Treatment Of Non-healing Wounds Research Articles

Acellular Fetal Bovine Dermal Matrix in the Treatment of Nonhealing Wounds in Patients with Complex Comorbidities

In contrast to the narrow indications for living skin equivalents, extracellular matrix biomaterials are clinically used in a wide range of wound-healing applications. Given the breadth of possible uses, the goal of this study was to retrospectively compile and analyze the clinical application and effectiveness of an extracellular matrix biomaterial derived from fetal bovine dermis (PriMatrix; TEI Biosciences, Boston, Massachusetts) in patients treated by a single physician and monitored postsurgically in an outpatient wound care center. A retrospective medical record review was conducted of consecutive patients treated from January 2007 through January 2009 with meshed PriMatrix after sharp/surgical debridement and coverage with standard moist wound therapy dressings. Twenty-nine patients and 34 wounds were compiled. All of the wounds were unresponsive to conservative treatment owing to complications, including infection, exposed bone or tendon, and other comorbidities known to delay healing. Wounds included 11 diabetic ulcers, 8 venous stasis ulcers, 10 nonhealing traumatic wounds, and 5 other chronic wounds. Thirty of 34 wounds healed, with four patients lost to follow-up. Mean time to healing for diabetic foot ulcers was 105 days with an average of 2.6 PriMatrix applications. Mean time to healing for venous, traumatic, and other chronic wounds was 74 to 82 days with an average of 1.2 to 1.4 PriMatrix applications. In patients with comorbidities known to delay healing, the implantation of PriMatrix promoted the healing and, ultimately, full reepithelialization of otherwise unresponsive wounds of varied etiology, including those with complications of infection or exposed bone or tendon.

Myiasis: A Boon or a Bane?

ABSTRACT Myiasis is known to man since ages and has always been considered bane due to its prevalence in unhygienic conditions. But nowadays it is considered as a boon as it is being tried in treatment of nonhealing wounds. How to cite this article Kulkarni S, Joshi S, Bhalerao A, Chopde Y, Somalwar S. Myiasis: A Boon or a Bane? J South Asian Feder Obst Gynae 2012;4(2):116-117.

Superabsorbent polymer-containing wound dressings have a beneficial effect on wound healing by reducing PMN elastase concentration and inhibiting microbial growth

A comprehensive in vitro approach was used to assess the effects of superabsorbent polymer (SAP) containing wound dressings in treatment of non-healing wounds. A slight negative effect on HaCaT cells was noted in vitro which is most likely due to the Ca(2+) deprivation of the medium by binding to the SAP. It could be shown that SAP wound dressings are able to bind considerable amounts of elastase reducing enzyme activity significantly. Furthermore, SAP's inhibit the formation of free radicals. The SAP-containing wound dressings tested also exhibited a significant to strong antimicrobial activity effectively impeding the growth of gram-negative and gram-positive bacteria as well as yeasts. In conclusion, in vitro data confirm the positive effect of SAP wound dressings observed in vivo and suggest that they should be specifically useful for wound cleansing.

Treatment of non-healing wounds with autologous bone marrow cells, platelets, fibrin glue and collagen matrix

Recalcitrant diabetic wounds are not responsive to the most common treatments. Bone marrow-derived stem cell transplantation is used for the healing of chronic lower extremity wounds. We report on the treatment of eight patients with aggressive, refractory diabetic wounds. The marrow-derived cells were injected/applied topically into the wound along with platelets, fibrin glue and bone marrow-impregnated collagen matrix. Four weeks after treatment, the wound was completely closed in three patients and significantly reduced in the remaining five patients. Our study suggests that the combination of the components mentioned can be used safely in order to synergize the effect of chronic wound healing.

Successful treatment of nonhealing wounds with Xelma®

Chronic wounds come in all shapes and sizes and may be associated with co-morbidities that have a direct impact upon healing and the quality of life of patients, their families, carers, and even co-workers. Cosmetic appearance is important to both genders but especially so to female patients and unsightly wounds that are difficult to hide cause extreme problems that may have psychological implications. In addition to the effect that they have on patients, these wounds are associated with considerable resource requirements, which impact heavily on the already burdened NHS. This article presents three case studies of patients with chronic wounds that have shown a positive response, in terms of healing and impact upon the patient's quality of life, to an advanced wound care product - Xelma(R).

Combined treatment of nonhealing wounds with bioengineered skin and mesenchymal stem cells

Combined treatment of nonhealing wounds with bioengineered skin and mesenchymal stem cells

Does hyperbaric oxygenation therapy benefit in the treatment of non-healing wounds in diabetic patients?

As the incidence of diabetes mellitus type II is steadily increasing in our society, diabetic non-healing lower extremity wounds are complicating patient care. Hospitalization and amputation rates relating to diabetic lower extremity wounds are increasing causing concern relating to quality of life and healthcare expense. Treatment of these wounds can be difficult and alternative therapy such as hyperbaric oxygenation (HBO) is being used in clinical practice. A review of four studies challenging the HBO benefit in treating diabetic lower extremity non-healing wounds demonstrates a significant increase short term healing rates and reduction in amputation rates. However, results demonstrate no significant increase in long term healing rates. Multiple studies have been linked to the Undersea and Hyperbaric Medical Society, creating possible bias. More non-bias research should be performed to clearly demonstrate HBO benefits for diabetic non-healing wounds and to guide practitioners in treating diabetics with non-healing wounds.

Hyperbaric oxygen therapy in the management of nonhealing wounds in patients with critical limb ischemia

Critical limb ischemia is characterized with intolerable pain at rest and nonhealing wounds and/or gangrene. The treatment of nonhealing wounds in patients with critical limb ischemia calls for an extraordinary effort. However, major amputation is required in a significant number of patients. Hyperbaric oxygen therapy is one of the adjunctive treatments used in nonhealing wounds. Hyperbaric oxygen therapy enhances collagen synthesis and maturation, fibroblast proliferation, epithelialization, increases leukocyte bacterial-killing capacity and induces angiogenesis. Hyperbaric oxygen therapy also exerts an antibacterial effect on selected microorganisms and reduces wound infection. Hyperbaric oxygen therapy is not a miraculous treatment modality. It is a good adjunctive therapy that increases the healing rate of wounds in selected patients. Hyperbaric oxygen therapy should be instituted together with conventional treatments. Antibiotherapy, strict metabolic control, daily wound care and debridement should n...

Hyaluronate-iodine (hyiodine) complex in the treatment of non-healing wounds

Hyaluronate-iodine (hyiodine) complex in the treatment of non-healing wounds

Osteonecrosis of the jaw and oral bisphosphonate treatment

Bisphosphonates are becoming recognized increasingly as having a significant impact on dental therapies. This case report describes adverse clinical sequelae and successful treatment following periodontal surgery in a dental patient receiving bisphosphonate treatment. A 78-year-old woman experienced a nonhealing interproximal wound subsequent to a minor periodontal procedure performed to facilitate restoration of an adjacent tooth. Her medical history revealed that she had been taking an oral bisphosphonate every day for the previous five years for treatment of osteoporosis. After three months of periodic débridement and meticulous oral home care, one of the authors recovered a large piece of necrotic bone. The wound healed after the author performed surgery at the site. Dentists should exercise caution when considering surgical procedures for patients with a history of oral bisphosphonate use. Thorough treatment of nonhealing wounds in these patients can lead to favorable outcomes.

Targeting matrix metalloproteases to improve cutaneous wound healing

Wound repair is a physiological event in which tissue injury initiates a repair process leading to restoration of structure and function of the tissue. Cutaneous wound repair can be divided into a series of overlapping phases including formation of fibrin clot, inflammatory response, granulation tissue formation incorporating re-epithelialisation and angiogenesis and finally, matrix formation and remodelling. Matrix metalloproteases (MMPs) are a family of neutral proteases that play a vital role throughout the entire wound healing process. They regulate inflammation, degrade the extracellular matrix (ECM) to facilitate the migration of cells and remodel the new ECM. However, excessive MMP activity contributes to the development of chronic wounds. Selective control of MMP activity may prove to be a valuable therapeutic approach to promote healing of chronic ulcers. Recent evidence indicates that the anticoagulant, activated protein C may be useful in the treatment of non-healing wounds by preventing excessive protease activity through inhibition of inflammation and selectively increasing MMP-2 activity to enhance angiogenesis and re-epithelialisation.

Detection and partial characterisation of two antibacterial factors from the excretions/secretions of the medicinal maggot Lucilia sericata and their activity against methicillin-resistant Staphylococcus aureus (MRSA)

Maggot therapy is a simple and highly successful method for cleansing infected and necrotic wounds. The use of maggots has become increasingly important in the treatment of non-healing wounds, particularly those infected with the multidrug-resistant pathogen, methicillin-resistant Staphylococcus aureus (MRSA). The increasing challenge concerning the treatment of MRSA infections and the recent finding of vancomycin-resistant strains of MRSA have elicited the search for novel antibacterial compounds and, in particular, investigations into the potent antibacterial mechanism(s) behind maggot therapy. In this study, we report that excretions/secretions (ES) from the blowfly, Lucilia sericata, exhibit potent, thermally stable, protease resistant antibacterial activity against MRSA in vitro. We describe the initial characterisation of two antibacterial factors from native ES of L. sericata. A small, <500 Da factor with significant antibacterial activity against MRSA was partially isolated using ultrafiltration techniques. The potent activity of this factor was comparable to that of native excretions/secretions. A larger, 0.5–3-kDa factor with significant activity against S. aureus was also partially characterised.

Wound microbiology and associated approaches to wound management.

The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds.

Autodermoimplantation technique for the treatment of non-healing wounds and trophic ulcers

Until now, the treatment of trophic leg ulcers is a difficult task. One of the treatment options was recognized as a surgical method by implanting small skin autoplants into the granulation tissue. However, the main reason for failure in its use is the imperfect technique of immersing skin grafts in granulation.

Omentum-enhanced reconstruction of chronic nonhealing wounds in cats: techniques and clinical use.

The greater omentum was used to aid in the reconstruction of nonhealing wounds in five cats. In each cat the cause of the nonhealing wound could not be determined. A vascular omental pedicle was created at laparotomy by dividing the dorsal leaf of the omentum at it pancreatic attachments (four cats) or by dividing the ventral leaf at its gastric attachments (one cat). The pedicle was then passed through either the ventral or lateral body wall into the nonhealing wound via a subcutaneous tunnel. The wounds were closed over the omentum after local tissue mobilization. All the wounds healed uneventfully and have remained healed with a mean follow-up period of 2.5 years. Complications included intestinal herniation through a ventral midline exit hole (one cat), presumed abdominal fat herniation through a ventral abdominal exit hole (one cat) and seroma formation (one cat). All of the complications were treated successfully. The omentum should be considered a useful adjunct in the treatment of nonhealing wounds in cats.

Carbon dioxide laser treatment of nonhealing wounds. (Russian)

Carbon dioxide laser treatment of nonhealing wounds. (Russian)

The α-glyceryl ethers

The glyceryl ethers have been identified in neonatal calf fat and methods of extraction and identification are described. They are found only in certain sites and their concentration falls very rapidly after birth. The glyceryl ethers have also been identified in meconium from human sources. It is considered that their formation is associated with cells of mesenchymal type, probably early forms of multilocular fat cells. The literature has been reviewed and their presence in adult bone marrow, erythrocytes and spleen can thus be explained. The presence of glyceryl ethers in atheromatous plaques is associated with other fractions of unsaponifiable material such as pigments, carotenoids and cholesterols, and is probably not specific. It has been shown that their experimental use in animals, and their clinical use in man is to initiate the first stage in wound healing if, and only if, this is pathologically inhibited. Therapeutic effect in the treatment of non-healing wounds and radiation injuries has been outlined, and the suggestion is made that their action is upon tissues of mesenchymal origin. Experiments have been put in hand to show if these substances have any prophylactic effect against the action of ionising radiation in minimal doses. No toxic effects have been noticed in prolonged oral administration in man, although individual tolerance in terms of nausea vary considerably.