Percentage Reduction In Area Research Articles

Percentage area reduction as surrogate for complete healing of hard-to-heal wounds: a review of clinical trials

Percentage area reduction as surrogate for complete healing of hard-to-heal wounds: a review of clinical trials

A novel approach for the treatment of diabetic foot ulcers using a multimodal wound matrix: a clinical study.

Innovation in wound healing, particularly regarding diabetic foot ulcers (DFUs), is needed to reverse the number of diabetes-related amputations. This study evaluated a novel approach and performance of a multimodal wound matrix in converting stalled DFUs into a healing trajectory. Patients with either type 1 or 2 diabetes and with foot ulcers (Wagner grade 1 and 2), were screened to determine eligibility for treatment. Ulcers improving >30% in area during a two-week screening phase were not eligible for the study treatment phase. The study was an open-label trial conducted in three phases: screening, treatment and healing confirmation. Patients enrolled in the study received a treatment protocol that included application of a wound matrix to the ulcer and offloading. A total of 19 patients (15 males, four females) with a median age of 60 years, and a median ulcer duration of 36 weeks took part in the study. Patients showed an average four-week percentage area reduction (PAR) of 62%, a 12-week PAR of 94%, and a 12-week healing rate of 57% (8/14). Results of this study support the viability and potential of a novel approach to treating DFUs that includes use of a multimodal wound matrix.

Retention processed placental membrane versus standard of care in treating diabetic foot ulcers.

Diabetic foot ulcers (DFUs) are a severe complication for diabetic patients, significantly impacting patient quality of life and healthcare system efficiency. Traditional standard of care (SOC) treatments are inadequate for many patients, necessitating the use of advanced wound care products, such as human placental membranes. We studied a real-world population of large, hard-to-heal and complicated wounds, otherwise under-studied in the wound care literature. To this end, we conducted a retrospective cohort analysis to compare the effectiveness of a human placental amnion/chorion membrane product using retention-based processing (RE-AC) and SOC in managing chronic DFUs. During the study period of September 2021 through April 2024, we collected retrospective observational data from electronic health records of 21 patients treated with RE-AC at three outpatient wound care centres. Additionally, 21 control SOC patients were matched from a wound registry using Coarsened Exact Matching. Patients were categorized into two cohorts based on whether they received RE-AC or SOC. Key metrics included wound size progression and wound closure. The analysis employed Bayesian regression and Hurdle Gamma Analysis of Covariance models. Despite their rather large size (average of 13.8 cm2), our results indicated that RE-AC achieved almost a 10% higher expected wound closure rate compared to SOC at 12 weeks (8.53% [credible interval: 5.60%-10.7%]). Further, for wounds that did not close, RE-AC resulted in a 93.6% (credible interval: 147.7%-41.6) improvement in expected Percent Area Reduction over the SOC group at 12 weeks. We noted that on average, SOC wounds stalled or grew larger. In terms of a risk ratio comparing the study group with SOC, we found a 52% benefit in the RE-AC group (RR = 1.52). The findings suggest that even with larger DFUs, R-AC is superior to SOC for wound closure and expected Percent Area Reduction by 12 weeks. This benefit likely leads to reduced treatment costs, optimized resource utilization and improved outcomes in the DFU patient population; ultimately resulting in improved patient care.

Efficacy and safety of autologous whole blood clot in diabetic foot ulcers: a randomised controlled trial.

Diabetic foot ulcers (DFUs) present a significant global health challenge, resulting in high morbidity and economic costs. Current available treatments often fail to achieve satisfactory healing rates, highlighting the need for novel therapies. This study evaluated the safety and efficacy of a novel autologous whole blood clot (AWBC)-a blood-based, biodegradable provisional matrix-in conjunction with standard of care (SoC) when compared to SoC alone in the treatment of hard-to-heal DFUs. A multicentre, prospective, blinded assessor, randomised controlled trial was conducted at 16 sites across the US, South Africa and Turkey. A cohort of patients with hard-to-heal DFUs was enrolled and randomised to either the AWBC group or the control group. The primary endpoint was complete wound closure at 12 weeks, while secondary endpoints included time to heal and percentage area reduction (PAR) at four and eight weeks. Data were analysed using both intention-to-treat (ITT) and per-protocol (PP) populations. The cohort included 119 patients. AWBC treatment resulted in a significantly higher healing rate compared to the control in both ITT (41% versus 15%, respectively; p=0.002) and PP populations (51% versus 18%, respectively; p=0.0075). AWBC treatment also resulted in a shorter mean time to heal and higher durability of wound closure. Safety analysis showed a similar incidence of adverse events (AEs) between groups, with no device-related AEs. The AWBC system, by modulating the wound microenvironment and providing a functional extracellular matrix, offered a promising new approach to treating hard-to-heal DFUs, demonstrating superior healing outcomes compared to SoC alone in this study.

Percentage area reduction at week 4 as a prognostic indicator of complete healing in patients treated with standard of care: a post hoc analysis.

Early indicators of healing provide valuable information on the potential benefit of treatment. In patients with hard-to-heal (chronic) diabetic foot ulcers (DFUs), timely intervention is critical. Ulcers that fail to show measurable progress within four weeks of treatment are considered recalcitrant. These ulcers increase the risk of soft tissue infection, osteomyelitis and lower extremity amputation. A prognostic indicator or surrogate marker allows for rapid evaluation of treatment efficacy and safety. An inverse correlation between a percentage area reduction (PAR) of ≤50% at week 4 and complete healing by week 12 has been previously established; however, the data were derived from a standard of care (SoC) arm of clinical trials that are over a decade old. In this post hoc analysis, data from a large multicentre prospective randomised controlled trial were reviewed to assess PAR at week 4 as a prognostic indicator in patients treated with SoC. Overall, 65.4% (17/26) of patients with PAR >50% at week 4 achieved complete closure at week 12. The receiver operating characteristic (ROC) curve for area reduction by week 4 showed strong discrimination for predicting non-healing (area under the ROC curve: 0.92; p<0.001; positive predictive value: 70.6%; negative predictive value: 87.2%). These findings are consistent with previous studies and support the use of four-week PAR as a prognostic indicator.

A multicentre clinical trial evaluating the outcomes of two application regimens of a unique keratin-based graft in the treatment of Wagner grade one non-healing diabetic foot ulcers.

Diabetic foot complications that lead to lower extremity amputations pose a significant challenge to the entire global health system. In this multicentre clinical trial, 26 patients with chronic Wagner one diabetic foot ulcers (DFUs) were treated with a unique human keratin matrix graft applied either weekly or bi-weekly, in addition to standard of care. The hypothesis was that bi-weekly application would be similar to weekly application. The primary endpoint was complete wound closure by 12 weeks, and secondary endpoints included healing time, percent area reduction and weekly changes in peripheral neuropathy, pain and quality of life. In the intent-to-treat population, 77% (10/13) of DFUs treated with bi-weekly application healed compared with 69% (9/13) treated with weekly application. The mean time to heal within 12 weeks in the bi-weekly group was 61 days and in the weekly group was 54 days. The mean percent area reduction at 12 weeks was 94.7% in the bi-weekly group compared with 84.8% in the weekly group. The number of grafts used in the bi-weekly group was 3.9 compared with 6.2 in the weekly group. The results of this trial confirm our hypothesis that whether bi-weekly or weekly application of the unique keratin matrix graft is used to treat nonhealing indolent DFUs, there is a high rate of complete healing. Based on these results, future studies should be conducted that further investigate the use of this novel human keratin matrix graft for the treatment of chronic DFUs.

The use of a multimodal wound matrix to treat a variety of hard-to-heal wounds: a case series surveillance.

This case series examines the use of a multimodal wound matrix (MWM) trialled in a selection of clinical practice settings and on a variety of hard-to-heal wounds. The objective was to evaluate the effects of MWM and its performance in managing such wounds, regardless of clinical setting and ulcer type. Treatment of the MWM was conducted by independent wound care practitioners on wounds that were of >4 weeks duration. Treatment was once a week. Assessment was taken after four weeks and at week 12 of the study to assess percentage area reduction (PAR) compared to baseline measurements taken at the first treatment visit. Complete (100%) re-epithelialisation was also recorded. A total of 63 wounds were treated with MWM, and ulcer types were grouped as: diabetic foot ulcers (n=21); venous leg ulcers (n=18); pressure injuries (n=10); and others (n=14). Of the wounds, 78% had 100% re-epithelialisation, with an average PAR of 57% at four weeks and 86% at 12 weeks. The average time to resolution for those wounds that closed was 7.9 weeks. Results from this series of independent case studies support the application of MWM to potentially benefit healing in hard-to-heal wounds of different aetiologies of any duration and in a variety of clinical settings.

Treatment of bacterially contaminated lower extremity ulcers with a fatty acid-containing wound matrix: a case series.

The aim was to evaluate the effectiveness of a marine omega fatty acid-containing multimodal wound matrix (MWM) in reducing bacterial contamination and supporting wound area reduction (WAR) in patients with hard-to-heal wounds of varying aetiologies. A prospective, single-site, pilot case series of patients with hard-to-heal wounds. All wounds were considered non-healing prior to inclusion as they had failed to achieve at least 50% WAR after at least four weeks of standard of care (SoC) treatments. Patients were seen once weekly for wound assessments, matrix application and dressing changes. Baseline and weekly fluorescence images, standard wound images and wound measurements were obtained. A total of three patients, two with venous leg ulcers (VLUs) and one with a diabetic foot ulcer (DFU) were enrolled in this pilot study. The mean baseline wound age prior to study enrolment was 24 weeks, with a mean baseline wound size of 8.61cm2. The two VLUs went on to complete closure. The DFU displayed a total WAR of 53% by six weeks, when the patient was lost to follow-up due to a geographical relocation. The mean percentage area reduction of all wounds combined was 82% upon study completion. The use of MWM proved to be effective and safe in this patient cohort. The wounds included in this case series failed to enter a healing trajectory with SoC wound therapies. The MWM supported wound closure and reduced bacterial loads in this patient cohort.

Assessing placental membrane treatment efficiency in diabetic foot ulcers: Processing for retention versus lamination.

Diabetic foot ulcers are a severe complication in diabetic patients, significantly impact healthcare systems and patient quality of life, often leading to hospitalization and amputation. Traditional Standard of Care (SOC) treatments are inadequate for many patients, necessitating advanced wound care products (AWCPs) like human placental membranes. This study conducts a retrospective analysis to compare the effectiveness of two human placental membrane products, retention-processed amnion chorion (RE-AC) and lamination-processed amnion chorion (L-AC) in managing chronic diabetic foot ulcers (DFUs). The study collected retrospective observational data from electronic health records (EHRs) of patients treated for DFU at three outpatient wound care centers. Patients were categorized into two cohorts based on the treatment received. Key metrics included wound size progression and the number of product applications. The analysis employed Bayesian estimation, utilizing an analysis of covariance model with a Hurdle Gamma likelihood. We found that RE-AC achieved a marginally higher expected Percent Area Reduction (xPAR) in DFUs compared to L-AC at 12 weeks (67.3% vs. 52.6%). RE-AC also required fewer applications, suggesting greater efficiency in general wound closure. Probability of full wound closure was similar in both groups (0.738 vs 0.740 in RE-AC and L-AC, respectively). The findings suggest that while L-AC might be slightly more effective in complete ulcer healing, RE-AC offers overall better treatment efficiency, especially in reducing the frequency of applications. This efficiency can lead to improved patient comfort, reduced treatment costs, and optimized resource utilization in healthcare settings.

Percentage Area Reduction of Uncut Fibre of Drilling Pineapple Leaf Fibres Reinforced Composites with Peck Drilling Canned Cycle Method

The effectiveness of utilizing the peck drilling canned cycle to minimize hole delamination has been demonstrated. However, its potential to reduce uncut fiber resulting from fiber fracture and pull-out has not been fully recognized, particularly in drilling natural fiber-reinforced polymer composites. Therefore, this study investigated the performance of this established method and compared it with the conventional drilling approach using a stepped geometry drill bit, which is purported to minimize hole delamination and, consequently, reduce uncut fiber. A series of hole-making processes were carried out according to a Completely Randomized Design (CRD) experimental plan. Different feed movements were employed to elicit responses, specifically the extent of uncut fiber area. The findings indicate that employing the established method could reduce uncut fibers by approximately 18.6%, representing a 2% enhancement compared to the alternative approach. Hence, the peck drilling canned cycle strategy offers a promising and cost-effective alternative to using specialized drill bits or high-performance cutting tools.

Effects of Annealing Temperature on Microstructural Evolution and Mechanical Properties in Cold-Rolled High-Nitrogen Austenitic Steel

High-nitrogen austenitic steel (HNS) cold-rolled with a reduction rate of 25% was subjected to an investigation of the effect of annealing temperature on microstructural evolution, tensile properties and the variation in fracture surface morphology. In cold-rolled HNS, matrix recovery occurred at an annealing temperature of 600 °C, and recrystallization was locally initiated at an annealing temperature of 800 °C. The 0.2% offset yield strength (0.2% YS) and ultimate tensile strength (UTS) were almost constant up to an annealing temperature of 500 °C, and these values gradually decreased above the annealing temperature of 600 °C, while a sharp reduction in the percentage reduction in area (RA) occurred at the annealing temperatures of 600 and 700 °C due to Cr2N precipitation along the grain and twin boundaries. The ratio of 0.2% offset yield strength to ultimate tensile strength (0.2% YS/UTS) remained constant until matrix recovery took place; however, once recrystallization occurred, the ratio decreased significantly. Furthermore, the variation in the morphology of Cr2N along the grain boundaries in the annealing temperature range from 600 to 800 °C influenced the intergranular fracture morphology, resulting in a transition from dimple to ledge and back to dimple.

Efficacy of acellular fish skin graft in the management of chronic ulcer: a systematic review and meta-analysis.

The wounds failing to heal through a timely and orderly standard of care (SOC) treatment are considered as chronic wounds, which add significant burden to healthcare systems around the world. SOC treatment has been commonly applied for management of chronic wounds, but SOC alone may not be adequate to heal all ulcers effectively. Fish skin graft (FSG) is a xenogenic skin substitute which could be used for accelerating skin healing. The current study was performed with the view of evaluating the effectiveness of FSG as an adjuvant treatment of SOC for chronic ulcer treatment. Two authors independently searched the following electronic databases: PubMed, Embase, and CENTRAL, using keywords including "diabetic foot ulcer," "fish skin graft," and "wound healing." Clinical studies that evaluated the clinical outcomes of FSG in treatment of chronic ulcers were included in this meta-analysis. Random- or fixed-effect modeled meta-analyses were performed according to the heterogeneity test result (i.e., I2), to analyze the clinical outcome of FSG. A total of 8 studies were included in qualitative synthesis and meta-analysis, with 145 patients treated by SOC and 245 patients treated by SOC plus FSG. There was no significant difference between two groups for time to healing (MD = 1.99, 95% CI: -3.70~7.67, p = 0.493). The complete healing rate was significantly higher in FSG group compared with SOC alone (OR = 3.44, 95% CI: 2.03~5.82, p < 0.001***). Mean percentage area reduction (PAR) was reported in six studies, with a range of 71.6~97.3%. However, many of these studies did not report the value of standard deviation (SD), so we could not pool the data. No significantly different ulcer recurrence rate (RR = 0.60, 95% CI: 0.07~5.27, p = 0.645) and severe adverse events (SAEs) risk (RR = 1.67, 95% CI: 0.42~6.61, p = 0.467) were found between two groups. The application of FSG treatment for patients with chronic ulcers that do not respond well to SOC management could significantly increase the complete healing rate compared with SOC alone, without increased recurrence rate and SAEs risk.

Remote assessment and monitoring with advanced wound therapy to optimise clinical outcomes, access and resources.

Patients in rural communities may have limited access to wound care; however, this may be mitigated by using a shared care approach. This study assessed the impact of a remote assessment and monitoring tool in combination with adjunctive continuous topical oxygen therapy (cTOT) in patients with diabetes and hard-to-heal wounds. Patients with hard-to-heal wounds (defined as no visible improvement in the previous four weeks) were enrolled to this 12-week pilot study to validate a shared care approach using an Advanced Digital Wound Care Platform-telehealth (ADWCPt) system (eKare Inc., US) coupled with cTOT. Patient and wound assessments were reviewed by the clinician either remotely, via telehealth calls, or at the clinic, and the number of face-to-face clinic visits was recorded. Patient health status scores were captured before and after the study, along with feedback on usability of the remote platform and cTOT device. The wounds in all eight patients studied reduced in size over 12 weeks (mean percentage area reduction 92.0%), and two wounds were completely re-epithelialised. Another wound almost healed (99.2% wound area reduction). Clinical interactions consisted of self-assessments (n=80, 50.0%), video assessments with the clinician (n=27, 16.9%), and face-to-face interactions in clinic (n=53, 33.1%). Operational efficiencies encompassed a 54.0% increase in the number of clinical interactions, whereas clinical time was reduced by 25.8%. Health status scores improved across all eight patients and feedback on the shared approach and cTOT device was favourable. A shared care model with ADWCPt coupled with an innovative cTOT device saved time and resources, improving patient access and engagement, along with a marked improvement in the wound healing trajectory.

Clinical and microbiological predictors of healing in Buruli ulcer disease

IntroductionWound measurements are relevant in monitoring the rate of healing (RoH) and may predict time to healing. Predicting the time to healing can help improve the management of Buruli ulcer. We examine three methods for the determination of RoH and their use as predictors of time to healing. MethodsLesion measurements of Buruli ulcer patients treated from 2007 to 2022 were obtained with acetate sheet tracings (2D) or Aranz software (3D) fortnightly. RoH was determined using the absolute area, percentage area reduction and linear methods at 4 weeks post onset of antibiotic treatment. Predicted time to healing was compared to the actual healing time. Baseline characteristics were assessed for associations with healing. ResultsAll three methods for calculating the RoH significantly distinguished between fast and slow healers (p < 0.0001). The predicted healing time using the linear method was comparable to the actual healing time for fast healers (p = 0.34). The RoH was influenced by the form of lesion, with plaques [OR 2.19 5 %CI (1.2–3.6), p = 0.009], and oedemas [OR 8.5; 95 %CI (1.9––36.9), p = 0.004] being associated with delayed healing. The proportion of patients with paradoxical reactions 16 % vs 3 %, p < 0.0001), higher baseline bacterial load (75/104;72 % vs 21/47;45 %, p = 0.001) and delayed clearance of viable organisms (71/104;68 % vs 9/47;19 %, p < 0.0001) was higher in the slow healers than the fast healers. ConclusionPredicted healing rates were comparatively lower for slow healers than fast healers. Baseline characteristics associated with healing can be explored for an improved disease management plan to reduce patient and caregiver anxiety.

Efficacy of Plasma Rich in Growth Factors for Healing Chronic Skin Ulcers: A Systematic Review of Randomized Controlled Trials With Meta-Analysis

Background. Chronic skin ulceration is a serious pathological condition for which the adjuvant use of platelet-rich plasma (PRP) has been indicated. However, evidence for the use of PRP in patients with chronic skin ulcers remains insufficient due to a large heterogeneity in experimental designs, PRP composition, and preparation protocols. Objective. To assess previously published reports of the clinical effect of plasma rich in growth factors (PRGF) on chronic skin wounds. Methods. A comprehensive search of the PubMed, Cochrane Library, and Scopus databases was performed to identify randomized controlled trials (RCTs) assessing the effect of PRGF on chronic ulcer healing, with no limitation regarding publication date (up to September 1, 2022). Percentage area reduction and probability of complete healing in chronic ulcers, pain reduction, infection risk, and cost savings were analyzed. A meta-analysis was performed, and the overall evidence was qualified using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results. A total of 113 studies were identified. After full-text screening, 5 RCTs met the inclusion criteria. The meta-analysis showed a significant effect of PRGF on both wound area reduction (mean difference, 56.90% [95% CI, 52.28-61.51], I² = 0%; P = .56) and on the probability of complete healing (RR, 7.07 [95% CI, 1.84-27.16], I² = 0%; P = .53) in chronic ulcers. The overall risk of bias rating was “some concerns,” whereas the certainty of evidence was high for both outcomes. A qualitative analysis suggested that PRGF did not increase infection risk and was able to reduce wound pain. Conclusion. The use of PRGF significantly enhances wound area reduction and also the probability of complete healing in chronic ulcers. More studies are needed to assess the effect of PRGF on pain and infection, as well as its cost-effectiveness.

Efficacy of a 3D Electrospun Synthetic Polymer Matrix on Hard-to-Heal Wounds.

The aim of this study was to evaluate the efficacy of a 3D electrospun synthetic polymer matrix (3DESPM) on hard-to-heal wounds. This prospective case series took place at four sites. The primary endpoints were the percentage area reduction (PAR) in wound area at four and eight weeks. Secondary endpoints included time to heal (Kaplan-Meier analysis) and the proportion of healed wounds at 12 weeks. After applying 3DESPM, the physician applied sterile saline, as appropriate, to adhere the matrix to the wound bed and facilitate the polymer degradation process. A nonadherent dressing, a secondary dressing, and additional bandages (as needed) were then applied. The physician left the product on the wound until complete degradation was observed, as appropriate, and reapplied, as appropriate. Combination advanced therapies were applied, per physician discretion. Thirty-eight patients (mean age: 64.3 years [SD: 17.6]) with 50 wounds (35 chronic, 70%) participated. The mean number of comorbidities per patient was 4.4 (2.3). All wounds received 3DESPM; 12 wounds (24%) received combination therapies; and 38 wounds (76%) completed the study. The mean (SD) PAR at four and eight weeks was 67.6% (38%) and 80% (35%), respectively. Thirty-three wounds (66%) healed at 12 weeks. The Kaplan-Meier mean time to heal for all wounds was 49.0 days (95% confidence interval: 41.3-56.7). In a complex patient population with severe comorbidities and heterogeneous wounds, 3DESPM appeared to accelerate the stalled healing process to contribute to wound closure. Further investigation of 3DESPM on a larger patient population and in a controlled setting is pending.

Investigation on the hydrogen induced cracking behaviour of heat-treated pipeline steel

In this paper, the hydrogen induced cracking (HIC) sensitivity of the austenitized Cu-containing pipeline steels after cooling processes in air and water conditions was evaluated. Microstructural test, as well as hydrogen-charging slow strain rate tensile test and hydrogen concentration tests were conducted. Results indicated that steels after both cooling processes exhibited lower HIC sensitivity compared to the untreated steel. Elongation and percentage reduction of area after the hydrogen-charging slow strain rate tensile tests were increased. This was related to the formation of strong hydrogen trapping sites and the decrease of weak hydrogen trapping sites such as high-angle grain boundaries. Moreover, the TDS test results confirmed the presence of more stable hydrogen trapping sites in air-cooled steel than water-cooler steel. The latest phenomenon effectively hindered the diffusion behaviour of hydrogen in steel and reduced the HIC sensitivity.

Modified restoring array-based power efficient approximate square root circuit and its application

In this paper, the authors present an investigation into the benefits of approximate computing in energy-efficient error-resilient applications. It proposes an approximate square root (SQR) circuit based on the modified restoring array square root (MRAS) architecture. The MRAS design incorporates strategic elimination, optimization, and simplification of restoring subtractor cells (SC) within a conventional restoring array SQR circuit. As a result, the proposed MRAS circuit efficiently computes the square root of a 2n-bit unsigned integer, offering a 27 percent reduction in area, 13 percent faster computation, and 50 percent lower power consumption compared to the exact SQR design. To introduce approximation, configurable SCs are integrated into the MRAS circuit, enabling dual operation modes for both accuracy and approximation. This feature allows the proposed approximate modified restoring array SQR (AMRAS) design to cater to both error-resilient and error-sensitive applications. The evaluation involves a thorough analysis of accuracy and design metrics for 16-bit unsigned exact, state-of-the-art, and proposed square rooters. The designs are implemented on Artix7 FPGA using Verilog-HDL and simulated in the Xilinx Vivado simulator. The results demonstrate that the proposed AMRAS achieves a good trade-off between accuracy and hardware, presenting an impressive 80 percent reduction in power consumption and a 36 percent faster computation. Additionally, the paper showcases the practical application of the proposed AMRAS square rooters in the Sobel edge detection for image processing.

Aquacel Ag Advantage/Ag+ Extra and Cutimed Sorbact in the management of hard-to-heal wounds: a cohort study.

To compare Aquacel Ag Advantage/Ag+ Extra (Aquacel Ag+) (Convatec, UK) and Cutimed Sorbact (Sorbact) (Essity, US) dressings indicated for the treatment of patients with venous leg ulcers (VLUs), diabetes foot ulcers (DFUs) and pressure injuries (PIs) for clinical performance and outcomes using real-world evidence in Germany and the US. This study was a chart audit review of patients who used either Aquacel Ag+ or Sorbact dressings in the 24 months prior to October 2022. Healthcare providers with access to electronic medical records and charts were asked to capture data via patient record forms. The quantitative data were analysed. Findings in Germany were comparable between Aquacel Ag+ and Sorbact with regards to wound description, management and treatment outcomes, including percent area reduction and wound closure. A difference was that a greater proportion of Sorbact patients required surgery (0% versus 11%; p=0.039). In the US, a greater proportion of wounds were worsening before dressing in the Aquacel Ag+ cohort (49% versus 34%; p=0.010). A multinomial logistic regression yielded the result that patients who received Aquacel Ag+ were 3.53 times more likely to have the wound completely healed (p=0.033). Both Aquacel Ag+ and Sorbact dressings are widely used in Germany and the US for patients with VLUs, DFUs and PIs. Our study found two important differences: patients who used Aquacel Ag+ were less likely to need further surgery in Germany; and in the US, there were significantly higher odds that wounds would completely heal with Aquacel Ag+ dressings compared to Sorbact.

Efficacy of mixture of injectable-platelet rich fibrin and type-1 collagen particles on the closure of through-and-through periapical bone defects - A randomized controlled trial.

To determine the efficacy of a combination of injectable-platelet rich fibrin and type-1 collagen particles on the healing of through-and-through periapical bone defect and subsequent closure of bony window. The clinical trial was registered in ClinicalTrials.gov(NCT04391725). Thirty eight individuals with radiographic evidence of periapical radiolucency in maxillary anterior teeth and confirmed loss of palatal cortical plates in cone beam computed tomographic imaging were randomly assigned to either experimental group(n=19) or the control group(n=19). Mixture of i-PRF and collagen as a graft was applied to the defect in adjunct to periapical surgery in experimental group. No guided bone regeneration procedures were used in the control group. The healing was evaluated using Molven's(2D) and modified PENN 3D(3D) criteria. Percentage reduction of the buccal and palatal bony window area, and complete closure of through-and-through periapical bony window (tunnel defect) were assessed using Radiant Diacom viewer software(Version 4.0.2). The reduction in the periapical lesion area and volume was measured using Corel DRAW and ITK Snap software. Thirty four participants(18 and 16 in the experimental and control group, respectively) reported for follow-up at 12 months. There was 96.9% and 97.96% reduction of buccal bony window area in experimental and control groups respectively. Similarly, palatal window showed 99.03% and 100% reduction in experimental and control groups respectively. No significant difference in both buccal and palatal window reduction was noticed between the groups. A total of 14 cases(7 in experimental and 7 in control group) showed complete closure of through-and-through bony window. No significant difference in clinical, 2D and 3D radiographic healing, percentage reduction in area and volume was observed between experimental and control group(P>0.05). Neither the area nor the volume of lesion, and the size of buccal or palatal window had significant effect on healing of through-and-through defects. Endodontic microsurgery results in high success rate in large peripical lesions with through-and-through communication with more than 80% reduction in volume of lesion and size of both buccal and palatal window after one year. Mixture of type-1 collagen particles and i-PRF, adjunct to periapical micro-surgery did not improve the healing in through-and-through periapical defects.