Treatment Of Complex Wounds Research Articles

Explore the Applications of Nano-Silver Polyurethane Skin Wound Dressing

Polyurethane is a medical material, which has excellent physical properties and high mechanical compatibility. At present, one of the most effective application methods for antibacterial bacterial biofilm is to combine polyurethane with nano-silver, so that the polyurethane material itself has bactericidal performance and finally plays a good antibacterial effect. From August 2011 to January 2014, 75 patients with crush injury or avulsion injury who had difficulty healing were randomly divided into 5 groups. Results: Comparison of colony count results of different concentrations of nano-silver polyurethane; comparison of colony count results of two groups in vitro; comparison of anticoagulant degree and determination of whole blood coagulation time; comparison of coagulation routine examination results of two groups; comparison of epithelial growth factor levels at different time after treatment; comparison of tumor necrosis factor- a levels at different time after treatment between two groups; comparison of change times, visual analogue score of pain during treatment and hospitalization time of two groups; comparison of white blood cell count of two groups of polyurethane patients within 1 week; comparison of clinical efficacy between two groups. Conclusion: The medical material containing nano-silver polyurethane is a good bacteriostatic biomaterial, which can inhibit common iatrogenic pathogens in vitro. The application of 5% nano-silver polyurethane medical material to open wound, especially in patients with avulsion and crush injury in orthopaedics, can inhibit the growth of common hospital pathogenic bacteria. can significantly reduce the level of tumor necrosis factor- a in the wound, reduce the local inflammatory response, and can significantly improve the clinical effect of the treatment of complex wounds, which is worthy of clinical promotion.

Clinical Outcomes of Negative-Pressure Wound Therapy with Instillation without Commercial Devices in the Treatment of Complex Wounds

Background: Negative-pressure wound therapy with instillation (NPWTi) is an adjunctive treatment modality for complex and infected wounds. However, commercial devices are expensive and not readily available in many countries. The objective of this study is to introduce an NPWTi method that is applicable where commercial NPWTi devices are not available and to report the clinical outcomes of the NPWTi method for the adjunctive treatment of complex wounds.Methods: This prospective clinical experimental study included 51 patients who had wounds on which operative debridement was performed between January 2017 and March 2019. A negative-pressure wound therapy (NPWT) device was applied with an intravenous (IV) line for continuous instillation of 0.9% normal saline plus 1% povidone-iodine solution for chronic wounds. The outcomes measured were the number of operating room visits, time to final surgical procedure, number of infected wounds, time to resolution of infection, type of reconstruction operation, and occurrence of complications.Results: The average number of operations performed was 2.5±0.8, and the time to final surgical procedure was 28.4±15.4 days. The number of infected wounds was 35 (68.6%), and the time to resolution of infection was 15.0±14.6 days. All wounds were closed or covered. Though partial graft failure occurred in two cases, they healed completely by secondary healing in 2 weeks.Conclusion: A continuous-instillation NPWT system using an IV line could be an adjunctive modality in treating complex wounds at institutions where commercial NPWTi systems are not readily available.

Analysis of “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds”

Objectives: Analyze critically the “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds” (from Portuguese, “1a Recomendação Brasileira para o Gerenciamento de Biofilme em Feridas Crônicas e Complexas”). Method: Reviewing information contained in said document according to current literature. Results: The publication was showed to lack methodology compatible with its title; gaps in the recommendations were perceived regarding evidence classification, as well as an absence of grounding from important international consensus, published in the last three years, about treatment of complex wounds with suspected biofilm. Conclusion: The document was concluded to be inadequate for use as a clinical guideline, being considered only a bibliographic review about the theme.

Treatment of burned children using dermal regeneration template with or without negative pressure

ObjectiveEvaluate the results obtained using a Dermal Regeneration Template (DRT) associated or not with the Negative Pressure Wound Therapy (NPWT) for skin cover in paediatric patients who were victims of burns. MethodRetrospective study of a cross-sectional study that evaluated the medical records of children submitted to the application of DRT, associated or not with NPWT, for the treatment of burned children admitted to the Joana de Gusmão Children's Hospital (JGCH) in Florianópolis, in the period from January 2011 to December 2016, totalling 45 patients. ResultsThe majority of the patients were pubescent (31.8%) males (56.8%), and the main aetiology of the burn was flammable substances (75%). In the group that used only DRT, the average take of DRT was 85% with an average time of maturity of 17.65days and the mean take rate of the skin graft was 85.2%. In the group that used DRT plus NPWT, the mean DRT take was 99.8%, with a mean maturation time of 16.68days and the mean of the skin graft take rate was 89.1%. ConclusionNPWT associated with DRT offers a higher rate of success in the treatment of complex wounds caused by burns, promotes increased DRT take rate, reduces DRT maturation time and increases the take rate of the skin graft.

Pelnac® Artificial Dermis Assisted by VSD for Treatment of Complex Wound with Bone/Tendon Exposed at the Foot and Ankle, A Prospective Study

Purpose: This study aims to assess the efficacy and safety of Pelnac dermal regeneration template assisted by vacuum sealing drainage (VSD) and a split-thickness skin graft to cover the large skin and soft-tissue defects at foot and ankle. Methods: This study began from March 2013, up to February 2017. A total of 16 patients met the inclusion and exclusion criteria and were included. For every patient, 2 separate operations were performed, the first being thorough debridement of necrotic tissues immediate coverage of VSD at continuous negative pressure suction, and the second being the autologous split-thickness skin graft. At each follow-up, relevant data were documented. Results: The average follow-up was 16.5 months (range, 12 to 42 months). No infections, hematoma, or seroma were observed. 13 out of 16 patients had a complete skin graft “take” (100%). Patients’ satisfaction of esthetic appearance was 76.5 ± 5.2/100. The VSS value was 2.2 ± 2.1, representing a good result. Regarding the sensory recovery, the response “normal or near normal” could be obtained in 14/16 patients. Mean AROM for extension/flexion of the ankle was 48.5 ± 4.8° (range 35–62°), and 93.7% (15/16) of patient could obtain a satisfying functional result. Conclusions: Our report indicated Pelnac provided an effective method for management of complex wounds with underlying bone or tendons exposed.

Capacidade funcional e qualidade de vida de pacientes com feridas crônicas

Objective: To evaluate functional capacity and quality of life (QoL) of patients with chronic wounds. Methods: A cross-sectional analytical study composed of 74 patients with chronic wounds accompanied at a reference center for the treatment of complex wounds in Teresina, state of Piaui. Data were collected using the Katz index and the Cardiff Wound Impact Schedule. Results: Among the domains, the “well-being” had a lower mean score and the degree of dependence obtained a significant association with the well-being and “social life” domains. The bathing, dressing, personal hygiene and locomotion activities showed an association between the domains of QoL. Conclusion: The degree of independence in performing the basic activities of daily living, especially bathing, dressing and personal hygiene, presented higher scores between domains, indicating a better QoL. It is expected that the implantation of measures that help to preserve the functional capacity will improve the patients’ QoL.

Functional capacity and quality of life of patients with chronic wounds

Objective: To evaluate functional capacity and quality of life (QoL) of patients with chronic wounds. Methods: A cross-sectional analytical study composed of 74 patients with chronic wounds accompanied at a reference center for the treatment of complex wounds in Teresina, state of Piaui. Data were collected using the Katz index and the Cardiff Wound Impact Schedule. Results: Among the domains, the “well-being” had a lower mean score and the degree of dependence obtained a significant association with the well-being and “social life” domains. The bathing, dressing, personal hygiene and locomotion activities showed an association between the domains of QoL. Conclusion: The degree of independence in performing the basic activities of daily living, especially bathing, dressing and personal hygiene, presented higher scores between domains, indicating a better QoL. It is expected that the implantation of measures that help to preserve the functional capacity will improve the patients’ QoL.

Quality of life of patients with vasculogenic ulcers in outpatient treatment

Objective: assess the quality of life of patients with vasculogenic ulcers in outpatient treatment. Methods: this is a quantitative, descriptive-comparative study of the type before and after, carried out at an outpatient unit specialized in the treatment of complex wounds, with patients suffering from vasculogenic ulcers, totaling 10 patients and 26 wounds. Results: the overall score for quality of life increased 6.8 units on average. In the overall evaluation, epithelialized tissue, presence of foul odor, conduction of surgical debridement and use of hydrogel were influencers of higher scores. Conclusion: there was a significant increase in quality of life scores in all areas and in the overall score. The aspects type of tissue and odor influenced significantly the increase of the scores of all the domains and of the overall score.

Phototherapy in complex treatment of wounds in patients with ischemic and neuroischemic form of diabetic syndrome

The aim of the study was to improve results of wound healing in patients with ischemic and neuroischemic forms of diabetic foot syndrome by using a combination of phototherapy, platelet-derived growth factor and modern cover materials The results of surgical treatment of 48 patients with ischemic and neuroischemic diabetic foot syndrome, which were divided into main group (24 patients) and comparison group (24 patients). All these patients who underwent treatment in the Department of acute vascular diseases in the Clinic of the SI “Institute of General and Urgent Surgery named after V.T. Zaitsev of the National Academy of Sciences of Ukraine” suffered from diabetes mellitus type II and had IV degree of foot ischemia according to Fontaine. The diagnostic was performed for all patients according to a standard algorithm. Analysis of the results of clinical, laboratory, non-invasive and invasive methods of examination in the preoperative period enabled to determine the degree of disorder in blood flow, the nature of collateral circulation and microcirculation. Patients of both groups underwent femoro-tibial and femoro-popliteal bypass, as well as hybrid reconstructions. The parameters of regional hemodynamics in patients of main group and the comparison group before and after revascularization were comparable. The patients of main group used the treatment technology developed by us. In cases of development of phlegmons of the foot after the opening of the abscess, vacuum therapy was performed for 7–14 days until the wound was completely cleaned. In the preoperative preparation complex, phototherapy was performed, according to local situation, wounds were irradiated with different wavelengths (405, 470 or 525 nm). After the wounds were cleaned, the wound defect was covered with PCL coating (Nanopharma, Czech Republic) with the application of a fibrin clot and platelet-rich plasma without fibrin, after which further local treatment was accompanied by irradiation of wounds with A. Korobov-V. Korobov photon matrices “Barva-Flex” (the wavelength of the maximum of the emission band of 660 nm). In two cases, the closure of bone defects with ILAYAOSTEOGEN® “A.A. PARTNERS” L.L.C. bone implants of medical company “ilaya” was used. Using these tactics, allow to achieve complete wound healing in 91.7% of patients and partial healing (more than 50%) in 8.3% of patients in main group. The terms of treatment of these patients did not exceed 2 months, high amputations were not required. In patients of comparison group against the background of traditional local treatment, the wounds healed within 2–4 months; in eight cases, repeated hospitalization was required to perform a plastic closure; in two cases amputation was performed below the knee. Thus, phototherapy and plastic closure of wounds of the lower extremities after revascularization in isch- emic diabetic foot syndrome is indicated in cases where the wounds have no tendency to spontaneous healing; introduction of the developed tactics of treatment of “problem” wounds of the lower extremities allowed to achieve complete healing in 91.7% of patients, partial (more than 50%) healing in 8.3% of patients and avoid high amputations; the use of a complex of treatment including phototherapy, wound closure with a synthetic coating with platelet growth factor, and the closure of bone defects with implants is an extremely effective stim- ulator of development in the wound of granulation tissue suitable for further autodermoplasty

Use of Antibiotic-Impregnated Absorbable Beads and Tissue Coverage of Complex Wounds

The treatment of complex wounds is commonplace for plastic surgeons. Standard management is debridement of infected and devitalized tissue and systemic antibiotic therapy. In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fasciocutaneous flaps. The use of nondissolving polymethylmethacrylate and absorbable antibiotic-impregnated beads has been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic. We present a multicenter retrospective review of all cases that used absorbable antibiotic-impregnated beads for complex wound management from 2003 to 2013. A total of 104 cases were investigated, flap coverage was used in 97 cases (93.3%). Overall, 15 patients (14.4%) required reoperation with the highest groups involving orthopedic wounds and sternal wounds. The advantages of using absorbable antibiotic-impregnated beads in complex infected wounds have been demonstrated with minimal disadvantages. The utilization of these beads is expanding to a variety of complex infectious wounds requiring high concentrations of local antibiotics.

Maggot Debridement Therapy in Disaster Medicine.

When disaster strikes, the number of patients requiring treatment can be overwhelming. In low-income countries, resources to assist the injured in a timely fashion may be limited. As a consequence, necrosis and wound infection in disaster patients is common and frequently leads to adverse health outcomes such as amputations, chronic wounds, and loss of life. In such compromised health care environments, low-tech and cheap wound care options are required that are in ready supply, easy to use, and have multiple therapeutic benefits. Maggot debridement therapy (MDT) is one such wound care option and may prove to be an invaluable tool in the treatment of wounds post-disaster. This report provides an overview of the wound burden experienced in various types of disaster, followed by a discussion of current treatment approaches, and the role MDT may play in the treatment of complex wounds in challenging health care conditions. Maggot debridement therapy removes necrotic and devitalized tissue, controls wound infection, and stimulates wound healing. These properties suggest that medicinal maggots could assist health care professionals in the debridement of disaster wounds, to control or prevent infection, and to prepare the wound bed for reconstructive surgery. Maggot debridement therapy-assisted wound care would be led by health care workers rather than physicians, which would allow the latter to focus on reconstructive and other surgical interventions. Moreover, MDT could provide a larger window for time-critical interventions, such as fasciotomies to treat compartment syndrome and amputations in case of life-threatening wound infection. There are social, medical, and logistic hurdles to overcome before MDT can become widely available in disaster medical aid. Thus, research is needed to further demonstrate the utility of MDT in Disaster Medicine. There is also a need for reliable MDT logistics and supply chain networks. Integration with other disaster management activities will also be essential. In the aftermath of disasters, MDT could play an important role facilitating timely and efficient medical treatment and improving patient outcomes. Existing social, medical, and logistic barriers will need to be overcome for MDT to be mainstreamed in Disaster Medicine.

Abstract 1804: The role of adipose derived stromal cells for reversal of radiation fibrosis

Abstract Hypothesis: Up to 70% of patients after radiotherapy develop radiation fibrosis (RF), an irreversible scarring of normal tissue resulting in functional morbidity and increased risk of surgical complications. Adipose-derived stromal cells (ADSCs) have been used effectively for the treatment of complex wounds in animal models and clinical trials. We hypothesize that ADSCs may reverse RF by repopulating mesenchymal precursor cells and by providing angiogenic, anti-inflammatory, and matrix remodeling factors. Methods: A RF animal model was developed and ADSC isolation was confirmed by immunophenotype and differentiation assay. GFP and luciferase labelled ADSCs were used to assess biodistribution after transplantation. To determine the therapeutic effect of ADSC transplantation for RF, we assessed functional changes to leg contracture, oxygen saturation and perfusion and molecular changes to inflammation, vascularization, and matrix remodeling. To determine the mechanism of ADSC-mediated fibrosis reversal, we assessed transcriptomic and epigenetic changes to RF tissue. Results: A RF model was created by radiating the hind limb of C3H mice. This model showed a dose dependent leg contracture and histological findings of fibrosis. We confirmed the immunophenotype of isolated ADSC and their ability to differentiate into adipogenic, chondrogenic, and osteogenic lineages. ADSC transplantation showed a statistically significant trend towards improved leg contracture (2-way ANOVA, p<0.05). Biodistribution studies confirmed the presence of ADSCs in the subdermis of RF tissue with persistence for at least 18 days post-transplantation. Preliminary RNA-seq analysis using unsupervised hierarchical clustering showed ADSC treated radiation tissue was more similar to normal tissue than control. In depth RNA-seq data analysis is underway. Conclusions: ADSC transplantation may be an effective treatment for the reversal of radiation fibrosis. As cancer survivorship increases, the prevalence of radiation fibrosis will rise and necessitate increased focus on effective treatment strategies for this condition. Citation Format: Xiao Zhao, Ju Hee Lee, Kenneth Yip, Laurie Ailles, Fei-Fei Liu. The role of adipose derived stromal cells for reversal of radiation fibrosis. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1804. doi:10.1158/1538-7445.AM2015-1804

Negative-pressure wound therapy for management of diabetic foot wounds: a review of the mechanism of action, clinical applications, and recent developments.

Negative-pressure wound therapy (NPWT) plays an important role in the treatment of complex wounds. Its effect on limb salvage in the management of the diabetic foot is well described in the literature. However, a successful outcome in this subgroup of diabetic patients requires a multidisciplinary approach with careful patient selection, appropriate surgical debridement, targeted antibiotic therapy, and optimization of healing markers. Evolving NPWT technology including instillation therapy, nanocrystalline adjuncts, and portable systems can further improve results if used with correct indications. This review article summarizes current knowledge about the role of NPWT in the management of the diabetic foot and its mode of action, clinical applications, and recent developments.

Elastic suture: An alternative for extensive skin loss

The treatment of complex wounds in soft tissues remains a major challenge for plastic surgeons. In this context, skin detachments, slow expansion, and presuture and elastic suture methods use the basic principles of skin biomechanics to correct various skin defects that are the result of various causes such as car accidents, tissue necrosis, resection of skin lesions, and scar formation, which would otherwise require grafts, flaps, or spreaders. ABSTRACT The treatment of complex wounds in soft tissues remains a major challenge for plastic surgeons. Several reconstruction methods have been used for this purpose, including the use of grafts, flaps, and spreaders. This study aimed to improve the technique of elastic suture by using the biomechanical properties of the skin and in which the open wound areas are closed without the need for detachment and often under local anesthesia, in two surgical stages, and without causing further sequelae. The contribution to the improvement of the technique is based on the use of a polypropylene mesh (Marlex) fixed to wound edges, allowing the elastic traction to be homogeneously distributed throughout the tissue, thus avoiding ischemic necrosis of the wound edges.

VAC® therapy for wound management in patients with contraindications to surgical treatment

The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient's general conditions contraindicate surgical procedures, topical negative pressure with vacuum assisted closure (VAC)) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC when surgical procedures are contraindicated.

Atuação da cirurgia plástica no tratamento de feridas complexas

To report the performance of plastic surgery in the treatment of complex wounds in a tertiary hospital, analyzing its characteristics, types of injuries and approaches adopted, with emphasis on surgical treatment. We conducted a etrospective analysis of patients with complex wounds treated by plastic surgery in a tertiary hospital in a period of five years (2006 to 2010). Data collection was obtained from visits made, serial assessments and records of the medical charts. There were 1927 patients treated (32 queries/month), mean age 46.3 years, predominantly male (62%). The surgical specialties requested 1076 consultations (56%), and the clinical, 851 (44%). The distribution by type of wound showed predominance of pressure ulcers (635/33%), traumatic wounds (570/30%), complicated surgical wounds (305/16%) and necrotizing wounds (196/10%), with the remainder represented by vasculitis (83/4%), venous ulcers (79/4%), diabetes (41/2%) and post-radiation (18/1%). The treatment was surgical in 1382 patients (72%) and non-operative in 545 cases (28%). There were 3029 operations, predominantly debridement (1988/65%) and skin grafting (619/21%) associated or not with negative pressure therapy (vacuum), followed by pedicle flaps (237/8 %), digital reimplantation (81/3%), microsurgical flaps (66/2%) and other (38/1%). The plastic surgeon played an important role in the treatment of complex wounds by adopting early surgical treatment, contributing to the effective resolution of cases.

Novel Use of Insulin in Continuous-Instillation Negative Pressure Wound Therapy as “Wound Chemotherapy”

Negative pressure wound therapy (NPWT) is frequently employed in the treatment of complex wounds. A variety of wound chemotherapeutic agents such as insulin, which acts as a growth factor, may prove helpful in treatment as well. We present a case report in which insulin was used as a chemotherapeutic agent in continuous-instillation NPWT. To our knowledge, this is the first report in the literature describing this method of delivery.

Novel Use of Doxycycline in Continuous-Instillation Negative Pressure Wound Therapy as "Wound Chemotherapy"

Negative-pressure wound therapy (NPWT) is frequently employed in the treatment of complex wounds. The authors present a description of real-time streaming therapy of a variety of wound chemotherapeutic agents through NPWT. Doxycycline, which acts as a competitive inhibitor of matrix metalloproteinases and tumor necrosis factor alpha and further decreases inflammation through the reduction of nitrous oxide production, may prove helpful when delivered in this manner. To the authors' knowledge, this is the first report in the literature describing this method of delivery of doxycycline.

Pautas para el uso de terapia de vacío en el Servicio de Cirugía Plástica del Hospital La Fe en Valencia (España)

Treatment of complex wounds that imply loss of substance or important anatomic structures exposure has a great relevance in Plastic Surgery Departments nowad...

Uso de terapia con presión negativa en heridas con fístulas entéricas

Objective Negative pressure therapy (VAC, vacuum assisted closure) is a method used still in our country. It consists of a system of aspirating a wound by means of a piece of foam and a few adhesive films. It allows the treatment of complex wounds, included (although this is still controversial) those with intestinal fistulas. We present 3 cases of treatment with VAC in this situation and a review of the published literature. Patients and method We have treated 10 patients, since VAC therapy was introduced into our centre of which 3 of whom had a fistula in the bed of the surgical wound. We describe the clinical information of the patients and the therapy that followed in each of the cases. Results Significant local clinical improvement of the disease, with control of the symptoms, was achieved in all 3 cases. We were able to re-operate to close the fistula in one of the patients, with subsequent good progression of the wound. In the other two cases it gave them a better quality of life although both died due to the overall complexity of their situation. Conclusions VAC therapy, although controversial in the treatment of intestinal fistulas, can help to improve the local situation of the wounds, the comfort of the patients and their general situation.