Treatment Of Complex Wounds Research Articles

A systematic review of the Novosorb® Biodegradable Temporizing Matrix in the treatment of complex wounds

BackgroundRestoringafunctionaldermisfollowingextensive,deepwounds,suchasthosecausedbysevereburns,presentsasignificantreconstructivechallenge. Although split thickness skin graft (STSG) and full thickness skin graft (FTSG) can provide adequate coverage, dermal templates are becoming increasingly important in restoring function. The purpose of this systematic review is to assess the efficacy, advantages and limitations of employing NovoSorb® Biodegradable Temporizing Matrix (BTM) in the treatment of complex wounds. MethodsThe systematic review was carried out in accordance with PRISMA and MOOSE guidelines when appropriate. All studies until April 2024 involving patients treated with NovoSorb® BTM were considered. Infection,adverseevents,andBTMlosswereamongtheoutcomesevaluated. ResultsWe identified 725 studies, and 69 were included after screening. The included studies involved 880 participants and were mostly concerned with the management of burns, but other difficult wounds were also addressed. The infection rate was 10%, yet only few reported losing their BTM as a result of this consequence. The incidence of adverse events was low, with the majority of trials reporting no adverse events related to BTM. ConclusionOur systematic review focused primarily on case series and case reports that demonstrated the efficacy of Novosorp BTM and the rarity of side effects. However, there were very few comparison research. More research is needed to fully analyze the efficacy, limitations, and downsides of using Novosorb (BTM).

Novosorb Biodegradable Temporizing Matrix for Reconstruction of Complex Upper-Extremity Wounds

Dermal matrices can be used in management of upper-extremity wounds to create vascularized wound beds in the setting of exposed bone or tendon. Early outcomes of Novosorb biodegradable temporizing matrix (BTM) demonstrated success when used in the treatment of complex wounds. We hypothesize that BTM is effective for reconstruction of upper-extremity wounds. A retrospective review was performed for patients who underwent reconstruction of upper-extremity wounds with BTM between January 2017 and May2022. In total, 51 patients (39 males and 12 females) were included. Wound etiology included trauma (n= 30), burn (n= 12), infection (n= 8), and vasopressor-related injury (n= 1). The average size of BTM was 162.5 cm2, and the average time from BTM application to wound closure was 90.1 days. Twenty-seven (52.9%) patients required skin grafting, whereas 20 (39.2%) did not and re-epithelialized spontaneously. Those who did not require skin grafting had significantly smaller wound sizes compared to those who required skin grafting (58.5 cm2 vs 248.6 cm2; P= .002). Complications occurred in 14 patients, including infection (n= 5), fluid collection (n= 5), and template dehiscence (n= 4). Wound closure was successful in 92% of patients. Novosorb BTM is effective for the management of upper-extremity wounds with exposed bone and tendon. In the management of complex upper-extremity wounds with exposed bone and tendon, even when devoid of paratenon or periosteum, Novosorb BTM provides a safe and effective alternative to more complex reconstructive options.

The Ongoing Challenges: Comments on “Clinical Outcomes of Negative-Pressure Wound Therapy with Instillation without Commercial Devices in the Treatment of Complex Wounds”

The Ongoing Challenges: Comments on “Clinical Outcomes of Negative-Pressure Wound Therapy with Instillation without Commercial Devices in the Treatment of Complex Wounds”

Response to Letter: The Ongoing Challenges: Comments on “Clinical Outcomes of Negative-Pressure Wound Therapy with Instillation without Commercial Devices in the Treatment of Complex Wounds”

Response to Letter: The Ongoing Challenges: Comments on “Clinical Outcomes of Negative-Pressure Wound Therapy with Instillation without Commercial Devices in the Treatment of Complex Wounds”

Autologous Fat Grafting: an Emerging Treatment Option for Complex Anal Fistulas

BackgroundAutologous fat grafting (AFG) has shown promise in the treatment of complex wounds, with trials reporting good healing rates and safety profile. We aim to investigate the role of AFG in managing complex anorectal fistulas. MethodsThis was a retrospective review of a prospectively maintained IRB-approved database. We examined the rates of symptom improvement, clinical closure of fistula tracts, recurrence, complications, and worsening fecal incontinence. Perianal disease activity index (PDAI) was obtained for patients undergoing combination of AFG and fistula plug treatment. ResultsIn total, 52 unique patients underwent 81 procedures, of which Crohn’s was present in 34 (65.4%) patients. The majority of patients previously underwent more common treatments such as endorectal advancement flap or ligation of intersphincteric fistula tract. Fat-harvesting sites and processing technique were selected by the plastic surgeons based on availability of trunk fat deposits. When analyzing patients by their last procedure, 41 (80.4%) experienced symptom improvement, and 29 (64.4%) experienced clinical closure of all fistula tracts. Recurrence rate was 40.4%, and complication rate was 15.4% (7 postoperative abscesses requiring I&D and 1 bleeding episode ligated at bedside). The abdomen was the most common site of lipoaspirate harvest at 63%, but extremities were occasionally used. There were no statistically significant differences in outcomes when comparing single graft treatment to multiple treatments, Crohn’s and non-Crohn’s, different methods of fat preparation, and diversion. ConclusionAFG is a versatile procedure that can be done in conjunction with other therapies and does not interfere with future treatments if recurrence occurs. It is a promising and affordable method to safely address complex fistulas.

Clinical performance characteristics for bordered foam dressings in the treatment of complex wounds: An international wound dressing technology expert panel review.

The aim of this article is to identify and describe clinical practice performance characteristics for bordered foam dressings in the treatment of complex wounds. Our recently published systematic review of outcomes and applied measurement instruments for the use of bordered foam dressings in complex wounds has led to us identifying a range of important clinical and patient-centred issues related to this dressing class. Specifically, here, we focus on an overview of performance criteria in the areas of application, adhesion, exudate management and debridement functions of bordered foam dressings. Our hope is that by highlighting the clinical performance criteria, future testing standards for wound dressings will more closely match our clinical expectations and, thereby, assist clinicians to make better wound treatment choices based on meaningful and clinically relevant dressing product performance standards. complex wounds, complex wound care, treatment, bordered foam dressings, dressing performance.

The development of a core outcome set for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds

AimThe aim of this project was to develop a core outcome set (COS) for clinical effectiveness studies of bordered foam dressings in the treatment of complex wounds. MethodsThe research project followed the Core Outcome Measures in Effectiveness Trials (COMET) initiative and consisted of two phases. The first phase prepared the background and process, while the second phase had three steps: outcome list generation via systematic review and qualitative study, Delphi consensus study, and consensus meeting. The study has been registered in the Core Outcome Measures in Effectiveness Trials database. ResultsThe systematic review resulted in 82 outcomes and 20 additional outcomes were obtained during the interviews. After refinement, 111 panellists from 23 countries rated a list of 51 outcomes. In the following consensus meeting, six outcomes were prioritized to be included in the core outcome set. After the consensus meeting, a patient-reported outcome was added to the core outcome set. ConclusionThe COS for evaluating the effectiveness of bordered foam dressings in treating complex wounds includes 7 outcomes: “ability to stay in place”, “leakage”, “pain”, “dressing related periwound skin changes”, “change in wound size over time”, and “overall satisfaction”. These identified outcomes are correlated with contemporary bioengineering testing and evaluation methods for dressing performance, which underpins the need for a close multidisciplinary collaboration to advance the field of wound dressings. The outcome ‘overall satisfaction’ reflects the impact of complex wounds and their treatment on a patient's daily life. The use of these outcomes is recommended to improve data synthesis and promote evidence-based practice. Future developments in COS development involve creating measurement instruments and relevant endpoints for these outcomes.

Лечение огнестрельных ран конечностей с использованием физических и ортобиологических методов

Currently, despite the wide possibilities in the treatment of wounds, patients with gunshot wounds of the extremities present a complex surgical task. The study included 60 patients with gunshot wounds of the extremities who underwent inpatient examination and treatment at the Center of Traumatology and Orthopedics of the Main Military Clinical Hospital named after academician N.N. Burdenko of Ministry of Defence of the Russian Federation. The patients were divided into groups. In group I, physical methods of treatment were used, such as vacuum therapy (35 people), of which 19 patients underwent combined vacuum therapy with laser irradiation of the wound (group IA), 16 patients underwent vacuum therapy in combination with high-intensity pulsed optical irradiation (group IB). Group II included patients in whom orthobiological techniques were used in the complex treatment of wounds (25 patients), including platelet-enriched fibrin glue — in 13 patients (group IIA) and a composition of heterogeneous implantable gel SpheroGEL® in the LONG version (hereinafter SpheroGEL®) — in 12 patients (group IIB). Results. Comparison of the results of the treatment revealed a significant improvement in the regenerative process according to the histological method in group IA: the maturation of mature granulation tissue was observed on the 9th day after the application of local treatment methods. Positive adhesive and wound healing effects were observed in group IIA. According to the "AnalyRan" program, there was a significant reduction in the time of wound healing in all groups under study. According to the results of the study, all techniques showed positive dynamics of wound healing and reduction of the inflammatory process.

Clinical validation of computer vision and artificial intelligence algorithms for wound measurement and tissue classification in wound care

One of the most important challenges in the management and treatment of complex wounds is the observation and measurement of different indicators that can be observed on the wound over time. This article will present the idea of addressing this challenge with the use of images captured on a mobile device. The aim of this work is to evaluate the use of digitization systems in the field of chronic wound management as tools that support the professional in improving patient care and decision making, as well as to use computer vision and artificial intelligence to improve wound assessment. An approach based on visual recognition and a classification system is proposed; visual recognition using superpixel techniques to determine the region of interest of the wound, as well as calculating its area and a classification system based on convolutional networks to classify its tissues. We found that our proposed approach, Visual Computing methods to detect Wound contour and measurement (with a Median Relative Error of 2.907 and inter-rater reliability of 0.98%) and Tissue Classification CNN with excellent results using Resnet50 with 0.85 of accuracy.

Treatment of complex wounds with PVC prosthesis and autologous partial skin graft: Accelerated and low-cost third-intention healing protocol

Treatment of complex wounds with PVC prosthesis and autologous partial skin graft: Accelerated and low-cost third-intention healing protocol

Treatment of Complex Wounds with NovoSorb® Biodegradable Temporising Matrix (BTM)-A Retrospective Analysis of Clinical Outcomes.

Complex and chronic wounds represent a highly prevalent condition worldwide that requires a multimodal and interdisciplinary treatment approach to achieve good functional and aesthetic outcomes. Due to increasing costs of health care, an aging population and an increase in difficult-to-treat microbial colonization of wounds, complex wounds will become a substantial clinical, social and economic challenge in the upcoming years. In plastic reconstructive surgery, a variety of dermal skin substitutes have been established for clinical use. Since its approval as a dermal skin substitute in Germany, NovoSorb® Biodegradable Temporising Matrix (BTM) has become a valuable therapeutic option for the treatment of full-thickness wound defects. The clinical data published to date are limited to case reports and small-scale case series with the main focus on single wounds. The aim of this single-center study was a retrospective analysis of our own patient collective that has received treatment with BTM for complex wounds. Overall, BTM showed to be a reliable and versatile reconstructive option, especially for patients with multiple co-morbidities and microbiologically colonized wounds. Although the preliminary findings have produced promising results, further investigation and research are warranted regarding long-term outcomes and additional clinical applications.

Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds

Study protocol for the development of a core outcome set (COS) for clinical effectiveness trials of bordered foam dressings in the treatment of complex wounds

Lower Extremity Necrotizing Fasciitis Managed With Negative Pressure Wound Therapy (NPWT) and Split-Thickness Skin Graft: A Case Report

Introduction: Necrotizing fasciitis (NF) is an infection of the soft tissues (skin, subcutaneous tissue and fascia) that implies a rapidly and progressive evolution. In general, the treatment consists of stabilizing the patient, as well as the use of antibiotics that cover the most common agents, however, in most cases this is not useful without definitive management that consists of cleaning and surgical debridement. In addition to surgical lavage, adjunctive measures are often used in the treatment of complex wounds, such as vacuum-assisted closure (VAC) systems, also known as microdeformation wound therapy (MDWT) or negative pressure wound therapy (NPWT). Objective: The objective is to present a successful case in the treatment of necrotizing fasciitis by negative pressure therapy with subsequent placement of grafts.

Comprehensive treatment of gunshot wounds using vacuum therapy and technomolecular silver preparations

Introduction. Burn wounds from the moment of their occurrence are primarily infected, and are accompanied by a violation of microcirculation, which contributes to the formation of massive necrosis of soft tissues, and leads to the delayed healing of such wounds. The speed of wound healing depends on a number of factors, not least of which is local treatment. An effective solution to this problem is the use of vacuum therapy (Vacuum Assisted Closure), which in combination with technomolecular silver preparations improves the course of all phases of the wound process, promotes active drainage of the wound, which reduces the level of microbial contamination of the wound, reduces local swelling of tissues, activates local blood circulation, which promotes faster healing of wounds. The aim of the study. To improve the results of treatment of patients with gunshot wounds of soft tissues, using vacuum therapy and technomolecular silver preparations. Materials and methods. In 2022, there were 35 patients with gunshot wounds of soft tissues of various degrees of complexity undergoing inpatient treatment in the surgical and trauma departments of the Uzhhorod City Multidisciplinary Hospital. Patients were divided into two groups. The first group, the control group, included 18 patients who were treated with VAC therapy and water-based antiseptics in the complex treatment of wounds after dismantling the VAC therapy device. In the second, main group of patients, the complex of wound healing measures included VAC therapy and the use of technomolecular silver preparations in the form of a spray, which was applied to the wound once a day, after dismantling the VAC therapy device. Research results . The use of VAC-therapy accelerates the time of wound cleaning, and the use of technomolecular silver preparations promotes the active growth of granulations in significant wound defects, and active marginal epithelization on the surface where the granulations filled the defect. After dismantling the VAC-therapy device, the bacterial landscape of wounds decreased in almost all patients compared to the beginning of treatment. Also, preparations of technomolecular silver were applied for a long time to wounds in which autodermoplasty was performed, which contributed to good engraftment of transplanted skin flaps and faster healing of wounds. The duration of inpatient treatment of patients in the control group was 23.5±2.3 days, and in the main one – 19.4±2.1 days, which is 1.2 times faster than in the control group of patients. Conclusion. The use of the vacuum therapy method in the complex treatment of gunshot wounds, in combination with technomolecular silver preparations, helps to quickly clean the wound from necrotic tissues, activates the growth of granulations, and promotes good engraftment of transplanted skin flaps, which in general contributes to faster healing of wounds, and accordingly shortens the duration of an inpatient treatment.

Topical Autologous Blood Clot Therapy: An Introduction and Development of Consensus Panel to Guide Use in the Treatment of Complex Wound Types

Complex or hard-to-heal wounds can be acute or chronic; the complexity is based on patient-specific local, systemic, and psychosocial factors. Use of autologous tissue can be a significant adjunct to wound closure. Grafts and flaps are the most common autologous tissue used in wound reconstruction. However, patient factors, wound size, and exposed structures may preclude using these methods as primary or even secondary closure techniques. Alternative autologous tissue therapies include those derived from adipose, epidermis or dermis, bone marrow, and blood. Limitations of these treatment modalities include access-related difficulty, cost, creation of a secondary donor site, use of singular or limited cell types, and sparse or contradictory evidence basis of their efficacy of use. A panel of providers experienced in wound care and surgical wound management was convened to create a series of publications on the use of topical autologous blood clot therapy (TABCT) in the treatment of complex wounds. This publication, the first in a series, provides an evidence basis of the gap between definition and treatment of complex wounds, an overview of the use of autologous therapies in these wounds, and the science behind TABCT. The development of a consensus panel for decision pathways and recommendations for TABCT use in specific complex wound types are also discussed. Subsequent articles will provide consensus recommendations on the use of TABCT in full-thickness wounds with exposed tendon and/or bone and undermining or tunneling wounds, in wounds in patients who are nonsurgical candidates, in those who cannot undergo sharp debridement, in patients with arterial wounds who have been maximally revascularized, and in those with transsphincteric anal fistula. This article provides a foundation of knowledge and describes the plan for consensus panel decision pathways and recommendation development of use of TABCT in the treatment of specific complex wound types.

Management of complex wounds treatment with a hydrofiber dressing in a public hospital in Bogota (Colombia)

Objective. To evaluate the efficacy of the use of a last generation hydrofiber dressing with silver, for the treatment of complex wounds that are difficult to heal.Materials and research methods. A prospective observational case-follow-up study was carried out, which included patients with acute or chronic wounds that were difficult to heal, treated in the plastic surgery service of a public hospital in Bogota-Colombia, who underwent healing with hydrofiber dressings reinforced, with silver ions, benzethonium chloride and EDTA (Aquacel Agplus®, ConvaTec). The wound was monitored, evaluating infection control, exudate and biofilm, as well as the number of required dressings and the time required for the complete closure of the wound.Research results. A total of 55 patients were included, with a median age of 44 years. In all cases, a follow-up was carried out until the definitive closure of the wound. At the end of the study, it was observed that, in 35 (63.6 %) patients, the wounds evolved to complete closure by second intention in an average of 59.3 days, requiring 12.5 dressings. 20 (36.4 %) patients had adequate wound bed preparation for definitive surgical coverage with grafts, flaps or dermal substitutes, in an average of 31.4 days, requiring 6.5 dressings on average.33 (60.0 %) wounds were infected and adequate infection control was achieved on average with 5 dressings. A decrease in the direct and indirect signs of biofilm was achieved after 6 dressings.Conclusion. The results show that the dressing studied is effective to control exudate, infection and biofilm, as well as to prepare the bed for a definitive surgical coverage.

Novel Negative-Pressure Wound Therapy System Provides Accurate Pressure Delivery and Exceptional Fluid Handling Capability.

Negative-pressure wound therapy (NPWT) is a widely accepted modality in the treatment of complex wounds.1 However, there are fundamental requirements2 not incorporated in all current NPWT systems that must be met in order to realize its full clinical benefits, which include (1) accurately delivering a set level of negative pressure to the wound bed, (2) creating a pressure gradient between the wound bed and the waste canister to efficiently remove fluid and prevent stagnation in the tubing, and (3) maintaining a sealed wound environment. The objective of this investigation3 was to use a simulated wound model to compare the ability of two NPWT systems (System A, Invia® Liberty™ [Medela AG] and System B, V.A.C.ULTA™ [3M+KCI]) to deliver set levels of NPWT and simultaneously manage volumes of simulated wound exudate.* TEST METHOD 1: ACCURATE PRESSURE DELIVERY TO THE WOUND BED This test assessed the ability of System A and System B to accurately deliver set pressure to the wound at three different heights with respect to the wound model and was repeated at two different pressure settings. Data were recorded three times at each height and pressure setting (Figure 1).Figure 1.: TEST METHODOLOGY FOR 1 M ABOVE, SAME LEVEL, AND 1 M BELOWResults. Both System A and System B accurately and precisely delivered the set level of negative pressure regardless of their position relative to the wound model without pressure loss. (Figure 1). TEST METHOD 2: EFFICIENT EXUDATE REMOVAL System A and System B were compared to assess their ability to efficiently remove simulated wound fluid at a pressure setting of −125 mmHg. The test was repeated three times per system. Wound models were dressed with the respective black foam dressing kits specific to each NPWT system, and the systems were set up to simulate the delivery of therapy with the wound and at the same height. After each system’s wound dressing was applied, therapy was initiated and allowed to reach a steady state (~10 minutes), and pressure sensors confirmed pressure at the wound bed of −125 mmHg. After this, 150 ml of simulated wound fluid was introduced into the wound model. Measurements of airflow cycles, pressure at the wound bed, and fluid weight in the canister were continuously recorded (Figure 2). This test method simulated a bolus fluid challenge and measured each NPWT system’s distinct ability to efficiently react and manage wound fluid. (The results shown here represent a set pressure of 125 mmHg with the device at the same level as the wound model; similar observations were made at a set pressure of −75 mmHg [data not shown].)Figure 2.: TEST METHOD AT THE SAME LEVELResults. System A removed simulated wound fluid more efficiently than System B, evacuating 89% of the fluid from the simulated wound into the canister in less than 20 minutes after introduction of the fluid. System B did not attain 89% fluid removal throughout the 125-minute duration of the experiment (Figure 3).Figure 3.: COMPARISON OF EXUDATE REMOVAL RATESIn less than 20 minutes, System A was able to reestablish a set pressure of −125 mmHg, returning patency and delivering consistent levels of therapy at the wound bed. System B fluctuated widely from the set pressure (−125 mmHg) throughout the test method. In addition, System B had frequent excursions that exceeded +/−10 mmHg of the set pressure, directly impacting its ability to maintain set pressure at the wound bed (Figure 4).Figure 4.: COMPARISON OF PRESSURE DELIVERY AT THE WOUND BEDCONCLUSIONS This study demonstrated the Intelligent Pressure Control™ and Dynamic Exudate Removal™ technologies provided by System A; it improved fluid management and helped reduce the risk of tubing blockages from simulated exudate while maintaining a set pressure at the wound bed. The results confirm the Intelligent Pressure Control™ feature illustrated by System A meets the standard of care. Further, the results of the bolus fluid challenge illustrate that the Dynamic Exudate Removal™ (unique to System A) allowed for faster and more efficient removal of fluid volumes while maintaining set pressure at the wound bed when compared with System B. Accordingly, System A innovates the standard of care.

Polyphenols: A Promising Avenue in Therapeutic Solutions for Wound Care

In chronic wounds, the regeneration process is compromised, which brings complexity to the therapeutic approaches that need to be adopted, while representing an enormous loss in the patients’ quality of life with consequent economical costs. Chronic wounds are highly prone to infection, which can ultimately lead to septicemia and morbidity. Classic therapies are increasing antibiotic resistance, which is becoming a critical problem beyond complex wounds. Therefore, it is essential to study new antimicrobial polymeric systems and compounds that can be effective alternatives to reduce infection, even at lower concentrations. The biological potential of polyphenols allows them to be an efficient alternative to commercial antibiotics, responding to the need to find new options for chronic wound care. Nonetheless, phenolic compounds may have some drawbacks when targeting wound applications, such as low stability and consequent decreased biological performance at the wound site. To overcome these limitations, polymeric-based systems have been developed as carriers of polyphenols for wound healing, improving its stability, controlling the release kinetics, and therefore increasing the performance and effectiveness. This review aims to highlight possible smart and bio-based wound dressings, providing an overview of the biological potential of polyphenolic agents as natural antimicrobial agents and strategies to stabilize and deliver them in the treatment of complex wounds. Polymer-based particulate systems are highlighted here due to their impact as carriers to increase polyphenols bioavailability at the wound site in different types of formulations.

Atendimento domiciliar no tratamento de feridas complexas: uma abordagem integrativa

Objective: Report the experience of home care in the treatment of complex wounds in person with the help of telemedicine.

A neglected problem in the utilization of free anterolateral thigh flap toward reconstructing complicated wounds of extremities: the obliteration of deep dead space

BackgroundDeep dead space may be thought as an independent risk factor of the poor infection control after flap reconstruction in complex limb wounds. But it can be easily neglected. The conventional skin flap and musculocutaneous flap are difficult to obliterate the deep dead space in irregular shape effectively. It was investigated that the clinical application of chimeric anterolateral thigh perforator flap in the treatment of complex wounds complicated with deep dead space of the extremities in the paper.MethodsFifty-six cases complicated with deep dead space wounds were registered in group. Following thorough debridement and treatment with VSD, the granulation tissues grew with well-controlled infection. And then the chimeric anterolateral thigh perforator flap was used to obliterate the deep dead space and repair the wounds. The postoperative flap survival and infection conditions were evaluated.ResultsOverall, the infection was effectively controlled, without persistent exudation or sinus tract formation after wound healing. While 5 cases lost to follow-up, the remaining 51 cases were followed up until 15 months on average. Generally, the affected extremities recovered satisfactorily with normal appearances and texture of the flaps, along with normal functions. Importantly, no recurrence of infection was observed.ConclusionDuring the grafting of chimeric perforator flap pedicled with lateral thigh muscle flap, the muscle flap is recommended to obliterate the deep dead space while the skin flap is being used to cover the wound. The combination of these two technologies performed well in the repair and reconstruction of the complex wounds of the extremities, possessing potential for broader clinical application.