Treatment Of Lower Extremity Wounds Research Articles

Feasibility of Remote Wound Care: A Pilot Study Implementing a Patient-centered Remote Wound Monitoring System Using a Smartphone Application

Regular clinical assessment is critical to optimize lower extremity wound healing. However, social, transportation, and time barriers often limit patient follow-up. We aimed to assess the feasibility of using a novel, patient-centered, remote wound monitoring application (Healthy.io Minuteful for Wound smartphone “app”) for the surveillance of lower extremity wounds. We enrolled 25 patients who presented to our outpatient multidisciplinary clinic with a lower extremity wound related to peripheral artery disease and/or diabetes. All patients underwent definitive revascularization and podiatric interventions prior to enrollment. Patients and their caregivers were instructed on wound app use and asked to perform one at-home wound scan per week for a total of 8 weeks (Fig 1). Patient engagement, wound app useability, and patient and provider satisfaction with the app were collected prospectively and reported using descriptive statistics. Twenty-five patients (mean age, 65.5 ± 13.7 years, 60.0% male, 52.0% Black, 68.0% with diabetes) were enrolled over the course of 3 months. Mean baseline wound area was 18.0 ± 15.2 cm2, 24.0% of patients were recovering from osteomyelitis, and post-surgical Wound, Ischemia, foot Infection stage was 1 in 24.0%, 2 in 40.0 %, 3 in 28.0%, and 4 in 8.00% of patients. Twenty-eight percent of patients required a borrowed smartphone, and wound scans were obtained by both patients (40.0%) and caregivers (60.0%). The mean number of wound scans acquired per patient was 0.72 ± 0.63 per week, for a total mean of 5.80 ± 5.30 scans over the course of 8 weeks. Wound app use triggered an early change in wound management for 36.0% of patients. Ninety-four percent of patients and physicians involved in the study reported the app was useful (Fig 2). The Healthy.io Minuteful for Wound app is a feasible means of remote wound monitoring for use by patients and/or their caregivers. This study is the impetus for a new randomized controlled trial investigating the efficacy of wound healing with remote wound app monitoring vs standard in-person clinic visits for the treatment of lower extremity wounds, in which we hope to show the barriers that often interfere with in-person follow-up visits will no longer interfere with proper wound care.Fig 2Post-study patient survey results documenting perceived ease of use, patient empowerment, and overall usefulness of the Healthy.io Minuteful for smartphone app.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Parallel Cross-Leg Free Flap with Posterior Tibial Artery Perforator Pedicle Propeller Cable Bridge Flap for the Treatment of Lower Extremity Wounds: A Case Series Report

Background A cross-leg flap can be used to treat severely injured lower limbs but associated with complications. Herein, we describe a technique of a parallel cross-leg free flap combined with posterior tibial artery perforator pedicle propeller cable bridge flap for the treatment of lower extremity wounds. Methods The artery and veins of the free flap are anastomosed to the contralateral posterior tibial artery and vein, respectively. The vascular pedicle is wrapped with a posterior tibial artery perforator pedicle propeller flap. The legs are allowed to remain in a straight, relaxed position which is maintained with a bandage or Kirschner wire placed at the distal limbs. Pedicle division is performed around 21 days after flap creation, and the posterior artery is re-anastomosed and pedicled flap returned to its original position. Results From June 2017 to March 2020, 7 patients with lower extremity wounds and tissue loss received reconstruction with this method. The recipient vessels for all flaps were the posterior tibial artery and vein. The average operation time was 5 hours. The average time to ambulation was 4 weeks, and the average follow-up time was 13.7 months. All flaps survived, and limb salvage was successful in all patients. Patients were not uncomfortable with the limbs held in position until pedicle division, and there were no complications. At the final follow-up, the function of all limbs was normal, and the esthetic appearance was acceptable to all patients. Conclusions The method described overcomes the disadvantages of traditional cross-leg flaps for the treatment.

Direct use of autologous fat graft on the treatment of lower extremity wounds

Direct use of autologous fat graft on the treatment of lower extremity wounds

Zor İyileşen Alt Ekstremite Yaralarının Tedavisinde Negatif Basınçlı Yara Tedavi Yönteminin Etkinliği ve Sonuçları

Aim: The chronic infected wounds are commonly encountered in the orthopedic practice and occur due to several etiological factors. They are responsible for serious morbidity and mortality. Regardless of the etiology, the underlying factors at these wounds are healing problems and predisposition to infection due to microvascular insufficiency. There are several methods for the treatment of these wounds. One of them is vacuum assisted closure systems (VAC) or negative pressure wound therapy (NPWT). The aim of present study is to evaluate the NPWT methods’ efficacy in the treatment of chronic lower extremity wounds with insufficient microvascular blood supply.Material-method: The data and results of a case series of five patients with several etiologies who had been treated by NPWT are analyzed and the results are evaluated retrospectively in this study.Findings and results: Five patients with chronic wound in their lower extremities due to microvascular circulation insufficiency were treated with NPWT for a period ranging from 11 to 51 days (average 31 days). The chronicity time was average 53,3 days in patients. NPWT was applied in -75 mmHg with -150 mmHg pressures. According to findings of this study, the NPWT was found influent as a method for the treatment of chronic wounds with insufficient blood circulation in lower extremities.

Differential Keratin Expression During Epiboly in a Wound Model of Bioengineered Skin and in Human Chronic Wounds

Epiboly represents the process by which keratinocytes migrate to envelop a surface. The authors have been investigating a living bilayered skin construct (BSC) that is used in the treatment of lower extremity wounds due to venous insufficiency and diabetes. The construct demonstrates epiboly after injury and incubation in vitro, and this model may be useful for studying epidermal migration and the process of skin maturation. Punch biopsies of the construct in vitro were cultured and immunostained for specific keratins at baseline and at 24 to 72 hours. For comparison, skin biopsy specimens from human chronic venous ulcers and acute healing wounds were similarly processed. The authors found that K1 and K10 were fully expressed in the epidermis of the fully epibolized surface on BSC. K1 was also present in the migrating edge of specimens, whereas K10 was not detectable. K16 and K6 were evident in normal skin and the epibolized area of the construct; K6 expression was very prominent in the migrating edge. Importantly, K17 was distinctly limited to the epibolized surface and the migrating edge, and its expression was very similar to that observed in healing human wounds. In conclusion, differential expression of keratins in this epiboly model closely reflects in vivo studies and supports keratin specificity in the processes of migration and differentiation of new epidermis. Therefore, these findings provide further and important validity for the study of epithelialization and the hope of developing prognostic markers for venous ulcer healing.

Evidence-Based Recommendations for the Use of Topical Oxygen Therapy in the Treatment of Lower Extremity Wounds

Topical oxygen therapy provides another tool in the armamentarium of clinicians treating refractory lower extremity wounds. Devices suitable for providing topical oxygen therapy in a clinical setting have recently become available. This article reviews the evidence to justify the use of this treatment modality, including in vitro, preclinical data, and clinical data. It also provides a protocol for how to administer topical oxygen therapy as well as guidance on patient selection and management to optimize outcomes. Randomized controlled trials are not yet reported and clearly necessary. The current body of evidence suggests that topical oxygen therapy may be considered as a second line of therapy for refractory wounds.

The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16‐week pilot study

A prospective, single-centre, randomized controlled study was performed to evaluate the effectiveness of Graftjacket, a human acellular regenerative tissue matrix as a treatment option for chronic non healing lower extremity wounds. Twenty-eight diabetic patients with full-thickness wounds that had been present for at least 6 weeks were treated with sharp debridement and randomized to a single application of Graftjacket tissue matrix plus mineral oil-soaked fluff compression dressing or to a control treatment of wound gel with gauze dressings. All patients were seen weekly. By week 16, 12 of 14 patients treated with Graftjacket tissue matrix demonstrated complete wound closure compared with 4 of 14 patients in the control group. Patients treated with Graftjacket tissue matrix showed a statistically significant higher percentage of wound healing with respect to wound area, and clinically significant differences in wound depth and wound volume. This comparison is not performed to demonstrate that the application of the Grafjacket is more effective than sharp debridement. This study is done to help assign a role to the use of Graftjacket matrix in lower extremity wound care.

The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16‐week pilot study

The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16‐week pilot study

Gene Therapy in the Treatment of Lower Extremity Wounds

This article presents a brief overview of the etiology of chronic wounds of the lower extremities and their current medical and surgical treatment. Gene therapy as a potential tool for treating therapeutically challenging wounds is described in terms of the vectors employed in gene transfer, as well as the strategies used to promote wound healing. Results from animal model studies, as well as clinical trials, are presented.

Third-party reimbursement for lower-extremity wound care.

This article describes the treatment of lower-extremity wounds, specifically foot and ankle ulcerations, in the context of reimbursement for treatments rendered. Therefore, such issues as standard of care, documentation, classification of foot wounds, coding, and reimbursement are discussed.