Periwound Area Research Articles

Local Phage Therapy During Surgical Treatment of Burn Wounds Reduces the Risk of Colonization of the Skin of the Periwound Area by Pathogens of the ESKAPE Group

Aim of study To study the effect of local phage therapy alone and in combination with systemic antibiotic therapy on the dynamics of microflora colonizing the skin of the periwound area during surgical treatment of infected burn wounds.Material and methods Scientific hypothesis: the use of local phage therapy in monotherapy in the treatment of burn wound infections reduces the risk of colonization of the skin of the periwound area by bacteria of the ESKAPE group. The experimental study analyzed the results of microbiological studies of washings from the skin surface of 40 animals with infected burn wounds, in the course of phage therapy in monotherapy and in combination with systemic antibiotic therapy.Results In the group of animals receiving phage therapy alone, the proportion of ESKAPE group bacteria colonizing the skin of the periwound area at the time of completion of the course of antimicrobial therapy was 9%, while in the group receiving phage therapy in combination with systemic antibiotic therapy it was 43% (p=0.011).Conclusion The use of local phage therapy in single mode during the surgical treatment of infected burn wounds reduces the risk of colonization of the skin of the peri-wound area by pathogens of the ESKAPE group. At the same time, systemic antibiotic therapy causes an imbalance of resident and transient skin microbiota in the periwound area and an increase in the frequency of its colonization by pathogens of the ESKAPE group.

Contrast-Free High Frame Rate Ultrasound Imaging for Assessment of Vascular Remodeling During Wound Healing

BackgroundMonitoring of wound healing progression is critical due to the risk of infection, non-healing wounds, or evolution towards a chronic state. Tissue vasculature is one of the most representative features reflecting healing status. This study explores the feasibility of vascular ultrasound imaging of open wounds and the extraction of vascular-related features in a longitudinal study. Material and methodsC57BL/6 mice received a 1 cm-diameter full-thickness wound on their dorsum and were imaged using ultrasound from the surgical day (Day 0) to 25 days post-wounding. The high frame rate, plane waves acquisitions with a 15 MHz transducer were postprocessed with Singular Value Decomposition (SVD) filtering to provide vascular information. ResultsVascularity Index (VI) calculations showed an increased vascular signal in the wound from Day 2 post-wounding and were significantly higher from day 6 to day 10 post-wounding compared to Day 0 (p<0.05). VI values were back to the basal level after 3 weeks. In comparison, no significant difference was highlighted for the vascular signal in the peri-wound area. ConclusionsThese results show that vascular ultrasound imaging can be applied to track vascular changes of open wounds during the healing process. This approach may also be extended to other types of wounds for detecting early signs likely to cause complications.

Conservative Wound Treatment in DMT2 Patients Using Honey

Background : The number of diabetic patients in Indonesia is on the rise. In contrast to typical wounds in non DMT2 patients, chronic wounds in DMT2 patients heal more slowly, which makes it difficult to achieve complete primary wound healing. Thus, surgery is frequently required to achieve optimal healing. Patients' physical condition, age, comorbidities, and financial circumstances such as high medical costs frequently limiting patients from receiving comprehensive care, resulting alternative treatments are required to treat chronic wounds in DMT2 patients whom prefer conventional medications, addressing all circumstances. Honey, in addition to having fructose compounds, which has the benefit of increasing glucose homeostasis and insulin response, resulting in lower insulin and plasma glucose levels, also has been shown to contain anti-inflammatory and antimicrobial substances that aid in wound healing. Thus, it may be an alternative therapy for chronic wound in DMT2 patients.&#x0D; Methods : A Case-series studies of four DMT2 patients who were referred to Plastic and Reconstructive Outpatient ward with chronic wound were evaluated on a monthly basis following conservative treatment using Nusantara local honey-coated gauze.&#x0D; Result : Secondary wound healing, which can be assessed from the epithelialization process started from the peri-wound area has been obtained through monthly observations.&#x0D; Conclusion : Honey is used as an alternative therapy for patients with diabetic foot ulcers due to its anti-microbial and anti-inflammatory properties in the wound healing process. Furthermore, honey is considered less expensive and more affordable alternative for patients with co-morbidities that is impossible to operate, or with financial limitations.&#x0D; Keywords: DMT2, Chronic wound, Honey

Structural and functional assessment of the condition of wound bed using microwave dielectrometry and laser doppler flowmetry

The aim of the work was to develop and test a combined method for assessing the structural and functional features of the burn wound and periwound area with the use of microwave dielectrometry and Dopplerometry. The study was performed on twenty Wistar rats, thermal injuries from contact were created on each rat, and ten healthy animals. The assessment of the wound condition was performed 24 and 72 hours after burn injury. The study of the dielectric properties of tissues was carried out using a hardware and software complex for near-field resonant microwave sensing. From the results of our studies, it can be concluded that in the early post-injury period (within the first days), a sharp coordinated decrease in the intensity of microcirculation and dielectric permittivity is observed in the wound tissues, gradually and partially restored by the end of the third day after burning. The increased microcirculatory blood flow to the periwound area, leading to an increase in the degree of tissue hydration was observed, and as a consequence, the values of these two indices became higher. In addition, it has been shown that during thermal trauma, a regulatory imbalance of factors providing capillary blood flow around a burn wound area and surrounding tissues is formed, which is compensatory in nature and, in the absence of adequate correction, contributes to the inhibition of regeneration processes. Thus, the combination of the methods used in this study may potentially provide more specific information for a description of the structural and functional features of the analyzed tissue and their dynamics. This is clearly shown by the example of an experimental burn wound.

Elabela inhibits TRAF1/NF-κB induced oxidative DNA damage to promote diabetic foot ulcer wound healing

Diabetic foot ulcer (DFU) is a serious complication of diabetes. Elabela (ELA), a ligand of apelin receptor (APJ), was shown to promote angiogenesis and suppress inflammation. This study aimed to illustrate the role of ELA in DFU wound healing. A whole-skin defect model was constructed using db/m and db/db mice to observe the effects of ELA on wound healing. The function of ELA in endothelial cells cultured in high glucose medium was investigated. Administration of ELA in peri-wound area of db/db mice accelerated wound closure and reduced inflammatory infiltration. Indicators of DNA damage, elevated reactive oxygen species (ROS) levels and tail DNA amounts, were downregulated by ELA but compromised after TRAF1 overexpression. ELA-mediated inhibition of NF-κB phosphorylation improved cell migration and angiogenesis, which were blocked by APJ silencing. The findings imply that ELA suppresses TRAF1-mediated NF-κB signal activation, reducing ROS-related oxidative DNA damage and improving protection of endothelial function.

A Rare Case of a Second-Degree Chemical Burn due to Successive Contacts of Acidic Wart Removal Solution and Paint Solution

Introduction: Chemical burns are an uncommon form of burn injury, accounting for 2.1% to 6.5% of all burn centre admissions. We presented one rare case of a second degree chemical burn due to successive contacts of acidic wart removal solution and paint mixture solution. Case: A 38-year-old male with chemical burn on both feet due to reckless usage of a self-purchased wart removal solution, and accidental contact with paint mixture solution. Our surgeon author diagnosed a superficial partial thickness (second-degree) chemical burn on this patient, and performed surgical debridement followed by hyaluronic-enhanced silver sulfadiazine topical dressing to provide antimicrobial protection to the wound and topical petrolatum-based ointment to maintain moist environment for the wound and the periwound. Our team also gave Ceftaroline, a cephalosporin for serious infections of the skin and tissues below the skin, intravenously. Result: One day after the surgical procedure, the wound dimensions were slightly more extensive than the initial size due to extensive debridement and necrotomy. All wounds produced no or minimal exudate, showed no slough nor pus inside the granulation area, and no swelling nor maceration in the periwound area. The fifth day after the surgical procedure, the wound on the lateral side of patient’s right foot was almost completely covered by epithelialization. The wound on the sole of patient’s right foot was about 70-80% covered by epithelialization, and the wound on the sole of patient’s left foot was also about 70% covered by epithelialization. Discussion: Topical solution for wart removal consists of many chemicals agents (i.e. salicylic acid and acetic acid) and its application should strongly be under guidance and monitoring by physician due to its potential to harm human bodies and trigger chemical burn injury in varying degrees. Paint mixture is usually safe, risks no or minimal harms when in contact with skin, however it can provide a more difficult scenario and consequently a more extensive cleansing during the wound debridement procedure. Immediate decontamination and adequate dilution through massive irrigation is a major determinant of burn severity after chemical injury. Application of 1% silver sulfadiazine topical antibiotics enhanced with 0.2% hyaluronic acid for moisturizer displayed significant improvement for the burn wound healing. Conclusion: Knowing exactly what type of chemical substance in contact with the skin and tissues that caused the chemical burn injury is as equally important as the comprehensive management itself. For acidic burn injuries, a proper and sometimes extensive necrotomy procedure is mandatory to provide a good tissue regeneration.

In Situ-Formed Fibrin Hydrogel Scaffold Loaded With Human Umbilical Cord Mesenchymal Stem Cells Promotes Skin Wound Healing

Healing of full-thickness skin wounds remains a major challenge. Recently, human umbilical cord mesenchymal stem cells (hUC-MSCs) were shown to possess an extraordinary potential to promote skin repair in clinical settings. However, their low survival rate after transplantation limits their therapeutic efficiency in treating full-thickness skin wounds. Hydrogels are considered an ideal cell transplantation vector owing to their three-dimensional mesh structure, good biosafety, and biodegradation. The objective of this study was to investigate the skin wound healing effect of a fibrin hydrogel scaffold loaded with hUC-MSCs. We found that the fibrin hydrogel had a three-dimensional mesh structure and low cytotoxicity and could prolong the time of cell survival in the peri-wound area. The number of green fluorescent protein (GFP)-labeled hUC-MSCs was higher in the full-thickness skin wound of mice treated with hydrogel–hUC-MSCs than those of mice treated with cell monotherapy. In addition, the combination therapy between the hydrogel and hUC-MSCs speed up wound closure, its wound healing rate was significantly higher than those of phosphate-buffered saline (PBS) therapy, hydrogel monotherapy, and hUC-MSCs monotherapy. Furthermore, the results showed that the combination therapy between hydrogel and hUC-MSCs increased keratin 10 and keratin 14 immunofluorescence staining, and upregulated the relative gene expressions of epidermal growth factor (EGF), transforming growth factor-β1 (TGF-β1), and vascular endothelial growth factor A (VEGFA), promoting epithelial regeneration and angiogenesis. In conclusion, the fibrin hydrogel scaffold provides a relatively stable sterile environment for cell adhesion, proliferation, and migration, and prolongs cell survival at the wound site. The hydrogel–hUC-MSCs combination therapy promotes wound closure, re-epithelialization, and neovascularization. It exhibits a remarkable therapeutic effect, being more effective than the monotherapy with hUC-MSCs or hydrogel.

Hydrocolloid Wound Dressing for Sealing Periwound With Poor Normal Skin: Negative Pressure Wound Therapy for Deep Limb Burns With Extensive Burns

BACKGROUND: Negative pressure wound therapy (NPWT) is effective for wounds with exposed bones and tendons, but when the wound is accompanied by extensive burns, sealing is difficult. We performed sealing with a hydrocolloid wound dressing on limb burns. CASE REPORT: A 61-year-old woman was burned in a fire at her home. Split-thickness skin grafting was performed 14 and 35 days post injury, but exposure of the right patella and patellar tendon became apparent. The hydrocolloid wound dressing was wrapped around the proximal and distal aspects of a deep wound. The limb was sandwiched from the front and back surfaces and sealed with 2 film dressings, including the hydrocolloid, according to the sandwich method. Using this method, NPWT could be performed without leakage, the exposed tendons and bones were covered with granulation, and skin grafts were performed on day 88 after injury. CONCLUSION: Our method allows NPWT to be easily and effectively performed for deep limb burns with poor normal skin periwound area.

Use of the DermaBlade for Debridement of Hypergranulatory Wound Tissue.

Use of the DermaBlade for Debridement of Hypergranulatory Wound Tissue.

A sebkörnyéki szövődmények megelőzése és kezelése a krónikus nem gyógyuló lábszársebek kezelésében

Chronic non-healing lower extremity ulcers represent a significant burden for the patient and society. Periwound breakdown delays wound healing, worsens patients’ quality of life, and increases the costs of wound treatment. Damage to the periwound area may result from moisture-associated skin damage, medical-adhesive related skin injury, contact dermatitis, and infections. Essential elements of preventing periwound complications are identifying predisposing risk factors for periwound damage, regular assessment of the condition of the periwound area, proper wound treatment technique, and exudate control. Timely detection and rapid multidisciplinary treatment of complications are necessary

The influence zone: a critical performance measure for negative pressure wound therapy systems.

This article provides an introduction to the theory of, what is termed, the 'influence zone' in the context of negative pressure wound therapy (NPWT). It is a quantitative bioengineering performance measure for NPWT systems, to indicate their effectiveness, namely, how far from the wound bed edges a specific system is able to deliver effective mechano-stimulation into the periwound, and at which intensity. The influence zone therefore provides objective and standardised metrics of one of the fundamental modes of action of NPWT systems: the ability to effectively and optimally deform both the wound and periwound macroscopically and microscopically. Most important is the mechanical deformation of the periwound area to activate cells responsible for tissue repair, particularly (myo)fibroblasts. Notably, the influence zone must extend sufficiently into the periwound to stimulate (myo)fibroblasts in order that they migrate and progress the wound healing process, facilitating the formation of scar tissue, without overstretching the periwound tissues so as not cause or escalate further cell and tissue damage. The inclusion of the influence zone theory within research to investigate the efficacy of NPWT systems facilitates systematic comparisons of commercially available and potentially new systems. This approach has the capacity to guide not only research and development work, but also clinical decision-making. Recently published research found that inducing an effective influence zone first and foremost requires continuous delivery of the intended pressure to the wound bed.

Preoperative contaminated wound management using short-term negative pressure wound therapy with instillation.

The short-term application of negative pressure wound therapy with instillation and dwell time (NPWTi-d) enables the delivery of topical wound solutions, the solubilisation of debris and cleansing of the wound bed. The application of NPWTi-d may support the transition of the wound to a more manageable state and minimises the use of more invasive techniques. In this case series, we describe the process of applying NPWTi-d early as part of a contaminated wound treatment plan. The case series included 15 patients in the preoperative setting. Wound types included surgical dehiscence, hard-to-heal wounds, heel pressure ulcers, diabetic foot ulcers, a cat bite and an amputation left open. Normal saline or a 0.125% sodium hypochlorite solution were instilled and allowed to dwell for five minutes, followed by 15 minutes of continuous negative pressure at -125mmHg. NPWTi-d was continued for 4-36 hours, or until the operating room became available. After NPWTi-d, we observed a decreased amount of devitalised tissue in the wound bed and reduced oedema and erythema in the periwound area. Patient white blood cells also significantly decreased in all cases after NPWTi-d (p<0.001). Short-term use of NPWTi-d may be a useful option for supporting the surgical treatment of contaminated lower extremity wounds.

Periwound skin care considerations for older adults.

This article discusses the effects of ageing on the skin, particularly the main structural and functional changes that occur in the epidermis and dermis that make the skin more vulnerable to damage. Specific alterations that occur with ageing include slower epidermal turnover, flattening of the epidermal-dermal junction, loss of moisture and hydration as well as reduced immunity placing the skin at increased risk of damage. The discussion will also examine common periwound complications associated with ageing including; maceration, excoriation, dry skin, hyperkeratosis, callus, contact dermatitis and eczema. Strategies to manage these problems and interventions to reduce the risk of these complications include moisturising the skin to make it more resilient, debriding keratinised and callus tissue in the periwound area, appropriate choice of dressings to manage excessive exudate, careful removal of dressings as well as treating inflammatory conditions of the periwound skin.

Photobiomodulation as an Adjunct Therapy in Wound Healing.

"Light amplification by stimulated emission of radiation" or more commonly known as Laser has become very popular in the field of dermatology and aesthetic medicine over the past decades. For the treatment of wound healing, a combination of different wavelengths for laser therapy has been introduced which includes 660, 800, and 970 nm. The aim of this study was to note wound healing utilizing photobiomodulation as an adjunct therapy by measuring the wound size in terms of length and width (area measurement). Study participants were selected randomly from a pool of patients who were attending for their routine follow-up visits in the Wound Care Unit in Hospital Kuala Lumpur. Eleven patients with chronic wounds of different etiologies, ie, diabetic foot ulcer and nonhealing ulcer, were recruited for this study . Wound assessment was done prior to cleansing using distilled water and followed by debridement if necessary. Subsequently, the laser technician and patients used protective goggles before applying a super intense continuous flow of laser with 3 wavelengths, ie, 660, 800, and 970 nm with 30 kJ of energy with the handpiece over a 3 min period whereby it is focused on the wound milieu and then rotated around the periwound area. There were 9 diabetic foot ulcers and 2 nonhealing ulcers treated with photobiomodulation as an adjunct therapy. All wounds were managed with the standard of care. Three wounds ie, 3 diabetic foot ulcers and 1 nonhealing ulcer were closed completely. Meanwhile, the other 7 ulcers are at 68.2% to 99% in terms of wound area reduction and new granulomatous tissue was present indicating high healing potential. Therefore, the photobiomodulation was effective as an adjunct in the management of diabetic foot and nonhealing ulcers in this case series. A larger sample size would be able to show the significance of this finding.

Negative-Pressure Wound Therapy for a Replanted Finger with Complicated Wound

Negative-pressure wound therapy (NPWT) is widely used for open wounds in various anatomical sites. Extensive research has been carried out on the application of NPWT; exposed blood vessels in the periwound area are a known contraindication to NPWT. In this study, we report a case where a replanted finger with not only exposed vessels but also uncontrolled infection was treated with NPWT. A 60-year-old man visited our emergency department with incomplete amputation of his left index and middle fingers. After replantation of his two fingers, necrosis of the middle finger with severe methicillin-resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; infection complicated managing the wound. After 3 weeks of maintaining conventional wound dressings, we performed NPWT for successful granulation tissue formation and infection control. After the treatment, the wound was completely covered by a split-thickness skin graft. We thus suggest that NPWT can be an effective reconstructive method, including for intractable wounds with exposed pedicle and severe infection after replantation.

Microcirculatory changes in venous leg ulcers using intermittent electrostimulation of common peroneal nerve.

Activation of the venous muscle pumps of the leg by intermittent transdermal neuromuscular stimulation of the common peroneal nerve has been previously shown to augment venous and arterial flow in patients with leg ulcers. This study aims to establish if microcirculation in the wound bed and periwound area are augmented by the activation of a neuromuscular electrostimulation device (NMES) (Geko, Firstkind Ltd., UK). In this self-controlled, observational study, laser speckle contrast imaging was used to map and quantify microcirculatory flow in the wound bed and periwound area of patients with venous leg ulcers (VLU). Values of flow and pulsatility in these locations were compared with the NMES device, both active and inactive. A total of 16 patients took part in the study. Microvascular flux increased by 27% (p=0.014) in the wound bed, and by 34% (p=0.004) in the periwound area, when the NMES device was activated. Pulsatility increased by 170% (p<0.001) in the wound bed and 173% (p<0.001) in the periwound area when the device was activated. Intermittent electrostimulation of the common peroneal nerve substantially increased both microcirculatory flux and pulsatility in the wound bed and in the periwound area of the VLUs of patients in this study. This provides a plausible mechanistic explanation for its reported efficacy in healing VLUs.

Periwound skin care considerations for older adults

Samantha Holloway and Kirsty Mahoney discuss the unique ageing effects on adult skin and how these changes can cause the skin to be more prone to damage This article discusses the effects of ageing on the skin, particularly the main structural and functional changes that occur in the epidermis and dermis that make the skin more vulnerable to damage. Specific alterations that occur with ageing include slower epidermal turnover, flattening of the epidermal-dermal junction, loss of moisture and hydration as well as reduced immunity placing the skin at increased risk of damage. The discussion will also examine common periwound complications associated with ageing including; maceration, excoriation, dry skin, hyperkeratosis, callus, contact dermatitis and eczema. Strategies to manage these problems and interventions to reduce the risk of these complications include moisturising the skin to make it more resilient, debriding keratinised and callus tissue in the periwound area, appropriate choice of dressings to manage excessive exudate, careful removal of dressings as well as treating inflammatory conditions of the periwound skin.

The experience of polyhexanide usage as a part of wet environment in the treatment of limited burns

INTRODUCTION. The results of the treatment of patients with restrictive burns I-II degrees are presented in the article. The OBJECTIVE of the research was to establish the efficiency of the usage of polyhexanide included in wet environment in the treatment of burns I-II degrees. METHODS AND MATERIALS. The research was conducted in 2 groups of patients. In the first group (N=33), local treatment of hand wounds was performed in condition of wet environment created by isotonic solution of sodium chloride, in the second group (N=18) - with usage of polyhexanide as antiseptic and isotonic chloride saline solution. For evaluation of efficiency of the treatment, we studied the terms of the beginning of epithelialization of the wound surface, pain syndrome severity, microcirculation and conducted microbiological research of wound exudate. RESULTS. The appearance of the first signs of wound epithelialization after the beginnings of treatment was observed in 1.5 times in average sooner in the second group than in the first group. Pain syndrome was jugulated by the 3rd day in the first (research) group in 19 % of cases, in the second (control) group - in 46 % (p&lt;0.05). In the second group, perfusion of tissues in the border area reduced, in the same time in the first group, it remained unchanged. The number of swabbing cases with Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumoniae and Enterococcus faecalis increased in the first group by the 3rd day in contrast with the second group, where such cases was not noted or occurred significantly less often. CONCLUSION. The usage of polyhexanide as a part of wet environment promotes the reduction of wound surface swabbing level that allows to speed up the appearance of the first signs of wound epithelialization, reduces the severity of pain syndrome, and modeling of tissue microcirculation in periwound area.

Prospective clinical study on the efficacy of bacterial removal with mechanical debridement in and around chronic leg ulcers assessed with fluorescence imaging.

Bacterial colonisation in wounds delays healing, mandating regular bacterial removal through cleaning and debridement. Real‐time monitoring of the efficacy of mechanical debridement has recently become possible through fluorescence imaging. Red fluorescence, endogenously produced during bacterial metabolism, indicates regions contaminated with live bacteria (>104 CFU/g). In this prospective study, conventional and fluorescence photos were taken of 25 venous leg ulcers before and after mechanical debridement, without use of antiseptics. Images were digitally segmented into wound bed and the periwound regions (up to 1.5 cm outside bed) and pixel intensity of red fluorescence evaluated to compute bacterial area. Pre‐debridement, bacterial fluorescence comprised 10.4% of wound beds and larger percentages of the periwound area (~25%). Average bacterial reduction observed in the wound bed after a single mechanical debridement was 99.4% (p<0.001), yet periwound bacterial reduction was only 64.3%. On average, across bed and periwound, a single mechanical debridement left behind 29% of bacterial fluorescence positive tissue regions. Our results show the substantial effect that safe, inexpensive, mechanical debridement can have on bacterial load of venous ulcers without antiseptic use. Fluorescence imaging can localise bacterial colonised areas and showed persistent periwound bacteria post‐debridement. Fluorescence‐targeted debridement can be used quickly and easily in daily practice.

Validation of Harikrishna Periwound Skin Classification for wound assessment.

To validate the accuracy and reliability of Harikrishna Periwound Skin Classification (HPSC) for wound assessment. Post-basic students (staff nurses and medical assistants) were given real life pictures showing the wound and periwound area. The students were asked to classify all pictures according to the HPSC at zero months (before attachment) and after two months of attachment. The images were the same but the answers were never given or discussed after the first test. A total of 30 post-basic students participated in the study, assessing wound 30 images. The results showed that there was an increase of 25.42% in accuracy of wound assessment using the HSPC after two months of clinical attachment compared to pre-attachment. The reliability of the HPSC in wound assessment 79.87%. Health professionals have to be able to assess and classify wounds accurately to be able to manage them accordingly. Assessment and classifications of the periwound skin are important and need to be validated and integrated as a part of a full wound assessment. With experience and adequate training, health professionals are able to comprehensively assess wounds using the validated tool, to enable effective wound management and treatment, accelerating wound healing and improving the quality of life for patients.