Volume Of Wounds Research Articles

Contemporary management of abdominal stab wound with retained knife – A practical guide

The incidence of penetrating abdominal trauma (PAT) varies widely depending on geography. In New Zealand, where the proportion of major trauma secondary to penetrating injury is approximately 5%, the overall volume of stab wounds (SW) is relatively low compared with countries such as the United States of America and South Africa. There is no current national guideline for the management of abdominal SW and thus the treatment is largely clinician dependent. The specific clinical scenario of abdominal SW with an associated retained knife is even rarer, but is challenging to manage. Most literature on the topic consists of anecdotal case reports. Very few centres will have accumulated sufficient experience to formulate management algorithms for this particular scenario. This article focuses on the general principles and management strategies for this specific injury. This is based on the author’s personal published and institutional experience over a decade from a high-volume major trauma centre in South Africa. It is aimed at medical students and qualified clinicians who may encounter such injury in the emergency department.

Efficacy of photodynamic therapy in the treatment of venous trophic ulcers: results from the experiment

Introduction. Today, antimicrobial photodynamic therapy (a-PDT) becomes more and more popular, because of it pronounced bactericidal activity, anti-inflammatory effect. At the same time, no animal model studies have been conducted on morphological changes in cells after exposure to PDT on venous ulcers (VU) when using different types of photosensitizers (PS). The problem of comparing morphological changes in tissues when using a-PDT vs conventional PDT have not yet been resolved.Aim. Evaluation of the effectiveness of PDT and APDT in a comprehensive examination of trophic ulcers in an in vivo experiment and compare them with standard methods for the treatment of VLU.Materials and мethods. A series of experiments was conducted on 21 rabbits, separated into 3 equal groups of 7 rabbits each. Venous trophic ulcer was originally modeled for all rabbits. To obtain a VU, we performed an additional ligation of v. femoralis. The control group received standard therapy for VU. The PDT group had PDT with Photosens. The a-PDT group underwent a-PDT using Cholosens. Every 3 days, picture of local inflammation, regeneration rate and ulcer volume were determined. A morphological study of VLU was carried out on the first, 9th and 15th days.Results. The a-PDT group, day 15: 100% wound epithelization. Control group, day 21st: The volume of wounds decreased on average by 50%. The PDT group: 100% wound epithelization. The morphological study indicated a positive trend in the a-PDT group compared with PDT and control groups, which resulted in a decrease in the total mass of necrotic detritus, a change in the quantitative and qualitative composition of inflammatory infiltrate.Conclusion. The data obtained indicate that the use of a-PDT is recommended in treatment of VLU. Both PDT and a-PDT methods showed better results in comparison with standard therapy.

Evaluating the impact of using a wound-specific oral nutritional supplement to support wound healing in a rehabilitation setting.

Chronic wounds adversely affect patient quality of life, increase the risk of mortality, and impose high costs on healthcare systems. Since protein-energy malnutrition or specific nutrient deficiencies can delay wound healing, nutritionally focused care is a key strategy to help prevent or treat the occurrence of non-healing wounds. The objective of our study of inpatients in a rehabilitation hospital was to quantify the effect of daily wound-specific oral nutritional supplementation (WS-ONS) on healing chronic wounds. Using electronic medical records, we conducted a retrospective analysis of patients with chronic wounds. We identified records for (a) a treatment group who received standard wound care + usual hospital diet + daily WS-ONS for ≥14 days, and (b) a control group who received standard wound care + a usual hospital diet. We collected data for demographics, nutritional status, and wound-relevant health characteristics. We examined weekly measurements of wound number and sizes (surface area for superficial wounds or volume for non-superficial wounds). There were 341 patients identified, 114 with 322 wounds in the treatment group and 227 patients with 420 wounds in the control group. We found that rehabilitation inpatients who were given nutritional support had larger wounds and lower functional independence on admission. At discharge, wound area reduction (percent) was nearly two-fold better in patients who were given daily WS-ONS + usual hospital diet compared to those who consumed usual diet only (61.1% vs 34.5%). Overall, weekly wound improvement (lowered wound area or wound volume) was more likely in the WS-ONS group than in the Control group, particularly from the start of care to week 2. Inpatients with largest wounds and lowest functional independence on admission were most likely to be given WS-ONS, an indication that caregivers recognised the need for supplementation. Week-to-week improvement in wound size was more likely in patients who received WS-ONS than in those who did not. Specifically, wound areas and wound volumes were significantly lower at discharge among patients who were given specialised nutritional support. More research in this field is needed to improve care and reduce healthcare costs.

A clinical trial of the efficacy of a combination of antiseptic and antimicrobial agent in the treatment of inflammatory processes of the skin and soft tissue

Purpose of the study. To conduct a clinical trial of the local treatment efficacy of skin and soft tissue inflammatory processes combination with sodium carboxymethylcellulose, immobilized miramistin and metronidazole.Patients and methods. The study involved patients with purulent-inflammatory skin processes, divided into two groups – control and experimental – 30 in each. The most common nosological form were abscesses of various localization. In the control group, local treatment was carried out with dioxomethyltetrahydropyrimidine ointment with chloramphenicol, and in the experimental group – with a combination of sodium carboxymethylcellulose with miramistin and metronidazole. We studied the local temperature, wound pH, wound planimetry, the appearance of wounds, the species composition of infectious agents in the discharge from the wound, a general blood test (with the determination of leukocyte indices), blood biochemical parameters, and the number of bed-days in the hospital. The data obtained were processed statistically.Results. The percentage of reduction in the area and volume of wounds in the experimental group was significantly higher than in the control. The maximum rate of wound healing in the experimental group was noted on days 1-3 and amounted to 9.7 (6.3; 15.5) % / day, and in the control group – 5.6 (2.9; 7.7). Starting from the 5th day of treatment, the local temperature indices in the experimental group were significantly lower than in the control group, and the pH values of the wounds in the experimental group tended to neutral values from the 5th day of treatment, and in the control group there was an increase in pH. Most often, S. epidermidis and S. aureus were inoculated from the wound discharge (in total, more than 50 % of observations); in the control group, pathogenic microorganisms were inoculated 1.6 times more often than in the experimental group.Conclusion. Patients in the experimental group were hospitalized for 2.5 days less than patients in the control group. It is possible to recommend further study and application of the combination of miramistin and metronidazole immobilized on the sodium salt of carboxymethylcellulose in the treatment of wounds.

Structure, processes, and initial outcomes of The Ottawa Hospital Multi-Specialist Limb-Preservation Clinic and Programme: A unique-in-Canada quality improvement initiative.

In 2017, The Ottawa Hospital initiated a unique‐in‐Canada quality improvement initiative by opening a novel, multi‐specialist limb‐preservation clinic. We sought to describe the structure, processes, and initial outcomes of the clinic and evaluate whether it is achieving its mandate of providing high‐quality wound clinical care, education, and research. We conducted a descriptive prospective cohort study alongside a nested study of 162 clinic patients requiring serial assessments. There have been 1623 visits, mostly (72.2%) from outpatients. During 17.8% of visits, patients were evaluated by >1 specialist. Therapies provided most often included negative‐pressure wound therapy (32.7%), biological wound dressings (21.6%), and total contact casting (18.5%). Furthermore, 1.2% underwent toe/ray amputations or skin grafting in clinic and 22.8% were initiated on antimicrobials. Mixed‐effects models suggested that mean wound volumes for those requiring serial assessments decreased by 1.6 (95% confidence interval = −0.86 to −2.27) cm3 between visits. The clinic provided seven rotations to vascular surgery, infectious diseases, dermatology, and palliative care physicians; three nursing preceptorships; and two educational workshops. It also initiated provincial and national vascular health and wound care research initiatives. This study may be used to guide development of other limb‐preservation clinics and programmes. Findings support that our programme is achieving its mandate.

Association between Torso Gunshot Wound Volumes of Trauma Centers and Outcomes of Torso Gunshot Wound Patients. A Propensity-Matched Nationwide Cohort Study

Objective: The number and type of patients treated by trauma centers can vary widely because of a number of factors. There might be trauma centers with a high volume of torso GSWs that are not designated as high-level trauma centers. We proposed that, for torso gunshot wounds (GSWs), the treating hospital’s trauma volume and not its trauma center level designation drives patient prognosis. Methods: The National Trauma Data Bank was queried for torso GSWs. The characteristics of torso GSWs in trauma centers with different volumes of torso GSWs were compared. The association between torso GSW volumes of trauma centers and the outcomes of torso GSWs were evaluated with propensity score matching (PSM) and multivariate logistic regression (MLR) analysis. Results: There were 618 trauma centers that treated 14,804 torso GSW patients in two years (2014-2015). In 191 level I trauma centers, 82 of them (42.9%, 82/191) treated <1 torso GSW per month. After well-balanced PSM, patients who were treated in higher volume trauma centers (≥9 torso GSWs/month) had a significantly lower mortality rate (7.9% vs. 9.7%). Patients treated in trauma centers with ≥9 torso GSWs/month had a 30.9% (odds ratio = 0.764) lower probability of death than if sent to trauma centers with <9 torso GSWs/month. Treatment in level I or II trauma centers did not significantly affect mortality. Conclusion: There is an uneven distribution of torso GSWs among trauma centers. Torso GSWs treated in trauma centers with ≥9 torso GSWs/month have significantly superior outcomes with regard to survival.

Efficacy of Miramistin-Metronidazole Combination in the Treatment of Purulent-Inflammatory Processes of Soft Tissues

Importance of the topic. The patients with purulent-inflammatory processes of soft tissues are the most common category of surgical patients, since the effectiveness of their treatment decreases due to the development of microorganism resistance to antibiotics and antiseptics. The aim of research was to study the clinical efficacy of topical application of miramistin-metronidazole combination immobilized on sodium salt of carboxymethyl cellulose in the treatment of purulent-inflammatory processes of soft tissues.Materials and methods. The study included 60 patients with purulent-inflammatory diseases of soft tissues. They were divided into 2 groups, 30 people in each group. All patients were exposed to partial surgical treatment of the purulent focus. In the first group, the treatment consisted of local application of dioxomethyltetrahydropyrimidine ointment with the antibiotic chloramphenicol, and in the second group with miramistin-metronidazole combination immobilized on the sodium salt of carboxymethylcellulose. The course of the wound process was assessed by the dynamics of the local wound temperature, the percentage of reduction of the wound size and volume and the rate of its healing; the terms of edema and purulent discharge elimination, the onset of the appearance of mature granulations and epithelialization of wounds, the cessation of the microflora growth in wounds, the average number of inpatient days were also registered. Results. Measurements of the local wound temperature demonstrated that the inflammatory process in patients of the first group lasted for 10 days, and in patients of the second group for 5-6 days. Prior to discharge from the hospital, the wound area was 16.1% and the volume of wounds was 14% less in patients of the second group compared with similar findings in patients of the first group. The edema of the tissues surrounding the wound eliminated within 1.5 days, and the exudation from the wound stopped 2 days earlier in patients of the second group. Granulation in the wound appeared 2 days, and marginal epithelialization 1 day earlier in patients of the second group. With bacterial culturing of the wound discharge, the growth ceased 1 day earlier in patients of the second group compared to patients in the first group. Such dynamics of the course of the wound process led to a 3 bed-day decrease in the hospital stay of patients of the second group.Conclusion. Local treatment of purulent-inflammatory diseases of soft tissues with miramistin-metronidazole combination allowed optimizing the course of the wound process, reducing duration of inpatient stay.

IMPLEMENTATION THE PRINCIPLES OF RECONSTRUCTIVE SURGERY WOUNDED WITH SOFT TISSUE DEFECTS AT THE IV LEVEL OF MEDICAL CARE

Resume. The experience of providing medical care during the anti-terrorist operation in eastern Ukraine has shown that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are 64.9-68.2%, of which 36.4-37.5% small and medium, 28.5-30.7% are large and very large defects. Goal: To improve the results of surgical care for soft tissue defects by introducing differentiated surgical tactics for wound closure to each level. Material and methods. The total amount of the study was 136 wounded with shrapnel, bullet and explosive injuries from April 2014 to September 2018. Determination of surgical tactics for closing soft tissue defects was performed on the basis of metric classification, taking into account the area, volume and anatomical areas of the lesion. Results. The combination of metric characteristics of wound defects by area, volume and location of wounds in a single classification allowed to offer a comprehensive approach to sorting the wounded by the level of medical care and determine further reconstructive surgical tactics to close soft tissue defects. Conclusions. The introduction of differentiated surgical tactics in wounded with gunshot defects of the soft tissues at the all levels of medical care improved functional results: the proportion of satisfactory increased from 46.9% to 53.7%, the relative number of unsatisfactory decreased from 18.8% to 11.6%

Early Advanced Therapy for Diabetic Foot Ulcers in High Amputation Risk Veterans: A Cohort Study.

Veterans with diabetic foot ulcers (DFUs) represent the highest percentage of lower extremity amputations (LEAs) within the Veterans Affairs (VA) population. Many veterans have additional risk factors for amputation. Few studies focus on advanced therapies for this population. This study explores the impact of early application of dehydrated human amniotic membrane allograft (DAMA) with comprehensive care on preventing amputation. This prospective, single-center cohort study (ClinicalTrials.gov Identifier NCT02632929) was conducted through Boise VA Medical Center. Patients with DFUs were objectively stratified for LEA risk. Those with moderate to high amputation risk could participate. Participants received comprehensive care and weekly application of DAMA. Primary endpoint was avoidance of major LEA. Secondary endpoint was wound epithelialization. Monitoring continued 4 months. Between July 2015 and March 2017, 20 patients (mean age 67.2 years) with 24 DFU classified as moderate (12 wounds) to high risk (12 wounds) for amputation were enrolled. Wound volumes ranged from 0.072 cm3 to 56.4 cm3. Risk factors included neuropathy (20 patients), osteomyelitis (16 wounds), exposed tendon/ligament/bone (19 wounds), Charcot (5 patients), and peripheral arterial disease (13 wounds). All subjects avoided amputation within the study period, all 24 wounds achieved re-epithelialization within 4 to 33 weeks; mean healing time 13.2 weeks. Cost for the DAMA tissue ranged from $750 to $38 150. Estimated cost for LEA ranges from $30 000 to $50 000. No treatment-related adverse events during the study period were reported. The results suggest that early and frequent application of DAMA with comprehensive care may help prevent amputation. Additional research will help inform third-party payors and clinicians.

Effects of platelet-rich plasma combined with polylactic acid/polycaprolactone on healing of pig deep soft tissue defect caused by fragment injury

Objective: To investigate the effects of platelet-rich plasma (PRP) combined with polylactic acid/polycaprolactone (PLA/PCL) on healing of mininature pig deep soft tissue defect caused by fragment injury. Methods: Two male Bama miniature pigs with 11 to 12 months (the same below) were selected by lottery to prepare PRP. The other twenty-seven male Bama miniature pigs were used to reproduce deep soft tissue defect caused by high-explosive ammunition fragment injury on bilateral posterior femoral region. According to the random number table, 27 pigs were divided into control group, material group, and PRP+material group, with 9 pigs in each group. After debridement, wounds of pigs in material group and PRP+material group were filled with PLA/PCL and PLA/PCL+2 mL activated PRP, respectively. Pigs in each group received suture of full-thickness skin to close the wounds. The operative duration was recorded. The length and volume of wounds of pigs in the above groups were measured immediately after surgery. In 1, 2, and 4 weeks after surgery, 3 pigs in each group were sacrificed to collect femoral wounds tissue on two sides, and PLA/PCL were collected from wounds of pigs in material group and PRP+material group for general observation of wounds tissue and degradation of the material. In 2 and 4 weeks after surgery, wounds tissue was obtained to observe the histological changes by hematoxylin-eosin staining, and expressions of transforming growth factor β (TGF-β) and vascular endothelial growth factor (VEGF), and angiogenesis were determined by immunohistochemical method. In 1, 2, and 4 weeks after surgery, wounds tissue was collected to determine mRNA expressions of TGF-β and VEGF by real-time quantitative reverse transcription polymerase chain reaction. Data were processed with analysis of variance of factorial design, one-way analysis of variance, and least significant difference-t test. Results: (1) There were no significantly statistical differences in length and volume of the wounds of pigs among the three groups (F=0.336, 0.282, P>0.05). The operative duration in control group [(30.9±2.1)min] was significantly shorter than that of material group [(39.7±2.2)min] and PRP+material group[(40.0±2.6)min], t=-11.45, -11.88, P<0.01. (2) There were respectively 10, 7, and 5 wounds tissue with infection in pigs of control group, material group, and PRP+material group. In 1, 2, 4 weeks after surgery, all of the wounds tissue of pigs was infected in control group, while none of wounds tissue of pigs was infected in material group and PRP+material group. In pigs of material group and PRP+material group, materials and tissue were easily separated in 1 week after surgery; some materials were integrated with tissue and showed a tendency of degradation in 2 weeks after surgery; materials were completely embedded with tissue in 4 weeks after surgery. (3) In pigs of control group, erythrocytes and inflammatory cells infiltration in wounds tissue were observed in 2 weeks after surgery, and necrotic tissue and inflammatory cells infiltration in wounds tissue were still observed in 4 weeks after surgery. In pigs of material group and PRP+material group, a large number of erythrocytes and inflammatory cells infiltration were observed in 2 weeks after surgery. Compared with that of material group, wounds tissue of pigs in PRP+material group had no inflammatory cells infiltration in 4 weeks after surgery. (4) Protein expressions of TGF-β in fibroblasts and multinuclear macrophagocytes, VEGF in fibroblasts and vascular endothelial cells, and blood vessel formation in wounds tissue of pigs in PRP+material group were significantly more than those of pigs in control group and material group in 2 and 4 weeks after surgery. (5) The mRNA expression of TGF-β in wounds tissue of pigs in material group was significantly higher than that in control group in 4 weeks after surgery (t=-3.93, P<0.01). Compared with those of pigs in control group and material group, the mRNA expression of TGF-β in wounds tissue of pigs in PRP+material group was significantly increased at each time point (t=9.23, 13.81, 11.73, -7.51, -12.04, -7.80, P<0.01). The mRNA expression of VEGF in wounds tissue of pigs increased significantly in material group compared with that of pigs in control group in 4 weeks after surgery (t=-3.94, P<0.01). Compared with those of pigs in control group and material group, the mRNA expression of VEGF in wounds tissue increased significantly in wound tissue of pigs in PRP+material group at each time point (t=12.33, 3.95, 7.97, -11.36, -2.97, -4.04, P<0.01). Conclusions: PRP combined with PLA/PCL can accelerate wound healing of deep soft tissue defect of mininature pigs caused by fragment injury by providing physical scaffold for newborn tissue growth, promoting mRNA and protein expressions of TGF-β and VEGF.

The tubed pedicle flap centennial: its concept, origin, rise and fall

Part of the conceptual thinking that characterizes reconstructive surgery is to consider the way tissue is transferred: locally pedicled, pedicled from a distance, or free. In 1917, now 100 years ago, the concept of the distant tubed pedicle skin flap was published. The tubed flap has raised a debate about priority in the past. This historical review elucidates this debate and identifies Filatov from Odessa, Ukraine, as the originator of the procedure. Ganzer in Germany published a little later, independently from Filatov, about tubing, while Gillies in England, not knowing the work of either, started to use pedicled flaps at the end of 1917, which primeur was contested by his colleague Aymard. Tubing a pedicle was the final refinement of the distantly pedicled flap. The high volume of facial wounds during the First World War gave army surgeons like Ganzer and Gillies the opportunity to gain experience with all kinds of tubed pedicled flaps. This resulted in a real impetus of reconstructive surgery in the interbellum. This made the tubed pedicle flap the main reconstructive method for large skin defects until the 1970s of the last century, when pedicled myocutaneous flaps and free flap surgery were introduced. There is still a modest place for tubed pedicled flaps in reconstructive surgery. Tubed groin flaps are still useful to cover hand defects and tubed deltopectoral flaps are still used for facial reconstruction in hospitals in less-privileged countries where free flap surgery is not feasible.

Simulated Wound Assessment Using Digital Planimetry versus Three-Dimensional Cameras: Implications for Clinical Assessment

Clinical management of wounds can benefit from objective measures of response to treatment. Wound surface area and volume are objective measures of wound healing. Using a synthetic wound model, we compare the accuracy and reproducibility of 2 commercially available 3-dimensional (3D) cameras against planimetry and water displacement. Twelve ulcers of various sizes and colors were reproduced in modeling clay and cured. Five naive observers used digital planimetry, water displacement, Eykona camera (Fuel 3D, UK), and Silhouette camera (ARANZ, New Zealand) to measure the wounds. When compared with traditional planimetry, wound surface area measurement with Eykona and Silhouette tended to underestimate wounds by 1.7% and 3.7%, respectively. Spearman correlation coefficients were 0.94 (Eykona) and 0.92 (Silhouette). Intraclass correlations for planimetry and the 2 cameras were all 1. Eykona and Silhouette tended to underestimate wound volumes when compared with water displacement by 58% and 23%, respectively. Spearman correlation coefficients were 0.92 (Eykona) and 0.72 (Silhouette). Intraclass correlations for water displacement and the two cameras were all1. Serial accurate objective area measurements are feasible as part of ongoing clinical assessment of wounds. 3D cameras are reliable but have not shown superior accuracy to manual planimetry, and financial concerns and IT integration may limit general clinical usage. Volume measurements of wounds are practicable as part of clinical care.

The effects of topical vitamin C solution on the necrotic tissue volume of burn wounds

Background and Purpose: Vitamin C is administered orally or intravenously for the treatment of burn wounds. However, effects of the topical application of vitamin C remain unclear. This study aimed to evaluate the effects of topical vitamin C solution on the necrotic tissue volume of second-degree burn wounds. Methods: This clinical trial was conducted on 30 patients with second-degree burns admitted to the burn unit of Vasee Hospital of Sabzevar, Iran. Burn wound areas were divided into two parts, receiving routine treatment with sulfadiazine ointment and vitamin C in addition to sulfadiazine. After cleaning the wounds, dressings were replaced daily. Depth of burn wounds in each area was observed to be similar. Burn wounds were examined on days one, three, seven and 14 after the burn incidents using Bates-Jensen Wound Assessment Tool. Data analysis was performed in SPSS version 20 using repeated measures ANOVA. Results: In patients of the experimental area, mean volume of necrotic tissue was1.033±0.182 at baseline, while it reached 1.233±0.430 on day 14 after the incident. In the control group, mean volume of necrotic tissue was 1.000±0.000 at baseline, while it increased to 1.700±0.794 on day 14 after the incident. On day 14, a significant difference was observed between the experimental and control groups in this regard (P=0.018; f=5.982). Conclusion: According to the results of this study, topical administration of vitamin C could be largely effective in the treatment of second-degree burn wounds.

Methods to assess area and volume of wounds - a systematic review.

Wound measurement is important in monitoring the healing process of chronic wounds and in evaluating the effect of treatment. The objective of this systematic review was to evaluate evidence from the literature on accuracy, agreement, reliability and feasibility of wound measurement techniques described since 1994. Studies were identified by searching the electronic databases PubMed, Embase and Cochrane Library. Of the 12 013 studies identified, 43 were included in the review. A total of 30 papers evaluated techniques for measuring wound area and 13 evaluated techniques for measuring wound volume. The six approaches for measuring wound area were simple ruler method (10 papers), mathematical models (5 papers), manual planimetry (10 papers), digital planimetry (16 papers), stereophotogrammetry (2 papers) and digital imaging method (20 papers). Of these studies, 10 evaluated accuracy, 15 agreement, 17 reliability and 25 mentioned feasibility. The number of wounds examined in the studies was highly variable (n = 3-260). Studies evaluating techniques for measuring wound volume included between 1 and 50 wounds and evaluated accuracy (4 studies), agreement (6 studies), reliability (8 studies) and feasibility (12 studies). Digital planimetry and digital imaging were considered the most accurate and reliable methods for area measurement, particularly in larger and irregularly shaped wounds. None of the three-dimensional technologies have so far had a major impact, because of their low accuracy, high cost and complexity in handling the system set-up.

The state of cytokine reactivity in patients treated with ozonobaroterapy at the complex treatment of festering diseases and wounds of limbs

Foundation. One of the mechanisms of ozone effect is its impact on immune state of organism. The work is devoted to study of peculiarities of the state of proinflammatory cytokines at the complex treatment of patients with festering diseases and wounds of limbs.Materials and methods: It was examined and treated 162 patients with festering diseases and wounds of limbs. In the main group 87 patients underwent treatment with ozonebaro- and ozonetherapy, and in the group of comparison 75 patients were treated according to accepted standards. It was studied the content of proinflammatory cytokines TNFα, Il-2, Il-8 in the blood of patients with festering wounds in both groups depending on the volume and area of wounds in the dynamics of treatment.Results: Studying the group of comparison it was established a positive connection between the concentration of TNFα, Il-2, Il-8 and the volume and area of the wound process. It was revealed that hyperactivity of organism that led to the “necrotic” script of development of an alternative phase of the wound process was one of the causes of large necrosis. At chronization of the wound process the level of cytokines decreased on the 15 day comparing with patients with a smooth clinical course that indicated the decrease of reactivity of organism.The offered medical and diagnostic algorithm of the treatment patients using ozone- and ozonebarotherapy favored an improvement of the results of treatment and fastened the healing of wounds.In analysis of the level of cytokines in patients of the main group it was revealed that at the high levels of proinflammatory cytokines the use of the offered methods of treatment favor the decrease of its level and at chronization (with the low level of cytokines) its concentration increases. So the use of ozonebaro- and ozonetherapy leads to normalization of immune response and diminishes the probability of chronization of the wound process.Conclusions: The study of the level of proinflammatory cytokines allows evaluate the clinical course of the wound process objectively, to reveal the tendency to its chronization. The use of ozonebaro and ozonetherapy leads to normalization of immune response at the too high or too low levels of IL-2, IL-8, TNFa and diminishes the probability of chronization of the wound process. The data received during the research indicate an efficiency of the offered methods of treatment

Three‐dimensional documentation of wound healing: First results of a new objective method for measurement

The objective assessment of wound healing is one essential parameter of quality assurance in a modern chronic wound management program. In the past assessment has been based exclusively on a two-dimensional measurement of the wound surface with planimetry or digital photo documentation in combination with such measurements. An objective method for measuring the volume of chronic wounds has not yet been available. In cooperation with the company RSI, we linked digital photography, optical raster by means of digital scanner, and picture processing software (DigiSkin) for an exact three-dimensional image of chronic wounds. The generated point clouds allow the visual, computer-assisted three-dimensional quantification and can document the course of healing of chronic wounds. In comparison to currently available systems, our new method makes possible the objective measurement of volume changes and wound healing course in chronic wounds.We demonstrate the utility of the system in reference to three patients with chronic venous leg ulcers. Using this new, objective three-dimensional wound measurement system,it is possible to reliably quantify changes in wound healing for the first time. Future clinical studies have a new option for the gathering of data which will facilitate evidenced-based conclusions.

Dreidimensionale Dokumentation von Wundheilung: Erste Ergebnisse einer neuen objektiven Vermessungsmethode

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 4, Issue 10 Dreidimensionale Dokumentation von Wundheilung: Erste Ergebnisse einer neuen objektiven Vermessungsmethode Andreas Körber, Andreas Körber Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this authorJost Rietkötter, Jost Rietkötter Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this authorStephan Grabbe, Stephan Grabbe Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this authorJoachim Dissemond, Joachim Dissemond Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this author Andreas Körber, Andreas Körber Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this authorJost Rietkötter, Jost Rietkötter Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this authorStephan Grabbe, Stephan Grabbe Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this authorJoachim Dissemond, Joachim Dissemond Dermatologische Klinik und Poliklinik, Universitätsklinikum EssenSearch for more papers by this author First published: 19 September 2006 https://doi.org/10.1111/j.1610-0387.2006.06113_supp.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume4, Issue10October 2006 RelatedInformation

084 Effects of Fat Autografting on Porcine Skin Wound Healing after Injury

It has been evidenced that the fat may have a potential to secret some growth factors or be a source of stem cells. So, we explore the effects of fat on healing of porcine skin wounds so as to provide a new method for clinical skin wound repair after injury.Forty‐eight full‐thickness skin wounds were produced on both sides of the back in 6 male minipigs (8 wounds in each animal). Then these wounds were randomly divided into 4 groups, which were saline control group, fat autografting group, basic fibroblast growth factor (bFGF) treatment group and epidermal growth factor (EGF) treatment group. At day 3, 7, 14 and 21 after wounding, the area and the volume of wounds were measured and the histological examination was performed to evaluate the velocity and quality of wounds healing in different groups.At day 3 and 7, the amount of granulation tissues and vessel density in fat treatment group were significantly more than that in other groups. Wound areas and volume in fat treatment wounds were markedly decreased in compared with those in other groups (P &lt; 0.01). Regenerated epidermis in fat treatment group was thicker than that in other groups.These results confirmed that the wound healing velocity and quality in wounds treated with fat autografting were enhanced. It indicated that fat has a potential to accelerate velocity and improve the quality of wound healing after skin injury.

MAVIS: a non-invasive instrument to measure area and volume of wounds

Accurate measurement of the physical size of wounds is vital for assessment of the progress of healing. An instrument has been developed to measure area and volume of skin wounds, ulcers, and pressure sores. MAVIS— Measurement of Area and Volume Instrument System—is based on the principle of colour coded structured light. A set of parallel stripes of alternating colours is projected onto the wound area at an angle of approximately 45° and is recorded by a CCD camera. From the known position of the focal points of projector and camera, and from the observed intersection points of the stripes of light with the wound surface, a computer calculates a three-dimensional map of the observed wound. The volume of the wound is defined as the volume of the region sandwiched between the observed surface and the original healthy skin surface which is simulated by cubic spline interpolation. This paper compares the performance of the instrument with three traditional wound measurement techniques using results obtained from a clinical trial involving 50 patients. Traditional area measurement techniques such as transparency tracings produce results with standard deviations between 4% (large wounds) and up to 20% (small wounds) of the measured mean value. MAVIS measurements reduce these standard deviations by 3–5%. Measuring the wound volume by alginate casts produces errors in volume figures between 5% and 40%. Standard deviations of MAVIS results are 5% smaller on average. The results demonstrate that MAVIS yields more reproducible results with a minimum of inter-observer error. The instrument does not make contact with the wound, provided visual records and measurements are made in less then 5 min. It is not suitable for undermined, very deep or very large wounds.

Evaluation of a pressure sore model using monoplegic pigs.

This study evaluated a newly developed swine monoplegic pressure sore model by testing the uniformity of the initial wound size. The natural healing also was evaluated. Nine minipigs were used. The hindlimb was denervated by transecting the unilateral nerve roots L1 through S2. At 5 to 14 days, 800 mmHg of pressure was applied to the denervated skin over the trochanteric area with a 3-cm-diameter disk compressing the skin and subcutaneous tissue against the underlying bone for 48 hours. The wound was then debrided of devascularized tissue. Wound surface areas were calculated from photographs. Wound volumes were obtained by measuring the volume of saline needed to fill the wound defect. Full-thickness sores of uniform size developed in all pigs without mortality or complications. Wound surface area and volume increased initially, peaked, and then decreased in an exponential fashion. This model provides a new tool for direct comparison of pressure sore treatment modalities for short- and long-term studies.