Wound Volume Research Articles

Double versus single internal thoracic artery in coronary artery bypass grafting: role in sterna wound healing

Objective To investigate the effect of double versus single internal thoracic artery on sterna wound healing in coronary artery bypass grafting (CABG). Methods Patients undergoing CABG were randomly divided into experimental group (double internal thoracic artery group) and control group (single internal thoracic artery group) according to the number of internal thoracic artery used in operations. Experimental group: skeletonized double internal mammary arteries were harvested in all 50 cases (37 males and 13 females). Control group: skeletonized left internal mammary artery was harvested in all 50 cases (34 males and 16 females). Sterna wound healing and post-operational complications were observed. Results The incidence of poor sterna wound healing and volume of drainage after operation in the experimental group were more than those in the control group [volume of drainage on the first day: (350.67±56.86)ml vs (240.72±48.35)ml; total volume of drainage: (595.65±102.35)ml vs (398.85±75.84)ml; poor sterna wound healing rate: 20% vs 0; P<0.05 or P<0.01]. The sterna wound healing rate of high-risk patients between two groups had significant difference (8 cases vs 0 case, P<0.05). Conclusions Compared to the single internal mammary artery grafting, the double internal mammary artery grafting increased the risk of sternal wound healing. Key words: Coronary artery bypass/MT; Mammary arteries/SU; Sternum/IN/SU; Fracture healing

Angiogenesis is induced and wound size is reduced by electrical stimulation in an acute wound healing model in human skin.

Angiogenesis is critical for wound healing. Insufficient angiogenesis can result in impaired wound healing and chronic wound formation. Electrical stimulation (ES) has been shown to enhance angiogenesis. We previously showed that ES enhanced angiogenesis in acute wounds at one time point (day 14). The aim of this study was to further evaluate the role of ES in affecting angiogenesis during the acute phase of cutaneous wound healing over multiple time points. We compared the angiogenic response to wounding in 40 healthy volunteers (divided into two groups and randomised), treated with ES (post-ES) and compared them to secondary intention wound healing (control). Biopsy time points monitored were days 0, 3, 7, 10, 14. Objective non-invasive measures and H&E analysis were performed in addition to immunohistochemistry (IHC) and Western blotting (WB). Wound volume was significantly reduced on D7, 10 and 14 post-ES (p = 0.003, p = 0.002, p<0.001 respectively), surface area was reduced on days 10 (p = 0.001) and 14 (p<0.001) and wound diameter reduced on days 10 (p = 0.009) and 14 (p = 0.002). Blood flow increased significantly post-ES on D10 (p = 0.002) and 14 (p = 0.001). Angiogenic markers were up-regulated following ES application; protein analysis by IHC showed an increase (p<0.05) in VEGF-A expression by ES treatment on days 7, 10 and 14 (39%, 27% and 35% respectively) and PLGF expression on days 3 and 7 (40% on both days), compared to normal healing. Similarly, WB demonstrated an increase (p<0.05) in PLGF on days 7 and 14 (51% and 35% respectively). WB studies showed a significant increase of 30% (p>0.05) on day 14 in VEGF-A expression post-ES compared to controls. Furthermore, organisation of granulation tissue was improved on day 14 post-ES. This randomised controlled trial has shown that ES enhanced wound healing by reduced wound dimensions and increased VEGF-A and PLGF expression in acute cutaneous wounds, which further substantiates the role of ES in up-regulating angiogenesis as observed over multiple time points. This therapeutic approach may have potential application for clinical management of delayed and chronic wounds.

Modeling of anisotropic wound healing

Biological soft tissues exhibit non-linear complex properties, the quantification of which presents a challenge. Nevertheless, these properties, such as skin anisotropy, highly influence different processes that occur in soft tissues, for instance wound healing, and thus its correct identification and quantification is crucial to understand them. Experimental and computational works are required in order to find the most precise model to replicate the tissues' properties. In this work, we present a wound healing model focused on the proliferative stage that includes angiogenesis and wound contraction in three dimensions and which relies on the accurate representation of the mechanical behavior of the skin. Thus, an anisotropic hyperelastic model has been considered to analyze the effect of collagen fibers on the healing evolution of an ellipsoidal wound. The implemented model accounts for the contribution of the ground matrix and two mechanically equivalent families of fibers. Simulation results show the evolution of the cellular and chemical species in the wound and the wound volume evolution. Moreover, the local strain directions depend on the relative wound orientation with respect to the fibers.

Feasibility of an electrostimulation system treatment for wound healing: a case series of patients with chronic ulcers in Barbados.

Major advances have been made in the development of new therapies for chronic wounds. Fenzian™, an electrostimulation system (ES), has been clinically used for a variety of conditions. The ES was recently tested in the Barbadian population for tolerability and acceptability by asthma patients, with encouraging results. Barbados has an estimated 170 people with diabetes having some form of lower-extremity amputation annually. Here, we describe a case series of 21 chronic ulcer patients with diabetes recruited as inpatients (n = 10) and outpatients (n = 11) in a pilot study to evaluate the feasibility and acceptability of ES in the Barbadian population. Results showed statistically significant improvement among those in the inpatient- versus outpatient-recruited group for wound perimeter (P = 0·04), wound surface area (P = 0·03) and wound volume (P = 0·08). We also demonstrate that the improvement continued after cessation of ES treatment. Participants reported increased levels of pain at the end of treatment, and there was no statistically significant change in the reported quality of life. Our results showed greater improvements in reduction of ulcer size for participants from the inpatient- versus outpatient-recruited group.

Comparison of a new laser beam wound camera and a digital photoplanimetry-based method for wound measurement in horses

The aim of this study was to compare the accuracy, precision, inter- and intra-operator reliability of a new laser beam (LB) wound camera and a digital photoplanimetry-based (DPB) method for measuring the dimensions of equine wounds. Forty-one wounds were created on equine cadavers. The area, circumference, maximum depth and volume of each wound were measured four times with both techniques by two operators. A silicone cast was made of each wound and served as the reference standard to measure the wound dimensions.The DPB method had a higher accuracy and precision in determining the wound volume compared with the LB camera, which had a higher accuracy in determining the wound area and maximum depth and better precision in determining the area and circumference. The LB camera also had a significantly higher overall inter-operator reliability for measuring the wound area, circumference and volume. In contrast, the DPB method had poor intra-operator reliability for the wound circumference. The LB camera was more user-friendly than the DPB method.The LB wound camera is recommended as the better objective method to assess the dimensions of wounds in horses, despite its poorer performance for the measurement of wound volume. However, if the wound measurements are performed by one operator on cadavers or animals under general anaesthesia, the DPB method is a less expensive and valid alternative.

Role of Negative Pressure Therapy in Healing of Diabetic Foot Ulcers

Thirty patients (17 female and 13 males) with chronic diabetic foot ulceration, age ranged from 50 to 65 years (53.4+ 4.1years), were selected from outpatient clinic of Benha teaching hospitals, Egypt from April 2013 to March 2014. Aim: Foot ulceration is one of the most common and severe complications of diabetes. The aim of the current was to clarify the effectiveness of topical negative pressure as a non invasive treatment approach for diabetic ulcers. Methods: Patients were divided into two equal groups; the first group was the control group and treated by traditional dressing while the second one was treated by negative pressure. The treatment course was extended up to six weeks; dressing was changed daily for the first group and day after day for the second group. Assessment was carried out before starting the course and after six weeks of treatment for both groups. The ulcer volume assessment was done by using a 10 cm syringe filled by terramycin ointment, and the wound surface area by using a graded plastic sheet. Student t-test was used to analyze the gained data of wound volume and surface area. Results: There was a significant improvement in the wound volume and surface area in the negative pressure group than that of the control group. Conclusion: It could be concluded that topical negative pressure is an effective non-invasive method in treating chronic diabetic foot ulceration.

Topical phenytoin for managing various ulcers: A meta-analysis

Objective: The aim of this meta-analysis was to evaluate the efficacy of topical phenytoin in the treatment of ulcers of different origin compared with other standard topical treatment. Methods: Randomized controlled trials were identified by searching PubMed, Embase, Medline, and Web of Science. Outcomes were complete wound healing rate and reduction in wound volume or surface area. Results: Thirteen studies with 980 patients were included. Topical phenytoin were associated with a statistically significant improvement of complete wound healing rate compared with other line of management in 11 randomized control trial of 815 patients (odds ratio = 3.03, 95% confidence interval 2.23-4.10, Z = 7.14, P < 0.00001). No publication bias exists in this meta-analysis. Three studies from India also confirmed that the topical phenytoin was associated with a statistically significant percent reduction in wound volume compared with the other dressing (mean difference 23.56, 95% confidence interval 19.48-27.64, Z = 11.32, P < 0.00001). Conclusion: The existent evidence shows that topical phenytoin is more effective for ulcer treatment.

Autologous platelet-rich plasma in treatment of chronic venous leg ulcers: A prospective case series.

We report our results on a case series of 19 patients receiving platelet-rich plasma application in treatment of patients with chronic unhealing venous leg ulcers. There were 16 males and three females with a mean age of 38.55 ± 16.46 years. Planimetric size measurements were performed and pain was tested throughout the treatment period. Follow-up was made in seven-day periods. Patients received 5 ml of platelet-rich plasma for each 5 cm(2) of the wound surface with half of the amount being injected 1-2 mm deep into the wound and the wound surface was covered with the remaining half. Complete wound healing occurred in 18 of 19 patients (94.7%) within a mean of 4.82 ± 2.16 week. There were significant reductions in wound area among all consecutive measurements except for first week. A significant reduction in wound volume was apparent even in first week and sustained among consecutive measurements. Platelet-rich plasma seems effective in terms of promoting healing of venous leg ulcers. Improvement in wound depth was slightly more prominent than that in wound area, indicating a potential role of platelet-rich plasma especially in deep venous ulcers.

Effect of Noncontact Low-Frequency Ultrasound on Wound Healing

Purpose: Recent research suggests the use of noncontact low-frequency ultrasound (US) as an adjunct to standard wound care to facilitate the healing process. The purpose of this systematic review was to examine the effect of noncontact low-frequency US on the healing of chronic wounds. Methods: CINHAL and PubMed were used to identify studies published from 2000 to 2011 written in English with the key words ultrasound and debridement, chronic wounds, ultrasonic-assisted wound treatment, and MIST Therapy®, resulting in the retrieval of 51 potential articles. Ten studies met the inclusion criteria and were included in the review. Two reviewers independently rated study quality and extracted data concerning study methods, quality, and outcomes. Results: Nine of the studies reviewed demonstrated improved wound healing when noncontact low-frequency US was used either as the sole treatment or as an adjunct to standard wound care, whereas the findings of one study were inconclusive. Discussion/Conclusions: The literature reviewed supports the use of noncontact low-frequency US as an adjunct in the treatment of chronic wounds. The studies reviewed suggest that noncontact low-frequency US aids in the reduction of wound volume and that healing occurs at a faster rate than with standard wound care alone. Evidence is limited by the existence of only two studies with control groups. Future research should use comparison groups and focus on dosing parameters, outcomes on the basis of the wound type, and other meaningful patient outcomes such as wound pain or cost of treatment.

Combined Negative Pressure Wound Therapy and Ultrasonic MIST Therapy for Open Surgical Wounds

Surgical wounds are at increased risk of infection when left open to heal through secondary intention; they increase length of hospital stay, hospital costs, readmission rates, and patient morbidity. New technologies and methods of treating acute and chronic wounds are emerging. Two recent developments for the treatment of open wounds are noncontact low-frequency ultrasound (NCLFU) treatment and negative pressure wound therapy (NPWT). This case series reports findings from 4 hospitalized patients with complex conditions who underwent colorectal surgery resulting in open abdominal wounds. The wounds were treated with NCLFU in combination with NPWT. Data were collected via retrospective review of medical records. After concurrent treatment with NPWT (range, 13-18 days) and NCLFU (range, 5-9 treatments), wound areas in these 4 cases were reduced by 4.5% to 37% and wound volume decreased by 17% to 62%. Granulation tissue increased in the open tissue areas in all patients. In addition, 3 of the cases received a mesh graft. Combination treatment with NPWT and NCLFU therapy with or without sharp debridement enhanced wound healing in the open abdominal wounds of these 4 patients.

Selective case study describing the use of Apligraf on necrobiosis lipoidica associated with diabetes

Necrobiosis lipoidica is a rare skin disease characterised by large, well-demarcated, symmetrical plaques with overlying telangiectasias and atrophic, fibrotic features. The disease is associated with diabetes mellitus (1 in 300 cases), but can also be linked to other diseases such as rheumatoid arthritis. Women are three times more likely to develop necrobiosis lipoidica compared to men. Ulcerations are the most serious type of complications in necrobiosis lipoidica, and they occur most frequently on the legs of patients. However, the aetiology of necrobiosis lipoidica still remains unclear. Although many studies have been conducted in order to determine necrobiosis lipoidica's pathophysiology, a clear and definite path to disease has not been recorded. In this case study, a patient with necrobiosis lipoidica that had been refractory to conventional therapy received treatment with Apligraf® bioengineered wound dressings. Apligraf was shown to be effective in managing the patient's multiple hard-to-heal wounds. It was more successful than previous therapies in achieving granulation tissue formation and wound volume reduction, in addition to being a more rapid form of treatment.

Progenitor cell therapy for sacral pressure sore: a pilot study with a novel human chronic wound model

IntroductionChronic wounds are a major health-care issue, but research is limited by the complexity and heterogeneity in terms of wound etiology as well as patient-related factors. A suitable animal model that replicates the situation in humans is not available. Therefore, the aim of the present work is to present a standardized human wound model and the data of a pilot study of topically applied progenitor cells in a sacral pressure sore.MethodsThree patients underwent cell harvest from the iliac crest at the time of the initial debridement. Forty-eight hours after bone marrow harvest and debridement, the CD34+ selected cell suspension was injected into the wound. With the aid of a laser scanner, three-dimensional analyses of wound morphometry were performed until the defect was reconstructed with a local flap 3 weeks after debridement.ResultsDecreases in volume to 60% ± 6% of baseline on the sham side and to 52% ± 3% of baseline on the cell side were measured. Histologic work-up revealed no signs of metaplastic, dysplastic, or neoplastic proliferation/differentiation after progenitor cell treatment. CD34+ cells were detected in the biopsies of day 0.ConclusionsThe pressure sore wound model allows investigation of the initial 3 weeks after cell-based therapy. Objective outcome analysis in terms of wound volume and histology can be performed without, or with, minimal additional morbidity, and the anatomy of the sacral area allows a control and study side in the same patient. Therefore, this model can serve as a standard for wound-healing studies.Trial registrationClinicalTrials.gov NCT00535548.

Cyclic negative pressure wound therapy: an alternative mode to intermittent system

The purpose of this study was to develop and test a novel mode of negative pressure wound therapy (NPWT) that minimises pain while preserving the efficacy in wound healing. A porcine model was used in this study. Wounds were generated in animals and treated with either simple dressing or various treatment modes of NPWT. The wound volume, perfusion level and vasculature status were analysed and compared among different groups. Clinical application was performed to evaluate the level of pain occurring when negative pressure is applied. Among the NPWT groups, the Cyclic-50 group showed most decrement in wound volume, even though statistical relevance was not found (P = 0·302). The perfusion level was significantly increased in the Cyclic-50 group compared with the Intermittent group (P < 0·001) and the Cyclic-100 group (P = 0·004). Evaluation of blood vessel formation revealed that the Cyclic-50 group showed the highest number of vasculature with statistical significance (P < 0·001). In clinical application, the cyclic group showed significant decrease in pain compared with the intermittent group (P = 0·001). The cyclic NPWT mode decreased patient discomfort while maintaining superior wound healing effects as the intermittent mode.

Splinting Strategies to Overcome Confounding Wound Contraction in Experimental Animal Models

Clinical healing by secondary intention frequently occurs in skin that is firmly anchored to underlying (human) connective tissue. Small animals (rodents) are extensively utilized to model human cutaneous wound healing, but they heal by wound contraction, a process that is limited in the human and confounds quantitative and qualitative evaluation of experimental wound repair. To alleviate wound contraction in loose-skinned species, practical solutions include choosing anatomical sites with firmly attached dermis and subcutis (e.g., rabbit ear) or performing mechanical fixation of the skin by using one of a number of devices or splints. In each case, the wound volume remains relatively constant, allowing the histomorphometric or biomolecular quantification of the cellular response under well-controlled, experimental conditions. In addition, the defined aperture of the splinted wound allows the placement of a variety of materials, including scaffolds, cells, and biologically active formulations into the wound site in an effort to potentiate the healing response and abrogate scarring. In contrast, production of larger experimental wounds or the deliberate distraction of wound margins can be used to model a hypertrophic response. Device design parameters should consider ease of application, durability, and lack of interference with the normal influx of local and circulating cells to the wound site. Improved methods of securing flexible splints would provide a more efficient experimental platform. These devices could also incorporate optical or electronic sensors that report both the mechanical and physiological status of the healing.

Repeatability and clinical utility in stereophotogrammetric measurements of wounds

To investigate the hypothesis that stereophotogrammetric wound size monitoring shows suitable inter-observer reliability and user acceptance for clinical practice use. Veterans admitted for conservative management of severe pressure ulcers were eligible for inclusion in the study. Three-dimensional (3D) digital wound images were independently captured by two expert and two non-expert nurse-observers using a commercially available stereophotogrammetry system,weekly for 6 weeks.A double-blinded analyst generated 3D wound reconstructions, using software to determine geometry. Clinical opinion of wound progression was provided by an expert physician. Thirteen wounds were assessed with more than 80% of all images being readable. Interclass correlation of 0.9867 (p < 0.000 I) was observed. Compared with clinical opinion, 3D wound measurement was sensitive between improving and static wounds for wound perimeter, volume, depth and length. These preliminary findings suggest that 3D wound measurement minimises differences in wound measurement between expert and non-expert observers, suggesting it could be implemented with high reliability in health-care settings where several observers are involved in wound care management.

Potential of Oncostatin M to accelerate diabetic wound healing

Oncostatin M (OSM) is a multifunctional cytokine found in a variety of pathologic conditions, which leads to excessive collagen deposition. Current studies demonstrate that OSM is also a mitogen for fibroblasts and has an anti-inflammatory action. It was therefore hypothesised that OSM may play an important role in healing of chronic wounds that usually involve decreased fibroblast function and persist in the inflammatory stage for a long time. In a previous in vitro study, the authors showed that OSM increased wound healing activities of diabetic dermal fibroblasts. However, wound healing in vivo is a complex process involving multiple factors. Thus, the purpose of this study was to evaluate the effect of OSM on diabetic wound healing in vivo. Five diabetic mice were used in this study. Four full-thickness round wounds were created on the back of each mouse (total 20 wounds). OSM was applied on the two left-side wounds (n = 10) and phosphate-buffered saline was applied on the two right-side wounds (n = 10). After 10 days, unhealed wound areas of the OSM and control groups were compared using the stereoimage optical topometer system. Also, epithelialisation, wound contraction and reduction in wound volume in each group were compared. The OSM-treated group showed superior results in all of the tested parameters. In particular, the unhealed wound area and the reduction in wound volume demonstrated statistically significant differences (P < 0·05). The results of this study indicate that topical application of OSM may have the potential to accelerate healing of diabetic wounds.

Comparison of tissue damage, cleansing and cross‐contamination potential during wound cleansing via two methods: lavage and negative pressure wound therapy with instillation

The use of lavage was compared to negative pressure wound therapy (NPWT) with instillation (NPWTi) to assess extent of soft tissue damage, debris removal and environmental cross-contamination susceptibility in three distinct models. Scanning electron microscopy in an ex vivo model showed increased visible tissue trauma from lavage treatment at low and high pressures versus NPWTi, with the degree of trauma relative to the pressure of the irrigant. These results were corroborated in granulating full-thickness excisional swine wounds coated with dextran solution to simulate wound debris. Both low-pressure lavage and NPWTi demonstrated effective cleansing in this model, reducing debris by >90%. However, using three-dimensional photography to evaluate tissue damage by measuring immediate tissue swelling (changes in wound volume and depth) showed significantly greater (P < 0.05) swelling in low-pressure lavage-treated wounds compared with NPWTi-treated wounds. Lastly, bench top wound models were inoculated with fluorescent bacterial particles to assess environmental cross-contamination potential and collected at measured distances after treatment with low-pressure lavage and NPWTi. No evidence of cross-contamination was found with NPWTi, whereas one-half of the particles became 'aerosolised' during low-pressure lavage (P < 0.05). Collectively, these studies demonstrate the effective wound cleansing capabilities of NPWTi without the tissue damage and environmental contamination associated with lavage.

A Prospective Randomized Trial Comparing Subatmospheric Wound Therapy With a Sealed Gauze Dressing and the Standard Vacuum-Assisted Closure Device

Two methods of subatmospheric pressure wound therapy--wall suction applied to a sealed gauze dressing (GSUC) and the vacuum-assisted closure device (VAC)--were compared in hospitalized patients at University of Chicago Medical Center. VAC therapy is widely used, but can be expensive and difficult to apply; it also fails in some patients. A randomized prospective study of 87 patients (N = 45 in the GSUC arm and N = 42 in the VAC arm) was undertaken between October 2006 and May 2008. The study comprised patients with acute wounds resulting from trauma, dehiscence, or surgery. Demographics and wound characteristics were similar in both groups. There were significant reductions in wound surface area and volume in each group. In the GSUC group, the reductions in wound surface area and volume were 4.5%/day and 8.4%/day, respectively (P < 0.001 for both), and in the VAC group, this was 4.9%/day and 9.8%/day, respectively (P < 0.001 for both). The reductions in wound surface area and volume were similar in both groups (P = 0.60 and 0.19, respectively, for the group-by-time interaction). The estimated difference (VAC - GSUC) was 0.4% (95% confidence interval: -1.0, 1.7) for wound surface area and 1.4% (95% confidence interval: -0.7, 3.5) for volume. The mean cost per day for GSUC therapy was $4.22 versus $96.51 for VAC therapy (P < 0.01) and the average time required for a GSUC dressing change was 19 minutes versus 31 minutes for a VAC dressing change (P < 0.01). The sum of pain intensity differences was 0.50 in the GSUC group compared with 1.73 for the VAC group (P = 0.02). GSUC is noninferior to VAC with respect to changes in wound volume and surface area in an acute care setting. In addition, GSUC dressings were easier to apply, less expensive, and less painful.

Wound model reconstruction from three-dimensional skin surface imaging using the convex hull approximation method

Ulcer wound refers to a wound with underlying medical conditions that prevent healing. The ability to measure objectively early therapeutic response is important for wound management. Early therapeutic efficacy is best assessed by measurement of wound depth and volume. This study presents a non-invasive technique for assessing ulcer wound volume from three-dimensional (3D) surface scans. The accuracy of volume computation is dependent on the performance of the solid reconstruction of the wound. However, it is difficult to reconstruct solid models of wounds such as leg ulcers that extend over a large area along leg curvature and when irregularities exist on the skin surrounding the wound. The convex hull approximation preceded by surface division of the wound surface scan is proposed for solid reconstruction of wound models. This approach enables the reconstruction of models for large wounds without being affected by the surrounding irregularities. The performance of the algorithm is compared against reference volumes of wound models developed on AutoCAD. The best results are achieved using convex hull preceded by 20 surface divisions with volume computation error from 0 to 7%. Furthermore, moulds of wounds are developed to compute volumes using invasive and non-invasive methods, their percentage differences are below 8%.

Demonstration of a Microcurrent-Generating Wound Care Device for Wound Healing Within a Rehabilitation Center Patient Population

PurposeWound care in a rehabilitation environment is a costly and difficult problem. The goal of this retrospective study is to evaluate differences in wound closure outcomes in acute and chronic wounds when treated with a microcurrent-generating wound care device as compared to standard wound care methods. MethodsData files of 38 patients who received either standard wound treatment (SOC; n = 20), or were treated with a microcurrent-generating wound device (MCD, n = 18), were retrospectively reviewed. Wounds were assessed until deemed clinically to have closed or healed with up to 100% epithelialization. All patients (18–99 years) with single wounds were included. The number of days to wound closure and the rate of wound volume reduction were compared across groups. Persistent reduction of wound size improvement was also examined. ResultsThe wounds in the SOC group closed on average at 36.25 days (SD = 28.89), while the MCD group closed significantly faster in 19.78 days (SD = 14.45), p = 0.036. The rate of volume reduction per day was −3.83% for SOC vs. −9.82% volume reduction per day (p = 0.013) for the MCD group. The SOC group had 50% of its wounds close monotonically vs. 83.3% in the MCD group (p = 0.018). ConclusionThis two-center retrospective study demonstrated a 45.4% faster, and more robust healing of wounds with the use of the MCD, when compared to SOC in a rehabilitation center environment. This translates into improved patient care, and potentially significant cost savings. Economic benefits for the use of MCD compared to other wound care methods are planned for future research.