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Fujimori M, Toriyabe Y, Sakakibara N, Nojima M, Makino S. What Affects Healing Rates in Patients Treated for Medication-Related Osteonecrosis of the Jaw? The Role of Operative Therapy and Other Clinical Factors. J Oral Maxillofac Surg 2024; 82:1441-1455. [PMID: 39013476 DOI: 10.1016/j.joms.2024.06.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND In the therapy of medication-related osteonecrosis of the jaw (MRONJ), the healing rate, effectiveness of operative therapy, and factors associated with healing remain unclear. PURPOSE This study aimed to estimate MRONJ therapy healing rates and identify associated prognostic factors. STUDY DESIGN, SETTING, SAMPLE A 25-center prospective cohort study was conducted on 291 patients with MRONJ treated with a common therapeutic protocol during 2013-2016. Patients unable to continue examinations or treatment were excluded. PREDICTOR VARIABLE The primary predictor variable was MRONJ therapy grouped into two categories: operative and nonoperative. Secondarily, the prognostic factors categorized as demographic, medical, clinical, and perioperative were evaluated. MAIN OUTCOME VARIABLES The primary outcome variable was treatment duration, defined as the time (in months) between the initiation of therapy and when the site was healed or the date of the final visit or loss to follow-up. COVARIATES Not applicable. ANALYSES Descriptive statistics and 3-year cumulative healing rates were calculated. The association between clinical factors and time to healing was analyzed using bivariate and multivariate analyses and propensity score analysis. P < .05 was considered significant. RESULTS We analyzed data from 291 subjects with 76 (26.1%) and 215 (73.9%) subjects in the operative and nonoperative therapy groups, respectively. The healing rates for operative and nonoperative therapies were 95.8 and 70.7%, respectively (hazard ratio [HR] = 1.6, 95% confidence interval [CI] = 1.1-2.2, P value [P] < .01). The healing rates in patients for whom anti-resorptive agent (ARA) treatment was discontinued and continued were 87.2 and 37.4%, respectively (HR = 1.8, 95% CI = 1.1-3.0, P = .02). In a multiple regression analysis using ARA indication, the therapy method showed a significant association in the MRONJ malignancy group (HR = 2.75, 95% CI = 1.46-5.17, P < .01). CONCLUSION AND RELEVANCE Operative therapy and ARA discontinuation were associated with better healing rates in MRONJ therapy. However, the choice of therapy for MRONJ should be based on a comprehensive consideration of the patient's condition. ARA discontinuation should be considered an adjunctive measure because of the possibility of adverse events such as fragility fractures and skeletal related events.
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Affiliation(s)
- Masaki Fujimori
- Department of Oral and Maxillofacial Surgery, Kushiro Rosai Hospital, Kushiro, Japan.
| | - Yoshiyuki Toriyabe
- Department of Oral and Maxillofacial Surgery, Kaiseikai Onishi Hospital, Asahikawa, Japan
| | - Noriyuki Sakakibara
- Department of Oral and Maxillofacial Surgery, Nikko Memorial Hospital, Muroran, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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Ran F, Mu K, Liu G, Liu Y, Pang Y, Feng G, Zhou L, Peng L. Preparation, Characterization, and Wound Healing Promotion of Hydrogels Containing Glucosyloxybenzyl 2-Isobutylmalates Extract from Bletilla striata (Thunb.) Reichb.f. Int J Mol Sci 2024; 25:10563. [PMID: 39408888 PMCID: PMC11476415 DOI: 10.3390/ijms251910563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 09/27/2024] [Accepted: 09/29/2024] [Indexed: 10/20/2024] Open
Abstract
Plant-derived medicinal materials have significant potential and promising applications in wound healing and skin regeneration. This study aims to develop a plant-based extract hydrogel from Bletilla striata (Thunb.Reichb.f.), specifically a glucosyloxybenzyl 2-isobutylmalates extract (B), and characterize its potential effects on wound healing. We synthesized the hydrogel using carbomer (C), glycerol (G), and triethanolamine (T) as the matrix, incorporating B into the hydrogel base, and evaluated its physical and chemical properties. In vitro tests assessed the biocompatibility of the glucosyloxybenzyl 2-isobutylmalates-carbomer-glycerol-triethanolamine (B-CGT) hydrogel and its effects on cell proliferation, migration, and adhesion. Animal model experiments evaluated its potential to promote wound healing. The results showed that the prepared B-CGT hydrogel possessed a good three-dimensional network structure and stability, demonstrating significant free radical scavenging capacity in antioxidant tests. In cell experiments, the B-CGT hydrogel exhibited no potential cytotoxicity and showed good hemocompatibility and promotion of cell proliferation. Animal experiments indicated that wounds treated with the B-CGT hydrogel healed significantly faster, with improved formation of new epithelial tissue and collagen. This study suggests that the developed B-CGT hydrogel is a promising candidate for wound dressings, with excellent physicochemical properties and controlled drug release capabilities, effectively promoting the wound healing process.
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Affiliation(s)
| | | | - Gang Liu
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China; (F.R.); (K.M.); (Y.P.); (G.F.); (L.Z.); (L.P.)
| | - Yuchen Liu
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China; (F.R.); (K.M.); (Y.P.); (G.F.); (L.Z.); (L.P.)
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Sadeghianmaryan A, Ahmadian N, Wheatley S, Alizadeh Sardroud H, Nasrollah SAS, Naseri E, Ahmadi A. Advancements in 3D-printable polysaccharides, proteins, and synthetic polymers for wound dressing and skin scaffolding - A review. Int J Biol Macromol 2024; 266:131207. [PMID: 38552687 DOI: 10.1016/j.ijbiomac.2024.131207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/15/2024]
Abstract
This review investigates the most recent advances in personalized 3D-printed wound dressings and skin scaffolding. Skin is the largest and most vulnerable organ in the human body. The human body has natural mechanisms to restore damaged skin through several overlapping stages. However, the natural wound healing process can be rendered insufficient due to severe wounds or disturbances in the healing process. Wound dressings are crucial in providing a protective barrier against the external environment, accelerating healing. Although used for many years, conventional wound dressings are neither tailored to individual circumstances nor specific to wound conditions. To address the shortcomings of conventional dressings, skin scaffolding can be used for skin regeneration and wound healing. This review thoroughly investigates polysaccharides (e.g., chitosan, Hyaluronic acid (HA)), proteins (e.g., collagen, silk), synthetic polymers (e.g., Polycaprolactone (PCL), Poly lactide-co-glycolic acid (PLGA), Polylactic acid (PLA)), as well as nanocomposites (e.g., silver nano particles and clay materials) for wound healing applications and successfully 3D printed wound dressings. It discusses the importance of combining various biomaterials to enhance their beneficial characteristics and mitigate their drawbacks. Different 3D printing fabrication techniques used in developing personalized wound dressings are reviewed, highlighting the advantages and limitations of each method. This paper emphasizes the exceptional versatility of 3D printing techniques in advancing wound healing treatments. Finally, the review provides recommendations and future directions for further research in wound dressings.
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Affiliation(s)
- Ali Sadeghianmaryan
- Department of Biomedical Engineering, University of Memphis, Memphis, TN, USA; Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada.
| | - Nivad Ahmadian
- Centre for Commercialization of Regenerative Medicine (CCRM), Toronto, Ontario, Canada
| | - Sydney Wheatley
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Hamed Alizadeh Sardroud
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Emad Naseri
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Ahmadi
- Department of Mechanical Engineering, École de Technologie Supérieure, Montreal, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
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Elkholy YA, Mahboub T, Zaki AA, ElSharkawy OA, Noaman A. Lower Third Leg Trauma Management Algorithm; Kasr Alainy Protocol. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5754. [PMID: 38756955 PMCID: PMC11098258 DOI: 10.1097/gox.0000000000005754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/28/2024] [Indexed: 05/18/2024]
Abstract
Background Soft tissue defects in the lower third of the leg present significant challenges for surgeons. Despite various options available for soft tissue coverage, selecting the most suitable option is limited by potential complications. In response to this challenge, some surgeons have sought to develop algorithms to guide decision-making in the management of lower leg trauma. Methods This prospective observational cross-sectional study included 53 patients with traumatic injuries to the lower third leg and ankle regions. Each patient underwent a management plan based on our proposed algorithm, which incorporated the utilization of negative pressure wound therapy and dermal substitutes. Outcomes were assessed in terms of the ability to achieve complete coverage, complication rates, duration of hospital stay, and return to normal daily activity. Results The proposed algorithm proved to be comprehensive and easily applicable, achieving complete coverage in 98.1% of cases. The mean duration for definitive coverage was 21.89 ± 12.84 days, and the majority of cases (81.1%) returned to normal daily activity within a mean duration of 60.69 ± 56.7 days. The use of dermal substitutes resulted in achieving coverage in wounds with exposed structures, with favorable outcomes in cases with a mean size of 11.39 ± 10.05 cm². Conclusions Our algorithm provides a safe and effective approach to manage traumatic defects of the lower third leg and ankle, considering the patient's general condition and the complexity of the wound. Proper utilization of dermal substitutes and negative pressure wound therapy is emphasized in the algorithm.
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Affiliation(s)
- Yusuf A. Elkholy
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Tarek Mahboub
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Amr A. Zaki
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Omar A. ElSharkawy
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Ayman Noaman
- From the Department of Plastic and Reconstruction Surgery, Kasr Alainy Faculty of Medicine, Cairo University, Egypt
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Derwin R, Patton D, Strapp H, Moore Z. Integrating Point-of-Care Bacterial Fluorescence Imaging-Guided Care with Continued Wound Measurement for Enhanced Wound Area Reduction Monitoring. Diagnostics (Basel) 2023; 14:2. [PMID: 38201311 PMCID: PMC10802895 DOI: 10.3390/diagnostics14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
AIM This prospective observational study investigated wound area reduction (WAR) outcomes in a complex wound population composed of non-healing acute and chronic wounds. The relationship between bacterial autofluorescence signals and WAR was investigated. Area measurements were collected both manually and digitally, and both methods were compared for accuracy. METHODS Twenty-six participants with 27 wounds of varying etiologies were observed twice weekly for two weeks. Digital wound measurement, wound bacterial status assessment, and targeted debridement were performed through a point-of-care fluorescence imaging device (MolecuLight® i: X, MolecuLight Inc, Toronto, Canada). The wound area reduction (WAR) rate was calculated using baseline and last visit measurements. Statistical analyses, including t-tests, Fisher exact tests, the Wilcoxon signed rank test for method comparison, and ANOVA for bacterial subgroups, were applied as pertinent. RESULTS The overall average WAR was -3.80 cm2, or a decrease of 46.88% (manual measurement), and -2.62 cm2, or a 46.05% decrease (digital measurement via MolecuLight® device). There were no statistically significant differences between the WAR of acute and chronic wounds (p = 0.7877). A stepwise correlation between the WAR and bacterial status classification per fluorescence findings was observed, where persistent bacteria resulted in worse WAR outcomes. An overestimation of wound area by manual measurement was 23% on average. CONCLUSION Fluorescence imaging signals were linked to WAR outcome and could be considered predictive. Wounds exhibiting bacterial loads that persisted at the end of the study period had worse WAR outcomes, while those for which management was able to effectively remove them demonstrated greater WAR. Manual measurement of the wound area consistently overestimated wound size when compared to digital measurement. However, if performed by the same operator, the overestimation was uniform enough that the WAR was calculated to be close to accurate. Notwithstanding, single wound measurements are likely to result in overestimation.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- Fakeeh College of Health Sciences, Jeddah 23323, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong NSW 2522, Australia
| | - Helen Strapp
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
- School of Nursing & Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Belfast BT15 1AP, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah 23323, Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
- Lida Institute, Shanghai 201609, China
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Bao MZ, Zhou LB, Zhao L, Zhang H, Li Y, Yang L, Tai AT. Efficacy of lidocaine wet compress combined with red-light irradiation for chronic wounds. World J Clin Cases 2023; 11:7277-7283. [PMID: 37969445 PMCID: PMC10643062 DOI: 10.12998/wjcc.v11.i30.7277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Chronic wounds that fail to progress through normal phases of healing present a significant healthcare burden owing to prolonged treatment and associated costs. Traditional wound care typically involves regular dressing changes, which can be painful. Recent approaches have explored the use of lidocaine to manage pain and red-light irradiation (RLI), known for its anti-inflammatory and cell proliferation effects, to potentially enhance wound healing. AIM To investigate the therapeutic efficacy of lidocaine wet compression (LWC) combined with RLI for chronic wounds. METHODS We enrolled 150 patients with chronic wounds from the Wound and Ostomy Outpatient Clinic of the Second Hospital of Anhui Medical University from April to September 2022. The wounds were treated with dressing changes. The patients were randomly assigned to the control and experimental groups using a random number table and given the same first dressing change (2% LWC for 5 min and routine dressing change). From the second dressing change, in addition to 2% LWC for 5 min and routine dressing change, the experimental group received RLI, whereas the control group continued to receive the same LWC and dressing change. The first and second dressing changes were performed on days 1 and 2, respectively. The third dressing change was performed 3 d after the second change. The frequency of subsequent dressing changes was determined based on wound exudation and pain. Pain during the first three dressing changes was evaluated in both groups. The average number of dressing changes within 28 d and the degree of wound healing on day 28 were also recorded. RESULTS During the initial dressing change, no noticeable differences were observed in the pain levels experienced by the two groups, indicating similar pain tolerance. However, during the second and third dressing changes, the experimental group reported significantly less pain than the control group. Furthermore, over 28 d, the experimental group required fewer dressing changes than the control group. CONCLUSION Notably, the effectiveness of wound healing on the 28th day was significantly higher in the experimental group than that of in the control group. The combination of LWC and RLI was effective in reducing early-stage pain, promoting wound healing, decreasing the frequency of dressing changes, and enhancing patients' overall quality of life with chronic wounds.
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Affiliation(s)
- Man-Zhen Bao
- Department of Nursing, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Lian-Bang Zhou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Ling Zhao
- Department of General Surgery, Huaibei People’s Hospital of Anhui Province, Huaibei 235000, Anhui Province, China
| | - Hui Zhang
- Department of Outpatient, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yuan Li
- Department of Outpatient, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Li Yang
- Department of Outpatient, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - An-Ting Tai
- Department of Outpatient, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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Medication-Related Osteonecrosis of the Jaws (MRONJ) in Children and Young Patients-A Systematic Review. J Clin Med 2023; 12:jcm12041416. [PMID: 36835951 PMCID: PMC9962332 DOI: 10.3390/jcm12041416] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/25/2022] [Accepted: 12/25/2022] [Indexed: 02/12/2023] Open
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is defined by the American Association of Oral and Maxillofacial Surgeons (AAOMS) as the presence of an exposed bone area in the maxillofacial region, present for more than eight weeks in patients treated with the use of antiresorptive or antiangiogenic agents, with no history of radiation or metastatic disease. Bisphosphonates (BF) and denosumab (DS) are widely used in adults for the management of patients with cancer and osteoporosis, and recently there has been an increase in their use in child and young patients for the management of disorders such as osteogenesis imperfecta (OI), glucocorticoid-induced osteoporosis, McCune-Albright syndrome (MAS), malignant hypercalcemia, and others. There are differences between case reports in adults compared to child and young patients related to the use of antiresorptive/antiangiogenic drugs and the development of MRONJ. The aim was to analyze the presence of MRONJ in children and young patients, and the relation with oral surgery. A systematic review, following the PRISMA search matrix based on the PICO question, was conducted in PubMed, Embase, ScienceDirect, Cochrane, Google Scholar, and manual search in high-impact journals between 1960 and 2022, publications in English or Spanish, including randomized and non-randomized clinical trials, prospective and retrospective cohort studies, cases and controls studies, and series and case reports. A total of 2792 articles were identified and 29 were included; all of them published between 2007 and 2022, identifying 1192 patients, 39.68% male and 36.24% female, aged 11.56 years old on average, using these drugs mainly for OI (60.15%); 4.21 years on average was the therapy time and 10.18 drug doses administered on average; oral surgery was observed in 216 subjects, reporting 14 cases of MRONJ. We concluded that there is a low presence of MRONJ in the child and youth population treated with antiresorptive drugs. Data collection is weak, and details of therapy are not clear in some cases. Deficiencies in protocols and pharmacological characterization were observed in most of the included articles.
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de Albuquerque PBS, Rodrigues NER, Silva PMDS, de Oliveira WF, Correia MTDS, Coelho LCBB. The Use of Proteins, Lipids, and Carbohydrates in the Management of Wounds. Molecules 2023; 28:1580. [PMID: 36838568 PMCID: PMC9959646 DOI: 10.3390/molecules28041580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Despite the fact that skin has a stronger potential to regenerate than other tissues, wounds have become a serious healthcare issue. Much effort has been focused on developing efficient therapeutical approaches, especially biological ones. This paper presents a comprehensive review on the wound healing process, the classification of wounds, and the particular characteristics of each phase of the repair process. We also highlight characteristics of the normal process and those involved in impaired wound healing, specifically in the case of infected wounds. The treatments discussed here include proteins, lipids, and carbohydrates. Proteins are important actors mediating interactions between cells and between them and the extracellular matrix, which are essential interactions for the healing process. Different strategies involving biopolymers, blends, nanotools, and immobilizing systems have been studied against infected wounds. Lipids of animal, mineral, and mainly vegetable origin have been used in the development of topical biocompatible formulations, since their healing, antimicrobial, and anti-inflammatory properties are interesting for wound healing. Vegetable oils, polymeric films, lipid nanoparticles, and lipid-based drug delivery systems have been reported as promising approaches in managing skin wounds. Carbohydrate-based formulations as blends, hydrogels, and nanocomposites, have also been reported as promising healing, antimicrobial, and modulatory agents for wound management.
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Affiliation(s)
| | | | - Priscila Marcelino dos Santos Silva
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235 Cidade Universitária, Recife 50.670-901, Brazil
| | - Weslley Felix de Oliveira
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235 Cidade Universitária, Recife 50.670-901, Brazil
| | - Maria Tereza dos Santos Correia
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235 Cidade Universitária, Recife 50.670-901, Brazil
| | - Luana Cassandra Breitenbach Barroso Coelho
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Avenida Professor Moraes Rego, 1235 Cidade Universitária, Recife 50.670-901, Brazil
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Treatment of Complex Wounds with NovoSorb ® Biodegradable Temporising Matrix (BTM)-A Retrospective Analysis of Clinical Outcomes. J Pers Med 2022; 12:jpm12122002. [PMID: 36556223 PMCID: PMC9781929 DOI: 10.3390/jpm12122002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
Complex and chronic wounds represent a highly prevalent condition worldwide that requires a multimodal and interdisciplinary treatment approach to achieve good functional and aesthetic outcomes. Due to increasing costs of health care, an aging population and an increase in difficult-to-treat microbial colonization of wounds, complex wounds will become a substantial clinical, social and economic challenge in the upcoming years. In plastic reconstructive surgery, a variety of dermal skin substitutes have been established for clinical use. Since its approval as a dermal skin substitute in Germany, NovoSorb® Biodegradable Temporising Matrix (BTM) has become a valuable therapeutic option for the treatment of full-thickness wound defects. The clinical data published to date are limited to case reports and small-scale case series with the main focus on single wounds. The aim of this single-center study was a retrospective analysis of our own patient collective that has received treatment with BTM for complex wounds. Overall, BTM showed to be a reliable and versatile reconstructive option, especially for patients with multiple co-morbidities and microbiologically colonized wounds. Although the preliminary findings have produced promising results, further investigation and research are warranted regarding long-term outcomes and additional clinical applications.
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Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons' Position Paper on Medication-Related Osteonecrosis of the Jaws-2022 Update. J Oral Maxillofac Surg 2022; 80:920-943. [PMID: 35300956 DOI: 10.1016/j.joms.2022.02.008] [Citation(s) in RCA: 413] [Impact Index Per Article: 137.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022]
Abstract
Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaws (MRONJ) - formerly referred to as bisphosphonate-related osteonecrosis of the jaws (BRONJ)-were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007, 2009 and 2014. The position papers were developed by a committee appointed by the AAOMS Board of Trustees and comprising clinicians with extensive experience in caring for these patients, as well as clinical and basic science researchers. The knowledge base and experience in addressing MRONJ continues to evolve and expand, necessitating modifications and refinements to the previous position papers. Three members of the AAOMS Committee on Oral, Head, and Neck Oncologic and Reconstructive Surgery (COHNORS) and three authors of the 2014 position paper were appointed to serve as a working group to analyze the current literature and revise the guidance as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis and management strategies and highlights the current research status. AAOMS maintains that it is vitally important for this information to be disseminated to other relevant healthcare professionals and organizations.
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Affiliation(s)
- Salvatore L Ruggiero
- Clinical Professor, Division of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Hofstra North Shore-LIJ School of Medicine, New York Center for Orthognathic and Maxillofacial Surgery, Lake Success, NY.
| | - Thomas B Dodson
- Professor and Chair, University of Washington School of Dentistry, Department of Oral and Maxillofacial Surgery, Seattle, Wash
| | - Tara Aghaloo
- Professor, Oral and Maxillofacial Surgery, UCLA School of Dentistry, Los Angeles, Calif
| | - Eric R Carlson
- Professor and Kelly L. Krahwinkel Endowed Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tenn
| | - Brent B Ward
- Chalmers J Lyons Professor of Oral and Maxillofacial Surgery, Associate Professor of Dentistry, Chair of the Department of Oral and Maxillofacial Surgery/Hospital Dentistry in the School of Dentistry and Associate Professor of Surgery for the Medical School, University of Michigan Hospital, Ann Arbor, Mich
| | - Deepak Kademani
- Chief of Staff North Memorial Health, Fellowship Director, Oral/Head and Neck Oncologic and Reconstructive Surgery Attending Surgeon, North Memorial Health and the University of Minnesota. Private practice, Minnesota Oral and Facial Surgery and Minnesota Head and Neck Surgery, Minneapolis, Minn
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Evaluating the Biocompatibility of an Injectable Wound Matrix in a Murine Model. Gels 2022; 8:gels8010049. [PMID: 35049584 PMCID: PMC8774422 DOI: 10.3390/gels8010049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/14/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Developing a high-quality, injectable biomaterial that is labor-saving, cost-efficient, and patient-ready is highly desirable. Our research group has previously developed a collagen-based injectable scaffold for the treatment of a variety of wounds including wounds with deep and irregular beds. Here, we investigated the biocompatibility of our liquid scaffold in mice and compared the results to a commercially available injectable granular collagen-based product. (2) Methods: Scaffolds were applied in sub-dermal pockets on the dorsum of mice. To examine the interaction between the scaffolds and the host tissue, samples were harvested after 1 and 2 weeks and stained for collagen content using Masson’s Trichrome staining. Immunofluorescence staining and quantification were performed to assess the type and number of cells infiltrating each scaffold. (3) Results: Histological evaluation after 1 and 2 weeks demonstrated early and efficient integration of our liquid scaffold with no evident adverse foreign body reaction. This rapid incorporation was accompanied by significant cellular infiltration of stromal and immune cells into the scaffold when compared to the commercial product (p < 0.01) and the control group (p < 0.05). Contrarily, the commercial scaffold induced a foreign body reaction as it was surrounded by a capsule-like, dense cellular layer during the 2-week period, resulting in delayed integration and hampered cellular infiltration. (4) Conclusion: Results obtained from this study demonstrate the potential use of our liquid scaffold as an advanced injectable wound matrix for the management of skin wounds with complex geometries.
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Paolini G, Sorotos M, Firmani G, Gravili G, Ceci D, Santanelli di Pompeo F. Low-vacuum negative pressure wound therapy protocol for complex wounds with exposed vessels. J Wound Care 2022; 31:78-85. [PMID: 35077217 DOI: 10.12968/jowc.2022.31.1.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Treating high-risk surgical patients with complex wounds over exposed blood vessels is a challenge. Guided wound healing may be the only treatment possible. Negative pressure wound therapy (NPWT) is not recommended in these cases. The authors challenged these current recommendations and share their preliminary experience. METHOD The authors adapted a NPWT protocol that uses low-vacuum continuous pressure (-80mmHg) with a silicone sheath and gauze/foam dressing between the wound bed and the device. They monitored the clinical features of patients' wounds to detect bleeding/ischaemia early on. Dressings were changed every 72-96 hours. RESULTS This protocol was followed in five male patients (aged 23-68 years) with complex wounds over exposed vessels. Two cases were foot crush injuries, one midfoot amputation, one hand self-subamputation and one vascular bypass infection. Comorbidities included monoarterial limbs/stump, severe arteriopathy and psychiatric disorder. The exposed vessels were femoral, radial and ulnar, anterior and posterior tibial arteries and veins. Mean treatment lasted 37 days (range 20-61 days). No episodes of severe bleeding/ischaemia of the extremities were observed. Treatment was discontinued once debridement was complete and granulation tissue allowed spontaneous closure/grafting. All wounds appeared stable at 1-year follow-up. CONCLUSION The low-vacuum NPWT protocol was successful in solving five difficult cases. This regimen reduces risks associated with NPWT use on wounds with exposed vessels. The authors believe further validation is required to strengthen the evidence. However, preliminary data are encouraging and might help to change future NPWT recommendations by extending the indications for its use to exposed vessels.
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Affiliation(s)
- Guido Paolini
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy.,Sant'Andrea Hospital in Rome, Rome, Italy
| | - Michail Sorotos
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, PhD School of Translational Medicine of Development and Active Aging, Università degli Studi di Salerno, Salerno, Italy
| | - Guido Firmani
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
| | | | - Diego Ceci
- Sant'Andrea Hospital in Rome, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Plastic Surgery Unit, Nesmos Department, Faculty of Medicine and Psychology University Sapienza of Rome, Italy
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Salleh A, Fauzi MB. The In Vivo, In Vitro and In Ovo Evaluation of Quantum Dots in Wound Healing: A Review. Polymers (Basel) 2021; 13:E191. [PMID: 33430272 PMCID: PMC7825662 DOI: 10.3390/polym13020191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 01/09/2023] Open
Abstract
Wound is defined as primarily damaged or disruption of skin contributed to the loss of its microstructure stability and which undergoes complex wound healing process. However, there are tons of factors that could affect the wound healing process such as infection and slow angiogenesis. Involvement of nanotechnologies therapies in wound care research aims to facilitates this healing process. Quantum dots (QDs) are an advanced nanomaterial technology found to be useful in clinical and biomedical applications. This review has been carried out to provide a summary of the application of QDs in acute or chronic wound healing. A thorough searching was done via Web of Science and SCOPUS database to obtain relevant articles including the in vivo, in vitro and in ovo studies. The results demonstrated a similar effect of different types of QDs, or an improvement of QDs in wound healing, antibacterial and angiogenesis properties. This review demonstrated the effectiveness of QDs for the wound healing process mainly by their antibacterial activity. Uniquely, the antibacterial effect unraveled an increasing trend over time influenced by the various concentration of QDs. In conclusion, the application of QDs support the wound healing phases and proven to be effective in vivo, in vitro and in ovo. However, the future QDs work should focus on the molecular level for the details of cellular interactions and pathways.
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Affiliation(s)
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia;
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15
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Pasek J, Szajkowski S, Cieślar G. Therapeutic efficacy of physical combined therapy in the treatment of venous crural ulcers. Phlebology 2021; 36:481-488. [PMID: 33407055 DOI: 10.1177/0268355520982452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Venous crural ulcer is a serious medical problem indeed, which is connected with patients' suffering and long term treatment generating high cost. The prognosis is unfavourable in many cases, as complete treatment of ulceration, when it is profound or really extensive is difficult to achieve, and sometimes impossible altogether. The aim of the study was to evaluate the therapeutic efficacy of treatment of venous crural ulcers with the use of multifunctional device LASEROBARIA-S, designed for combined physical therapy procedures. METHOD 147 succeeding patients (67 women and 80 men) diagnosed with venous crural ulcer participated in the study, with age varied between 41 and 79 years (average age - 70.2 years). The patients underwent a 60 day cycle of combined physical therapy, with the use of multifunctional device LASEROBARIA-S, during which therapy the lower extremity of the patient was placed in the therapeutic chamber and simultaneously subjected to the action of: local oxygen hyperbaria, low-frequency variable magnetic field and low energy light radiation emitted by semiconductor LED diodes. Prior to the therapeutic cycle and after its completion, planimetric measurements of the area of ulcer and the assessment of pain intensity with use of VAS scale were performed, in relation to selected factors potentially affecting therapeutic effects of applied therapy, as: sex and age of patients, as well as initial size of the ulcer and duration of the ulcer presence. RESULTS After the completion of therapeutic cycle, statistically significant reduction of the area of treated ulcer was found, by 5.4 cm2 on the average (16.3 cm2 vs 10.5 cm2) (p < 0.05). Moreover, as a result of the combined therapy procedures performed, the statistically significant lowering of the intensity of pain sensation experienced by patients, assessed by means of VAS scale, was obtained (2.55 points vs 0.48 points) (p < 0.05). The obtained improvement was not dependent statistically significantly on any of analysed selected factors potentially affecting regenerative and analgesic effect of applied therapy. CONCLUSIONS The application of combined physical therapy with the use of LASEROBARIA-S device results in significant reduction of the area of the venous crural ulcer surface, as well as reduction of the intensity of accompanying pain complaints and this therapeutic effect was not dependent on sex and age of patients, as well as initial size of the ulcer and duration of the ulcer presence.
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Affiliation(s)
- Jarosław Pasek
- Faculty of Health Sciences, Jan Długosz University in Częstochowa, Częstochowa, Poland.,Department of Osteopathic Medicine, Department of Physiotherapy, Masovian Medical College, Warsaw, Poland
| | - Sebastian Szajkowski
- Department of Osteopathic Medicine, Department of Physiotherapy, Masovian Medical College, Warsaw, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
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16
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Xing D, Yang Z, Cao C, Dong Z, Wei J, Zheng X, Li W. A modified negative pressure wound therapy for the treatment of refractory wounds: A preliminary study. Medicine (Baltimore) 2020; 99:e21148. [PMID: 32664147 PMCID: PMC7360312 DOI: 10.1097/md.0000000000021148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Negative pressure wound therapy (NPWT) is an important therapy for the management of refractory wounds. The aim of this retrospective preliminary study was to introduce a modified NPWT (m-NPWT) and compared the efficacy of it with conventional NPWT (c-NPWT) in the management of refractory wounds.A total of 127 patients with refractory wounds receiving the NPWT from January 2010 to October 2017 in our hospital were retrospectively reviewed. The demographics and clinical data were collected from medical records and compared between m-NPWT group and c-NPWT group.There were 65 patients in c-NPWT group and 62 patients in m-NPWT group. No significant difference was observed between 2 groups in antimicrobial use (P = .51), hospitalization time (P = .24), wound-healing rate (P = .44) or complication rate (P = .59). However, patients in m-NPWT group had shorter wound-healing time (24.82 vs 27.66 days, P < .01), less debridement times (1.23 vs 2.08, P < .01), less total cost (3743.93 vs 6344.33 yuan, P < .01) and higher satisfaction rate (56/62 vs 44/65, P = .02) compared to those in c-NPWT group.The m-NPWT technique was an efficient and safe alternative therapy for refractory wounds.
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17
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Reese AM, Haag CK, Jung E, Nauta AC, Swerlick RA, Ortega-Loayza AG. Pyoderma gangrenosum underrepresentation in non-dermatological literature. Diagnosis (Berl) 2020; 8:85-90. [DOI: 10.1515/dx-2019-0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/06/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Pyoderma gangrenosum (PG) is a chronic, ulcerative neutrophilic dermatosis. PG presents a diagnostic challenge, largely due to the many mimicking diseases, the lack of confirmatory laboratory or biological markers, and the absence of widely accepted diagnostic criteria. In particular, PG is often mistaken for necrotizing soft tissue infections (NSTI).
Methods
We reviewed four major textbooks each in general surgery, plastic surgery, trauma surgery, vascular surgery, emergency medicine, and dermatology. We also performed a search of review articles addressing NSTI and necrotizing fasciitis (NF).
Results
Ten out of the 20 non-dermatology textbooks did not list PG anywhere, and only two listed a differential diagnosis for PG. None of the non-dermatology textbooks indicated PG in the NSTI differential diagnosis, while three of the dermatology textbooks included PG in the NSTI differential diagnosis. PG was listed in all of the dermatology textbooks. Only one of the NSTI and NF articles mentioned PG in the differential diagnosis.
Conclusions
There is an underrepresentation in major textbooks of surgery and emergency medicine and in NSTI and NF review articles when it comes to diagnosing PG. This might be leading to trainees and advanced providers in these fields being uninstructed on PG, and likely contributes to PG misdiagnosis and mismanagement. We recommend PG be included in the differential diagnosis of chronic ulcers and NSTI in non-dermatology textbooks. We also suggest adding identification and diagnosis of inflammatory mimickers of NSTI (e.g. PG) in teaching modules in surgical and emergency specialties to address this knowledge gap.
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Affiliation(s)
- Ashley M. Reese
- Department of Dermatology, School of Medicine , Oregon Health and Science University , Portland , OR , USA
| | - Carter K. Haag
- Department of Dermatology, School of Medicine , Oregon Health and Science University , Portland , OR , USA
| | - Enjae Jung
- Division of Vascular Surgery , Oregon Health and Science University , Portland , OR , USA
| | - Allison C. Nauta
- Division of Plastic and Reconstructive Surgery , Oregon Health and Science University , Portland , OR , USA
| | | | - Alex G. Ortega-Loayza
- Department of Dermatology , Oregon Health and Science University , Portland , OR , USA
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Lieberman JA, Stansbury LG, Kufera JA, Chiu WC, Punch LJ, Hess JR, Scalea TM, Henry SM. Red Blood Cell Transfusions and Anemia on Admission Are Associated with Poor Outcomes in Necrotizing Soft Tissue Infections. J Appl Lab Med 2019; 3:250-260. [PMID: 33636946 DOI: 10.1373/jalm.2017.025643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/27/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) are highly morbid infections often requiring critical care and transfusion support. We explored a large 2-year experience from a regional trauma center with a dedicated soft tissue service (STS) in an attempt to identify factors in current care with potential for improving outcomes for these critically ill patients. METHODS New adult (>17 years) STS admissions, 2008-2009, were identified from the Trauma Registry. Patient records were extracted and assessed via descriptive statistics, univariate analysis, and multivariable logistic regression models. RESULTS Mortality among 253 eligible primary admissions was 8.3% overall and 10.3% for those with an admission diagnosis of NSTI. No significant differences in wound characteristics, use of VAC (vacuum-assisted closure) dressing or hyperbaric oxygen, or wound microbiology emerged between survivors and nonsurvivors. Median time to first debridement was 5 h (interquartile range, 2-21 h). Multivariable modeling indicated association of worse outcome (death or discharge to chronic/rehab care) with age >60 years [odds ratio (OR), 3.82; P < 0.001], anemia (OR, 0.98; P = 0.03), increasing number of transfusions (OR, 1.09; P < 0.001), NSTI diagnosis (OR, 2.47; P = 0.005), preexisting diabetes mellitus (OR, 3.20; P = 0.001), and low admission hemoglobin (OR, 0.80; P = 0.004). CONCLUSIONS Mortality was less than previously reported. Number of transfusions and anemia at admission emerged as risk factors for poor outcomes. Future research should focus on the effects of transfusion on NSTI outcomes, on potentially confounding factors, and on whether a restrictive transfusion strategy reduces mortality.
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Affiliation(s)
- Joshua A Lieberman
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Lynn G Stansbury
- Shock Trauma and Anesthesia Research Center, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - Joseph A Kufera
- Shock Trauma and Anesthesia Research Center, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - William C Chiu
- R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - Laurie J Punch
- Acute and Critical Care Surgery, Washington University School of Medicine, St Louis, MO
| | - John R Hess
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Thomas M Scalea
- R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
| | - Sharon M Henry
- R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD
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Cheng B, Tian J, Peng Y, Fu X. Iatrogenic wounds: a common but often overlooked problem. BURNS & TRAUMA 2019; 7:18. [PMID: 31165077 PMCID: PMC6544969 DOI: 10.1186/s41038-019-0155-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/09/2019] [Indexed: 01/06/2023]
Abstract
Iatrogenic wounds are a common but often overlooked concept. They can lead to increases in hospital stays, therapy costs, repeat surgeries, and implant removal. If not handled properly, these wounds have a very poor prognosis and will cause serious physical and psychological harm to patients, which may result in medicolegal disputes. In recent years, the incidence of iatrogenic wounds has increased because of (1) an increase in the population of older people owing to increased life expectancy, (2) the continued expansion of surgical indications, (3) an increase in difficult surgeries, and (4) the constant emergence and application of new implantable biomaterials and other therapies. Thus, there is a pressing clinical need to improve the therapy of iatrogenic wounds. However, the difficulty in treating these wounds is considerable due to the emergence of drug-resistant bacteria, the high number of patients with metabolic diseases, and complex complications in patients. In particular, iatrogenic wounds caused by surgical site infections due to implantable biomaterials could lead to material leakage and conflicts regarding whether to retain or remove the implants. This review provides a definition of iatrogenic wounds, describes their characteristics, classifies them, and provides information about the importance of analyzing iatrogenic wounds. We hope that this review will provide useful information for the diagnosis and treatment of iatrogenic wounds and help to reduce their incidence in the future.
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Affiliation(s)
- Biao Cheng
- Department of Plastic Surgery, General Hospital of Southern Theater Command of PLA, 111 Liuhua Road, Guangzhou, 510010 Guangdong People's Republic of China.,Department of Plastic Surgery and the Key Laboratory of Trauma Treatment and Tissue Repair of Tropical Area, PLA, Guangzhou, People's Republic of China
| | - Ju Tian
- Department of Plastic Surgery, General Hospital of Southern Theater Command of PLA, 111 Liuhua Road, Guangzhou, 510010 Guangdong People's Republic of China.,5Department of Plastic Surgery, Zhongshan City People's Hospital, Zhongshan, 528400 Guangdong People's Republic of China
| | - Yan Peng
- 3Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokulam, Hong Kong SAR People's Republic of China
| | - Xiaobing Fu
- 4Wound Healing Unit, The First Affiliated Hospital, General Hospital of PLA, 51 Fu Cheng Road, Beijing, 100048 People's Republic of China
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Development and Evaluation of an Injectable Chitosan/β-Glycerophosphate Paste as a Local Antibiotic Delivery System for Trauma Care. J Funct Biomater 2018; 9:jfb9040056. [PMID: 30322006 PMCID: PMC6306749 DOI: 10.3390/jfb9040056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/23/2018] [Accepted: 10/09/2018] [Indexed: 01/03/2023] Open
Abstract
Complex open musculoskeletal wounds are a leading cause of morbidity worldwide, partially due to a high risk of bacterial contamination. Local delivery systems may be used as adjunctive therapies to prevent infection, but they may be nondegradable, possess inadequate wound coverage, or migrate from the wound site. To address this issue, a thermo-responsive, injectable chitosan paste was fabricated by incorporating beta-glycerophosphate. The efficacy of thermo-paste as an adjunctive infection prevention tool was evaluated in terms of cytocompatibility, degradation, antibacterial, injectability, and inflammation properties. In vitro studies demonstrated thermo-paste may be loaded with amikacin and vancomycin and release inhibitory levels for at least 3 days. Further, approximately 60% of thermo-paste was enzymatically degraded within 7 days in vitro. The viability of cells exposed to thermo-paste exceeded ISO 10993-5 standards with approximately 73% relative viability of a control chitosan sponge. The ejection force of thermo-paste, approximately 20 N, was lower than previously studied paste formulations and within relevant clinical ejection force ranges. An in vivo murine biocompatibility study demonstrated that thermo-paste induced minimal inflammation after implantation for 7 days, similar to previously developed chitosan pastes. Results from these preliminary preclinical studies indicate that thermo-paste shows promise for further development as an antibiotic delivery system for infection prevention.
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21
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Ivins N, Braumann C, Kirchhoff JB, Waldemar U, Jones NJ. Use of a gelling fibre dressing in complex surgical or chronic wounds: a case series. J Wound Care 2018; 27:444-454. [PMID: 30016138 DOI: 10.12968/jowc.2018.27.7.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the safety and performance of a gelling fibre dressing, with respect to wound exudate management, maceration and periwound skin conditions. METHOD Complex (non-healing) surgical or chronic wounds healing by secondary intention were treated with a gelling fibre dressing (Biosorb, Acelity) as part of a prospective, two-centre case series product evaluation study. Dressing performance was evaluated at each change, and weekly for up to four weeks or until the wound healed, if this was in less than four weeks. The main outcome measure was dressing performance, wound bed and periwound skin condition. RESULTS A total of 15 patients, aged 26-87 years, were enrolled; 10 patients (66.7%) presented with chronic wounds including venous leg ulcers (VLUs), arterial leg ulcer, one mixed leg ulcer, pressure ulcer (PU), and diabetic foot ulcers (DFUs). The remaining wounds (33.3%) were postsurgical complex wounds healing by secondary intention, located in the upper leg, foot, abdomen, and sacrum. Mean wound area was 22.6±36.6cm2 (range: 1.3-144.0cm2). Treated wounds showed complete granulation in eight (53.0%) wounds, 75% granulation coverage in two (13.3%) wounds, 50% coverage in three (20.3%), and 25% coverage in two (13.3%) wounds. Patients evaluated the dressing effectiveness as 'excellent' or 'very good' in 45% of cases, 'moderate' in 45%, and 'poor' in 10% of cases. Results of Visual Analogue Scale (VAS) showed 70% of patients rated their pain as 'low' and 30% as 'moderate' at dressing removal. Clinicians' evaluation of dressing ability to absorb and retain wound exudate was rated 'excellent' or 'very good' in 80% of cases, and moderate in 20% and poor in 10% of cases. Overall, clinicians' impression of the dressing performance was reported as 'excellent' or 'very good' in 80% of cases and 'moderate' in 20% of cases. No patient had to be removed from the study due to adverse events directly related to the dressing or its performance. CONCLUSION These clinical findings suggest the new gelling fibre dressing to be safe and effective in wound treatment of complex (non-healing) surgical or chronic wounds, to manage exudate effectively, and to optimise the conditions of wounds healing by secondary intention.
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Affiliation(s)
- Nicola Ivins
- Clinical Research Director; Welsh Wound Innovation Centre, Rhodfa Marics, Pontyclun, Wales
| | - Chris Braumann
- Clinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Jan-Birger Kirchhoff
- Clinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Uhl Waldemar
- Clinic for General and Visceral Surgery, St. Josef-Hospital, Ruhr University Bochum, Germany
| | - Nia J Jones
- Welsh Wound Innovation Centre, Rhodfa Marics, Pontyclun, Wales
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Khoshim K, Hersant B, Hotz C, SidAhmed-Mezi M, Meningaud JP. Wound healing of cutaneous substance losses based on infectious, inflammatory and traumatic skin disorders: The experience of a center. ANN CHIR PLAST ESTH 2017; 63:330-337. [PMID: 29239728 DOI: 10.1016/j.anplas.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is no reference available concerning the standard healing time based on dermatological diseases responsible for cutaneous substance losses. The aim of our study was to assess the healing time after surgical debridement of necrotizing fasciitis (NF), hidradenitis suppurativa (HS) and skin necrosis due to trauma (SNT) based on multiples existing co-morbidities among these patients to provide surgeons with accurate scientific data in order to inform and educate patients and nurses who are practicing care under the supervision of the surgeon. MATERIALS AND METHODS This was a retrospective study. The primary endpoint was the time for complete wound healing, which was calculated from the time of the last surgical procedure to the complete wound healing corresponding to the time of complete reepithelialization, when daily dressings were no longer needed. RESULTS A total of 107 patients were included. The mean time for complete wound healing was 64.94±31.55 days in patients with NF, 45.70±21.40 days in patients with SNT and 75.02±26.41 days in patients with HS (SNT versus NF, P=0.004** and SNT versus HS, P<0.0001**). CONCLUSION The mean time for complete wound healing was 64.94 days in patients with NF, 45.70 days in patients with SNT, 75.02 days in patients with HS. This study can be considered as a referential based on the experience of a reference centre for these 3 pathologies (NF, HS, and SNT) whose aim is to inform plastic surgeons in order to anticipate the management or educate the patient.
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Affiliation(s)
- K Khoshim
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - B Hersant
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - C Hotz
- Départementde dermatologie, hôpital Henri-Mondor, université Paris-Est, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - M SidAhmed-Mezi
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - J P Meningaud
- Département de chirurgie plastique et reconstructrice, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Rhodes CS, Alexander CM, Berretta JM, Courtney HS, Beenken KE, Smeltzer MS, Bumgardner JD, Haggard WO, Jennings JA. Evaluation of a chitosan-polyethylene glycol paste as a local antibiotic delivery device. World J Orthop 2017; 8:130-141. [PMID: 28251063 PMCID: PMC5314142 DOI: 10.5312/wjo.v8.i2.130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/20/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy of a chitosan/polyethylene glycol blended paste as a local antibiotic delivery device, particularly in musculoskeletal wounds.
METHODS Acidic (A) chitosan sponges and neutralized (N) chitosan/polyethylene glycol (PEG) blended sponges were combined in ratios of 3A:2N, 1A:1N, and 2A:3N; then hydrated with phosphate buffered saline to form a chitosan/PEG paste (CPP). Both in vitro and in vivo studies were conducted to determine the potential CPP has as a local antibiotic delivery device. In vitro biocompatibility was assessed by the cytotoxic response of fibroblast cells exposed to the experimental groups. Degradation rate was measured as the change in dry mass due to lysozyme based degradation over a 10-d period. The antibiotic elution profiles and eluate activity of CPP were evaluated over a 72-h period. To assess the in vivo antimicrobial efficacy of the CPP, antibiotic-loaded paste samples were exposed to subcutaneously implanted murine catheters inoculated with Staphylococcus aureus. Material properties of the experimental paste groups were evaluated by testing the ejection force from a syringe, as well as the adhesion to representative musculoskeletal tissue samples.
RESULTS The highly acidic CPP group, 3A:2N, displayed significantly lower cell viability than the control sponge group. The equally distributed group, 1A:1N, and the highly neutral group, 2A:3N, displayed similar cell viability to the control sponge group and are deemed biocompatible. The degradation studies revealed CPP is more readily degradable than the chitosan sponge control group. The antibiotic activity studies indicated the CPP groups released antibiotics at a constant rate and remained above the minimum inhibitory concentrations of the respective test bacteria for a longer time period than the control chitosan sponges, as well as displaying a minimized burst release. The in vivo functional model resulted in complete bacterial infection prevention in all catheters treated with the antibiotic loaded CPP samples. All experimental paste groups exhibited injectability and adhesive qualities that could be advantageous material properties for drug delivery to musculoskeletal injuries.
CONCLUSION CPP is an injectable, bioadhesive, biodegradable, and biocompatible material with potential to allow variable antibiotic loading and active, local antibiotic release to prevent bacterial contamination.
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Frykberg RG, Gibbons GW, Walters JL, Wukich DK, Milstein FC. A prospective, multicentre, open-label, single-arm clinical trial for treatment of chronic complex diabetic foot wounds with exposed tendon and/or bone: positive clinical outcomes of viable cryopreserved human placental membrane. Int Wound J 2016; 14:569-577. [PMID: 27489115 PMCID: PMC7950156 DOI: 10.1111/iwj.12649] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 12/19/2022] Open
Abstract
Complex diabetic foot ulcers (DFUs) with exposed tendon or bone remain a challenge. They are more susceptible to complications such as infection and amputation and require treatments that promote rapid development of granulation tissue and, ultimately, reepithelialisation. The clinical effectiveness of viable cryopreserved human placental membrane (vCHPM) for DFUs has been established in a level 1 trial. However, complex wounds with exposed deeper structures are typically excluded from randomised controlled clinical trials despite being common in clinical practice. We report the results of a prospective, multicentre, open‐label, single‐arm clinical trial to establish clinical outcomes when vCHPM is applied weekly to complex DFUs with exposed deep structures. Patients with type 1 or type 2 diabetes and a complex DFU extending through the dermis with evidence of exposed muscle, tendon, fascia, bone and/or joint capsule were eligible for inclusion. Of the 31 patients enrolled, 27 completed the study. The mean wound area was 14·6 cm2, and mean duration was 7·5 months. For patients completing the protocol, the primary endpoint, 100% wound granulation by week 16, was met by 96·3% of patients in a mean of 6·8 weeks. Complete wound closure occurred in 59·3% (mean 9·1 weeks). The 4‐week percent area reduction was 54·3%. There were no product‐related adverse events. Four patients (13%) withdrew, two (6·5%) for non‐compliance and two (6·5%) for surgical intervention.
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Affiliation(s)
- Robert G Frykberg
- Department of Podiatry, Carl T. Hayden VA Medical Center, Phoenix, AZ, USA
| | - Gary W Gibbons
- Center for Wound Healing, South Shore Hospital, Weymouth, MA, USA
| | - Jodi L Walters
- Department of Podiatry, Southern Arizona VA Health Care System, Tucson, AZ, USA
| | - Dane K Wukich
- UPMC Wound Healing Services, UPMC Mercy, Pittsburgh, PA, USA
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25
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Price G, Hodgins N, Fogarty B. A comparison of fasciotomy wound closure methods following extremity compartment syndrome at a regional trauma centre. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moghazy AM, Ellabban MA, Adly OA, Ahmed FY. Evaluation of the use of vacuum-assisted closure (VAC) and platelet-rich plasma gel (PRP) in management of complex wounds. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1140-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Xie Z, Aphale NV, Kadapure TD, Wadajkar AS, Orr S, Gyawali D, Qian G, Nguyen KT, Yang J. Design of antimicrobial peptides conjugated biodegradable citric acid derived hydrogels for wound healing. J Biomed Mater Res A 2015; 103:3907-18. [PMID: 26014899 DOI: 10.1002/jbm.a.35512] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 01/13/2023]
Abstract
Wound healing is usually facilitated by the use of a wound dressing that can be easily applied to cover the wound bed, maintain moisture, and avoid bacterial infection. In order to meet all of these requirements, we developed an in situ forming biodegradable hydrogel (iFBH) system composed of a newly developed combination of biodegradable poly(ethylene glycol) maleate citrate (PEGMC) and poly(ethylene glycol) diacrylate (PEGDA). The in situ forming hydrogel systems are able to conform to the wound shape in order to cover the wound completely and prevent bacterial invasion. A 2(k) factorial analysis was performed to examine the effects of polymer composition on specific properties, including the curing time, Young's modulus, swelling ratio, and degradation rate. An optimized iFBH formulation was achieved from the systematic factorial analysis. Further, in vitro biocompatibility studies using adult human dermal fibroblasts (HDFs) confirmed that the hydrogels and degradation products are not cytotoxic. The iFBH wound dressing was conjugated and functionalized with antimicrobial peptides as well. Evaluation against bacteria both in vitro and in vivo in rats demonstrated that the peptide-incorporated iFBH wound dressing offered excellent bacteria inhibition and promoted wound healing. These studies indicated that our in situ forming antimicrobial biodegradable hydrogel system is a promising candidate for wound treatment.
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Affiliation(s)
- Zhiwei Xie
- Department of Biomedical Engineering, Materials Research Institute, the Huck Institutes of the Life Sciences, the Pennsylvania State University, University Park, Pennsylvania, 16802
| | - Nikhil V Aphale
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019.,Joint Biomedical Engineering Program between the University of Texas at Arlington and the University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Tejaswi D Kadapure
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019.,Joint Biomedical Engineering Program between the University of Texas at Arlington and the University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Aniket S Wadajkar
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019.,Joint Biomedical Engineering Program between the University of Texas at Arlington and the University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Sara Orr
- Department of Biomedical Engineering, Materials Research Institute, the Huck Institutes of the Life Sciences, the Pennsylvania State University, University Park, Pennsylvania, 16802
| | - Dipendra Gyawali
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019.,Joint Biomedical Engineering Program between the University of Texas at Arlington and the University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Guoying Qian
- Department of Biology, College of Biological and Environmental Sciences, Zhejiang Wanli University, Ningbo, 315100, China
| | - Kytai T Nguyen
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019.,Joint Biomedical Engineering Program between the University of Texas at Arlington and the University of Texas Southwestern Medical Center, Dallas, Texas, 75390
| | - Jian Yang
- Department of Biomedical Engineering, Materials Research Institute, the Huck Institutes of the Life Sciences, the Pennsylvania State University, University Park, Pennsylvania, 16802
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McCormack M, Valiquette AS, Ismail S. Fournier's gangrene: A retrospective analysis of 26 cases in a Canadian hospital and literature review. Can Urol Assoc J 2015. [PMID: 26225189 DOI: 10.5489/cuaj.2445] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We performed a systematic review of all cases of Fournier's Gangrene (FG) at our hospital over a 12-year period. A total of 26 cases were assessed. Our goal was to determine the mortality rate and to identify risk factors associated with FG. We also wanted to examine three potential prognostic factors in relation to patient survival, including the time delay from emergency room admission to surgery, the initial extent of the disease, and the impact of more than one debridement procedure under general anesthesia. The time between emergency room admission and the beginning of surgical debridement was not statistically different between survivors and non-survivors. The extent of surgical debridement was close to the margin of statistical significance (p = 0.07) and can be considered an index of the extent of the disease. FG extending to the thighs or to the abdominal wall carries a worse prognosis. The number of surgical debridement procedures done under anesthesia was statistically different between survivors and non-survivors. Patients were 4.8 times more at risk of dying if they are required to have more than one surgical debridement under general anesthesia. This presumably reflects persistent gangrene following initial surgical debridement, fluid resuscitation, and wide spectrum antibiotic treatment.
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Affiliation(s)
| | | | - Salima Ismail
- Department of Surgery, University of Montreal, Montreal, QC
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29
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Magalhães MAB, Petroianu A, Martins SGDO, Resende V, Alberti LR, Barbosa AJA, Vasconcellos LDS, Tavares Junior WC. Closure of large wounds using rubber bands in rabbits. Rev Col Bras Cir 2015; 42:56-61. [PMID: 25992702 DOI: 10.1590/0100-69912015001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/15/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to verify the effectiveness of the rubber elastic band in the treatment of large wounds of the body wall of rabbits by means of traction of its edges. METHODS we studied 30 New Zealand rabbits, divided into three groups (n=10): Group 1- healing by secondary intention; Group 2- removal and eutopic repositioning of skin as full thickness skin graft; Group 3- Approximation of wound edges with elastic rubber band. In all animals, we removed a segment of the back skin and subcutaneous tissue down to the fascia, in accordance with an acrylic mold of 8 cm long by 12 cm wide. All animals were observed for 21 days. RESULTS two animals of groups 1 and 2 had wound abscess. In Group 2, there was partial or total graft loss in 90% of animals. The complete closure of the wounds was observed in four animals of Group 1, six of Group 2 and eight of Group 3. There was no difference between the scar resistance values of groups 2 and 3, which were higher than those in Group 1. The scars of the three groups were characterized by the presence of mature connective tissue mixed with blood vessels and inflammatory infiltration, predominantly polymorphonuclear. CONCLUSION the tensile strength of the wound edges with rubber elastic band is as efficient as the skin graft to treat rabbits' large body wounds.
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Affiliation(s)
| | - Andy Petroianu
- Department of Surgery, Faculty of Medicine, UFMG, Minas Gerais, Brazil
| | | | - Vivian Resende
- Department of Surgery, Faculty of Medicine, UFMG, Minas Gerais, Brazil
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Wahab N, Roman M, Chakravarthy D, Luttrell T. The Use of a Pure Native Collagen Dressing for Wound Bed Preparation Prior to Use of a Living Bi-layered Skin Substitute. J Am Coll Clin Wound Spec 2015; 6:2-8. [PMID: 26442205 DOI: 10.1016/j.jccw.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Management of chronic wounds in the outpatient setting is quite challenging. The extensive co-morbid medical problems of the chronically ill patient along with the complexities of the wound bed and its biochemical environment has led to a plethora of patients with poor wound healing. This ever increasing population is a challenge for the wound care practitioner and cost to the health care system and patient. Increased wound chronicity has promulgated the use of advanced wound care products, including Living Skin Substitutes (LSS), in an attempt to obtain wound closure, and ultimately both physiological and functional healing.(1-3) In the outpatient setting, it is evident that the efficacy of the LSS varies widely depending on the patient type with some patients responding quite favorably while others who do not achieve healing despite repeated applications of LSS. This case series demonstrates that a systematic method of wound bed preparation prior to the application of LSS improved healing outcomes. The entire wound bed preparation protocol included autolytic, non-selective, and sharp-selective debridement, if deemed appropriate, followed by the weekly application of a pure native collagen. The wound bed preparation protocol was completed prior to LSS application. This case series presents evidence supporting the application of a 100% native collagen dressing to wound bed prior to the final step of LSS utilization.
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Affiliation(s)
- Naz Wahab
- University Medical Center, 1800 West Charleston Blvd, Las Vegas, NV 89120, USA
| | - Martha Roman
- University Medical Center, 1800 West Charleston Blvd, Las Vegas, NV 89120, USA
| | | | - Tammy Luttrell
- University Medical Center, 1800 West Charleston Blvd, Las Vegas, NV 89120, USA
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McLean MM, Thames S, Palmer E, Tilney PVR. A 56-year-old man with necrotizing fasciitis. Air Med J 2014; 33:125-8, 135. [PMID: 25049179 DOI: 10.1016/j.amj.2014.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/10/2014] [Indexed: 11/17/2022]
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Carlson ER, Schlott BJ. Anti-resorptive osteonecrosis of the jaws: facts forgotten, questions answered, lessons learned. Oral Maxillofac Surg Clin North Am 2014; 26:171-91. [PMID: 24630868 DOI: 10.1016/j.coms.2014.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Osteonecrosis of the jaws associated with bisphosphonate and other anti-resorptive medications (ARONJ) has historically been a poorly understood disease process in terms of its pathophysiology, prevention and treatment since it was originally described in 2003. In association with its original discovery 11 years ago, non-evidence based speculation of these issues have been published in the international literature and are currently being challenged. A critical analysis of cancer patients with ARONJ, for example, reveals that their osteonecrosis is nearly identical to that of cancer patients who are naive to anti-resorptive medications. In addition, osteonecrosis of the jaws is not unique to patients exposed to anti-resorptive medications, but is also seen in patients with osteomyelitis and other pathologic processes of the jaws. This article represents a review of facts forgotten, questions answered, and lessons learned in general regarding osteonecrosis of the jaws.
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Affiliation(s)
- Eric R Carlson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, University of Tennessee Cancer Institute, 1930 Alcoa Highway, Knoxville, TN 37920, USA.
| | - Benjamin J Schlott
- Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, University of Tennessee Cancer Institute, 1930 Alcoa Highway, Knoxville, TN 37920, USA
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Local use of insulin in wounds of diabetic patients: higher temperature, fibrosis, and angiogenesis. Plast Reconstr Surg 2014; 132:1015e-1019e. [PMID: 24281606 DOI: 10.1097/prs.0b013e3182a806f0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Clinical trials have shown the effectiveness of systemic and local insulin therapy in improving wound healing. Diabetic wounds remain a challenge for healthcare providers. Impaired angiogenesis and reduced granulation tissue formation contribute to inadequate wound healing. The aim of this study was to investigate the effect of local insulin administration in acute and chronic diabetic wounds. METHODS Eight diabetic patients presenting with full-thickness wounds, of different causes, were included in this study. Five wounds were due to necrobiosis, one to trauma, and two to postneoplasm resection. All wounds were treated with regular bedside treatment. In addition, half of the wound surface was treated with insulin and the other half did not receive insulin. Thermographic and biopsy specimens of the two sides were obtained on days 0 and 14. The presence of fibrosis, change in temperature, and amount of blood were evaluated. RESULTS Significant differences in the number of vessels were observed on the insulin-treated side (96 ± 47) when compared with the no-insulin side (32.88 ± 45) (p < 0.026). The percentage of fibrosis (insulin: 44.42 ± 30.42 percent versus no insulin: 12.38 ± 36.17 percent; p < 0.047) and the mean temperature (insulin: 1.27 ± 1.12°C versus no-insulin: 0.13 ± 1.22°C; p < 0.001) were also significantly different between sides. No adverse events related to the study occurred. CONCLUSION The use of local insulin improves the formation of new blood vessels, increases fibrosis, and correlates with increased temperature. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Heckmann A, Radtke C, Rennekampff HO, Jokuszies A, Weyand B, Vogt PM. [One-stage defect closure of deperiosted bone and exposed tendons with MATRIDERM® and skin transplantation. Possibilities and limitations]. Unfallchirurg 2013; 115:1092-8. [PMID: 21607790 DOI: 10.1007/s00113-011-2003-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Full-thickness skin defects over functional structures (tendons, vessels) or deperiosted bones of the extremities usually require extensive soft tissue reconstruction to cover the defect. A new option for coverage of the defect is the application of MATRIDERM®, a bovine matrix consisting of collagen and elastin, as a neodermis underneath skin transplants. Can this combined one-stage surgical intervention successfully cover deperiosted bone or tendon? PATIENTS AND METHODS We performed this one-stage procedure in ten patients instead of soft tissue reconstruction. The success of wound coverage with the one-stage method and in combination with skin transplantation for defects generally associated with considerable loss of transplants (deperiosted bones and tendons without paratenons) was determined. RESULTS In nine of ten patients, complete defect coverage could be achieved. A one-stage wound closure in extensive defects with exposed tendons in four of five locations could be achieved. In deperiosted bone defects the one-stage coverage was only successful in two of six patients. However, complete wound closure could be achieved with a second skin transplantation in a patient with exposed tendon and bone in three of the four locations. CONCLUSION As a one- or two-stage procedure, MATRIDERM® application with skin transplantation resulted in an effective defect closure without the need for a complex plastic reconstructive procedure. With regard to its functionality it cannot be considered as a substitute for skin flaps. In selected cases MATRIDERM® is an interesting and successful method in plastic reconstructive surgery.
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Affiliation(s)
- A Heckmann
- Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
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Carr D, Kieser J, Mabbott A, Mott C, Champion S, Girvan E. Damage to apparel layers and underlying tissue due to hand-gun bullets. Int J Legal Med 2013; 128:83-93. [PMID: 23604393 DOI: 10.1007/s00414-013-0856-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 03/26/2013] [Indexed: 11/30/2022]
Abstract
Ballistic damage to the clothing of victims of gunshot wounds to the chest can provide useful forensic evidence. Anyone shot in the torso will usually be wearing clothing which will be damaged by the penetrating impact event and can reportedly be the source of some of the debris in the wound. Minimal research has previously been reported regarding the effect of bullets on apparel fabrics and underlying tissue. This paper examines the effect of ammunition (9 mm full metal jacket [FMJ] DM11 A1B2, 8.0 g; and soft point flat nose Remington R357M3, 10.2 g) on clothing layers that cover the torso (T-shirt, T-shirt plus hoodie, T-shirt plus denim jacket) and underlying structures represented by porcine thoracic wall (skin, underlying tissue, ribs). Impacts were recorded using a Phantom V12 high speed camera. Ejected bone debris was collected before wound tracts were dissected and measured; any debris found was recovered for further analysis. Size and mass of bony debris was recorded; fibre debris recovered from the wound and impact damage to fabrics were imaged using scanning electron microscopy (SEM). Remington R357M3 ammunition was characteristically associated with stellate fabric damage; individual fibres were less likely to show mushrooming. In contrast, 9 mm FMJ ammunition resulted in punch-out damage to fabric layers, with mushrooming of individual fibres being more common. Entry wound sizes were similar for both types of ammunition and smaller than the diameter of the bullet that caused them. In this work, the Remington R357M3 ammunition resulted in larger exit wounds due to the bullet construction which mushroomed. That fabric coverings did not affect the amount of bony debris produced is interesting, particularly given there was some evidence that apparel layers affected the size of the wound. Recent work has suggested that denim (representative of jeans) can exacerbate wounding caused by high-velocity bullet impacts to the thigh when the bullet does not impact the femur. That more bony debris was caused by Remington R357M3 rather than 9 mm FMJ ammunition was not surprising given the relative constructions of these two bullets, and is of interest to medical practitioners.
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Affiliation(s)
- Debra Carr
- Impact and Armour Group, Department of Engineering and Applied Science, Cranfield Defence and Security, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, Wiltshire, SN6 8LA, UK,
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Ball CG, Ouellet JF, Anderson IB, Kirkpatrick AW. Avoidance of total abdominal wall loss despite torso soft tissue clostridial myonecrosis: a case report. J Med Case Rep 2013; 7:5. [PMID: 23298523 PMCID: PMC3599755 DOI: 10.1186/1752-1947-7-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 11/07/2012] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Clostridial necrotizing soft tissue infections are often fatal. Myonecrosis of the torso is a particularly lethal combination given the classic need for radical debridement of the abdominal and thoracic walls, and therefore total exposure of the intraperitoneal and intrathoracic viscera. This case is unusual do to our ability to preserve anatomical separation between the viscera and the atmosphere. CASE PRESENTATION We present a 42-year-old Caucasian man with obesity and diabetes who developed clostridial myonecrosis of his right torso following a mesenteric lymph node biopsy. This required an aggressive debridement (sparing subcutaneous flaps and internal oblique aponeurosis) followed by reconstruction of his right hemi-torso with a biologic prosthesis to prevent subsequent hernia formation. CONCLUSION Although basic principles associated with radical debridement were maintained, a full thickness torso wall resection was avoided. This provided reconstruction advantages that included endogenous subcutaneous flap coverage, separation of the peritoneal cavity by the internal oblique aponeurosis, and prevention of a subsequent hernia below the arcuate line. This technique would be of interest to any surgeon or clinician who treats patients with life-threatening torso soft tissue infections.
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Affiliation(s)
- Chad Geoffrey Ball
- Department of Surgery, University of Calgary, Foothills Medical Centre, 1403-29 St, N,W,, T2N 2T9, Calgary, AB, Canada.
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Sipponen A, Kuokkanen O, Tiihonen R, Kauppinen H, Jokinen JJ. Natural coniferous resin salve used to treat complicated surgical wounds: pilot clinical trial on healing and costs. Int J Dermatol 2012; 51:726-32. [PMID: 22607295 DOI: 10.1111/j.1365-4632.2011.05397.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Resin is a natural product of coniferous trees. Salves manufactured from spruce resin (Picea abies) have been used for centuries to treat wounds and skin infections. We report a pilot clinical trial designed to investigate healing rates, factors that contribute to delayed wound healing, cost-effectiveness, and incidence of allergic reactions when resin salve is used to treat complicated surgical wounds. The trial involved 23 patients in whom wound healing after surgery was delayed. These patients were assigned to resin salve treatment. The primary outcome measure was the number of days to complete wound healing. Secondary objectives included an assessment of factors contributing to delayed wound healing, an estimation of associated costs, and an investigation into the occurrence of allergic reactions related to resin salve therapy. The study achieved a healing rate of 100%. The mean ± SD healing time was 43 ± 24 days. The mean ± SD wound size (length × width × depth) was (29 ± 19) × (12 ± 7) × (4 ± 3) mm. Wound size, use of corticosteroids or other immunosuppressants, and immobilization were statistically significant (P < 0.05) contributors to delayed wound healing and impaired re-epithelialization. The total mean ± SD costs of the resin salve treatment were €45.0 ± 26.0 per patient during the entire treatment period and €1.2 ± 0.5 per treatment day. The rate of allergic reactions was 0%. The results of this pilot trial indicate that complicated surgical wounds may be treated successfully with resin salve. The treatment method is clinically effective and cost-effective, and the rate of allergic reactions is low.
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Affiliation(s)
- Arno Sipponen
- Department of Orthopedics and Traumatology, Päijät-Häme Central Hospital, Lahti, Finland.
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Tolg C, Hamilton SR, Zalinska E, McCulloch L, Amin R, Akentieva N, Winnik F, Savani R, Bagli DJ, Luyt LG, Cowman MK, McCarthy JB, Turley EA. A RHAMM mimetic peptide blocks hyaluronan signaling and reduces inflammation and fibrogenesis in excisional skin wounds. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:1250-70. [PMID: 22889846 DOI: 10.1016/j.ajpath.2012.06.036] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 06/14/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
Hyaluronan is activated by fragmentation and controls inflammation and fibroplasia during wound repair and diseases (eg, cancer). Hyaluronan-binding peptides were identified that modify fibrogenesis during skin wound repair. Peptides were selected from 7- to 15mer phage display libraries by panning with hyaluronan-Sepharose beads and assayed for their ability to block fibroblast migration in response to hyaluronan oligosaccharides (10 kDa). A 15mer peptide (P15-1), with homology to receptor for hyaluronan mediated motility (RHAMM) hyaluronan binding sequences, was the most effective inhibitor. P15-1 bound to 10-kDa hyaluronan with an affinity of K(d) = 10(-7) and appeared to specifically mimic RHAMM since it significantly reduced binding of hyaluronan oligosaccharides to recombinant RHAMM but not to recombinant CD44 or TLR2,4, and altered wound repair in wild-type but not RHAMM(-/-) mice. One topical application of P15-1 to full-thickness excisional rat wounds significantly reduced wound macrophage number, fibroblast number, and blood vessel density compared to scrambled, negative control peptides. Wound collagen 1, transforming growth factor β-1, and α-smooth muscle actin were reduced, whereas tenascin C was increased, suggesting that P15-1 promoted a form of scarless healing. Signaling/microarray analyses showed that P15-1 blocks RHAMM-regulated focal adhesion kinase pathways in fibroblasts. These results identify a new class of reagents that attenuate proinflammatory, fibrotic repair by blocking hyaluronan oligosaccharide signaling.
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Affiliation(s)
- Cornelia Tolg
- Cancer Research Laboratory Program, Lawson Health Research Institute and London Regional Cancer Program, London Health Sciences Center, London, Ontario, Canada
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Wong VW, Gurtner GC. Tissue engineering for the management of chronic wounds: current concepts and future perspectives. Exp Dermatol 2012; 21:729-34. [PMID: 22742728 DOI: 10.1111/j.1600-0625.2012.01542.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2012] [Indexed: 01/13/2023]
Abstract
Chronic wounds constitute a significant and growing biomedical burden. With the increasing growth of populations prone to dysfunctional wound healing, there is an urgent and unmet need for novel strategies to both prevent and treat these complications. Tissue engineering offers the potential to create functional skin, and the synergistic efforts of biomedical engineers, material scientists, and molecular and cell biologists have yielded promising therapies for non-healing wounds. However, traditional paradigms for wound healing focus largely on the role of inflammatory cells and fail to incorporate more recent research highlighting the importance of stem cells and matrix dynamics in skin repair. Approaches to chronic wound healing centred on inflammation alone are inadequate to guide the development of regenerative medicine-based technologies. As the molecular pathways and biologic defects underlying non-healing wounds are further elucidated, multifaceted bioengineering systems must advance in parallel to exploit this knowledge. In this viewpoint essay, we highlight the current concepts in tissue engineering for chronic wounds and speculate on areas for future research in this increasingly interdisciplinary field.
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Affiliation(s)
- Victor W Wong
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Use of negative pressure wound therapy with silver base dressing for necrotizing fasciitis. J Wound Ostomy Continence Nurs 2011; 38:449-52. [PMID: 21747263 DOI: 10.1097/won.0b013e31821e43f1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Necrotizing fasciitis is a life-threatening infection requiring urgent surgical and medical therapy. Hemodynamic stabilization and antimicrobial therapy precede aggressive surgical excision of necrotic tissue, which should be performed as soon as possible. The rapidly spreading infection and aggressive surgical intervention create challenges for wound management. Multiple dressings are available to address the various challenges associated with management of these wounds; this article discusses negative pressure therapy and antimicrobial dressings in the management of Fournier's gangrene, a form of necrotizing fasciitis that involves tissue of the genital or perianal areas. CASE PRESENTATION This article reviews the case of a 56-year-old man with fever, tachycardia, and perianal pain associated with necrotizing fasciitis. Extensive surgical debridement was done on the day of admission. After several irrigations, the wound was dressed by negative pressure wound therapy with a silver dressing that minimized hospital stay and enabled early reconstruction. CONCLUSION We found that negative pressure wound therapy with a silver-based dressing promoted wound healing and provided a solid matrix for surgical reconstruction.
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Chen E, Deng L, Liu Z, Zhu X, Chen X, Tang H. Management of gas gangrene in Wenchuan earthquake victims. ACTA ACUST UNITED AC 2011; 31:83-87. [PMID: 21336729 DOI: 10.1007/s11596-011-0155-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Indexed: 02/04/2023]
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