Unhealed Wounds Research Articles

A Comprehensive Review of Wound Healing

Unhealed wounds are a largely hidden epidemic, affecting 6.5 million Americans and costing about $25 billion a year, with numerous patients affected. Unhealed wounds result in lower quality of life and limit many all-day activities for patients. Despite this large socioeconomic burden, there have been only a few meaningful advances in the science of wound care. Wounds represent a cross section of many medical disciplines—diabetes, trauma, hypertension, vascular insufficiency, and rheumatologic diseases—and a multidisciplinary approach is typically needed. In this review, we provide an overview of wound healing, its pathophysiology, different types of wounds, and the current state of therapeutic art. Key words: chronic wounds, infection, inflammation, mathematical modeling, ulcers, wounds

An Autologous Anti-Inflammatory Protein Solution Yielded a Favorable Safety Profile and Significant Pain Relief in an Open-Label Pilot Study of Patients with Osteoarthritis.

Osteoarthritis (OA) is a progressive and degenerative disease, which may result in significant pain and decreased quality of life. Recent updates in our understanding of OA have demonstrated that it is a whole joint disease that has many similarities to an unhealed wound containing inflammatory cytokines. The nSTRIDE Autologous Protein Solution (APS) Kit is a medical device under development for the treatment of OA. The APS Kit processes a patient's own blood at the point of care to contain high concentrations of anti-inflammatory cytokines and anabolic growth factors. This study assessed the safety and treatment effects of a single intra-articular injection of APS. Eleven patients were enrolled in this study. Sufficient blood could not be drawn from one patient who was subsequently withdrawn, leaving 10 patients treated. Minor adverse events (AEs) were experienced by seven subjects (63.6%). There was one serious AE (diverticulitis) unrelated to the device or procedure. One subject experienced AEs that were judged “likely” to be procedure related (arthralgia/musculoskeletal discomfort) and all resolved within 6 days of injection. All other AEs were unrelated to the device or procedure. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores improved significantly over time (ANOVA, p < 0.0001, 12.0 ± 1.2 preinjection, 3.3 ± 2.9 one year postinjection, and 72.5% WOMAC pain improvement). There was significant positive correlation between white blood cell concentration in APS and improvement in WOMAC pain scores.

Effects of arnebia root oil on wound healing of rats with full-thickness skin defect and the related mechanism

Objective: To observe the effects of arnebia root oil on wound healing of rats with full-thickness skin defect, and to explore the related mechanism. Methods: Eighty SD rats were divided into arnebia root oil group and control group according to the random number table, with 40 rats in each group, then full-thickness skin wounds with area of 3 cm×3 cm were inflicted on the back of each rat. Wounds of rats in arnebia root oil group and control group were treated with sterile medical gauze and bandage package infiltrated with arnebia root oil gauze or Vaseline gauze, respectively, with dressing change of once every two days. On post injury day (PID) 3, 7, 14, and 21, 10 rats in each group were sacrificed respectively for general observation and calculation of wound healing rate. The tissue samples of unhealed wound were collected for observation of histomorphological change with HE staining, observation of expressions of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) with immunohistochemical staining, and determination of mRNA expressions of VEGF and bFGF with real time fluorescent quantitive reverse transcription polymerase chain reaction. Data were processed with analysis of variance of factorial design, t test, and Bonferroni correction. Results: (1) On PID 3, there were a few secretions in wounds of rats in the two groups. On PID 7, there were fewer secretions and more granulation tissue in wounds of rats in arnebia root oil group, while there were more secretions and less granulation tissue in wounds of rats in control group. On PID 14, most of the wounds of rats in arnebia root oil group were healed and there was much red granulation tissue in unhealed wounds, while part of wounds of rats in control group was healed and there were a few secretions and less granulation tissue in unhealed wounds. On PID 21, wounds of rats in arnebia root oil group were basically healed, while there were still some unhealed wounds of rats in control group. (2) On PID 3 and 7, the wound healing rates of rats in arnebia root oil group were (39±5)% and (46±4)% respectively, which were close to (34±3)% and (44±4)% of rats in control group (with t values respectively 0.807 and 0.481, P values above 0.05). On PID 14 and 21, the wound healing rates of rats in arnebia root oil group were (76±4)% and (90±3)% respectively, which were significantly higher than (60±6)% and (73±5)% of rats in control group (with t values respectively 2.308 and 3.072, P<0.05 or P<0.01). (3) On PID 3, 7, and 14, granulation tissue, fibroblasts, and nascent capillaries in unhealed wound tissue of rats in the two groups both gradually increased, and more ranulation tissue, fibroblasts, and nascent capillaries were seen in unhealed wound tissue of rats in arnebia root oil group. On PID 21, granulation tissue, fibroblasts, and nascent capillaries in unhealed wound tissue of rats in the two groups both gradually decreased. (4) On PID 3, 7, and 14, the numbers of VEGF positive cells and bFGF positive cells in unhealed wound tissue of rats in the two groups both gradually increased; there were more VEGF positive cells and bFGF positive cells in unhealed wound tissue of rats in arnebia root oil group than those in control group. On PID 21, positive expressions of VEGF and bFGF both decreased in unhealed wound tissue of rats in the two groups. (5) On PID 3, 7, and 14, mRNA expressions of VEGF in unhealed wound tissue of rats in arnebia root oil group were higher than those of control group (with t values from 2.967 to 4.173, P values below 0.01). On PID 21, mRNA expression of VEGF in unhealed wound tissue of rats in arnebia root oil group was lower than that of control group (t=-4.786, P<0.001). From PID 3 to 21, mRNA expressions of bFGF in unhealed wound tissue of rats in arnebia root oil group were higher than those of control group (with t values from 2.326 to 4.702, P<0.05 or P<0.01). Conclusions: Arnebia root oil can promote wound healing of rats with full-thickness skin defect, which may relate to increasing expressions of VEGF and bFGF.

Visible Light-Cured Glycol Chitosan Hydrogel Containing a Beta-Cyclodextrin-Curcumin Inclusion Complex Improves Wound Healing In Vivo.

Scarless wound healing is ideal for patients suffering from soft tissue defects. In this study, we prepared a novel wet dressing (β-CD-ic-CUR/GC) based on the visible light-cured glycol chitosan (GC) hydrogel and inclusion complex between beta-cyclodextrin (β-CD) and curcumin (CUR). We also evaluated its efficacy in the acceleration of wound healing as compared to that of CUR-loaded GC (CUR/GC). The conjugation of glycidyl methacrylate (GM) to GC for photo-curing was confirmed by 1H-NMR measurement, and the photo-cured GC hydrogel was characterized by the analyses of rheology, swelling ratio, SEM and degradation rate. After visible light irradiation, the surface/cross-sectional morphologies and storage (G′)/loss (G′′) moduli revealed the formation of hydrogel with interconnected porosity. The dressing β-CD-ic-CUR/GC exhibited a controlled release of 90% CUR in a sustained manner for 30 days. On the other hand, CUR/GC showed CUR release of 16%. β-CD acted as an excipient in improving the water-solubility of CUR and affected the release behavior of CUR. The in vivo animal tests including measurement of the remaining unhealed wound area and histological analyses showed that β-CD-ic-CUR/GC may have potential as a wet dressing agent to enhance soft tissue recovery in open fractures.

Nasal decontamination for the prevention of surgical site infection in Staphylococcus aureus carriers.

Surgical site infection rates in the month following surgery vary from 1% to 5%. Due to the large number of surgical procedures conducted annually, the costs of these surgical site infections (SSIs) can be considerable in financial and social terms. Nasal decontamination using antibiotics or antiseptics is performed to reduce the risk of SSIs by preventing organisms from the nasal cavity being transferred to the skin where a surgical incision will be made. Staphylococcus aureus (S aureus) colonises the nasal cavity and skin of carriers and can cause infection in open or unhealed surgical wounds. S aureus is the leading nosocomial (hospital-acquired) pathogen in hospitals worldwide. The potential effectiveness of nasal decontamination of S aureus is thought to be dependent on both the antibiotic/antiseptic used and the dose of application; however, it is unclear whether nasal decontamination actually reduces postoperative wound infection in S aureus carriers. To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are S aureus carriers undergoing surgery. In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus. We also searched three clinical trial registries and the references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting. Randomised controlled trials (RCTs) which enrolled S aureus carriers with any type of surgery and assessed the use of nasal decontamination with antiseptic/antibiotic properties were included in the review. Two review authors independently performed study selection, data extraction, risk of bias assessment and GRADE assessment. We located two studies (291 participants) for inclusion in this review. The trials were clinically heterogeneous with differences in duration of follow-up, and nasal decontamination regimens. One study compared mupirocin (2% contained in a base of polyethylene glycol 400 and polyethylene glycol 3350) with a placebo in elective cardiac surgery patients; and one study compared Anerdian (iodine 0.45% to 0.57% (W/V), chlorhexidine acetate 0.09% to 0.11% (W/V)) with no treatment also in cardiac surgery patients. The trials reported limited outcome data on SSI, adverse events and secondary outcomes (e.g. S aureus SSI, mortality). Mupirocin compared with placeboThis study found no clear difference in SSI risk following use of mupirocin compared with placebo (1 trial, 257 participants); risk ratio (RR) 1.60, 95% confidence interval (CI) 0.79 to 3.25 based on 18/130 events in the mupirocin group and 11/127 in the control group; low-certainty evidence (downgraded twice due to imprecision). Anerdian compared with no treatmentIt is uncertain whether there is a difference in SSI risk following treatment with Anerdian compared with no treatment (1 trial, 34 participants); RR 0.89, 95% CI 0.06 to 13.08 based on 1/18 events in the Anerdian group and 1/16 in the control group; very low certainty evidence (downgraded twice due to imprecision and once due to risk of bias). There is currently limited rigorous RCT evidence available regarding the clinical effectiveness of nasal decontamination in the prevention of SSI. This limitation is specific to the focused question our review addresses, looking at nasal decontamination as a single intervention in participants undergoing surgery who are known S aureus carriers. We were only able to identify two studies that met the inclusion criteria for this review and one of these was very small and poorly reported. The potential benefits and harms of using decontamination for the prevention of SSI in this group of people remain uncertain.

Detection of Nocardia from Chronic Skin and Lung Infections in Bangladeshi Patients

Nocardiosis is an acute or chronic infectious disease that may occur in cutaneous, pulmonary and disseminated form in both immunocompromised and immunocompetent host. It may become potentially severe due to delayed diagnosis and incomplete or ineffective treatment. So the aim of the study was to isolate Nocardia spp. from suspected samples, mainly from chronic unhealed wounds and to identify appropriate antimicrobials by susceptibility testing in Bangladeshi patients. Methods: From January 2015-2017, 62 samples were collected which were studied for Nocardial identification and susceptibility testing. Results: Out of total 62 cases, 18 (29.03%) cases were Nocardia positive cases. Besides 6 Acinetobacter spp. and 2 Actinomyces spp. with other varied pathogens were isolated. Among 18 identified nocardiosis patients, majority (10) were post surgery cases, 6 suspected skin and glandular tuberculosis (TB) cases, one had breast sinus, and one was suspected pulmonary TB case. In terms of susceptibility of nocardial isolates, 100% were susceptible to linezolid, 88.9% to amikacin and 78% to trimethoprim-sulphamethoxazole.

TCTAP C-224 Persisting Rest Pain and Claudication of a Critical Limb Ischemia Patient After Performing a Superficial Femoral Artery Antegrade Approach Procedure

### Patient initials or identifier number Mr. Sun ### Relevant clinical history and physical exam A 63 year-old diabetes and heart failure with impaired LV function patient suffered from severe left leg pain and had an unhealed ulcerative wound at his left heel. The symptoms turned worse after he

Unhealed Wound of the Lower Leg due to Synovial Fistula of the Ankle Joint

Unhealed Wound of the Lower Leg due to Synovial Fistula of the Ankle Joint

Approach to peripheral arterial disease in the elderly

The prevalence of peripheral arterial disease, which usually develops on the basis of atherosclerosis and develops as a result of chronic arterial occlusive pathology, increases with age. Peripheral artery disease in the elderly patient population may be asymptomatic due to restrictive conditions associated with immobilization. Concurrent cerebrovascular disease and coronary artery disease risk and mortality rates are higher in elderly patients with peripheral artery disease. The life expectancy in patients with peripheral arterial disease is worse than in prostate cancer patients. Leading risk factors include advanced age, smoking, diabetes mellitus, hypertension, hyperlipidemia, hyperhomocysteinemia and hypothyroidism. The most important physical examination component is the palpation of the entire peripheral pulses. The cases in which the ankle-brachial systolic pressure index measurement for clinical diagnosis is below 0.9 are defined as peripheral arterial disease. It is aimed to completely correct or improve the existing clinical symptoms and to increase the survival rates of the patients. The existing risk factors are modified as the first step of the treatment. Smoking cessation, treatment of hypertension primarily with angiotensin-converting enzyme inhibitors, lowering of hemoglobin A1c levels below 7%, anti-hyperlipidemic treatment primarily with statin, antiaggregant therapy primarily with clopidogrel, cilostazol therapy, good foot care, controlled exercise program, if necessary, interventional or operational revascularization, amputation in the presence of irreversible effects are the main treatment components. Indications for major revascularization include the presence of resting pain in the limb and / or open and long-lasting unhealed wound in the extremity and / or severe complaints of intermittant claudication that will result in limitation in daily activities. It should not be forgotten that, all the clinical decisions to be taken in the treatment of elderly patients with peripheral arterial disease are determined by the patient's physical condition, current clinical condition and the expectation level of the patient.

A review of the peri-operative management of paediatric burns: Identifying adverse events.

Burn injuries are common in poverty-stricken countries. The majority of patients with large and complex burns are referred to burn centres. Of the children who qualify for admission, according to burn admission criteria, about half require some kind of surgical procedure to obtain skin cover. These range from massive full-thickness fire burns to skin grafts for small, residual unhealed wounds. Burn anaesthetic procedures are of the most difficult to perform and are known for high complication rates. Reasons include peri-operative sepsis, bleeding, issues around thermoregulation, the hypermetabolic state, nutritional and electrolyte issues, inhalation injuries and the amount of movement during procedures to wash patients, change drapes and access different anatomical sites. The appropriate execution of surgery is therefore of the utmost importance for both minor and major procedures. To review the peri-operative management and standard of surgical care of burnt children. This was a retrospective review and analysis of standard peri-operative care of burnt children at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. A total of 558 children were operated on and supervised by the first author. Factors that could adversely affect surgical and anaesthetic outcomes were identified. There were 257 males and 301 females in this study, with an average age of 50.1 months and average weight of 19.5 kg. The total body surface area involved was 1 - 80%, with an average of 23.5%. Inhalational injury was present in 11.3%, pneumonia in 13.1%, wound sepsis in 20.8%, and septicaemia in 9.7%, and organ dysfunction in more than one organ was seen in 6.1%. The average theatre temperature during surgery was 30.0°C. Core temperatures recorded at the start, halfway through and at completion of surgery were 36.9°C, 36.8°C and 36.5°C, respectively. The average preoperative and postoperative haemoglobin levels were 11.28 g/dL and 9.64 g/dL, respectively. Blood loss was reduced by the use of clysis from 1.5 mL/kg/% burn to 1.4 mL/kg/% burn. Adverse intraoperative events were seen in 17.6% of children. Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control, rapid blood loss, preceding respiratory illnesses and measures to reduce blood loss.

An Evaluation of the OTA-OFC System in Clinical Practice: A Multi-Center Study With 90 Days Outcomes.

The purpose of this study is to evaluate the predictive ability of the Orthopedic Trauma-Open Fracture Classification (OTA-OFC) system in regards to short-term (90 days) outcomes of amputation, infection necessitating intravenous antibiotics, and wound healing in clinical practice across multiple centers. Prospective observational study. Academic and private practice. Patients with open fractures. None. OTA-OFC, amputations, IV antibiotics, and wound healing. Three hundred seventy-three patients with a total of 419 open fractures were enrolled. Logistic regression to predict amputation demonstrated that arterial and skin injury were statistically significant contributors to the prediction of amputation. Bone loss and muscle injury were significant contributors to the prediction of readmission for IV antibiotics. None of the variables in the OTA-OFC were significant predictors of unhealed wounds. Our study demonstrates the predictive value of the OTA-OFC regarding the short-term (90 days) outcomes of amputation and infection necessitating IV antibiotics and is another step towards the validation of the OTA-OFC in widespread clinical practice. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Arginine Silicate Inositol Complex Accelerates Cutaneous Wound Healing

Arginine silicate inositol (ASI) complex is a composition of arginine, silicon, and inositol that has been shown to have beneficial effects on vascular health. This study reports the effects of an ASI ointment on wound healing in rats. A full-thickness excision wound was created by using a disposable 5mm diameter skin punch biopsy tool. In this placebo-controlled study, the treatment group's wound areas were covered by 4 or 10% ASI ointments twice a day for 5, 10, or 15days. The rats were sacrificed either 5, 10, or 15days after the wounds were created, and biopsy samples were taken for biochemical and histopathological analysis. Granulation tissue appeared significantly faster in the ASI-treated groups than in the control groups (P<0.05). The mean unhealed wound area was significantly smaller, and the mean percentage of total wound healing was significantly higher in ASI-treated wounds than in the control wounds. Hydroxyproline, collagen, and matrix metalloproteinases were measured in the granulated tissue and found to be affected. Inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), collagen, matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), epidermal growth factor (EGF), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and various cytokines (TNF-α and IL-1β) measured in this study showed a significant fall in expression level in ASI-treated wounds. The results suggest that topical application of ASI ointment (especially 4% concentration) has beneficial effects on the healing response of an excisional wound.

An empowerment health education program for children undergoing surgery for congenital heart diseases.

Since the surgery for congenital heart disease (CHD) is considered highly risky, appropriate postoperative care is crucial. After the surgery, children are often discharged with unhealed wounds, incomplete recovery, and continuing pain. Health education programs based on empowerment education model can assist clients to develop skills in self-management. This study aimed to evaluate the effectiveness of an empowerment health education program for improving caregiving knowledge, caring behaviors, and self-efficacy of parents caring for children after corrective surgery for CHD. This prospective clinical trial enrolled pediatric patients undergoing surgical correction for CHD. Patients were divided into two groups: the control group (n = 42), which received the standard education program, and the intervention group (n = 44), which participated in the empowerment theory-based education program. We collected data on left ventricular ejection fraction (LVEF); peripheral oxygen saturation (SpO2); New York Heart Association classification of the patients; and the parents' caregiving knowledge, caring behaviors, and self-efficacy before surgery and one month and three months after surgery. At one month and three months after surgery, the intervention group scored higher than the control group in caregiving knowledge, caring behavior, and self-efficacy. By the third month after surgery, the intervention group had significantly higher values of LVEF and SpO2 than the control group.

Time to Wound Healing and Major Adverse Limb Events in Patients with Critical Limb Ischemia Treated with Endovascular Revascularization

There are few studies that quantify the impact of time to wound healing on outcomes after endovascular revascularization of critical limb ischemia (CLI). In this retrospective study, 179 patients with CLI and tissue loss were assessed for adverse events after endovascular therapy. Associations between time to wound healing and outcomes were determined via Cox proportional hazards analysis. The long-term probability of events was assessed with Kaplan-Meier analysis. The primary end point was major adverse limb events (MALE-major amputation, surgical endarterectomy, or bypass). Secondary end points were major amputation, need for repeat endovascular therapy, and mortality. After multivariable adjustment for time-dependent wound healing, age, renal function, diabetes, and Rutherford class, independent predictors of MALE included the presence of an unhealed wound (hazard ratio [HR], 5.2; 95% confidence interval (CI), 2.3-11.8; P<0.0001) and creatinine≥2.0 (HR, 2.4; 95% CI, 1.4-4.3; P=0.003). On Kaplan-Meier analysis, the probability of MALE was greater in patients with unhealed wounds compared with healed wounds (log-rank P<0.0001). Patients whose wounds healed within 4months had a lower probability of MALE than patients who did not heal by 4months (log-rank, P=0.04). Unhealed wounds were also independently associated with major amputation (HR, 9.0; 95% CI, 2.6-31.1; P=0.0004), and patients whose wounds healed by 3months had less major amputation (log-rank, P=0.04). Unhealed wounds were independently associated with increased risk of mortality (HR, 42.7; 95% CI, 5.7-319.0; P=0.002) but not repeat revascularization. Unhealed wounds are an independent risk factor for MALE, major amputation, and mortality after endovascular treatment of CLI. Wound healing within 3months is associated with less risk of major amputation, and within 4months less risk of MALE. A focus should be on achieving wound healing as fast as possible in this population.

Health economic burden that different wound types impose on the UK's National Health Service.

The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to the management of different wound types by the UK's National Health Service (NHS) in 2012/2013 and the annual costs incurred by the NHS in managing them. This was a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) Database. Patients' characteristics, wound-related health outcomes and all health care resource use were quantified, and the total NHS cost of patient management was estimated at 2013/2014 prices. The NHS managed an estimated 2·2 million patients with a wound during 2012/2013. Patients were predominantly managed in the community by general practitioners (GPs) and nurses. The annual NHS cost varied between £1·94 billion for managing 731 000 leg ulcers and £89·6 million for managing 87 000 burns, and associated comorbidities. Sixty-one percent of all wounds were shown to heal in an average year. Resource use associated with managing the unhealed wounds was substantially greater than that of managing the healed wounds (e.g. 20% more practice nurse visits, 104% more community nurse visits). Consequently, the annual cost of managing wounds that healed in the study period was estimated to be £2·1 billion compared with £3·2 billion for the 39% of wounds that did not heal within the study year. Within the study period, the cost per healed wound ranged from £698 to £3998 per patient and that of an unhealed wound ranged from £1719 to £5976 per patient. Hence, the patient care cost of an unhealed wound was a mean 135% more than that of a healed wound. Real-world evidence highlights the substantial burden that wounds impose on the NHS in an average year. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (a) wound prevention, (b) accurate diagnosis and (c) improving wound-healing rates.

Hospital Readmissions Following Endovascular Therapy for Critical Limb Ischemia: Associations With Wound Healing, Major Adverse Limb Events, and Mortality.

BackgroundThe significance of hospital readmission after endovascular therapy for critical limb ischemia (CLI) is not well established. We sought to investigate the incidence, timing, and causes of readmissions after endovascular therapy for CLI and whether readmission is associated with major adverse limb events (MALE) or mortality.Methods and ResultsThis was a retrospective study of 252 patients treated with endovascular therapy for CLI. During median follow‐up of 381 days (interquartile range [IQR], 115–718), 140 (56%) were readmitted, with median time to readmission of 83 days (IQR, 33–190). Readmission within 30 days occurred in 14% of patients (n=35; 25% of readmissions). Most readmissions occurred between 30 and 180 days (n=67; 48% of readmissions). The most frequent reason for readmission was unhealed wounds (n=63; 45% of readmissions). Independent predictors of readmission by Cox proportional hazards analysis were unhealed wounds, presence of multiple wounds, age ≥70, female sex, hemodialysis, and history of heart failure (P<0.05 for each). By Kaplan–Meier analysis, readmission was greatest in patients with unhealed wounds, followed by patients who never had a wound, and lowest in patients whose wounds completely healed (P<0.0001 overall, and P<0.01 between groups). After multivariable adjustment, readmission remained an independent predictor of composite MALE (major amputation, bypass, or endarterectomy) or mortality (adjusted hazard ratio, 3.1; 95% CI, 1.5–6.5; P=0.002).ConclusionsMost readmissions occur 30 and 180 days after endovascular therapy for nonprocedural reasons. Unhealed wounds are an independent risk factor for readmission. Readmission is associated with increased MALE and mortality after endovascular therapy for CLI.

The Use of a Novel Canister-free Negative-Pressure Device in Chronic Wounds: A Retrospective Analysis.

Negative-pressure wound therapy (NPWT) is a mainstay in the treatment of acute and chronic wounds. Following the success of the Vacuum-Assisted Closure system (Kinetic Concepts Inc [KCI], an Acelity Company, San Antonio, Texas), many similar systems were developed with minor variations. However, these systems are best suited to wounds with soft-tissue defects. Moreover, the need for a canister to collect wound exudate adds to the size and weight of the device. A canister-free (CF) NPWT device was cleared by the FDA for the treatment of chronic wounds (Kalypto Medical, Mendota Heights, Minnesota). A retrospective study was designed to evaluate the effectiveness of the CF-NPWT device in promoting wound healing. The authors examined the records of 51 patients treated with the CF-NPWT device over a 21-month period. Study participants were treated in an outpatient setting, had at least 30 days of prior treatment, and carried insurance coverage through Medicare or Medicaid. The comparison of time to heal between groups was conducted using the log-rank, Breslow, and Tarone-Ware tests in conjunction with a Kaplan-Meier analysis. In the study population, 65% of the wounds achieved complete closure. For unhealed wounds, the mean wound area reduction was 31.9%, and the mean wound depth reduction was 57.5%. The mean time to heal was 56.9 days (95% confidence interval, 46.4-67.4 days). The results show that the CF-NPWT system meets or exceeds healing rates previously reported in the literature for canister-based systems. This CF device offers a more portable NPWT option, particularly effective in the treatment of shallow wounds.

Памяти И.М. Никольской

Deep and unhealed soul wound was the news of the death of the doctor of psychological sciences, Professor Irina Mikhailovna Nikolskaya. Light image of Irina Mikhailovna will stay forever in our hearts. It’s impossible to imagine, that with us there is no man, that was light, bright, open, unique and cheerful.

Grip and Muscle Strength Dynamometry Are Reliable and Valid in Patients With Unhealed Minor Burn Wounds.

Small burns are common and can cause disproportionate levels of disability. The ability to measure muscle impairment and consequent functional disability is a necessity during rehabilitation of patients. This study aimed to determine the reliability and validity of grip and muscle strength dynamometry in patients with unhealed, minor burn wounds. Grip and muscle strength were assessed three times on each side. Assessment occurred at presentation for the initial injury and again every other day (or every 5 days beyond 10 days post injury) until discharge from the service. Reliability was assessed using intraclass correlation. Minimum detectable differences were calculated for each muscle group. Validity was assessed using regression analysis, incorporating appropriate burn severity measures and patient demographics. Thirty patients with TBSA ≤15% were assessed. Both grip and muscle strength demonstrated very good reliability (intraclass correlation coefficient: 0.85-0.96). Minimum detectable differences ranged from 3.8 to 8.0 kg. Validity of both forms of dynamometry was confirmed through associations with gender for all muscle groups (P < .001). In addition, grip strength was associated with the dominant hand (P = .002) and time to assessment (P < .001). Strength was seen to improve over time in all muscle groups. Grip and muscle strength dynamometry are reliable and valid assessments of strength and are applicable for clinical use in patients who have unhealed, minor burn wounds.

Experiences of Depression in Low Income Elderly Women.

The purpose of this qualitative research was to understand the meaning of the depression in low income elderly women. Participants were 15 elderly women, aged between 60 and 80 who were registered in two senior welfare centers in Seoul. Data were collected from June to December, 2012 after having obtained consent from participants. In-depth interviews were done with open-ended questions about their depression experiences, which were audio-taped and transcribed with verbatim. Data were analyzed using qualitative content analysis to discover the categories considering their relationships and abstractness. Depressions of aged women were a part of the their life throughout their long lived hardship and was implied unhealed wounds within the relationship. Participants did not know how to manage with depression symptoms that they tried to overcome individually but due to decreased activities and interpersonal relationships, their depressions were tended to continue. They have tried to get out from depressive symptoms, but it still remains unseen shadow of mind. This results suppose that social support and aged welfare policy included reliving the economical difficulty and improving relationships will be provided to manage the depression for low income elderly women.