Reduction In Wound Surface Area Research Articles

Portulaca grandiflora phytochemicals as a potential source for wound healing activity: in vitro and in vivo studies

The management of chronic wounds presents considerable challenges and has a substantial influence on the quality of life among afflicted persons and their families. The discovery of naturally produced bioactive chemicals having good effects on the regeneration of tissue has been driven by the need for safe, effective, and cost-effective wound healing therapies. Portulaca grandiflora is an annual succulent that comes under the family of Portulacaceae. The purpose of this study was to evaluate the phytochemicals of n-hexane extracts and their effects on in vitro and in vivo wound healing models. In vitro study, Wound Scratch Assay shows that n-hexane extract of 100 ug/ml concentration significantly promotes wound healing through increased cell migration and wound closure compared to MEBO ointment-treated groups and negative control groups. The in vivo study shows that the formula of the extract ointment promotes wound healing without any complication and the percentage of wound surface area reduction was (5.39 ± 0.391) better than MEBO-treated groups (10.06 ± 0.536), and negative control groups (14.04 ± 0.304) through its ability to stimulate epidermal closure, re-epithelization, and granulation that appears in histological examination. As a result, Iraqi Portulaca grandiflora can be considered a potential resource of chemical substances, especially terpenoids, and steroids, which are helpful in healing wounds.

A randomized, placebo-controlled study of chitosan gel for the treatment of chronic diabetic foot ulcers (the CHITOWOUND study)

IntroductionTo assess the efficacy of a chitosan-based gel (ChitoCare) for the treatment of non-healing diabetic foot ulcers (DFUs).Research design and methodsForty-two patients with chronic DFUs were randomized to the ChitoCare...

Peculiarities of Skin Wound healing Under Ischemic Conditions With Topical Treatment Using a Combination of Benzalkonium Chloride and Dexpanthenol

Objective: To study peculiarities of skin wound healing under ischemic conditions with topical treatment using a combination of benzalkonium chloride and dexpanthenol.Materials and methods: We conducted an experiment on a rat model of skin wound healing under ischemic conditions. Male Wistar rats were divided into 4 groups, with 30 rats in each group. Group 1 received no treatment; group 2 was treated with the Levomecol ointment; group 3 and group 4 were treated with benzalkonium chloride immobilized based on the carboxymethylcellulose sodium salt and a combination of benzalkonium chloride and dexpanthenol immobilized based on the carboxymethylcellulose sodium salt, respectively. We used planimetric and biochemical (alkaline phosphatase [ALP] level) methods, measured the pH of the wound surface and wound bed temperature, determined the hydroxyproline concentration in the wound defect tissues, and performed statistical processing of the data.Results: Group 4 had the largest percentage of wound surface area reduction and pH values. Thermometry on day 10 showed a decrease in wound temperature in groups 2 and 4, whereas groups 1 and 3 demonstrated maximum values. By the end of the experiment, group 4 had the maximum hydroxyproline concentration that was significantly higher than the amino acid content in groups 1, 2, and 3: 1.2, 1.1 and 1.1 times higher, respectively. Maximum ALP levels were observed on day 5 in group 4, whereas in groups 2 and 3 they were observed on day 8 and only on day 10 in group 1.Conclusions: Skin wound healing under ischemic conditions was faster in the group in which topical treatment involved a combination developed by us: benzalkonium chloride and dexpanthenol immobilized based on the carboxymethylcellulose sodium salt.

"SCULP" study: The benefits of skin graft pellets on the pain of sickle cell leg ulcers (SCLU).

Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.

A Comparative Clinical Study of Marham-e-raal and Povidone-Iodine 5% Ointment in Nonhealing Ulcers

Introduction: Nonhealing ulcers are those that have not proceeded through timely and orderly reparation to produce anatomic and functional integrity. Povidone iodine is widely used ointment among physician and surgeons globally for wound dressings. In texts of Unani medicine literature, Marham-e-raal has been described as a potent ointment for gaining timely healing of wounds. The aim of this study is to compare the effects of povidone iodine and Marham-e-raal in nonhealing ulcers/chronic wounds. Methods: A randomized controlled study was carried out in the Department of Jarahat (Surgery) in National Institute of Unani Medicine, Bengaluru. A total of 45 subjects were included and randomized into Marham-e-raal and betadine dressing groups based on inclusion criteria. Dressing was done on daily basis and subjects were assessed on every 15 day from baseline to day 45 for primary outcomes (appearance of healthy granulation, epithelialization, and reduction in wound surface area) and secondary outcomes (decreases in tenderness score and depth of wound). Results: Nineteen out of 27 subjects in Marham-e-raal dressing group achieved complete healing as compared to one in povidone-iodine dressing group. There was significant reduction in wound surface area, median tenderness score and depth of wounds among subjects in Marham-e-raal dressing group at 0.05 level of significance. Conclusion: Marham-e-raal is an effective wound dressing and healing agent as compared to povidone-iodine ointment.

Role of cadexomer iodine ointment as debriding agent in 50 cases of skin and soft tissue infections

Background: The management of skin and soft tissue infections is a tedious job to tackle as many factors play important roles in wound healing. Wounds can be better managed and healed faster if infection is removed and the way to eliminate infection is by use of antiseptics, antibiotics and solutions over wounds along with the use of systemic antibiotics. In this study, we used cadexomer iodine ointment for management of various types of wounds. Methods: This study was conducted in a tertiary care hospital. After screening, 50 patients with various types of wounds (venous leg ulcers, postoperative infected wounds, infected traumatic wounds, controlled diabetic wounds, ulcers with slough, abscesses left for healing by secondary intention after operation) were taken and cadexomer iodine was applied when the wound was infected and had visible slough with pus discharge. Results: Majority of the patients (about 88%) were free of visible slough in about a week and in about two weeks, all patients (100%) were free from visible slough. 74% patients have complete closure of the wound and 22% patients have reduction in total wound surface area between 75-99% in 4 weeks period. Conclusions: Under controlled conditions, cadexomer iodine is a good topical agent for debridement of wounds which are infected and have a visible slough along with pus discharge. It also helps in healing the wound.

Topical oxygen therapy in acute traumatic musculoskeletal wounds of the foot and ankle

To quantify the reduction in wound size and change in wound quality following low-cost topical oxygen therapy (TOT) in patients with acute traumatic musculoskeletal wounds of the foot and ankle. This prospective interventional study included patients with acute traumatic musculoskeletal wounds of the foot and ankle of <3 weeks' duration after they had undergone debridement and required subsequent wound coverage. A sterile C-Arm cover was used to cover the wound and 100% oxygen was administered at 1 atm, at a rate of 10l/min for 90 minutes on each of four consecutive days, through a suction catheter connected to an oxygen cylinder. The cycle was repeated after a three-day break. Wound surface area (by plotting on graph paper) and wound quality (by modified wound infection checklist score and swabs for culture and Gram staining) were assessed before and after TOT application. The study cohort included 20 patients ≥18 years of age. There was a statistically significant (p<0.001) reduction in mean wound surface area from 79.3cm2 at baseline to 69.6cm2 after two cycles of TOT. The mean modified wound infection checklist score was 13.6 and 0.8, respectively, before and after two cycles of TOT, suggesting statistically significant improvement (p=0.02) in wound quality. All patients showed no growth in their wound culture after TOT. TOT appears to be a promising and cost-effective alternative in the management of traumatic wounds. However, future studies with larger sample sizes and control groups for comparison are needed to establish the benefit of TOT in acute traumatic musculoskeletal wounds.

The efficacy of combined ultrasound and electric field stimulation therapy in the treatment of venous leg ulcers.

Venous leg ulcers are the most common cause of leg ulcers. The aim of this study is to assess the effect of Combined Ultrasound and Electric Field Stimulation therapies (CUSEFS) on wound surface area and pain level in patients with venous leg ulcers, utilizing a novel device (BRH-A2 from BRH Medical, Ltd). This prospective case series study, conducted by the Department of Plastic Surgery at the Yitzhak Shamir Medical Center, Israel, collected data for subjects treated with CUSEFS with the BRH-A2 device, between April 2018 and September 2019. Measurements of wound area and assessment of pain intensity using a 10-point visual analog score were recorded. At the end of the four-week period, average wound area and pain scores were included for analysis. Ten consecutive patients met the inclusion criteria. During the study period, all patients exhibited a reduction in the wound surface area. The final average wound surface area was reduced by 53.52% following the combined treatment. Eight out of the ten patients (80%) reported a reduction in pain, with an average pain level reduction of 64% throughout eight consecutive treatments. CUSEFS therapies with BRH-A2 technology is a promising treatment for venous leg ulcers. In accordance with our preliminary results, this treatment modality can aid in the reduction of wound surface area as well as reducing the pain suffered by patients from these chronic wounds. Larger multicenter studies are needed to further quantify and qualify the beneficial effect of CUSEFS in venous leg ulcers and other chronic wounds. Venous leg ulcers (VLUs) are painful wounds occurring between the knee and ankle joint, that fail to heal for a period of at least two weeks and occur in the presence of venous disease. VLUs, are the most common cause of leg ulcers, affecting approximately 5% of the general population over the age of 65. Numerous non-invasive treatment modalities have been attempted for healing chronic wounds and ulceration, however, in some instances surgery, although invasive, is the preferred option. For many years, ultrasound (US) has been used therapeutically to treat chronic ulcers. US produces biophysical effects that are significantly beneficial to the wound healing process. Electrical stimulation therapy is another treatment option which contributes to wound healing by influencing the electrochemical wound process.Combined Modulated Ultrasound and Electric Field Stimulation (CUSEFS) have been shown to improve the healing of chronic wounds. However, research has focused predominantly on objective measures of healing, while less consideration has been given to researching the subjective discomfort and the negative impact that ulceration places on the patient. The aim of this study was to assess objective and subjective factors by measuring the short-term effect of CUSEFS on the surface area of wound and on pain levels in patients with venous leg ulcers (VLUs). Our study findings demonstrate that the combined treatment was effective in initiating wound healing and reducing levels of pain in chronic, stagnant, recalcitrant venous leg ulcers.

In vivo topical gene therapy for recessive dystrophic epidermolysis bullosa: a phase 1 and 2 trial

Recessive dystrophic epidermolysis bullosa (RDEB) is a lifelong genodermatosis associated with blistering, wounding, and scarring caused by mutations in COL7A1, the gene encoding the anchoring fibril component, collagen VII (C7). Here, we evaluated beremagene geperpavec (B-VEC), an engineered, non-replicating COL7A1 containing herpes simplex virus type 1 (HSV-1) vector, to treat RDEB skin. B-VEC restored C7 expression in RDEB keratinocytes, fibroblasts, RDEB mice and human RDEB xenografts. Subsequently, a randomized, placebo-controlled, phase 1 and 2 clinical trial (NCT03536143) evaluated matched wounds from nine RDEB patients receiving topical B-VEC or placebo repeatedly over 12 weeks. No grade 2 or above B-VEC-related adverse events or vector shedding or tissue-bound skin immunoreactants were noted. HSV-1 and C7 antibodies sometimes presented at baseline or increased after B-VEC treatment without an apparent impact on safety or efficacy. Primary and secondary objectives of C7 expression, anchoring fibril assembly, wound surface area reduction, duration of wound closure, and time to wound closure following B-VEC treatment were met. A patient-reported pain–severity secondary outcome was not assessed given the small proportion of wounds treated. A global assessment secondary endpoint was not pursued due to redundancy with regard to other endpoints. These studies show that B-VEC is an easily administered, safely tolerated, topical molecular corrective therapy promoting wound healing in patients with RDEB.

Wound Surface Area and Colony Count of Various Modes of Phototherapy

Background: The degree of tissue damage caused by related inflammatory and immunological sequelae poses a major therapeutic treatment problem in burn wounds. Chronic wounds frequently have a significant bioburden and pathogens that are resistant to antibiotics. This review article discusses present research on phototherapy, which is believed to be useful in managing wound bioburden and promoting healing. Objective: To evaluate the wound healing efficacy of polarized light therapy (BLT) against low-level laser therapy (Ga-As laser) in order to determine which is more efficient and successful at speeding burn healing. Subject and methods: The current study enrolled thirty patients having partial thickness thermal burn on the forearm (dermal burn). They were selected from Burn Unit at Legislation Association Hospital for Burns & Oncology. They were randomly assigned into two equal groups: Group (A) that included fifteen patients who received the BLT with mean age of 28.8 ± 2.51 years old and group (B) that enrolled fifteen patients who received LLLT with mean age of 29.6 ± 2.79 years old. Both groups also received traditional physical therapy and conservative treatment for the burn site three times weekly for four weeks. Results: Group A and B showed a significant reduction in colony count and wound surface area after treatment in comparison to that before treatment (p > 0.001). In group A, the colony count and wound surface area decreased by 38.63% and 55.1% respectively, but in group B, by 15.6% and 37.92% respectively. Conclusion: Both polarized light therapy and low-level laser therapy had a therapeutic efficiency on wound healing, but BLT is more efficient and more successful in the acceleration of the burned wounds healing.

Management of Acute and Chronic Wounds Using Negative Pressure Wound Therapy With Instillation and Dwell Time: A Retrospective Review of a 100-Patient Cohort in Padova, Italy.

The presence of debris covering a wound surface significantly impedes progression toward closure. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) of topical wound solutions is a versatile tool that can be applied to various wound types to promote wound healing. At the University Hospital of Padova in Padova, Italy, NPWTi-d has been incorporated into wound management plans that include debridement and antibiotic therapy, as necessary, for a diverse population of patients with open wounds, including acute, chronic, and infected wounds. A retrospective analysis of 100 patients (53 male, 47 female; age range, 22-95 years) who underwent NPWTi-d was performed, and key healing outcomes observed in subgroups differentiated by sex, wound etiology, initial wound size, and topical instillation solution were reported. Wound types included vascular ulcers, surgical wounds, dehiscences, and trauma; anatomic location of the wounds varied. Negative pressure wound therapy with instillation (0.05% sodium hypochlorite, normal saline, or 0.25% acetic acid) was implemented with a dwell time of 3 minutes to 10 minutes, followed by a negative pressure cycle length of 2 hours to 3.5 hours at -75 mm Hg to -125 mm Hg. Dressings were changed approximately every 3 days. After a median of 11 days (range, 1-35 days), the wound surface area significantly decreased (P <.0001), percentage of infected wounds declined from 72% to 46%, and wound closure was attained in 91% of cases. A significant reduction in wound surface area was detected in both sexes, small- and medium-sized wounds, vascular ulcers, surgical wounds, dehiscences, trauma wounds, and pressure ulcers (P <.05). This effect was detected in wounds regardless of topical instillation solution (P <.0001). This study showed that NPWTi-d is a valuable treatment option in a variety of circumstances and can help the clinician achieve a range of therapy goals based on individual patient needs.

Prospective Comparative Observational Study of Safety and Efficacy of Topical Ozone Gas Therapy in Healing of Diabetic Foot Ulcers versus Only Conventional Wound Management.

The prevalence of diabetic foot ulcers (DFUs) in India is 11.6%. DFU accounts for major cost expenditure, morbidity, and mortality. 1 Ozone gas has antimicrobial and antioxidant properties. We studied efficacy of topical ozone gas therapy in promoting healing of DFU. This is an observational comparative cohort study, n = 160, There were two groups of patients namely: those who received Conventional wound management alone C and those who received topical ozone therapy in addition to conventional wound management O + C therapy groups (81 each). Study group, i.e., O + C received five alternate day sessions of ozone therapy by bagging method for 30 minutes each session. Both groups were observed for 30 days for wound healing parameters like reduction of wound surface area, wound diameter, presence and character of discharge, granulation tissue, healing wound edges, microbial negativity, and requirement of revision (re-debridement and/or amputation) surgery. Mean baseline ulcer surface area is 17.43 ± 8.6 cm 2 for C and 17.87 ± 9.2 cm 2 (range 1–50 cm 2 ) in O + C group. Percentage change in ulcer surface after 21 days in O + C group is 32.37% compared with 17.15% in C group, which is statistically significant ( p = 0.01). Rates of microbial negativity and ulcer healing were significantly faster in ozone group. There was a statistically significant decrease in hospital stay, number of revision surgeries required, and mortality in ozone group. Topical ozone gas was well tolerated. Our study supports the efficacy of ozone therapy in DFU healing and reduction in the chances of infection and revision (re-debridement and/or amputation) surgery. More research is needed for dose, duration, and exposure time standardization.

Wound surface area measurement methods

Assessment of progress in chronic wound healing is very important as it enables deciding when the applied therapy should be replaced with a more advanced one. Wound healing societies recommend using the rate in wound surface area reduction as a marker of the therapy effectiveness. If the wound surface area did not reduce by 50% or more in 4 weeks of standard treatment, advanced therapy options should be introduced. The decrease of wound surface area by 10–15% in a week may also be useful in estimating the probability of wound closure. There is a range of methods for wound surface area measurements that differ in the technology used, accuracy, repeatability, and level of required contact with the patient’s skin or wound itself. Technical advancement of these methods is very wide, from area estimation based on linear measurements to 3D techniques able to analyze skin curvature using sophisticated models. Some methods are based on specialized equipment, thus may be less useful in telemedicine than, for instance, those based on a smartphone with dedicated software. This review presents the current state-of-the-art methods in wound area measurements, presenting selected commercial devices and the latest developments.

HYPOCHLOROUS ION BASED DRESSING: THROWBACK TO THE SURGEONS’ CHOICE

1.1 BACKGROUND : As per Robbin's pathology(Robbins &amp; Cotran Pathologic Basis of Disease - 10th Edition, n.d.) "an ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inamed necrotic tissue." In an era of modern-day fast track surgery and premier practices of medicine, management of wound remains an archaic, almost omnipresent challenge to a health care provider mediating the need for solutions. The hunt for an optimum dressing agent has been everlasting, one of which is our point of discussion in this study. The addition of Chlorine(Cl2) to Water(H2O) gives rise to Hypochlorous ion, a weak acid that has been used traditionally as disinfectant, sterilizer and beaches. These properties can be utilised for wound disinfection and swifter wound healing. 1.2 AIMS AND OBJECTIVES: Ÿ To study the efcacy of Hypochlorous ion-based dressing over traditional normal saline based dressing . Ÿ To study the effects factoring in various associated comorbidities in patients such as Diabetes Mellitus, Peripheral Vascular Disease, Trauma and Pressure Ulcer. 1.3 METHODOLOGY: A comparative study was conducted in a tertiary care facility in India that included 101 patients who were distributed randomly utilizing computerised algorithms into study and control group. The control group received daily normal saline dressing whereas the study group underwent daily hypochlorous ion-based dressing. The subjects were analysed after 4 weeks and evaluated for decrease in wound surface area and improvement of wound quality and tabulated for analysis. 1.4 CONCLUSION: Hypochlorous ion based daily dressing shows signicant reduction in wound surface area as well as signicantly better and faster improvement in the quality of wound in patients of Traumatic, Diabetic and Pressure Ulcer whereas the results in patients suffering from Peripheral Vascular Disease were equivocal.

Evaluation of the combination of a biofilm-disrupting agent and negative pressure wound therapy: a case series

Approximately three million people in the US have hard-to-heal pressure ulcers (PUs), including 10% of hospitalised patients. Healing depends on ulcer stage and patient comorbidities. Despite advances in nutrition and wound care, PUs can take months or years to reach complete closure. To date, clinical studies have focused on single modality therapy. However, there is no one therapy that can address all of the deficits in these complex, hard-to-heal wounds. A commonly used treatment for PUs, negative pressure wound therapy (NPWT), has demonstrated improved healing in Stage 3 and 4 PUs. NPWT entails applying suction to a porous sponge fitted into the wound cavity and sealed with an occlusive dressing. Negative pressure facilitates wound healing by removing wound fluid containing harmful proteases, stimulating the formation of granulation tissue and promoting wound contracture. However, it does not affect biofilm formation. We hypothesised that adding an antibiofilm agent might increase the effectiveness of NPWT in recalcitrant PUs. A prospective case series was conducted in outpatient wound care centres and a skilled nursing facility to examine the combination of a biofilm-disrupting antimicrobial agent (Blast-X, Next Science, US) in combination with NPWT (VAC, 3M, US) in healing and reducing bacterial burden in treatment-resistant pressure ulcers. Patients consented to application of the antibiofilm agent and NPWT three times per week for four weeks. The wounds were measured, imaged for bacteria and tested for host and bacterial protease activity weekly. Of the 10 patients, four dropped out of the study before the end of the four weeks. Of the remaining six, four patients experienced a reduction in wound surface area and volume, reduced protease activity and lower bacterial levels. The results of this study showed that multimodal therapy, including NPWT and biofilm disruption, may restart the healing of stagnant treatment-resistant PUs.

Safety and efficacy of larval therapy on treating leg ulcers: a protocol for systematic review and meta-analysis

IntroductionLeg ulcers (LUs) not only seriously affect life and work of patients, but also bring huge economic burden to the society. As a potential underused biological debridement, larval therapy provides...

Maggot Therapy in Wound Healing: A Systematic Review.

Background: It is estimated that 2% of the population in developing countries suffer from a chronic wound, making it a hidden phenomenon that is increasing as populations age. The ease of access to maggot therapy has made it increasingly attractive for implementation. This study aimed to explore the effectiveness of maggot therapy as compared to hydrogel dressings in the healing of chronic wounds. Methods: An electronic literature search until October 2019 was performed using Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature. The eligibility criteria were chronic wound patients with an intervention that involved a comparison of any maggot species with hydrogel dressings. Results: The full text of five studies, involving 580 patients with chronic wounds, was retrieved. Four studies used the Lucilia sericata species. The maggot therapy facilitated faster and more effective debridement of non-viable tissue. It enabled faster development of granulation tissue and increased reduction in the wound surface area compared to hydrogel dressings. Maggot therapy had no effect on disinfection or complete healing rate for the wound. Conclusion: Maggot therapy should be considered for faster wound debridement, granulation tissue development, and wound surface area reduction as well as in surgical contraindications. This review can be used as a guide to assist clinicians in identifying patients who may benefit from maggot therapy.

Silver Sulfadiazine's Effect on Keratin-19 Expression as Stem Cell Marker in Burn Wound Healing.

BackgroundBurn wounds are one of the causes of cutaneous injury that involve both epidermal and dermal layers of skin. Silver sulfadiazine (SSD) has been widely used to treat burn wounds, however recent studies have found the treatment to have some drawbacks, such as cellular toxicity effects. Cutaneous wound regeneration is known to start from the basal layer of the epidermal epithelial cells, which are enriched with highly proliferative cells. Keratin-19 (K19) is one of the epidermal stem cell biomarkers found in the skin. This study aims to explore the expression of K19 in burn wound tissue and to investigate the effect of SSD on its expression.MethodsWe created a burn wound model in Sprague Dawley rats and randomly divided them into control and SSD groups. Wound closure was evaluated (visitrak) overtime series followed by histological evaluation of K19 expression in the wound tissue (immunohistochemistry staining).ResultsOur model successfully represents full-thickness damage caused by a burn wound. The SSD group showed a faster reduction of wound surface area (wound closure) compared to the control group with the peak at day 18 post wounding (p < 0.05). K19 expression was found in both groups and was distributed on epidermal layers, hair follicles and dermis of granulation tissue showing similar patterns.ConclusionTopical application of SSD on burn wounds showed superiority in wound closure and is likely to have no harmful effect on epidermal stem cells. However, further study is required to investigate the effect of silver species on cell viability and toxicity effects during long term treatment.

Wound Healing in the Long-Term Acute Care Setting Using an Air Fluidized Therapy/Continuous Low-Pressure Therapeutic Bed: A Multiple Case Series.

We evaluated a new bed that updates the functionality of the current air fluidized therapy (AFT)/continuous low-pressure (CLP) pressure redistributing beds. This bed was evaluated in conjunction with standard wound care interventions in a long-term acute care hospital (LTACH). The AFT feature is designed to provide pressure distribution via a fluid-like medium that forces air though millions of tiny silicone beads that float the patient's body to achieve maximum immersion and envelopment. The CLP feature of the bed provides pressure distribution for the upper body. Standard wound care was provided that included debridement, topical treatments, and biophysical therapies such as negative pressure wound therapy, as indicated. Our multiple case series comprised 10 medically compromised patients with 25 wounds. Their mean age was 63 years, 50% were male, and the mean cumulative Braden Scale score was 12.4 out of 23, indicating a high risk for pressure injury (PI). Seven of 10 patients were incontinent of urine, 6 had fecal incontinence, and 2 had ostomies. Types of wounds treated included 2 large tissue defects from surgical excisions for the treatment of gangrene and 23 PIs. On admission, wounds had an average surface area of 139.1 cm. The mean percentage of reduction in wound surface area was 59.3% over an average of 31.3 days of therapy. No new wounds formed during their course of care despite being at elevated risk. Findings from this multiple case series suggest that the AFT/CLP bed facilitates healing of advanced wounds in medically complex patients when included as part of a wound care program. Despite mild to high risk, no new PIs developed, and severe PIs and large tissue defects significantly improved or completely resolved. One hundred percent of surveyed staff members recommend use of the AFT/CLP bed.

The Effect of Oral Consumption of Propolis Alone and in Combination With Silver Nanoparticles on Wound Healing in Male Wistar Rats.

This study was conducted to investigate the effects of orally administered propolis (a resinous substance found in beehives), alone and in combination with silver nanoparticles (SNPs), on the wound healing process in male rats. Forty (40) male Wistar rats were randomly divided into 4 groups of 10 each: 1 control group received no treatment, and 3 study groups received a daily dose of 1) propolis (100 mg/kg), 2) propolis + 30 ppm SNPs, or 3) propolis + 60 ppm SNPs. Healing rate was determined by wound surface area reduction on days 4, 6, 8, and 10 post-surgery. On day 12 after wound creation, histological changes of wound healing, including number of new vessels, inflammatory cells (neutrophils, eosinophils, and mast cells) and fibroblasts were counted based on morphology using a 400x objective lens, and collagen deposition density was determined using hematoxylin and eosin and trichrome staining, respectively. The histological scores were based on a 0 to 4 scale from lowest to highest amount of improving tissue status and were analyzed using one-way analysis of variance, Tukey test, Kruskal-Wallis test, t test, and Mann-Whitney U test to examine differences among the groups. Significance was set at P <.05. The rate of wound healing was significantly different between the control and the treated groups on days 4, 6, 8, and 10 (percent change was not assessed on day 12) post-surgery, especially in the propolis + 30 ppm SNPs group compared to the control group. This difference was more significant on days 6 (wound healing percentage [WHP]: 75% and 45%) and 8 (WHP: 88% and 65% ) post-surgery (P <.001). Mean neutrophil count on day 12 was highest in the control (34.8 ± 2.97) and lowest in the propolis + 30 ppm SNPs group (16.55 ± 2.12). The number of eosinophils on day 12 was considerably higher in the control group (1.05 ± 4) compared to those in the propolis group (3 ± 0.70), propolis + 30 ppm SNPs group (60/0 ± 1/1), and propolis + 60 ppm SNPs group (0.5 ± 0.52) (P <.001). Mean propolis + 30 ppm SNPs scores for epithelialization and granulation tissue formation were 3 and 4, respectively; in the propolis + 60 ppm SNPs, scores were 2 and 3, respectively; in the propolis alone group scores were 2 and 3, respectively (statistical significance not computed for semiquantitative values). The highest fibroblast count was in the propolis + 30 ppm SNPs group (114.44 ± 3.90) compared to control group (73.2 ± 2.8); P <.001). The difference in collagen fiber density scores was also significant: 1.2 ± 0.42 in the control and 3.66 ± 0.50 in the propolis + 30 ppm SNPs group; (P <.001). The mean of collagen fiber density in the propolis + 60 ppm SNPs group was 2.63 ± 0.51. Oral propolis alone and in combination with 30 ppm SNPs appears to provide anti-inflammatory effects and increase fibroblast proliferation and collagen deposition in experimental wounds, which may explain the observed differences in healing. Propolis + 60 ppm SNPs appears to have a cytotoxic effect. Research confirming these results and that examines toxicity levels in animals and humans is needed.