techniques of wound closure.Methods: This was a prospective observational study and consisted of 300 consecutive patients ≥18 years of age undergoing abdominal surgery through a midline incision in emergency setting. Patients who were included in the study were then randomised into two groups. In group I, midline laparotomy was closed with large tissue bites and in group II small tissue bites were used.Results: Out of 300 patients included in this study, 150 patients were subjected to large tissue bites and another 150 patients to small tissue bites. 29 patients out of 150 patients (19%) in large tissue bites group and 16 patients (11%) in small tissue bites developed surgical site infection (SSI). 23 patients out of 50 patients (15%) in large tissue bites group and 11 patients (7%) in small tissue bites developed wound dehiscence.Conclusions: In this study, we found that the patients in group II whose midline laprotomy was closed with small tissue bites had better wound outcome postoperatively in terms of wound site infection and wound dehiscence.

Use of Muscle Flaps for Salvage of Groin Wound Infection Following Vascular Surgery: A Systematic Review and Meta-Analysis.

Groin wound infections in vascular surgery are still a common complication and challenging problem. This systematic review aimed to establish a complete view of patient characteristics and clinical outcomes for infected groin wounds following vascular surgery reconstruction using muscle flaps and to evaluate the differences in outcomes between the sartorius muscle flap (SMF), rectus femoris muscle flap (RFF), and gracilis muscle flap (GMF). PubMed, Scopus, and Web of Science were systematically searched from inception to April 2021. Random-effects meta-analysis for comorbidities and outcomes and subgroup analyses for outcomes were performed. Thirty studies were included in qualitative and quantitative syntheses. Overall pooled data showed the following outcome rates: 4.5% muscle flap necrosis (95% confidence interval [CI], -3.4-12.3%; I2 = 0%), 21.8% overall complications (95% CI, 15.8-27.7%; I2 = 0%), 8.0% limb loss (95% CI, 1.9-14.1%; I2 = 0%), 15.4% graft loss (95% CI, 5.0-25.3%; I2 = 37.9%), and 7.4% 30-day mortality (95% CI, -.9-15.6%; I2 = 0%). The rates of overall complications were 20.3% (95% CI, 12.1-28.2%; I2 = 0%), 23.2% (95% CI, 11.2-34.5%; I2 = 10.2%), and 18.0% (95% CI, -3.537.8%; I2 = 0%) for the SMF, RFF, and GMF, respectively. The rate of limb loss was highest for the GMF (17.2%; 95% CI, -4.237.2%; I2 = 0%). The rate of graft loss for the RFF was the highest (20.7%; 95% CI, .6-39.1%; I2 = 53.9%). The rate of 30-day mortality was the lowest for the SMF (5.3%; 95% CI, -6.1-16.6%; I2 = 0%). The effectiveness and safety of muscle flap reconstruction for infected groin wounds following vascular surgery are clearly positive. This review indicated a tendency for lower complication rates with the SMF than with other muscle flaps.

Does method of closure effect cesarean wound healing? Stapler versus absorbable sub-cuticular closure done in a tertiary hospital, Nepal

Introduction: Postoperative wound complications for women undergoing cesarean delivery constitute a major cause of morbidity. Data on wound healing based on the type of cesarean wound closure is limited. In this study, we assess the outcome of stapler versus absorbable sub-cuticular suture for skin closure of the cesarean wound. Method: Prospective observational study. All cesarean section patients during the period of six months (Dec 2019 to May 2020) at Patan Hospital, Nepal, whose skin closure was done by sub-cuticular suture or stapler technique were recruited in the study. Ethical approval was obtained. These patients were followed up postoperatively on the 10th day for wound outcome (redness, edema, hematoma, seroma, discharge, gaping). Number and proportion were calculated, chi-square test, and Fisher’s exact test at 95% confidence interval were used to see the association and p&lt;0.05 was considered significant. Result: Out of 379 patients, 26(6.9%) were lost to follow-up. Among 353 patients, an unhealthy wound was seen in 7(1.98%) during follow-up. Of these unhealthy wounds, closure with stapler technique was 5(71.4%) and by sub-cuticular technique, 2(28.6%), statistically significant with a p-value of 0.014. Conclusion: Cesarean wound closure by sub-cuticular technique had a better wound outcome compared to closure by staplers.

Functional outcomes of penetrating eye injuries in children

To assess visual acuity (VA) in the outcome of a penetrating wound of the eyeball in children. The study retrospectively analyzed VA in the outcome of type B open trauma of scleral (12.1%), corneal (59.1%), and scleral-corneal (28.8%) localization in 132 children (132 eyes) older than 4 years (mean age 8.3 years), who were admitted to the hospital on the first day after injury. The exclusion criteria from the main selection were: the presence of an intraocular foreign body, the age of patient higher than 4 years old, and the time of admission more than 24 hours post the moment of injury. Visual acuity was checked at the time of discharge from the hospital (average stay was 19.02 days) and amounted to 0-light projection in 50 (37.9%) children; 0.01-0.1 in 43 (32.6%); 0.2-0.3 in 29 (22.0%); above 0.4 in 10 (7.6%). High rate of vascular reactions to trauma was noted on admission on the first day - intraocular hemorrhage (28.8%), hyphema (10.6%), endophthalmitis (5.3%) as a result of a penetrating injury to the eyeball - as well as their negative effect on vision at discharge. Upon discharge from the hospital, in 92.4% of children the visual acuity in the outcome was 0.3 and below. Adverse visual outcomes significantly correlated with the depth of the injury (correlation coefficient 0.5931) and vascular reactions to trauma (correlation coefficient 0.503333).

Analysis of Wound Healing Time and Wound-free Period in Patients With Chronic Limb-threatening Ischemia Treated With and Without Revascularization

Traditionally, reported outcomes in patients with ischemic wounds have centered around amputation-free survival; however, that minimizes the importance of other patient-centered outcomes like wound healing time (WHT) and wound-free period (WFP). We sought to evaluate the long-term wound outcomes of the patients treated for chronic limb-threatening ischemia at our institution.

Wound healing properties of a fibrin-based dermal replacement scaffold

When serious cutaneous injury occurs, the innate wound healing process attempts to restore the skin’s appearance and function. Wound healing outcome is affected by factors such as contraction, revascularisation, regeneration versus fibrosis and re-epithelialisation and is also strongly influenced by the pattern and extent of damage to the dermal layer. Dermal replacement scaffolds have been designed to substitute for lost tissue, provide a structure to promote dermal regeneration, and aid skin grafting, resulting in a superior healing outcome. In this study the wound healing properties of a novel fibrin-alginate dermal scaffold were assessed in the porcine wound healing model and also compared to two widely used dermal scaffolds and grafting alone. The fibrin-alginate scaffold, unlike the other scaffolds tested, is not used in combination with an overlying skin graft. Fibrin scaffold treated wounds showed increased, sustained superficial blood flow and reduced contraction during early healing while showing comparable wound closure, re-epithelialisation and final wound outcome to other treatments. The increase in early wound vascularisation coupled with a decrease in contraction and no requirement for a skin graft suggest that the fibrin-based scaffold could provide an effective, distinctive treatment option to improve healing outcomes in human patients.

The impact of topical agents and dressing on pH and temperature on wound healing: A systematic, narrative review.

To assess the impact of topical agents and dressings on surface wound pH, temperature, and subsequent wound healing. This was a systematic, narrative review of the literature, following the PRISMA (2020) guidelines. The databases searched were Medline PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Web of Science, and Scopus. Data synthesis and analysis were conducted using a structured narrative synthesis. The quality of the included clinical studies was appraised using the Evidence‐Based Literature (EBL) Critical Appraisal Tool. A total of six clinical studies were assessed as eligible for inclusion, A total of six dressings/topical agents were assessed and the types of wounds included non‐healing chronic wounds. Of the studies, five explored pH and one explored temperature. The EBL validity of the clinical studies was low (mean quality score was 51.3%). The five clinical studies that explored pH investigated different dressings and topical agents reporting an associated reduction in pH and improved wound outcomes. One clinical study investigated the impact of topical sodium nitrite on temperature and found that sodium nitrite increased peri‐wound skin temperature and improved wound outcomes with a reduction in leg ulcer size. Given the low certainty of the evidence, we cannot confidently recommend the use of any particular topical agent or dressing to manipulate pH, or temperature to improve wound outcomes. Thus, there is a need for further research to develop a greater understanding of this topic. Irish Research Council, Enterprise Partnership Scheme.

Measured Wound Outcome Feedback Improves Surgical Site Infection Rates

Feedback supports learning. No matter how effective medical professionals think they are, evidence of measured patient wound outcomes helps inform their wound care practice, empowering them to improve patient outcomes. Prospective randomized clinical trials (RCTs) proved this principle in relation to healing chronic wounds. Measuring wound healing outcomes and providing caregivers with feedback about the 4-week healing progress increased the percentage of diabetic foot ulcers healed within 20 weeks and venous leg ulcers healed within 24 weeks. Longitudinal research suggests this principle holds true in preventing surgical site infections (SSIs). When individual orthopedic surgeons were provided written feedback about their hand hygiene practices and corresponding SSI rates, surgeon hand hygiene improved and SSI rates in their patients were reduced. This Evidence Corner describes systematic review evidence indicating that feedback given to responsible wound care professionals reduced SSI incidence for patients undergoing orthopedic or trauma surgery3 and abdominal surgery.

Relationship Between Caregiver Attendance at Wound Clinic Visits and Wound Healing in Patients With Diabetes: A Retrospective Multicenter Evaluation

Lower extremity wounds in patients with diabetes are significant and burdensome. To evaluate retrospectively the correlation between lower limb wound outcomes in patients with diabetes and the presence of a caregiver during clinic visits. The study was conducted in 3 outpatient wound centers in North Carolina. Patients (N = 85) were categorized into 2 groups: those who were accompanied by a caregiver at 50% or more of their visits to the wound clinic (n = 30) and those accompanied by a caregiver at fewer than 50% of their visits (n = 55). Data were evaluated using descriptive statistics and 2 sample t-tests. Although significant findings between the 2 groups were seen in age, race, Visit Count, Weeks in Service, Accompanied Count, and percentage of visits accompanied, the strongest meaningful correlation was in the Accompanied group between Percent Accompanied and Visit Count. In this group, the number of accompanied visits was 7.47 (range [standard deviation], 1-23 [5.2]) and the percentage was 87% (range [standard deviation], 52-100 [15]). This was stastically significant and with a moderately negative correlation (P = .04; r = -0.38). Despite negative predictors of healing, those who were accompanied by a caregiver at 50% or more of their visits demonstrated a higher healing rate and a lower number of total visits than those who were accompanied by a caregiver at fewer than 50% of their visits.

Novel home use of mechanical negative pressure wound therapy in diabetic foot ulcers.

Mechanical negative pressure wound therapy is an ultraportable, light weight and disposable single-use device that has been shown to promote wound healing. This study evaluated home use of a mechanically powered negative pressure wound therapy (NPWT) in diabetic foot wounds. Patients underwent revascularisation and/or debridement or amputation before starting mechanical NPWT. Wound outcomes and images of the wounds were recorded at each follow-up visit by the wound nurse. Patients were followed up until wound closure or end of therapy. A total of 12 patients (each with one wound) were included in the study. Of the 12 wounds, 33.3% (n=4) of wounds achieved primary wound closure while the remaining 66.6% (n=8) of wounds demonstrated a mean wound size reduction of 37.5±0.13%. Of the closed wounds, mean time to healing was 4.75±2.50 weeks. There was 100% limb salvage with no further debridement or amputations, and no 30-day unplanned readmissions. Mean length of hospital stay before starting home NPWT was 9.75±6.31 days. Mean number of NPWT changes was 8.33±2.67 sessions, while mean duration of therapy was 4.0±1.54 weeks. Mean cost of home NWPT therapy was US$1904±731 per patient. The home use of mechanically powered NPWT in diabetic foot wounds demonstrated excellent wound healing rates and 100% limb salvage, with no complications.

Wound photography for evaluation of surgical site infection and wound healing after lower limb trauma.

Deep surgical site infection (SSI) is common after lower limb fracture. We compared the diagnosis of deep SSI using alternative methods of data collection and examined the agreement of clinical photography and in-person clinical assessment by the Centers for Disease Control and Prevention (CDC) criteria after lower limb fracture surgery. Data from two large, UK-based multicentre randomized controlled major trauma trials investigating SSI and wound healing after surgical repair of open lower limb fractures that could not be primarily closed (UK WOLLF), and surgical incisions for fractures that were primarily closed (UK WHiST), were examined. Trial interventions were standard wound care management and negative pressure wound therapy after initial surgical debridement. Wound outcomes were collected from 30 days to six weeks. We compared the level of agreement between wound photography and clinical assessment of CDC-defined SSI. We are also assessed the level of agreement between blinded independent assessors of the photographs. Rates of CDC-defined deep SSI were 7.6% (35/460) after open fracture and 6.3% (95/1519) after closed incisional repair. Photographs were obtained for 77% and 73% of WOLLF and WHiST cohorts respectively (all participants n = 1,478). Agreement between photographic-SSI and CDC-SSI was fair for open fracture wounds (83%; k = 0.27 (95% confidence interval (CI) 0.14 to 0.42)) and for closed incisional wounds (88%; k = 0.29 (95% CI 0.20 to 0.37)) although the rate of photographically detected deep SSIs was twice as high as CDC-SSI (12% vs 6%). Agreement between different assessors for photographic-SSI (WOLLF 88%, k = 0.63 (95% CI 0.52 to 0.72); WHiST 89%; k = 0.61 (95% CI 0.54 to 0.69)); and wound healing was good (WOLLF 90%; k = 0.80 (95% CI 0.73 to 0.86); WHiST 87%; k = 0.57 (95% CI 0.50 to 0.64)). Although wound photography was feasible within the research context and inter-rater assessor agreement substantial, digital photographs used in isolation overestimated deep SSI rates, when compared to CDC criteria. Wound photography should not replace clinical assessment in pragmatic trials but may be useful for screening purposes where surgical infection outcomes are paramount. Cite this article: Bone Joint J2021;103-B(12):1802-1808.

Perioperative outcomes of the Geriatric Assessment and Medical Preoperative Screening (GrAMPS) program pilot for older hernia patients: does chronological age predict outcomes?

The Geriatric Assessment and Medical Preoperative Screening (GrAMPS) program was an initial attempt to understand and to define the prevalence of age-related risk factors in older patients undergoing elective ventral hernia repair (VHR) or inguinal hernia repair (IHR). Preliminary analysis found significant rates of previously unrecognized objective cognitive dysfunction, multimorbidity and polypharmacy. We now examine whether chronological age as a sole risk factor can predict a patient's perioperative outcomes, and if traditional risk calculators that rely heavily on chronological age can accurately capture a patient's true risk. This was a retrospective secondary analysis of the previously reported GrAMPS trial enrolling patients 60years and older with a planned elective repair of a ventral or inguinal hernia. The rates of key postoperative outcomes were compared between various cohorts stratified by chronological age. Previously validated risk screening calculators [Charlson Comorbidity Index (CCI), National Surgical Quality Improvement Program (NSQIP)] were compared between cohorts. In total, 55 (78.6%) of the 70 patients enrolled in GrAMPS underwent operative intervention by May 2021, including 26 VHR and 29 IHRs. Cohorts stratified by chronological age had similar rates of key perioperative wound and age-related outcomes including readmissions, postoperative complications, non-home discharges, and length of stay. Additionally, while the commonly used risk calculators, CCI and NSQIP, consistently predicted worse outcomes for older hernia patients (stratified by both median age and age-tertiles), screening positive on these risk assessments were not actually predictive of a greater incidence of postoperative complications. Chronological age does not accurately predict worse adverse postoperative complications in older hernia patients. Additionally, traditional risk screening calculators that rely heavily on age to risk stratify may not accurately capture a patient's true surgical risk. Surgeons should continue to explore nuanced patient risk assessments that more accurately capture age-related risk factors to better individualize perioperative risk.

From Chronic Wounds to Scarring: The Growing Health Care Burden of Under- and Over-Healing Wounds.

Significance: Wound healing is the largest medical market without an existing small molecule/drug treatment. Both "under-healing" (chronic wounds) and "over-healing" (scarring) cause a substantial biomedical burden and lifelong consequences for patients. These problems cost tens of billions of dollars per year in the United States alone, a number expected to grow as the population ages and the prevalence of common comorbidities (e.g., diabetes) rises. However, no therapies currently exist to produce the "ideal" healing outcome: efficient wound repair through regeneration of normal tissue. Recent Advances: Ongoing research continues to illuminate possible therapeutic avenues for wound healing. By identifying underlying mechanisms of wound repair-for instance, tissue mechanics' role in fibrosis or cell populations that modulate wound healing and scarring-novel molecular targets may be defined. This Advances in Wound Care Forum issue includes reviews of scientific literature and original research from the Hagey Laboratory for Pediatric Regenerative Medicine at Stanford and its alumni, including developing approaches for encouraging wound healing, minimizing fibrosis, and coaxing regeneration. Critical Issues: Wound healing problems reflect an enormous and rapidly expanding clinical burden. The issues of both under- and over-healing wound outcomes will continue to expand as their underlying causes (e.g., diabetes) grow. Targeted treatments are needed to enable wound repair with functional tissue restoration and decreased scarring. Future Directions: Basic scientists will continue to refine understanding of factors driving undesirable wound outcomes. These discoveries are beginning to be translated and, in the coming years, will hopefully form the foundation for antiscarring drugs and other wound therapeutics.

Experiences of Bromelain-Based Enzymatic Debridement (Nexobrid) in Burn Patients: A Clinical Report

Early debridement (i.e., eschar removal) is regarded as a cornerstone for treating burn wounds. Although surgical debridement is the standard method for complete removal of eschars, it has inefficiencies such as blood loss, heat loss, and poor selectivity, the latter of which means that both viable and necrotic tissue are affected. To make up for the shortcomings, various alternative techniques have been developed. Nexobrid, a mixture of proteolytic enzymes with high bromelain content, has emerged as a viable option in recent years due to its selectivity and efficiency. This product enables dissolving eschar without sacrificing viable or healthy tissue, preserving the potential for spontaneous epithelialization, which accelerates wound healing and leads to better aesthetic outcomes in burn wounds. Herein, we present our experience with proteolytic enzyme debridement using Nexobrid.

Injury Patterns and Outcomes in Civilian and Military Abdominal Gunshot Wounds

Owattanapanich, Natthida MD; Biswas, Subarna MD, FACS; Benjamin, Elizabeth R. MD, PhD, FACS; Rasmussen, Todd E. MD, FACS; Shackelford, Stacy MD, FACS; Demetriades, Demetrios MD, FACS Author Information