Wound Surface Area Research Articles

Pilot Study to Assess Safety and Usability of the Kyron NPWT System.

Background:There is an evident need for Negative Pressure Wound Therapy (NPWT) systems specifically designed for use in resource-constrained settings to aid in the treatment of open wounds.Methods:Prospective single-arm interventional pilot study of 14 patients with complex wounds was conducted at Kirtipur Hospital in Kathmandu, Nepal. A novel NPWT device, the Kyron Suction Unit, was used by 4 plastic surgeons. Primary outcomes were ease of use (10-point Likert scale) and device safety (adverse events recorded). Pain (Visual Analogue Scale score), quality of life (modified EuroQol Derived Single Index scores), and wound dimensions were recorded.Results:User ratings on the 10-point Likert scale indicated high confidence and ease of use: median confidence setting up the device of 1.0 [interquartile range (IQR), 1.0; mean 2.3], median confidence maintaining the device of 1.0 (IQR, 1.0; mean, 1.5), and median ease of disassembly of 1.0 (IQR, 1.0; mean, 1.4). Significant improvement in Visual Analogue Scale scores (P = 0.03), modified EuroQol Derived Single Index scores (P < 0.001), and a reduction in wound volume [median, 47.25–9.75 cm3 (P = 0.01)]. Image analysis of wounds pretreatment and posttreatment demonstrated increase in granulation tissue surface area [median, 7.6–28.7 cm2 (P = 0.003)] and decrease in open wound surface area [median, 48.33–33.6 cm2 (P = 0.01)].Conclusions:The Kyron Suction Unit was safe and easily managed by plastic surgeons. The device design promoted access to NPWT, a therapy proven to reduce healing time and decrease complications for patients with open wounds, in a resource-constrained setting.

Effect of exposure to low salinity water on plasma ion regulation and survival rates in artificially wounded devil stinger &lt;i&gt;Inimicus japonicus&lt;/i&gt;

We investigated the effect of exposure to low salinity water on plasma ion regulation and survival rates in artificially wounded devil stinger Inimicus japonicus. All fishes survived in 33% seawater (SW), while survival rate in 100% SW was 5.1% at 24 h. In 100% SW, plasma Na+, K+, Mg2+, and Ca2+ concentrations significantly increased to 238 ± 49.9, 9.6 ± 2.4, 15.1 ± 3.5 and 5.0 ± 0.7 mmol/l at 6 h, respectively; the gill Na+/K+–ATPase (NKA) activity was almost stable, although only one fish survived to 24 h. In 33% SW, plasma Na+ and K+ concentrations remained at the same level, and plasma Mg2+ and Ca2+ concentrations gradually increased to 16.2 ± 0.7 and 4.5 ± 0.2 mmol/l until 24 h, respectively. The NKA activity significantly increased to 5.1 ± 1.1 µmol ADP/mg protein per h at 6 h. A positive correlation was observed between the wound surface area against body weight and the plasma ion concentrations, although no difference was observed in the restoration rate of the wounded area between 100 and 33% SW. These results indicate that exposure of wounded fish to low salinity water improves survivability by favoring plasma ion regulation without influencing the restoration rate.

Evaluation of wound fluid biomarkers to determine healing in adults with venous leg ulcers: A prospective study.

Clinical practice guidelines recommend using repeated wound surface area measurements to determine if a chronic ulcer is healing. This results in delays in determining the healing status. This study aimed to evaluate whether any of a panel of biomarkers can determine the healing status of chronic venous leg ulcers. Forty-two patients with chronic venous leg ulcers had their wound measured and wound fluid collected at weekly time points for 13 weeks. Wound fluid was analyzed using multiplex enzyme-linked immunosorbent assay to determine the concentration of biomarkers in the wound fluid at each weekly time point. Healing status was determined by examining the change in wound size at the previous and subsequent weeks. Predictive accuracy with 95% confidence intervals (CI) is reported. Of 42 patients, 105 evaluable weekly time points were obtained, with 32 classified as healing, 27 as nonhealing, and 46 as indeterminate. Thirteen biomarkers significantly differed between healing and nonhealing wounds (p < 0.1) and were included in a multivariate logistic regression model. Granulocyte macrophage-colony stimulating factor (p < 0.001) and matrix metalloprotease-13 (p = 0.004) were the best predictors of wound healing. Receiver operating characteristic curves indicated 92% accuracy (95% CI: 85%,100%) for granulocyte macrophage-colony stimulating factor, and 78% accuracy (95% CI: 65%,90%) for matrix metalloprotease-13 in discriminating between healing and nonhealing wounds. This study found that two biomarkers from wound fluid can predict healing status in chronic venous leg ulcers. These findings may lead to the ability to determine the future trajectory of a wound and the ability to modify treatment accordingly.

Wound protectors for improved exposure in open hernia repair

Achieving adequate surgical exposure is fundamental to good surgical practice. Traditionally, in the repair of ventral and open inguinal hernias, this has been accomplished with the aid of self-retaining retractors or by extending the incision length. We propose that using disposable wound protectors, surgical exposure will be improved for a given incision length in the repair of ventral and open inguinal hernias, compared to traditional methods. Through the use of an animal tissue model, we compared incisions of varying lengths and measured the dimensions of the exposure achieved with disposable wound protectors (Alexis™) and a Mollison self-retainer. We calculated the surface area and, therefore, exposure gained using the specified wound retraction devices and compared the results. The average superficial surface area of wound with a self-retainer compared to the small and extra-small disposable wound protector was 2.65cm2 vs 2.27cm2 (small) and 2.2cm2 (extra-small) for 2cm incision length, 3.6cm2 vs 4.93cm2 and 4.2cm2 for 3cm incision length, 5.19cm2 vs 8.25cm2 and 6.27cm2 for 4cm incision length, 6.17cm2 vs 12.25cm2 and 9.07cm2 for 5cm incision length, and 8.75cm2 vs 16.73cm2 and 10.78cm2 for 6cm incision length [p = 0.038 (small) and p = 0.049 (extra-small)]. Our results show a statistically significant increase in surface area of a wound for each incision length when a disposable wound protector was used for exposure, compared to a self-retainer. Our results demonstrate that the use of disposable wound protectors provides superior surgical exposure for a given incision length compared to traditional techniques in the repair of ventral and open inguinal hernia repairs.

Hydrosurgical debridement as an approach to wound healing: an animal thermal burn model.

This study investigates the advantages of hydrosurgical debridement compared with surgical debridement. Thermal skin burns were created on the backs of male Wistar rats. Surgical debridement was used to treat one wound and hydrosurgical debridement (Versajet Hydrosurgery System, Smith&Nephew, UK) used to treat the second wound. Debridement time, blood loss volume, time-to-heal and histologic changes in the wound areas were compared. A total of 23 rats were used in the study. Debridement time and time-to-heal were significantly shorter with hydrosurgical debridement than with surgical debridement (p<0.01 and p<0.05, respectively). Blood loss volume was significantly less with hydrosurgical debridement (p<0.01), and the wound surface area was significantly smaller on days two (p<0.01), four (p<0.05) and seven (p<0.05). Dense inflammatory cell infiltration into dermal muscle was deeper after surgical debridement (p=0.017). Reactive fibrotic tissue at the wound surface was significantly thinner (p<0.001) and the vascular endothelial cell count was significantly higher (p<0.001) after hydrosurgical debridement. The hydrosurgical system used appears to provide for minimally invasive debridement that can be performed in a relatively short period of time. Use of the device appears to minimise injury to healthy tissue and ameliorate inflammation, which in turn promotes early wound healing and reduces scar contracture. Hydrosurgical debridement appears to cause less damage to normal tissues. Furthermore, it is easier and requires less time.

Saline dressing versus povidone iodine dressing in chronic diabetic foot ulcer healing: a prospective comparative study

Background: Numerous topical agents are used for chronic diabetic foot ulcer (DFU) care and healing. In most of the hospitals in India povidone iodine is used topically for DFU dressing, however few other agents are more efficacious; the present study was aimed to compare the effect of povidone iodine and normal saline dressing in healing of DFU.Methods: A total of 50 patients (25 patients in each arm of povidone Iodine and Saline dressing group) with complaints of chronic DFU attending surgery outpatient department of Rajarajeswari Medical College and Hospital were considered in this prospective comparative study from July 2017 to December 2018. Dressings were done on daily basis for a period of 6 weeks, and the results were compared on 2nd, 4th and 6th week, using reduction in surface area of chronic DFU as parameter of healing process.Results: The mean surface area of wound in povidone iodine group was: baseline- 12.2 sq.cm, 2nd week- 11.7 sq.cm, 4th week- 10.6 sq.cm, 6th week- 9.8 sq.cm; While in saline group was: baseline- 13.3 sq.cm, 2nd week- 11.6 sq.cm, 4th week- 10.8 sq.cm, 6th week- 9.6 sq.cm. After 6 weeks, the mean reduction in surface area of wound is more in the saline dressing group compared with the povidone iodine dressing group and the results are statistically significant at a p&lt;0.05.Conclusions: Saline dressing is more effective than povidone iodine dressing in achieving complete healing, reducing wound surface area, and increasing comfort in subjects with chronic DFU.

A study of the prevalence and severity of vitamin D deficiency in patient with diabetic foot and its association with vascular calcification and effect on healing

Background: With the increasing prevalence of diabetes mellitus (DM), vitamin D (vit D) deficiency and vascular calcification is frequently observed in DM and is an indicator of diabetic peripheral vascular disease with variable implications. Due to the current limited understanding, this research was initiated. Aims and objective was to critically assess the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection, the association between vascular calcification and vitamin D deficiency and effect on healing in diabetic foot patient with and without vitamin D deficiency.Methods: This observational study was conducted on 50 patients with diabetes mellitus. A detailed clinical history was recorded. Infection was confirmed by culture positivity and Doppler was used to detect vascular calcification. A follow-up for 3 weeks was done after which wound healing rate was assessed by change in wound surface area. Data was analyzed by Chi-square test and multivariate regression analysis.Results: 58% patients were diagnosed with vitamin D deficiency. 40% of patients found to have VC associated with DM. 100 % association of VC was found in patients with severe vitamin D deficiency. Vitamin D deficiency significantly correlated with vascular calcification (p=0.0001). A significant difference was observed in wound healing between the patients with and without vitamin D deficiency i.e. 3.14±2.04mm.sq and 4.36±1.39mm.sq.Conclusions: This study opens up an issue of recognizing vitamin D deficiency as a possible risk factor for diabetic foot infections and suggests the need for vitamin D supplementation.

577 Successful allogeneic epidermal grafting of chronic recessive dystrophic epidermolysis bullosa wounds from hematopoietic cell donors in the outpatient setting

Chronic wounds, or non-healing epidermal erosions present >6 weeks, are common, contribute to morbidity, and lack definitive therapy in recessive dystrophic epidermolysis bullosa (RDEB). The immune tolerance established by allogeneic hematopoietic cell transplantation (HCT) permits adoptive transfer of donor epidermal grafts and establishment of induced mosaicism. In a prospective, open label clinical trial for post-HCT RDEB patients with stable peripheral blood donor chimerism of ≥5%, up to 3 chronic wounds were grafted. Epidermal skin grafts measuring 5 cm2 were obtained from related HCT donors in the outpatient setting using the CelluTomeTM Epidermal Harvesting System. Wound size was measured at baseline, 6, 12, and 52 weeks. Nine patients received a total of 23 epidermal grafts at a median of 1207 days (range 267-3111) post-HCT. The mean (±SD) percent reduction in wound surface area achieved was 61.8% (±31.3), 85.1% (±20.3), and 90.9% (±16.8), at 6, 12, and 52 weeks, respectively, each significantly reduced compared to baseline (p < 0.0001). Donor harvest sites healed quickly with no scarring, though mild hypopigmentation was noted in 5 of 9. Recipient reported benefits include absence of blistering, touch sensation equivalent to native skin, and normal temperature regulation at donor sites. Evaluation of one graft following completion of the study at 1 year revealed wild-type type VII collagen staining by immunofluorescence, normal ultrastructure including intact anchoring fibrils at the dermal-epidermal junction by electron microscopy, and full thickness skin whole DNA donor chimerism of 42% (compared to 16% in concurrently biopsied native skin). Persistence of the donor graft beyond 1 year and observed migration of donor-grafted cells into adjacent wound suggest the epidermal grafts include non-terminally differentiated cells.

Effects of silver sulfadiazine and Actilite® honey on bacteria wound colonisation and wound healing in children with partial superficial burn wounds at University Teaching Hospital, Lusaka, Zambia

Background: Burn wounds are a global public health concern and Zambia has not been spared. Burn wounds account for 6% of surgical admissions yearly and yet are amongst the common causes of mortality at University Teaching Hospital (UTH). Burn wounds seen at UTH affect children more than adults and the common size is £20 per cent and partial superficial thickness in depth. The hospital has no burns unit and as such patients are admitted in general wards where cross infection is not uncommon. With high infection and mortality rates at UTH this study is of importance as it examined the effects of Actilite® honey and Silver sulfadiazine on bacteria wound colonisation and wound healing in paediatric partial superficial burn wounds of £20 per cent total body surface area.&#x0D; Methods: This two-arm open label randomised trial was done at UTH over a period of seven months (July 2017-January, 2018). Children under twelve years with £20% partial superficial burn wounds were recruited. Simple randomisation was used to allocate patients to either honey or SSD group. Patients' clinical characteristics were noted on recruitment. Swabs for microbiological evaluation were collected on day 0, 3, 7 and 10 and wounds were assessed for healing. The University of Zambia Biomedical Research and Ethics Committee approved the research.&#x0D; Results: Of the 64 patients, 32 were allocated to each group. The modal age distribution was 1-2 years and the percentage burn wound surface area was 6-10 percent in both age groups. At baseline there was no significant association between the two treatment methods and bacterial wound colonisation (80% in honey group and 83% in SSD group; p = 0.74) using Chi-squared test. However, by day 10 on treatment, there was significant reduction in bacterial wound colonisation (Honey Vs SSD; P = 0.026). Using Student T-test it was found that wounds treated with Actilite® honey healed quicker than those treated with SSD (Mean 11± 4, 15±6, P=0.0049). &#x0D; Conclusion: The study showed that treatment of children under 12years with partial superficial burn wounds of £20 per cent TBSA using Actilite® honey significantly reduced levels of bacteria wound colonisation by day 10. Furthermore, wounds in the Actilite® honey group healed quicker than SSD group. Therefore, use of Actilite Honey on burn wounds could be explored as alternative to SSD in managing paediatric partial superficial burn wounds of 20% and below at UTH.

Negative pressure wound therapy versus microcurrent electrical stimulation in wound healing in burns.

To compare the efficacy of negative pressure wound therapy (NPWT) with that of microcurrent electrical stimulation (MES) on wound surface area, length of stay (LoS) and colony count of wounds in patients with burns. Patients with thermal dermal burn injuries covering 25-40% of total body surface area were enrolled in this clinical trial. Participants were randomly allocated into three, equal-sized groups: patients receiving NPWT, patients receiving MES and a control group which received standard wound care. All groups received the same traditional physical therapy programme in addition to the same nursing and medical care. In all groups, wound surface area, colony count and LoS were measured 72 hours after thermal burn injury (pre), after 10 days and again at 21 days from the beginning of the study. A total of 45 patients took part in the study. There were statistically significant decreases in wound surface area observed in all groups (p<0.05) while MES showed the highest mean percentage of reduction in wound surface. MES and NPWT both showed the lowest values for bacterial growth but NPWT was superior in colony count reduction. For LoS, both MES and NPWT showed the lowest mean value. From the findings of this study, MES was more effective in decreasing wound surface area in burn wounds while NPWT was more effective in reducing bacterial growth.

Topical Application of Lactobacillus plantarum on Burn Wound Healing in Diabetic Rats

Objective- This study was designed to investigate the effect of Lactobacillus plantarum gel on cutaneous burn wound healing in diabetic rats.Design- Randomized experimental studyAnimals- Forty adult male ratsProcedures- Two circular 1 cm cutaneous wounds were created in the dorsum back of each rat. 48 h post-burning, debridement with a 1 cm biopsy punch was performed. The wounds were divided into the following four treatment groups (n= 10, each): 1. Untreated or negative control (NC), 2. silver sulfadiazine (positive control-SSD), 3. base gel (BG) 4. Lactobacillus plantarum Gel (LP gel). The wound surface area and epithelialization were monitored. The animals were euthanized at 10 (n = 5), and 20 (n = 5) days post-injury (DPI) and the skin samples were used for histopathological, biochemical, TGF-β gene expression and biomechanical investigations. Results- It was indicated that the L. plantarum and SSD treated lesions had the lowest percentage of wound size and collagen content and also the L. plantarum treated group showed shortest inflammatory period and highest amount of TGF-β at 10 days post injury. The L. plantarum gel treated lesions also demonstrated greater ultimate load compared to the untreated and based gel treated wounds.Conclusions and Clinical Relevance- In conclusion, L. plantarum gel therapy improved wound healing and resulted in better outcomes after severe burn injury in diabetic rats compared with the silver sulfadiazine treatment.

Evaluating the Effects of a Topical Preparation with Dexpanthenol, Silbiol, Undecylenic Acid, and Lidocaine on Palatal Mucosa Wound Healing in a Rat Model

Background:Postoperative complications occur after periodontal plastic surgeries, but an ideal treatment to overcome them has not been found yet.Aims:To evaluate the effects of topically applied Oral-norm gel on the healing of excisional wounds.Study Design:Animal experiment.Methods:Excisional wounds with a diameter of 3 mm were made in the center of the palatal mucosa of 63 Sprague Dawley rats. Seven animals were sacrificed at time 0. The remaining rats were divided into two groups: a test group in which the topical Oral-norm gel was applied three times a day and a control group in which nothing was applied. Seven animals in each group were sacrificed at 3, 7, 14, and 21 days. Mean wound surface area was measured photographically, while wound healing and width were evaluated microscopically.Results:The mean wound surface area decreased significantly after 3 days in both groups (p<0.001). Between days 3 and 7, the mean wound surface area decreased from 6.62 (2.85) to 0.83 (1.62) mm2 in the control group and 5.07 (0.88) to 1.42 (1.67) mm2 in the test group. The wound width decreased significantly on day 7 in both groups (p<0.001), with no further changes by day 14. Both groups had a significant increase in inflammation and vascularization on day 3 (p<0.001), with a reduction thereafter. No significant differences in macroscopic and microscopic measurements were observed between the groups at any time point (p>0.05).Conclusion:The Oral-norm gel has no positive healing effects in the palatal mucosa of rats.

Measuring Surface Area of Skin Lesions with 2D and 3D Algorithms

Purpose The treatment of skin lesions of various kinds is a common task in clinical routine. Apart from wound care, the assessment of treatment efficacy plays an important role. In this paper, we present a new approach to measure the skin lesion surface in two and three dimensions. Methods For the 2D approach, a single photo containing a flexible paper ruler is taken. After semi-automatic segmentation of the lesion, evaluation is based on local scale estimation using the ruler. For the 3D approach, reconstruction is based on Structure from Motion. Roughly outlining the region of interest around the lesion is required for both methods. Results The measurement evaluation was performed on 117 phantom images and five phantom videos for 2D and 3D approach, respectively. We found an absolute error of 0.99±1.18 cm2 and a relative error 9.89± 9.31% for 2D. These errors are <1 cm2 and <5% for five test phantoms in our 3D case. As expected, the error of 2D surface area measurement increased by approximately 10% for wounds on the bent surface compared to wounds on the flat surface. Using our method, the only user interaction is to roughly outline the region of interest around the lesion. Conclusions We developed a new wound segmentation and surface area measurement technique for skin lesions even on a bent surface. The 2D technique provides the user with a fast, user-friendly segmentation and measurement tool with reasonable accuracy for home care assessment of treatment. For 3D only preliminary results could be provided. Measurements were only based on phantoms and have to be repeated with real clinical data.

Prospective study of cryopreserved placental tissue wound matrix in the management of chronic venous leg ulcers

ObjectiveChronic venous leg ulcers (VLUs) affect up to 2% of the general population, resulting in a significant socioeconomic burden. Placental tissue that contains mesenchymal stem cells and active growth factors has been shown to be beneficial in healing of chronic wounds. We compared the efficacy of a human viable wound matrix (hVWM) of cryopreserved placental tissue for the treatment of refractory VLUs with standard therapy. MethodsThis prospective single-center open-label single-arm study enrolled patients with Clinical, Etiology, Anatomy, and Pathophysiology clinical class C6 VLUs. The ulcers of all enrolled patients had failed to heal after a trial of standard therapy of at least 12 weeks, which included weekly multilayer compression therapy along with local wound care. The same patients subsequently received application of hVWM (Grafix; Osiris Therapeutics, Columbia, Md) every 1 to 2 weeks in addition to standard therapy. Healing with hVWM therapy was then compared with standard therapy, with each patient serving as his own control. ResultsThere were 30 VLUs in 21 consecutive eligible patients who were enrolled in the study. All patients were men with an average age of 67 years (standard deviation [SD], ±10.8 years), and the average area of venous ulcers before hVWM initiation was 12.2 cm2 (SD, ±14.6 cm2; range, 3.3-12.3 cm2). Duplex ultrasound confirmed superficial or deep system venous reflux in all patients. Complete ulcer healing was achieved in 53% (16/30) of VLUs refractory to standard therapy after application of hVWM. There was a mean reduction in wound surface area by 79% (SD, ±27.3%; P < .001 compared with standard therapy) after a mean treatment time of 10.9 weeks. Eighty percent of VLUs were reduced in size by half compared with 25% with standard therapy (P < .001). The mean rate of reduction in ulcer area after hVWM applications was 1.69% per day vs 0.73% per day with standard therapy (P = .01). ConclusionsCryopreserved placental tissue (hVWM) improves healing processes to achieve complete wound closure in a significant proportion of chronic VLUs refractory to standard therapy. Adjunctive therapy with hVWM provides superior healing rates in refractory VLUs.

Efficacy of Vacuum-Assisted Closure (VAC) in Wound Healing

Introduction: Management of wounds is one of the commonest, often quite challenging as well, in surgical practice. Dressing is an essential component of wound management. Given its importance in achieving wound healing and its complications, methods of dressing have been under constant review since time immemorial. Many innovative techniques of wound dressing have been introduced for quick and problem-free wound healing. Vacuum Assisted Closure (VAC) is one of such methods. Objective: To determine whether VAC can help in reducing the healing time of open wounds. Study Design: Quasi-experimental study. Setting: Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad. Patients and Methods: 120 patients with open wounds, surgical or accidental, were included in the study. They were alternatively assigned to either VAC (Group I) 2 or WMD {wet to moist dressing} (Group II). In both groups, the wounds were assessed for surface area, depth and percentage of granulation every 48 hours for 15 days. Mean change in above wound parameters at the end of study period was calculated. The difference between the two groups was statistically analyzed by applying student T test. P value less than 0.05 was considered significant. Results: In Group I, at the end of the study period, mean reduction in the wound surface area and volume was 39.4% and 60.3% respectively, while granulation tissue formation was 59.7%. In Group II, the respective figures were 26.9%, 38.2% and 24.5%. The difference between the two groups was statistically significant (P < 0.001). Conclusion: VAC was more effective than WMD in terms of reduction in wound surface, depth and degree of granulation tissue formation. VAC thus can be usefully employed for achieving speedy wound healing.

A Lightweight Approach to 3D Measurement of Chronic Wounds

This paper presents a light-weight process for 3D reconstruction and measurement of chronic wounds using a commonly available smartphone as an image capturing device. The first stage of our measurement pipeline comprises the creation of a dense 3D point cloud using structure-from-motion (SfM). Furthermore, the wound area is segmented from the surrounding skin using dynamic thresholding in CIELAB color space and a surface is estimated to simulate the missing skin in the wound area. Together with a mesh reconstruction of the wound, the skin surface and the segmented wound is used to calculate the wound dimensions, i.e., its length, surface area and volume. We evaluate the presented pipeline using three wound phantoms, representing different stages in healing, and compare the subsequently scanned and measured wound dimensions with manually measured ones.

Neuromuscular electrostimulation on lower limb wounds.

The geko™ is a disposable neuromuscular electrostimulation (NMES) device intended to increase blood circulation and promote wound healing in a range of lower limb conditions. The purpose of this case series was to evaluate the therapeutic effect of the geko device on wound healing outcomes over an 8-week period. Thirty patients with non-healing wounds (≥ 12-week duration) of either venous leg ulceration (VLU), mixed leg ulceration (MLU) or diabetic foot ulceration aetiology were recruited from a local outpatient wound clinic in the South Wales area. Over the 8 weeks 2 participants (8%) achieved complete re-epithelialisation between baseline and endpoint. Mean wound surface area decreased (7.6 cm2) and there was an increase of 21% in the mean percentage of granulation tissue in the wound bed. Pain levels reduced in 52% of patients who completed the study, but the extent of oedema reduction was difficult to establish given that 76% of the cohort were treated with a form of compression as part of standard care. The findings support the use of the therapy in patients with painful VLUs and MLUs, but further research needs to be conducted to establish the generalisability of the findings to the wider population of patients living with chronic wounds of differing aetiology in the lower limb.

An improvement in acute wound healing in mice by the combined application of photobiomodulation and curcumin-loaded iron particles.

Here, we examined the combined effect of pulse wave photobiomodulation (PBM) with curcumin-loaded superparamagnetic iron oxide (Fe3O4) nanoparticles (curcumin), in an experimental mouse model of acute skin wound. Thirty male adult mice were randomly allocated into 5 groups. Group 1 was served as the control group. Group 2 was a placebo and received distilled water, as a carrier of curcumin. Group 3 received laser (890nm, 80Hz, 0.2J/cm2). Group 4 received curcumin by taking four injections around the wound. Group 5 received laser + curcumin. One full-thickness excisional round wound was made on the back of all the mice. On days 0, 4, 7, and 14, bacterial flora, wound surface area, and tensile strength were examined and microbiological examinations were performed. In case of wound closure, the two-way ANOVA shows that wound surface area of entire groups decreased progressively. However, the decrease in laser + curcumin and laser groups, and especially data from laser + curcumin group were statistically more significant, in comparison with the other groups (F statistics = 2.28, sig = 0.019). In terms of microbiology, the two-way ANOVA showed that laser, and laser + curcumin groups have statistically a lower bacterial count than the curcumin, control, and carrier groups (F statistics = 35, sig = 0 = 000). Finally, the one-way ANOVA showed that laser + curcumin, curcumin, and curcumin significantly increased wound strength, compared to the control and carrier groups. Furthermore, laser + curcumin significantly increased wound strength, compared to the control, laser, and curcumin groups (LSD test, p = 0.003, p = 0.002, and p = 0.005, respectively). In conclusion, curcumin nanoparticles, pulse wave laser, and pulse wave laser + curcumin nanoparticles accelerate wound healing, through a significant increase in wound closure rate, as well as wound strength, and a significant decrease in Staphylococcus aureus counts. Furthermore, the statistical analysis of our data suggests that the combined treatment of pulse wave laser + curcumin nanoparticles enhances the wound closure rate, and wound strength, compared to the laser and curcumin nanoparticles alone.

Potential therapeutic effects of autologous platelet rich plasma on impaired wound healing: a prospective clinical study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The evolving state of technology in field of medicine has led to a plethora of new options in the realm of wound healing. The primary objective of present study was to assess the potential therapeutic effects of autologous platelet rich plasma in the healing of wound.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective clinical nonrandomized cohort study was performed in 50 patients (40 males, 10 females) with recalcitrant, chronic; non-healing wounds of different etiologies. Age ranged from 25 to 70 years (mean 39.14±13.38). Eligible patients were treated with autologous platelet rich plasma (PRP) at 4-days intervals for a maximum of 14 sessions. Patients were evaluated (reduction in size of the wound (area)) every week and continued until final healing has achieved. The primary outcome was positive response to therapy, defined as complete healing of the wound and absence of any raw area. Significance was set at p&amp;lt;0.05.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean time duration to wound healing was 6.33 weeks (S.D±2.16). A statistically significant difference (p&amp;lt;0.05) was observed between the baseline parameters and mean area after PRP injection. After 7 sessions (28 days of therapy) the wounds showed the significant change in wound surface area (p&amp;lt;0.05). None of the patients developed deep or superficial wound infections.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There is considerable improvement in wound characteristics like healthy granulation tissue, healing edge, pain, slough, bleeding on touch and discharge after 7 days of PRP therapy and considerable improvement on follow up.&lt;/p&gt;

Efficacy of negative pressure wound therapy using vacuum-assisted closure combined with photon therapy for management of diabetic foot ulcers.

BackgroundDiabetes mellitus, one of the most prevalent chronic metabolic diseases, causes many complications. Among the complications, one of the most common chronic complications is diabetic foot ulcers (DFUs).ObjectiveThis study was conducted to investigate the efficacy of negative pressure wound therapy using vacuum-assisted closure (VAC) combined with photon therapy for the management of DFUs.Patients and methodsThe study included a total of 69 patients with DFUs during the period from January 2014 to December 2015. All patients were diagnosed with DFUs with Wagner’s stage 2 or 3 and were divided into two groups – the VAC group in which patients received only VAC and the combined group in which patients received both VAC and photon therapy. Data on duration of the treatment, pre- and postoperative wound surface areas, dressing changing times, pain conditions assessed using visual analog scale scores, recurrence rate and amputation rate were collected.ResultsAmong all patients, 35 patients were divided into the VAC group and 34 patients into the combined group. Areas of foot ulcers for all patients ranged from 5 to 100 cm2. The treatment duration, dressing changing times and the peak value of visual analog scale scores were all significantly lower in the combined group compared with the VAC group (P < 0.05). However, the reduced area for wound surface showed no significant difference between the two groups. Both recurrence and amputation rates showed no significant difference between the two groups of patients.ConclusionBoth VAC and VAC combined with photon therapy were effective and safe in the treatment of DFUs, while the combined therapy might have accelerated wound healing, but did not influence the long-term efficacy.