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Dimova A, Boroš M, Dimov S, Konjevod J, Svetec M. Platelet-rich plasma treatment for chronic wounds: A case report and literature review. World J Clin Cases 2024; 12:6635-6643. [PMID: 39600480 PMCID: PMC11514336 DOI: 10.12998/wjcc.v12.i33.6635] [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: 06/30/2024] [Revised: 08/17/2024] [Accepted: 09/02/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Wound healing is a complicated process that can be heavily influenced by patient comorbidities, in some cases leading to a chronic non-healing wound. Evidence presented in the medical literature supporting the clinical use of autologous platelet-rich plasma (PRP) in treatment of such wounds is becoming increasingly compelling. Mechanisms involved include complex interactions between the patient's thrombocytes, cytokines, and growth factors. CASE SUMMARY We present a case of a 72-year-old male patient with a long-standing chronic wound and multiple comorbidities. Over the course of more than 7 months, the patient was unsuccessfully treated with all routinely used measures, including different dressing approaches. Multiple antibiotic regimens were administered for wound infection, with repeated evaluation of microbiological swab results. Finally, after three PRP applications, the wound showed clinical improvement with complete restitution of the epithelial layer of the skin. CONCLUSION PRP treatment may be beneficial to reduce healing time in chronic wounds.
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Affiliation(s)
- Ana Dimova
- Department of Surgery, Zabok General Hospital and the Croatian Veterans Hospital, Zabok 49210, Croatia
- Department of Surgery, St Catherine Specialty Hospital, Zagreb 10000, Croatia
| | - Martin Boroš
- Department of Surgery, Zabok General Hospital and the Croatian Veterans Hospital, Zabok 49210, Croatia
| | - Stefan Dimov
- Department of Surgery, Zabok General Hospital and the Croatian Veterans Hospital, Zabok 49210, Croatia
- Department of Surgery, St Catherine Specialty Hospital, Zagreb 10000, Croatia
| | - Janja Konjevod
- Department of Surgery, Zabok General Hospital and the Croatian Veterans Hospital, Zabok 49210, Croatia
| | - Maja Svetec
- Department of Emergency Medicine, Zabok General Hospital and the Croatian Veterans Hospital, Zabok 49210, Croatia
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Rech FV, Simões RS, Pires JA, Florêncio-Silva R, Fagundes DJ. Effect of hyperbaric oxygenation on random rat skin flaps vascularization. Acta Cir Bras 2021; 36:e360906. [PMID: 34755766 PMCID: PMC8580510 DOI: 10.1590/acb360906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate the effect of hyperbaric oxygenation (HBO) on angiogenesis in
random rat skin flaps, by immunoexpression of vascular endothelial growth
factor A (VEGF-A). Methods: Forty adult rats were divided into four groups: GE) epilated; GE/HBO)
epilated subjected to HBO; GER) epilated submitted to dorsal skin flap;
GER/HBO) epilated subjected to dorsal skin flap + HBO. HBO was performed
with rats inside a chamber under atmosphere close to 100% oxygen and
pressure of 2.4 absolute atmospheres, 2h per day during seven consecutive
days. GE and GER groups were placed in the hyperbaric chamber without HBO.
Then, under anesthesia, skin flaps were removed and separated into three
portions relative to pedicle fixation. The samples were fixed in formalin
and processed for paraffin embedding. Histological sections were submitted
to immunohistochemistry for VEGF-A detection. The number of
immunostained-blood vessels were counted under light microscopy. Results: GE and GE/HBO groups showed normal and similar skin morphology in the three
flap portions. A fibrin-leukocyte crust, along with denatured collagen and
intense leukocyte infiltrate, was mainly observed in the dermis of the
medial and distal flap portions of GER group. Meanwhile, the GER/HBO group
presented more regions with intact collagen and small areas of leukocyte
infiltrate in the three flap regions. VEGF-A-immunostained blood vessels
were largely seen in all regions of GE and GE/HBO groups, whereas no
significant differences were found between these groups. A decrease in
vascularization was noticed in GER and GER/HBO groups, which was more
evident in the most distal portion of the flaps. However, the number of
VEGF-A-immunostained blood vessels in GER/HBO group was significantly higher
when compared to GER group. Conclusions: Hyperbaric oxygenation was associated with increased angiogenesis and
improved viability of rat skin flaps.
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Bellmunt-Montoya S, Escribano JM, Pantoja Bustillos PE, Tello-Díaz C, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 2021; 9:CD009648. [PMID: 34590305 PMCID: PMC8481765 DOI: 10.1002/14651858.cd009648.pub4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (in French 'cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire' (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system. This is the second update of the review first published in 2013. OBJECTIVES To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, and the World Health Organisation International Clinical Trials Registry Platform and ClinicalTrials.gov trials registries to 19 October 2020. We also searched PUBMED to 19 October 2020 and checked the references of relevant articles to identify additional studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared CHIVA to other therapeutic techniques to treat varicose veins. DATA COLLECTION AND ANALYSIS Two review authors independently assessed and selected studies, extracted data, and performed quantitative analysis from the selected papers. A third author solved any disagreements. We assessed the risk of bias in included trials with the Cochrane risk of bias tool. We calculated the risk ratio (RR), mean difference (MD), number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI). We evaluated the certainty of the evidence using GRADE. The main outcomes of interest were the recurrence of varicose veins and side effects. MAIN RESULTS For this update, we identified two new additional studies. In total, we included six RCTs with 1160 participants (62% women) and collected from them eight comparisons. Three RCTs compared CHIVA with vein stripping. One RCT compared CHIVA with compression dressings in people with venous ulcers. The new studies included three comparisons, one compared CHIVA with vein stripping and radiofrequency ablation (RFA), and one compared CHIVA with vein stripping and endovenous laser therapy. We judged the certainty of the evidence for our outcomes as low to very low due to inconsistency, imprecision caused by the low number of events and risk of bias. The overall risk of bias across studies was high because neither participants nor personnel were blinded to the interventions. Two studies attempted to blind outcome assessors, but the characteristics of the surgery limited concealment. Five studies reported the outcome clinical recurrence of varicose veins with a follow-up of 18 months to 10 years. CHIVA may make little or no difference to the recurrence of varicose veins in the lower limb compared to stripping (RR 0.74, 95% CI 0.46 to 1.20; 5 studies, 966 participants; low-certainty evidence). We are uncertain whether CHIVA reduced recurrence compared to compression dressing (RR 0.23, 95% CI 0.06 to 0.96; 1 study, 47 participants; very low-certainty evidence). CHIVA may make little or no difference to clinical recurrence compared to RFA (RR 2.02, 95% CI 0.74 to 5.53; 1 study, 146 participants; low-certainty evidence) and endovenous laser (RR 0.20, 95% CI 0.01 to 4.06; 1 study, 100 participants; low-certainty evidence). We found no clear difference between CHIVA and stripping for the side effects of limb infection (RR 0.83, 95% CI 0.33 to 2.10; 3 studies, 746 participants; low-certainty evidence), and superficial vein thrombosis (RR 1.05, 95% CI 0.51 to 2.17; 4 studies, 846 participants; low-certainty evidence). CHIVA may reduce slightly nerve injury (RR 0.14, 95% CI 0.02 to 0.98; NNTH 9, 95% CI 5 to 100; 4 studies, 846 participants; low-certainty evidence) and hematoma compared to stripping (RR 0.59, 95% CI 0.37 to 0.97; NNTH 11, 95% CI 5 to 100; 2 studies, 245 participants; low-certainty evidence). For bruising, one study found no differences between groups while another study found reduced rates of bruising in the CHIVA group compared to the stripping group. Compared to RFA, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma, but may cause more bruising (RR 1.15, 95% CI 1.04 to 1.28; NNTH 8, CI 95% 5 to 25; 1 study, 144 participants; low-certainty evidence). Compared to endovenous laser, CHIVA may make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury or hematoma. The study comparing CHIVA versus compression did not report side effects. AUTHORS' CONCLUSIONS There may be little or no difference in the recurrence of varicose veins when comparing CHIVA to stripping (low-certainty evidence), but CHIVA may slightly reduce nerve injury and hematoma in the lower limb (low-certainty evidence). Very limited evidence means we are uncertain of any differences in recurrence when comparing CHIVA with compression (very low-certainty evidence). CHIVA may make little or no difference to recurrence compared to RFA (low-certainty evidence), but may result in more bruising (low-certainty evidence). CHIVA may make little or no difference to recurrence and side effects compared to endovenous laser therapy (low-certainty evidence). However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed, and the results were imprecise due to the low number of events. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.
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Affiliation(s)
- Sergi Bellmunt-Montoya
- Angiology, Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jose Maria Escribano
- Angiology, Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | | | - Cristina Tello-Díaz
- Angiology, Vascular and Endovascular Surgery, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Sen S, Sen S. Therapeutic effects of hyperbaric oxygen: integrated review. Med Gas Res 2021; 11:30-33. [PMID: 33642335 PMCID: PMC8103971 DOI: 10.4103/2045-9912.310057] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022] Open
Abstract
Hyperbaric oxygen therapy refers to inhalation of pure oxygen in a closed chamber. Hyperbaric oxygen has a therapeutic effect in numerous pathological conditions, such as decompression sickness, arterial gas embolism, carbon monoxide poisoning and smoke inhalation, osteomylitis, osteoradionecrosis and wound healing. Hyperbaric oxygen therapy is used for treating underlying hypoxia. This review indicates the action of hyperbaric oxygen on biochemical and various physiological changes in cellular level. Narrative review covers the current indications and contraindications of hyperbaric oxygen therapy. The review also focuses on the therapeutic effects of hyperbaric oxygen pretreatment and precondition in different pathological conditions. The complications and side effects of hyperbaric oxygen therapy are discussed.
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Affiliation(s)
- Suman Sen
- Department of Oral Medicine and Radiology, Haldia Institute of Dental Sciences and Research, Haldia, West Bengal, India
| | - Sheuli Sen
- Department of Pediatric Nursing, Sumandeep Nursing College, Sumandeep University, Vadodara, Gujarat, India
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Hajhosseini B, Kuehlmann BA, Bonham CA, Kamperman KJ, Gurtner GC. Hyperbaric Oxygen Therapy: Descriptive Review of the Technology and Current Application in Chronic Wounds. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3136. [PMID: 33133975 PMCID: PMC7544320 DOI: 10.1097/gox.0000000000003136] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
Hyperbaric oxygen therapy (HBOT) serves as "primary" or "adjunctive" therapy in a wide range of pathologies. It is considered the mainstay of management for potentially life-threatening conditions such as carbon monoxide poisoning, decompression illness, and gas embolisms. Moreover, HBOT has been utilized for decades as an adjunctive therapy in a variety of medical disciplines, including chronic wounds, which affect approximately 6.5 million Americans annually. In general, chronic wounds are characterized by hypoxia, impaired angiogenesis, and prolonged inflammation, all of which may theoretically be ameliorated by HBOT. Nonetheless, the cellular, biochemical, and physiological mechanisms by which HBOT achieves beneficial results in chronic wounds are not fully understood, and there remains significant skepticism regarding its efficacy. This review article provides a comprehensive overview of HBOT, and discusses its history, mechanisms of action, and its implications in management of chronic wounds. In particular, we discuss the current evidence regarding the use of HBOT in diabetic foot ulcers, while digging deeply into the roots of controversy surrounding its efficacy. We discuss how the paucity of high-quality research is a tremendous challenge, and offer future direction to address existing obstacles.
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Affiliation(s)
- Babak Hajhosseini
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
- Advanced Wound Care Center, Stanford University Medical Center, Redwood City, Calif
| | - Britta A. Kuehlmann
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
- University Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef, Regensburg, Germany
| | - Clark A. Bonham
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Kathryn J. Kamperman
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Geoffrey C. Gurtner
- From the Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
- Advanced Wound Care Center, Stanford University Medical Center, Redwood City, Calif
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Klassen A, van Haren EL, Cross K, Fan KL, Gibbons C, Hoogbergen MM, Longmire NM, Poulsen L, Sorensen JA, Squitieri L, Tsangaris E, van Alphen TC, van Dishoeck AM, Vasilic D, Pusic AL. International mixed methods study protocol to develop a patient-reported outcome measure for all types of chronic wounds (the WOUND-Q). BMJ Open 2020; 10:e032332. [PMID: 32217558 PMCID: PMC7170563 DOI: 10.1136/bmjopen-2019-032332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Most patient-reported outcome measures (PROM) for chronic wounds are specific to a single wound type (eg, pressure ulcer) or part of the body. A barrier to outcome assessment in wound care and research is the lack of a rigorously designed PROM that can be used across wound types and locations. This mixed method study describes the protocol for an international collaboration to develop and validate a new PROM called the WOUND-Q for adults with chronic wounds. METHODS AND ANALYSIS In phase I, the qualitative approach of interpretive description is used to elicit concepts important to people with wounds regarding outcome. Participants from Canada, Denmark, the Netherlands, and the USA are aged 18 years and older and have a wound that has lasted 3 months or longer. Interviews are digitally recorded, transcribed and coded. A conceptual framework and preliminary item pool are developed from the qualitative dataset. Draft scales are formed to cover important themes in the conceptual framework. These scales are refined using feedback from people with chronic wounds and wound care experts. After refinement, the scales are translated into Danish and Dutch, following rigorous methods, to prepare for an international field-test study. In phase II, data are collected in Canada, Denmark, the Netherlands, and the USA. An international sample of people with a large variety of chronic wounds complete the WOUND-Q. Rasch Measurement Theory analysis is used to identify the best subset of items to retain for each scale and to examine reliability and validity. ETHICS AND DISSEMINATION This study is coordinated at Brigham and Women's Hospital (Boston, USA). Ethics board approval was received at each participating site for both study phases. Findings will be published in peer-reviewed journals and presented at national and international conferences and meetings.
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Affiliation(s)
- Anne Klassen
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Emiel Lwg van Haren
- Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Karen Cross
- Plastic Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Kenneth L Fan
- Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Chris Gibbons
- Department of Surgery, Patient Reported Outcome, Value, and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maarten M Hoogbergen
- Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | | | - Lotte Poulsen
- Department of Plastic Surgery, University of Southern Denmark, Odense, Denmark
| | - Jens Ahm Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Lee Squitieri
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Elena Tsangaris
- Department of Surgery, Patient Reported Outcome, Value, and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tert C van Alphen
- Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | | | - Dali Vasilic
- Plastic and Reconstructive Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andrea L Pusic
- Department of Surgery, Patient Reported Outcome, Value, and Experience (PROVE) Center, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Coalson E, Bishop E, Liu W, Feng Y, Spezia M, Liu B, Shen Y, Wu D, Du S, Li AJ, Ye Z, Zhao L, Cao D, Li A, Hagag O, Deng A, Liu W, Li M, Haydon RC, Shi L, Athiviraham A, Lee MJ, Wolf JM, Ameer GA, He TC, Reid RR. Stem cell therapy for chronic skin wounds in the era of personalized medicine: From bench to bedside. Genes Dis 2019; 6:342-358. [PMID: 31832514 PMCID: PMC6888708 DOI: 10.1016/j.gendis.2019.09.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/07/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
With the significant financial burden of chronic cutaneous wounds on the healthcare system, not to the personal burden mention on those individuals afflicted, it has become increasingly essential to improve our clinical treatments. This requires the translation of the most recent benchtop approaches to clinical wound repair as our current treatment modalities have proven insufficient. The most promising potential treatment options rely on stem cell-based therapies. Stem cell proliferation and signaling play crucial roles in every phase of the wound healing process and chronic wounds are often associated with impaired stem cell function. Clinical approaches involving stem cells could thus be utilized in some cases to improve a body's inhibited healing capacity. We aim to present the laboratory research behind the mechanisms and effects of this technology as well as current clinical trials which showcase their therapeutic potential. Given the current problems and complications presented by chronic wounds, we hope to show that developing the clinical applications of stem cell therapies is the rational next step in improving wound care.
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Affiliation(s)
- Elam Coalson
- The University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Elliot Bishop
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Surgery, Section of Plastic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Wei Liu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Key Laboratory of Diagnostic Medicine (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Yixiao Feng
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Key Laboratory of Diagnostic Medicine (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Mia Spezia
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Bo Liu
- Department of Surgery, Section of Plastic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Key Laboratory of Diagnostic Medicine (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Yi Shen
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Orthopaedic Surgery, Xiangya Second Hospital of Central South University, Changsha 410011, China
| | - Di Wu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Scott Du
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Student Inquiry Research Program, Illinois Mathematics and Science Academy (IMSA), Aurora, IL 60506, USA
| | - Alexander J. Li
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Zhenyu Ye
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Ling Zhao
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Key Laboratory of Diagnostic Medicine (Ministry of Education), College of Laboratory Medicine, Chongqing Medical University, Chongqing, China
| | - Daigui Cao
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Department of Orthopaedic Surgery, Chongqing General Hospital, Chongqing 400013, China
| | - Alissa Li
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Ofir Hagag
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Alison Deng
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Student Inquiry Research Program, Illinois Mathematics and Science Academy (IMSA), Aurora, IL 60506, USA
| | - Winny Liu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Student Inquiry Research Program, Illinois Mathematics and Science Academy (IMSA), Aurora, IL 60506, USA
| | - Mingyang Li
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Student Inquiry Research Program, Illinois Mathematics and Science Academy (IMSA), Aurora, IL 60506, USA
| | - Rex C. Haydon
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Lewis Shi
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Aravind Athiviraham
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Michael J. Lee
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Jennifer Moriatis Wolf
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Guillermo A. Ameer
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60616, USA
- Center for Advanced Regenerative Engineering (CARE), Evanston, IL 60208, USA
| | - Tong-Chuan He
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Center for Advanced Regenerative Engineering (CARE), Evanston, IL 60208, USA
| | - Russell R. Reid
- Department of Surgery, Section of Plastic Surgery, The University of Chicago Medical Center, Chicago, IL 60637, USA
- Center for Advanced Regenerative Engineering (CARE), Evanston, IL 60208, USA
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Marston WA, Lantis JC, Wu SC, Nouvong A, Lee TD, McCoy ND, Slade HB, Tseng SC. An open-label trial of cryopreserved human umbilical cord in the treatment of complex diabetic foot ulcers complicated by osteomyelitis. Wound Repair Regen 2019; 27:680-686. [PMID: 31376297 PMCID: PMC6900178 DOI: 10.1111/wrr.12754] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/17/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
Clinical trials of potential new therapies for diabetic foot ulcers rarely enroll patients whose wounds extend to muscle, fascia, or bone with clinical and radiographic evidence of underlying osteomyelitis. An open‐label, multicenter trial of cryopreserved human umbilical cord (TTAX01) was undertaken in 32 subjects presenting with such complex wounds with a mean duration of 6.1 ± 9.0 (range: 0.2–47.1) months and wound area at screening of 3.8 ± 2.9 (range: 1.0–9.6) cm2. Aggressive surgical debridement at baseline resulted in 17 minor amputations and an increase in mean wound area to 7.4 ± 5.8 (range: 1.1–28.6) cm2. All subjects were placed on systemic antibiotics for at least 6 weeks in conjunction with baseline application of TTAX01. Repeat applications were made at no less than 4‐week intervals over the 16‐week trial. Initial closure occurred in 18 of 32 (56%) wounds, with 16 (50%) of these having confirmed closure in 16 weeks with a median of one‐product application. Cases with biopsy confirmed osteomyelitis (n = 20) showed initial closure in 12 (60%) wounds and confirmed closure in 10 (50%) wounds. Four of the five ulcers presenting as recurrences experienced confirmed closure. Mean overall time to healing was 12.8 ± 4.3 weeks. Mean wound area reduction from baseline was 91% for all wounds. Of the 16 wounds without confirmed closure during the 16‐week treatment period, five (31.3%) achieved 99–100% wound area reduction by their final visit. The product was well tolerated. Two minor amputations occurred during the study period due to recurrent or persistent osteomyelitis; however, there were no major amputations.
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Affiliation(s)
- William A Marston
- Division of Vascular Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - John C Lantis
- Department of Surgery, Mt Sinai West and St Luke's Hospitals, New York, New York
| | - Stephanie C Wu
- Department of Podiatric Surgery & Applied Biomechanics, Rosalind Franklin University, North Chicago, Illinois
| | | | - Tommy D Lee
- Research & Development, TissueTech, Inc., Miami, Florida
| | | | - Herbert B Slade
- Research & Development, TissueTech, Inc., Miami, Florida.,Department of Pediatrics, University of North Texas Health Sciences Center, Fort Worth, Texas
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9
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Horncastle E, Lumb A. Hyperoxia in anaesthesia and intensive care. BJA Educ 2019; 19:176-182. [PMID: 33456888 PMCID: PMC7807946 DOI: 10.1016/j.bjae.2019.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
| | - A.B. Lumb
- St James's University Hospital, Leeds, UK
- University of Leeds, Leeds, UK
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10
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Sharif M, Wong CHM, Harky A. Sternal Wound Infections, Risk Factors and Management – How Far Are We? A Literature Review. Heart Lung Circ 2019; 28:835-843. [DOI: 10.1016/j.hlc.2019.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/01/2019] [Accepted: 01/08/2019] [Indexed: 01/11/2023]
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11
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Hou S, Wu G, Liang J, Cheng H, Chen C. Hyperbaric oxygen on rehabilitation of brain tumors after surgery and effects on TNF-α and IL-6 levels. Oncol Lett 2019; 17:3277-3282. [PMID: 30867760 PMCID: PMC6396111 DOI: 10.3892/ol.2019.10000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 01/21/2019] [Indexed: 12/16/2022] Open
Abstract
Hyperbaric oxygenation (HBO) on postoperative rehabilitation of brain tumors and effects on tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were explored. A retrospective analysis of 132 patients with brain tumors treated in the People's Hospital of Rizhao from October 2014 to October 2017 was performed. There were 62 patients in the observation group and 70 patients in the control group. Patients in the control group were treated with conventional drugs, and patients in the observation group were treated with HBO on the basis of conventional drug therapy. Levels of serum TNF-α and IL-6 were measured by ELISA before and after treatment. Cerebral arterial flow velocity and spasticity were measured by cranial color Doppler ultrasonography. Neurological function deficit (NFD) and activities of daily living (ADL) were used to evaluate the clinical recovery of the patients. Clinical efficacy was compared and analyzed. There were no significant differences between the two groups before treatment (P>0.05). After treatment, serum TNF-α and IL-6 levels were significantly lower than pretreatment levels (P<0.05), and serum TNF-α and IL-6 levels in the observation group were lower than those in the control group (P<0.05). Cerebral arterial flow velocity in observation group after treatment was significantly lower than that in the control group. The number of patients with cerebral arterial spasm after treatment in the observation group was significantly smaller than that in the control group. NFD scores in the observation group were lower than those in the control group after treatment. After treatment, ADL scores in the observation group were significantly higher than those in the control group (P<0.05). The comprehensive treatment effect of HBO is significant. It can inhibit the expression of inflammatory factors in serum and reduce cerebral arterial flow velocity and effectively reduce the number of patients with cerebral arterial spasm. It can reduce NFD and improve the quality of life of patients. Therefore, it is worthy of clinical popularization.
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Affiliation(s)
- Shicai Hou
- Department of Rehabilitation, People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Guimei Wu
- Department of Neurosurgery (Ward 1), People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Jingjing Liang
- Pediatrics (III), People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
| | - Huanchun Cheng
- Department of Surgery, Xujiahu Health Center, Linyi, Shandong 276400, P.R. China
| | - Chao Chen
- Department of Neurosurgery (Ward 1), People's Hospital of Rizhao, Rizhao, Shandong 276800, P.R. China
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12
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Long Y, Wei H, Li J, Yao G, Yu B, Ni D, Gibson ALF, Lan X, Jiang Y, Cai W, Wang X. Effective Wound Healing Enabled by Discrete Alternative Electric Fields from Wearable Nanogenerators. ACS NANO 2018; 12:12533-12540. [PMID: 30488695 PMCID: PMC6307171 DOI: 10.1021/acsnano.8b07038] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/19/2018] [Indexed: 05/21/2023]
Abstract
Skin wound healing is a major health care issue. While electric stimulations have been known for decades to be effective for facilitating skin wound recovery, practical applications are still largely limited by the clumsy electrical systems. Here, we report an efficient electrical bandage for accelerated skin wound healing. On the bandage, an alternating discrete electric field is generated by a wearable nanogenerator by converting mechanical displacement from skin movements into electricity. Rat studies demonstrated rapid closure of a full-thickness rectangular skin wound within 3 days as compared to 12 days of usual contraction-based healing processes in rodents. From in vitro studies, the accelerated skin wound healing was attributed to electric field-facilitated fibroblast migration, proliferation, and transdifferentiation. This self-powered electric-dressing modality could lead to a facile therapeutic strategy for nonhealing skin wound treatment.
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Affiliation(s)
- Yin Long
- Department
of Materials Science and Engineering, University
of Wisconsin—Madison, Madison, Wisconsin 53706, United States
- State
Key Laboratory of Electronic Thin Films and Integrated Devices, University of Electronic Science and Technology of
China, Chengdu 610054, China
| | - Hao Wei
- Departments
of Radiology and Medical Physics, University
of Wisconsin—Madison, Madison, Wisconsin 53705, United States
- Department
of Nuclear Medicine, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan 430073, China
| | - Jun Li
- Department
of Materials Science and Engineering, University
of Wisconsin—Madison, Madison, Wisconsin 53706, United States
| | - Guang Yao
- Department
of Materials Science and Engineering, University
of Wisconsin—Madison, Madison, Wisconsin 53706, United States
- State
Key Laboratory of Electronic Thin Films and Integrated Devices, University of Electronic Science and Technology of
China, Chengdu 610054, China
| | - Bo Yu
- Departments
of Radiology and Medical Physics, University
of Wisconsin—Madison, Madison, Wisconsin 53705, United States
| | - Dalong Ni
- Departments
of Radiology and Medical Physics, University
of Wisconsin—Madison, Madison, Wisconsin 53705, United States
| | - Angela LF Gibson
- Department
of Surgery, University of Wisconsin—Madison, Madison, Wisconsin 53792, United States
| | - Xiaoli Lan
- Department
of Nuclear Medicine, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology, Wuhan 430073, China
| | - Yadong Jiang
- State
Key Laboratory of Electronic Thin Films and Integrated Devices, University of Electronic Science and Technology of
China, Chengdu 610054, China
| | - Weibo Cai
- Departments
of Radiology and Medical Physics, University
of Wisconsin—Madison, Madison, Wisconsin 53705, United States
- E-mail:
| | - Xudong Wang
- Department
of Materials Science and Engineering, University
of Wisconsin—Madison, Madison, Wisconsin 53706, United States
- E-mail:
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13
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Perren S, Gatt A, Papanas N, Formosa C. Hyperbaric Oxygen Therapy in Ischaemic Foot Ulcers in Type 2 Diabetes: A Clinical Trial. Open Cardiovasc Med J 2018; 12:80-85. [PMID: 30258500 PMCID: PMC6131315 DOI: 10.2174/1874192401812010080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/23/2018] [Accepted: 08/02/2018] [Indexed: 02/07/2023] Open
Abstract
Background and Aims: Several treatment modalities and protocols for ischaemic foot ulcers are available. However, little consensus exists on optimal treatment. The aim of this study was to compare Standard Wound Care (SWC) alone vs. SWC with adjunct hyperbaric oxygen therapy (HBOT) in the treatment of ischaemic Diabetic Foot Ulcers (DFUs). Patients and Methods: Twenty-six patients with Type 2 Diabetes Mellitus (T2DM) presenting with a newly diagnosed ischaemic foot ulcer were included. These were divided into group A (SWC with adjunct HBOT) and group B (SWC only). Participants were followed every week for 4 weeks and their ulcers were measured for their surface area and depth to assess any change in wound size. Results: Both treatment arms succeeded in reducing ulcer area and depth (p<0.001). However, ulcer area (p<0.001) and depth (p<0.001) exhibited superior improvement in group A. Conclusion : Adjunctive HBOT appears to improve wound healing in ischaemic DFUs and merits further study.
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Affiliation(s)
- Sarah Perren
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
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14
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Moen I, Ugland H, Strömberg N, Sjöström E, Karlson A, Ringstad L, Bysell H, Amiry‐Moghaddam M, Haglerød C. Development of a novel in situ gelling skin dressing: Delivering high levels of dissolved oxygen at pH 5.5. Health Sci Rep 2018; 1:e57. [PMID: 30623087 PMCID: PMC6266454 DOI: 10.1002/hsr2.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/05/2018] [Accepted: 05/16/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND AIMS Wound healing requires appropriate oxygen and pH levels. Oxygen therapy and pH-modulating treatments have shown positive effects on wound healing. Thus, a dressing, which combines high levels of dissolved oxygen (DO) with the pH of intact skin, may improve wound healing. Our aims were to (1) formulate an in situ gelling dressing with high levels of DO and with the pH level of intact skin, (2) evaluate physical and chemical properties of the dressing, and (3) elucidate basic effects of elevated levels of DO on human skin cells in vitro. METHODS A dressing was formulated with 15 to 16 wt% poloxamer 407, acetate buffer, and oxygenated water. Stability of pH and DO, rheology, and shelf life were analysed. Furthermore, in vitro studies of the effect of increased levels of DO were performed. RESULTS An in situ gelling wound dressing, with a DO concentration ranging between 25 and 35 mg/L and a pH of 5.5, was formulated. The DO concentration was stable above 22 mg/L for at least 30 hours when applied on a surface at 35°C and covered for directed diffusion into the intended wound area. At storage, the dressing had stable pH for 3 months and stable DO concentration over 30 mg/L for 7 weeks. Increasing DO significantly enhanced intracellular ATP in human skin cells, without changing reactive oxygen species production, proliferation rate, or viability. CONCLUSION The developed dressing may facilitate wound healing by delivering controlled and stable oxygen levels, providing adjustable pH for optimized healing, and increasing intracellular ATP availability.
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Affiliation(s)
| | | | | | | | | | | | | | - Mahmood Amiry‐Moghaddam
- Oxy Solutions ASOsloNorway
- Laboratory of Molecular Neuroscience, Department of Molecular Medicine, Institute of Basic Medical SciencesUniversity of OsloNorway
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15
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Henshaw FR, Brennan L, MacMillan F. Perceptions of hyperbaric oxygen therapy among podiatrists practicing in high-risk foot clinics. Int Wound J 2018; 15:375-382. [PMID: 29314628 PMCID: PMC7950176 DOI: 10.1111/iwj.12874] [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: 08/14/2017] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 11/29/2022] Open
Abstract
Foot ulceration is a devastating and costly consequence of diabetes. Hyperbaric oxygen therapy is recognised as an adjunctive therapy to treat diabetes-related foot ulceration, yet uptake is low. Semi-structured interviews were conducted with 16 podiatrists who manage patients with foot ulcers related to diabetes to explore their perceptions of, and the barriers/facilitators to, referral for hyperbaric oxygen. Podiatrists cited logistical issues such as location of facilities as well as poor communication pathways, lack of delegation and lack of follow up when patients presented for hyperbaric treatment. In general, podiatrists had an understanding of the premise of hyperbaric oxygen therapy and evidence to support its use but could only provide very limited citations of key papers and guidelines to support their position. Podiatrists stated that they felt a patient was lost from their care when referred for hyperbaric oxygen and that aftercare might not be adequate. Improved referral and delegation pathways for patients presenting for hyperbaric oxygen, as well as the provision of easily accessible evidence to support this therapy, could help to increase podiatrists' confidence in deciding whether or not to recommend their patients for hyperbaric oxygen therapy.
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Affiliation(s)
- Frances R Henshaw
- School of Science and HealthWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Lauren Brennan
- School of Science and HealthWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Freya MacMillan
- School of Science and HealthWestern Sydney UniversityPenrithNew South WalesAustralia
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16
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Abstract
Although there are various types of therapeutic footwear currently used to treat diabetic foot ulcers (DFUs), recent literature has enforced the concept that total-contact casts are the benchmark.Besides conventional clinical tests and imaging modalities, advanced MRI techniques and high-sensitivity nuclear medicine modalities present several advantages for the investigation of diabetic foot problems.The currently accepted principles of DFU care are rigorous debridement followed by modern wound dressings to provide a moist wound environment. Recently, hyperbaric oxygen and negative pressure wound therapy have aroused increasing attention as an adjunctive treatment for patients with DFUs.For DFU, various surgical treatments are currently available, including resection arthroplasty, metatarsal osteotomies and metatarsal head resections.In the modern management of the Charcot foot, surgery in the acute phase remains controversial and under investigation. While conventional fixation techniques are frequently insufficient to keep alignment postoperatively, superconstruct techniques could provide a successful fixation.Retrograde intramedullary nailing has been a generally accepted method of achieving stability. The midfoot fusion bolt is a current treatment device that maintains the longitudinal columns of the foot. Also, Achilles tendon lengthening remains a popular method in the management of Charcot foot. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170073.
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Affiliation(s)
- Önder İ. Kılıçoğlu
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Mehmet Demirel
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Şamil Aktaş
- Department of Underwater and Hyperbaric Medicine, İstanbul University, Istanbul Faculty of Medicine, Turkey
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17
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Sepehripour S, Dhaliwal K, Dheansa B. Hyperbaric oxygen therapy and intermittent ischaemia in the treatment of chronic wounds. Int Wound J 2018; 15:310. [PMID: 29417747 DOI: 10.1111/iwj.12852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sarvnaz Sepehripour
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, Queen Victoria Hospital, East Grinstead, UK
| | - Kiran Dhaliwal
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, Queen Victoria Hospital, East Grinstead, UK
| | - Baljit Dheansa
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, Queen Victoria Hospital, East Grinstead, UK
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18
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Gonzalez IG, Angel MAL, Baez MVJ, Ruiz Flores B, de Los Angeles Martinez Ferretiz M, Woolf SV, López I, Sandoval-Jurado L, Pat-Espadas FG, Cruz AAR, Delgado AT. Handcrafted Vacuum-Assisted Device for Skin Ulcers Treatment Versus Traditional Therapy, Randomized Controlled Trial. World J Surg 2017; 41:386-393. [PMID: 27822727 DOI: 10.1007/s00268-016-3782-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic lower limb ulcers constitute a public health problem, with important socioeconomic implications and high attention cost. This trial evaluates handcrafted vacuum-assisted therapy versus traditional treatment effectiveness for lower limbs ulcers. MATERIALS AND METHODS It was a prospective randomized clinical trial conducted over 144 patients with lower limbs ulcers. Patients were randomized into two groups of 72 patients: Experimental group were treated with debridement, cure and a handcrafted vacuum-assisted device that was changed every 72 h. Control group was treated with debridement and cure with soap every 24 h. Ulcers were evaluated every 72 h and on 10th day. The presence of systemic inflammatory response, pain, granulation tissue and viability for discharge was registered and analyzed . RESULTS After exclusion of 18 patients, 126 were included, 65.1% were men with an average of 58 years. Sole region ulcer by diabetic foot was the more frequent in both groups (73%). Leukocytes count, systemic inflammatory response and pain were significantly lower in experimental group (p < 0.05). Discharge criteria and granulation tissue were present earlier in experimental group (p < 0.05). CONCLUSION Handcrafted vacuum-assisted system is a feasible and safe method to treat chronic ulcers. This system would benefit patients favoring earlier infection control, faster granulation tissue appearance and earlier discharge. Clinical trials registered in https://www.clinicaltrials.gov/ Number NCT02512159.
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Affiliation(s)
- Israel Gonzalez Gonzalez
- General Surgery Department, Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Medina Andrade Luis Angel
- General Surgery, General Zone Hospital #30, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Maria Valeria Jimenez Baez
- Health Research Department, Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Brenda Ruiz Flores
- General Surgery Department, Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Maria de Los Angeles Martinez Ferretiz
- General Surgery Department, Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Stephanny Vanestty Woolf
- General Surgery Department, Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Israel López
- General Surgery Department, Instituto Mexicano del Seguro Social, Hospital General Regional No. 17, Quintana Roo University, Av. Politécnico Manzana 1 Lote 1 Región 509, C.P. 55750, Cancún, Quintana Roo, Mexico
| | - Luis Sandoval-Jurado
- Medical Assistant Coordination of Health Research, Mexican Social Security Institute, Cancún, Quintana Roo, Mexico
| | | | - Alan Alejandro Reyes Cruz
- General Surgery Department, The American British Cowdray Medical Center I.A.P, Universidad Nacional Autonoma de Mexico, Sur 136 #116, Col. Las Americas, Alvaro Obregon, C.P. 01120, Distrito Federal, Mexico
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19
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Everts PA, Warbout M, de Veth D, Cirkel M, Spruijt NE, Buth J. Use of epidermal skin grafts in chronic wounds: a case series. Int Wound J 2017; 14:1213-1218. [PMID: 29076239 DOI: 10.1111/iwj.12787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/07/2017] [Indexed: 12/22/2022] Open
Abstract
In stalled, chronic wounds, more aggressive and proactive wound closure efforts are needed. We describe adjunctive use of epidermal grafting in patients with chronic wounds. Wound bed preparation consisted of surgical necrotectomy or sharp debridement, hyperbaric oxygen therapy, negative pressure wound therapy, compression therapy, platelet-rich plasma therapy and/or heparan sulphate agents. Epidermal grafts were harvested from the patient's thigh and applied to the wound. Wound and donor site healing was monitored. A total of 78 patients (average age = 64·1 ± 15·6 years) were included in the study. Common comorbidities included hypertension (47·4%), venous insufficiency (37·2%) and obesity (28·2%). Average wound duration was 13·2 months (range: 0·3-180 months). The most common wound types were dehiscence (29·5%), radiation ulcer (24·4%) and venous ulcer (17·9%). Total time from epidermal grafting to wound closure was 10·0 ± 7·3 weeks. Of the 78 wounds, 66 (84·6%) reached full wound closure (49 < 3 months, 16 > 3 months, 1 without time data). Of 78 wounds, 10 (12·8%) underwent partial wound healing, while 2 wounds (2/78; 2·6%) remained unhealed. These results suggest that wound surface reduction can be achieved by proactive early application of biological therapies and epidermal skin grafts, which may help decrease time to wound healing.
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Affiliation(s)
| | | | | | | | | | - Jaap Buth
- Da Vinci Clinic, Geldrop, The Netherlands
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20
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Abstract
Wound healing is a complex, highly regulated process that is critical in maintaining the barrier function of skin. With numerous disease processes, the cascade of events involved in wound healing can be affected, resulting in chronic, non-healing wounds that subject the patient to significant discomfort and distress while draining the medical system of an enormous amount of resources. The healing of a superficial wound requires many factors to work in concert, and wound dressings and treatments have evolved considerably to address possible barriers to wound healing, ranging from infection to hypoxia. Even optimally, wound tissue never reaches its pre-injured strength and multiple aberrant healing states can result in chronic non-healing wounds. This article will review wound healing physiology and discuss current approaches for treating a wound.
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21
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Abstract
Critical limb ischemia (CLI) is a clinical syndrome of ischemic pain at rest or tissue loss, such as nonhealing ulcers or gangrene, related to peripheral artery disease. CLI has a high short-term risk of limb loss and cardiovascular events. Noninvasive or invasive angiography help determine the feasibility and approach to arterial revascularization. An endovascular-first approach is often advocated based on a lower procedural risk; however, specific patterns of disease may be best treated by open surgical revascularization. Balloon angioplasty and stenting form the backbone of endovascular techniques, with drug-eluting stents and drug-coated balloons offering low rates of repeat revascularization. Combined antegrade and retrograde approaches can increase success in long total occlusions. Below the knee, angiosome-directed angioplasty may lead to greater wound healing, but failing this, any straight-line flow into the foot is pursued. Hybrid surgical techniques such as iliac stenting and common femoral endarterectomy are commonly used to reduce operative risk. Lower extremity bypass grafting is most successful with a good quality, long, single-segment autogenous vein of at least 3.5-mm diameter. Minor amputations are often required for tissue loss as a part of the treatment strategy. Major amputations (at or above the ankle) limit functional independence, and their prevention is a key goal of CLI therapy. Medical therapy after revascularization targets risk factors for atherosclerosis and assesses wound healing and new or recurrent flow-limiting disease. The ongoing National Institutes of Health-sponsored Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia (BEST-CLI) study is a randomized trial of the contemporary endovascular versus open surgical techniques in patients with CLI.
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Affiliation(s)
- Scott Kinlay
- From the Cardiovascular Division, Department of Medicine, VA Boston Healthcare System, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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22
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Jockenhöfer F, Gollnick H, Herberger K, Isbary G, Renner R, Stücker M, Valesky E, Wollina U, Weichenthal M, Karrer S, Kuepper B, Roesch A, Dissemond J. Aetiology, comorbidities and cofactors of chronic leg ulcers: retrospective evaluation of 1 000 patients from 10 specialised dermatological wound care centers in Germany. Int Wound J 2016; 13:821-8. [PMID: 25483380 PMCID: PMC7949738 DOI: 10.1111/iwj.12387] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/02/2014] [Accepted: 10/07/2014] [Indexed: 12/16/2022] Open
Abstract
Numerous comorbidities and cofactors have been known to influence wound healing processes. In this multicentre study, clinical data of 1 000 patients with chronic leg ulcers from ten specialised dermatological wound care centers were analysed. The patient cohort comprised 567 females and 433 males with an average age of 69·9 years. The wounds persisted on average for 40·8 months and had a mean size of 43·7 cm(2) . Venous leg ulcers represented the most common entity accounting for 51·3% of all chronic wounds, followed by mixed-type ulcers in 12·9% and arterial ulcerations in 11·0% of the patients. Vasculitis was diagnosed in 4·5%, trauma in 3·2%, pyoderma gangrenosum in 2·8%, lymphoedema in 1·7%, neoplasia in 1·0% and delayed post-surgical wound healing in 0·6% of the included patients. In total, 70·5% of patients suffered from arterial hypertension, 45·2% were obese, 27·2% had non-insulin dependent diabetes, and 24·4% dyslipidaemia. Altogether 18·4% suffered from metabolic syndrome. Cofactors and comorbidities of patients with chronic leg ulcers have previously been studied but not in detail. Here, we were able to demonstrate the existence of several potentially relevant cofactors, comorbidities of their associations and geographical distributions, which should be routinely examined in patients with chronic leg ulcers and - if possible - treated.
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Affiliation(s)
- Finja Jockenhöfer
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Essen, Germany
| | - Harald Gollnick
- Department of Dermatology and Venereology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Katharina Herberger
- Institute for Healthcare Research of Dermatology and Health Care Professions, University Hospital of Hamburg, Hamburg, Germany
| | - Georg Isbary
- Department of Dermatology, Allergology and Environment Medicine, Clinical Centre Schwabing Munich, Munich, Germany
| | - Regina Renner
- Department of Dermatology and Venereology, University Hospital of Erlangen, Erlangen, Germany
| | - Markus Stücker
- Department of Dermatology, Centre for venous disease of the dermatological and vascular surgery, University Hospital of Bochum, Bochum, Germany
| | - Eva Valesky
- Department of Dermatology and Venereology, University Hospital of Frankfurt a. M., Frankfurt, Germany
| | - Uwe Wollina
- Department of Dermatology, Venereology and Allergology, Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Michael Weichenthal
- Department of Dermatology, Venereology, University Hospital of Kiel, Keil, Germany
| | - Sigrid Karrer
- Department of Dermatology, Venereology, University Hospital of Regensburg, Regensburg, Germany
| | - Bernhard Kuepper
- General Medical Department, Timaru Public Hospital, SCDHB, Timaru, New Zealand
| | - Alexander Roesch
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Essen, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venereology and Allergology, University Hospital of Essen, Essen, Germany.
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23
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Chaillou T, Lanner JT. Regulation of myogenesis and skeletal muscle regeneration: effects of oxygen levels on satellite cell activity. FASEB J 2016; 30:3929-3941. [PMID: 27601440 DOI: 10.1096/fj.201600757r] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/15/2016] [Indexed: 12/11/2022]
Abstract
Reduced oxygen (O2) levels (hypoxia) are present during embryogenesis and exposure to altitude and in pathologic conditions. During embryogenesis, myogenic progenitor cells reside in a hypoxic microenvironment, which may regulate their activity. Satellite cells are myogenic progenitor cells localized in a local environment, suggesting that the O2 level could affect their activity during muscle regeneration. In this review, we present the idea that O2 levels regulate myogenesis and muscle regeneration, we elucidate the molecular mechanisms underlying myogenesis and muscle regeneration in hypoxia and depict therapeutic strategies using changes in O2 levels to promote muscle regeneration. Severe hypoxia (≤1% O2) appears detrimental for myogenic differentiation in vitro, whereas a 3-6% O2 level could promote myogenesis. Hypoxia impairs the regenerative capacity of injured muscles. Although it remains to be explored, hypoxia may contribute to the muscle damage observed in patients with pathologies associated with hypoxia (chronic obstructive pulmonary disease, and peripheral arterial disease). Hypoxia affects satellite cell activity and myogenesis through mechanisms dependent and independent of hypoxia-inducible factor-1α. Finally, hyperbaric oxygen therapy and transplantation of hypoxia-conditioned myoblasts are beneficial procedures to enhance muscle regeneration in animals. These therapies may be clinically relevant to treatment of patients with severe muscle damage.-Chaillou, T. Lanner, J. T. Regulation of myogenesis and skeletal muscle regeneration: effects of oxygen levels on satellite cell activity.
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Affiliation(s)
- Thomas Chaillou
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Johanna T Lanner
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Galmer AM, Selim SM, Giri J, Lau JF, Weinberg MD. Building a Critical Limb Ischemia Program. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:50. [PMID: 27289583 DOI: 10.1007/s11936-016-0476-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT The need to develop highly qualified, multidisciplinary critical limb ischemia (CLI) programs has gained significant momentum. Due to the systemic nature of the disease, patients with CLI are inherently medically complex and often present with multiple comorbidities. Successful care for these patients depends on community screening, early referral, accurate diagnosis, risk stratification, risk factor modification, invasive and non-invasive treatment strategies, and appropriate surveillance. Patients with CLI are often treated by multiple subspecialists-often lacking a unified team which could lead to inefficiencies and redundancy. Establishing an effective critical limb ischemia program relies on the joint efforts of multiple physician specialists, nurses, technicians, wound care specialists, researchers, and administrators who together form an integrated network that is easily accessible to the patient. This article will focus on the various modalities needed to build an advanced critical limb ischemia program, while addressing the challenges facing the medical community in caring for this population.
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Affiliation(s)
- Andrew M Galmer
- Department of Cardiology:Vascular Medicine and Peripheral Vascular Intervention Program, Northwell Health, 300 Community Drive, Manhasset, NY, USA
| | - Samy M Selim
- Department of Cardiology:Vascular Medicine and Peripheral Vascular Intervention Program, Northwell Health, 300 Community Drive, Manhasset, NY, USA
| | - Jay Giri
- Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA, 19104, USA
| | - Joe F Lau
- Department of Cardiology:Vascular Medicine and Peripheral Vascular Intervention Program, Northwell Health, 27005 76th Ave, New Hyde Park, NY, 11040, USA
| | - Mitchell D Weinberg
- Department of Cardiology:Vascular Medicine and Peripheral Vascular Intervention Program, Northwell Health, 300 Community Drive, Manhasset, NY, USA.
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Sultana ST, Atci E, Babauta JT, Mohamed Falghoush A, Snekvik KR, Call DR, Beyenal H. Electrochemical scaffold generates localized, low concentration of hydrogen peroxide that inhibits bacterial pathogens and biofilms. Sci Rep 2015; 5:14908. [PMID: 26464174 PMCID: PMC4604468 DOI: 10.1038/srep14908] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/11/2015] [Indexed: 11/29/2022] Open
Abstract
We hypothesized that low concentrations of H2O2 could be generated through the electrochemical conversion of oxygen by applying an electric potential to a conductive scaffold and produce a low, but constant, concentration of H2O2 that would be sufficient to destroy biofilms. To test our hypothesis we used a multidrug-resistant Acinetobacter baumannii strain, because this species is often implicated in difficult-to-treat biofilm infections. We used conductive carbon fabric as the scaffold material ("e-scaffold"). In vitro experiments demonstrated the production of a maximum constant concentration of ~25 μM H2O2 near the e-scaffold surface. An e-scaffold was overlaid onto an existing A. baumannii biofilm, and within 24 h there was a ~4-log reduction in viable bacteria with an ~80% decrease in biofilm surface coverage. A similar procedure was used to overlay an e-scaffold onto an existing A. baumannii biofilm that was grown on a porcine explant. After 24 h, there was a ~3-log reduction in viable bacteria from the infected porcine explants with no observable damage to the underlying mammalian tissue based on a viability assay and histology. This research establishes a novel foundation for an alternative antibiotic-free wound dressing to eliminate biofilms.
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Affiliation(s)
- Sujala T. Sultana
- School of Chemical Engineering & Bioengineering, Washington State University, Pullman 99163, WA
| | - Erhan Atci
- School of Chemical Engineering & Bioengineering, Washington State University, Pullman 99163, WA
| | - Jerome T. Babauta
- School of Chemical Engineering & Bioengineering, Washington State University, Pullman 99163, WA
| | - Azeza Mohamed Falghoush
- Department of Veterinary Microbiology and Pathology, Washington State University, Pullman 99163, WA
| | - Kevin R. Snekvik
- Department of Veterinary Microbiology and Pathology, Washington State University, Pullman 99163, WA
- Washington Animal Disease Diagnostic Laboratory, Washington State University, Pullman 99163, WA
| | - Douglas R. Call
- Department of Veterinary Microbiology and Pathology, Washington State University, Pullman 99163, WA
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman 99163, WA
| | - Haluk Beyenal
- School of Chemical Engineering & Bioengineering, Washington State University, Pullman 99163, WA
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Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle) 2015; 4:560-582. [PMID: 26339534 PMCID: PMC4528992 DOI: 10.1089/wound.2015.0635] [Citation(s) in RCA: 1402] [Impact Index Per Article: 140.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients. Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing. Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based. Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.
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Curbing Inflammation in Skin Wound Healing: A Review. Int J Inflam 2015; 2015:316235. [PMID: 26356299 PMCID: PMC4556061 DOI: 10.1155/2015/316235] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/24/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
Wound healing is a complex regulated process that results in skin scar formation in postnatal mammals. Chronic wounds are major medical problems that can confer devastating consequences. Currently, there are no treatments to prevent scarring. In the early fetus wounds heal without scarring and the healing process is characterized by relatively less inflammation compared to adults; therefore, research aimed at reducing the inflammatory process related to wound healing might speed healing and improve the final scar appearance.
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Rogers LC, DellaCorte MP, Stavosky JW, Millington JT, Capotorto JV. Credentialing guidelines for doctors of podiatric medicine supervising hyperbaric oxygen therapy a position paper. J Am Podiatr Med Assoc 2015; 105:367-70. [PMID: 25649892 DOI: 10.7547/14-133.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hyperbaric oxygen therapy (HBOT) is a useful tool for many conditions within the scope of practice of a Doctor of Podiatric Medicine (DPM). More wound-care clinics are adding HBOT as a service line. The increasing prevalence of DPMs operating inside of these wound-care clinics has raised questions about the licensure and privileging of DPMs to supervise HBOT. This document reviews the safety of outpatient HBOT and provides guidelines for hospitals to credential DPMs to supervise treatments.
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Affiliation(s)
- Lee C. Rogers
- Amputation Prevention Center at Sherman Oaks Hospital, Los Angeles, CA
| | | | - James W. Stavosky
- American Board of Podiatric Medicine, Torrance, CA
- California School of Podiatric Medicine, Oakland, CA
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Bellmunt‐Montoya S, Escribano JM, Dilme J, Martinez‐Zapata MJ, Cochrane Vascular Group. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 2015; 2015:CD009648. [PMID: 26121003 PMCID: PMC7097730 DOI: 10.1002/14651858.cd009648.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system. This is an update of the review first published in 2013. OBJECTIVES To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins. SEARCH METHODS The Trials Search Co-ordinator of the Cochrane Peripheral Vascular Diseases Group searched the Specialised Register (April 2015), the Cochrane Register of Studies (2015, Issue 3) and clinical trials databases. The review authors searched PubMed (April 2015). There was no language restriction. We contacted study authors to obtain more information when necessary. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared the CHIVA method versus any other treatments. Two review authors independently selected and evaluated the studies. One review author extracted data and performed the quantitative analysis. DATA COLLECTION AND ANALYSIS Two independent review authors extracted data from the selected papers. We calculated the risk ratio (RR), mean difference (MD), the number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI) using Review Manager 5. MAIN RESULTS No new studies were identified for this update. We included four RCTs with 796 participants (70.5% women). Three RCTs compared the CHIVA method with vein stripping, and one RCT compared the CHIVA method with compression dressings in people with venous ulcers. We judged the quality of the evidence of the included studies as low to moderate due to imprecision caused by the low number of events and because the studies were open. The overall risk of bias across studies was high because neither participants nor outcome assessors were blinded to the interventions. The primary endpoint, clinical recurrence, pooled between studies over a follow-up of 3 to 10 years, showed more favorable results for the CHIVA method than for vein stripping (721 people; RR 0.63; 95% CI 0.51 to 0.78; I(2) = 0%, NNTB 6; 95% CI 4 to 10) or compression dressings (47 people; RR 0.23; 95% CI 0.06 to 0.96; NNTB 3; 95% CI 2 to 17). Only one study reported data on quality of life (presented graphically) and these results significantly favored the CHIVA method.The vein stripping group had a higher risk of side effects than the CHIVA group; specifically, the RR for bruising was 0.63 (95% CI 0.53 to 0.76; NNTH 4; 95% CI 3 to 6) and the RR for nerve damage was 0.05 (95% CI 0.01 to 0.38; I(2) = 0%; NNTH 12; 95% CI 9 to 20). There were no statistically significant differences between groups regarding the incidence of limb infection and superficial vein thrombosis. AUTHORS' CONCLUSIONS The CHIVA method reduces recurrence of varicose veins and produces fewer side effects than vein stripping. However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed and the results were imprecise due to low number of events. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.
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Affiliation(s)
- Sergi Bellmunt‐Montoya
- Hospital de la Santa Creu i Sant Pau, IBB Sant PauAngiology, Vascular and Endovascular SurgerySant Quinti No. 89BarcelonaSpain08041
| | - Jose Maria Escribano
- Hospital Universitario Vall d'HebronAngiology, Vascular and Endovascular SurgeryPasseo Vall d'Hebron, 119‐129BarcelonaBarcelonaSpain08035
| | - Jaume Dilme
- Hospital de la Santa Creu i Sant Pau, IBB Sant PauAngiology, Vascular and Endovascular SurgerySant Quinti No. 89BarcelonaSpain08041
| | - Maria José Martinez‐Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni M. Claret 171Casa de ConvalescènciaBarcelonaCataloniaSpain08041
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Park TH, Anand A. Management of diabetic foot: Brief synopsis for busy orthopedist. J Clin Orthop Trauma 2015; 6:24-9. [PMID: 26549948 PMCID: PMC4551462 DOI: 10.1016/j.jcot.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 10/21/2014] [Indexed: 12/28/2022] Open
Abstract
According to available medical reports, over 10% of diabetic patients will develop foot ulcers during their lifetimes. This condition still remains great challenges to many clinicians. Various mechanisms may explain treatment-resistant entity. Treatment varies widely, relying on the severity of the ulceration as well as the presence of infection or ischemia. However, the most important things to keep in mind should consist of the following: 1) appropriate debridement; 2) off-loading of pressure; 3) effective control of infection; 4) local wound care strategy; 5) timely reconstructive surgery. The ideal flap for diabetic foot reconstruction should provide a well-vascularized tissue to control infection, adequate contour for footwear, durability, and solid anchorage to resist shearing forces. A thorough assessment of patient's general condition and voluntary motivation of the patient should be warranted to prevent any sort of postoperative recurrence.
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Affiliation(s)
- Tae Hwan Park
- Buleun Health Care Center, Incheon, Republic of Korea
| | - Ashish Anand
- Staff Orthopaedic Surgeon, VAMC, Jackson, MS, USA,Corresponding author.
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Stuermer EK, Lipenksy A, Thamm O, Neugebauer E, Schaefer N, Fuchs P, Bouillon B, Koenen P. The role of SDF-1 in homing of human adipose-derived stem cells. Wound Repair Regen 2015; 23:82-9. [PMID: 25581571 DOI: 10.1111/wrr.12248] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/02/2014] [Indexed: 12/29/2022]
Abstract
One of the putative pathophysiological mechanisms of chronic wounds is a disturbed homing of stem cells. In this project, the stromal cell-derived factor 1 (SDF-1)/C-X-C chemokine receptor (CXCR) 4 and SDF-1/CXCR7 pathway were focused in human adipose-derived stem cells (ASCs). ASCs were incubated with acute (AWF) or chronic wound fluid (CWF) to analyze their effects by quantitative real-time polymerase chain reaction (SDF-1, CXCR4, CXCR7, TIMP3), enzyme-linked immunosorbent assay (SDF-1 in WFs and supernatant), and transwell migration assay with/without antagonization. Whereas SDF-1 amounted 73.5 pg/mL in AWF, it could not be detected in CWF. Incubation with AWF led to a significant enhancement (129.7 pg/mL vs. 95.5 pg/mL), whereas CWF resulted in a significant reduction (30 pg/mL vs. 95.5 pg/mL) of SDF-1 in ASC supernatant. The SDF-1 receptor CXCR7 was detected on ASCs. AWF but not CWF significantly induced ASC migration, which was inhibited by CXCR4 and CXCR7 antagonists. Expressions of SDF-1, CXCR4, and CXCR7 were significantly stimulated by AWF while TIMP3 expression was reduced. In conclusion, an uncontrolled inflammation in the chronic wound environment, indicated by a reduced SDF-1 expression, resulted in a decreased ASC migration. A disturbed SDF-1/CXCR4 as well as SDF-1/CXCR7 pathway seems to play an important role in the impaired healing of chronic wounds.
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Affiliation(s)
- Ewa K Stuermer
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
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Omar MTA, Alghadir A, Al-Wahhabi KK, Al-Askar AB. Efficacy of shock wave therapy on chronic diabetic foot ulcer: a single-blinded randomized controlled clinical trial. Diabetes Res Clin Pract 2014; 106:548-54. [PMID: 25451894 DOI: 10.1016/j.diabres.2014.09.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/02/2014] [Accepted: 09/14/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study was conducted to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) on the healing rate, wound surface area and wound bed preparation in chronic diabetic foot ulcers (DFU). METHODS Thirty eight patients with 45 chronic DFU were randomly assigned into; the ESWT-group (19 patients/24 ulcers) and the control-group (19 patients/21 ulcers). Blinded therapist measured wound surface area (WSA), the percentage of reduction in the WSA, rate of healing and wound bed preparation at baseline, after the end of the interventions (W8), and at 20-week follow-up (W20). The ESWT group received shock wave therapy twice per week for a total of eight treatments. Each ulcer was received ESWT at a frequency of 100 pulse/cm(2), and energy flux density of 0.11mJ/cm(2). All patients received standardized wound care consisting of debridement, blood-glucose control agents, and footwear modification for pressure reduction. RESULTS The overall clinical results showed completely healed ulcers in 33.3% and 54% in ESWT-groups and 14.28% and 28.5% in the control group after intervention (W8), and at follow-up (W20) respectively. The average healing time was significantly lower (64.5 ± 8.06 days vs 81.17 ± 4.35 days, p<0.05) in the ESWT-group compared with the control group. CONCLUSION ESWT-treated ulcers had a significant reduction in wound size and median time required for ulcer healing, with no adverse reactions. So, the ESWT is advocated as an adjunctive therapy in chronic diabetic wound.
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Affiliation(s)
- Mohammed T A Omar
- Faculty of Physical Therapy, Cairo University, Giza, Egypt; Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia.
| | - Ahmad Alghadir
- Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia; Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Abeer B Al-Askar
- Physical Therapy Department, King Saud Medical City, Riyadh, Saudi Arabia
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Zhang J, Li L, Li J, Liu Y, Zhang CY, Zhang Y, Zen K. Protein tyrosine phosphatase 1B impairs diabetic wound healing through vascular endothelial growth factor receptor 2 dephosphorylation. Arterioscler Thromb Vasc Biol 2014; 35:163-74. [PMID: 25395617 DOI: 10.1161/atvbaha.114.304705] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Impaired wound healing is a major complication of diabetes mellitus. The mechanisms that govern wound healing, however, are complex and incompletely understood. In the present study, we determined the inhibitory role of protein tyrosine phosphatase 1B (PTP1B) in the process of diabetic wound healing. APPROACH AND RESULTS First, by comparing the wound healing process in PTP1B knockout (PTP1B(-/-)) mice, ob/ob mice and their wild-type littermates in the presence or absence of streptozotocin treatment, we showed that the inhibition of mouse wound healing in streptozotocin-induced diabetic conditions is because of the upregulation and activation of PTP1B. Second, the impaired wound healing in ob/ob mice and streptozotocin-treated wild-type mice was rescued by a PTP1B inhibitor. Third, PTP1B, which is upregulated under hyperglycemic condition, inhibited the tube formation, proliferation, and migration of human microvascular endothelial cells induced by vascular endothelial growth factor, whereas this inhibition was largely abolished by the PTP1B inhibitor. Finally, mechanism study further indicated that PTP1B likely suppressed the proliferation, migration, and tube formation of vascular endothelial cells through dephosphorylation of vascular endothelial growth factor receptor 2. CONCLUSIONS Our study demonstrated that PTP1B negatively modulated the diabetic wound healing process by dephosphorylating the endothelial cell vascular endothelial growth factor receptor 2 and that the specific inhibitor of PTP1B might serve as a potential novel therapeutic tool for diabetic wound healing.
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Affiliation(s)
- Jing Zhang
- From the State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China (J.Z., L.L., J.L., C.-Y.Z., Y.Z., K.Z.); and Department of Biology, Center for Inflammation, Immunity and Infection, Georgia State University, Atlanta (Y.L.)
| | - Limin Li
- From the State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China (J.Z., L.L., J.L., C.-Y.Z., Y.Z., K.Z.); and Department of Biology, Center for Inflammation, Immunity and Infection, Georgia State University, Atlanta (Y.L.)
| | - Jing Li
- From the State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China (J.Z., L.L., J.L., C.-Y.Z., Y.Z., K.Z.); and Department of Biology, Center for Inflammation, Immunity and Infection, Georgia State University, Atlanta (Y.L.)
| | - Yuan Liu
- From the State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China (J.Z., L.L., J.L., C.-Y.Z., Y.Z., K.Z.); and Department of Biology, Center for Inflammation, Immunity and Infection, Georgia State University, Atlanta (Y.L.)
| | - Chen-Yu Zhang
- From the State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China (J.Z., L.L., J.L., C.-Y.Z., Y.Z., K.Z.); and Department of Biology, Center for Inflammation, Immunity and Infection, Georgia State University, Atlanta (Y.L.).
| | - Yujing Zhang
- From the State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China (J.Z., L.L., J.L., C.-Y.Z., Y.Z., K.Z.); and Department of Biology, Center for Inflammation, Immunity and Infection, Georgia State University, Atlanta (Y.L.).
| | - Ke Zen
- From the State Key Laboratory of Pharmaceutical Biotechnology, Jiangsu Engineering Research Center for MicroRNA Biology and Biotechnology, School of Life Sciences, Nanjing University, Nanjing, Jiangsu, China (J.Z., L.L., J.L., C.-Y.Z., Y.Z., K.Z.); and Department of Biology, Center for Inflammation, Immunity and Infection, Georgia State University, Atlanta (Y.L.).
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Fosen KM, Thom SR. Hyperbaric oxygen, vasculogenic stem cells, and wound healing. Antioxid Redox Signal 2014; 21:1634-47. [PMID: 24730726 PMCID: PMC4175035 DOI: 10.1089/ars.2014.5940] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022]
Abstract
SIGNIFICANCE Oxidative stress is recognized as playing a role in stem cell mobilization from peripheral sites and also cell function. RECENT ADVANCES This review focuses on the impact of hyperoxia on vasculogenic stem cells and elements of wound healing. CRITICAL ISSUES Components of the wound-healing process in which oxidative stress has a positive impact on the various cells involved in wound healing are highlighted. A slightly different view of wound-healing physiology is adopted by departing from the often used notion of sequential stages: hemostatic, inflammatory, proliferative, and remodeling and instead organizes the cascade of wound healing as overlapping events or waves pertaining to reactive oxygen species, lactate, and nitric oxide. This was done because hyperoxia has effects of a number of cell signaling events that converge to influence cell recruitment/chemotaxis and gene regulation/protein synthesis responses which mediate wound healing. FUTURE DIRECTIONS Our alternative perspective of the stages of wound healing eases recognition of the multiple sites where oxidative stress has an impact on wound healing. This aids the focus on mechanistic events and the interplay among various cell types and biochemical processes. It also highlights the areas where additional research is needed.
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Affiliation(s)
- Katina M. Fosen
- Department of Emergency Medicine, Institute for Environmental Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Stephen R. Thom
- Department of Emergency Medicine, University of Maryland, Baltimore, Maryland
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Abstract
Hyperbaric oxygen therapy (HBO) has been used as an adjunct for healing diabetic foot ulcers (DFUs) for decades. However, its use remains controversial. A literature search was conducted to locate clinical studies and assess the available evidence. Ten prospective and seven retrospective studies evaluating HBO for DFUs were located. These were reviewed and the outcomes were discussed. One study reported no difference in outcomes between patients receiving hyperbaric oxygen and the control group. However, their regime differed from all other studies in that the patients received hyperbaric oxygen twice rather than once daily. Reduced amputation rates and improved healing were the most common outcomes observed.
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Affiliation(s)
- Alexandra J Bishop
- Diving Diseases Research Centre, The Hyperbaric Medical Centre, Plymouth, Devon, UKDepartment of Wound Healing, Cardiff University, Cardiff, UK
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Abstract
Hyperbaric oxygen therapy (HBOT), the administration of pressurized 100% oxygen, is used as an adjunct to aid healing in selected chronic wounds. Though the therapy has had a controversial history, research is now elucidating the mechanisms by which HBOT helps to heal wounds. HBOT increases growth factors and local wound signaling, while also promoting a central stem cell release of endothelial progenitor cells from the bone marrow via nitric oxide pathways. The clinical data continue to accumulate in support of HBOT to help hasten wound healing, and reduce the amputation rate in diabetic ulcers. In appropriate patients, HBOT is an effective, noninvasive, adjunct modality that can be used to hasten chronic wound healing.
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Affiliation(s)
- Lee J Goldstein
- Division of Vascular and Endovascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, Florida 33169, USA.
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Abstract
Critical limb ischemia (CLI) is a severe form of peripheral artery disease associated with high morbidity and mortality. The primary therapeutic goals in treating CLI are to reduce the risk of adverse cardiovascular events, relieve ischemic pain, heal ulcers, prevent major amputation, and improve quality of life (QoL) and survival. These goals may be achieved by medical therapy, endovascular intervention, open surgery, or amputation and require a multidisciplinary approach including pain management, wound care, risk factors reduction, and treatment of comorbidities. No-option patients are potential candidates for the novel angiogenic therapies. The application of genetic, molecular, and cellular-based modalities, the so-called therapeutic angiogenesis, in the treatment of arterial obstructive diseases has not shown consistent efficacy. This article summarizes the current status related to the management of patients with CLI and discusses the current findings of the emerging modalities for therapeutic angiogenesis.
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Affiliation(s)
- Geoffrey O. Ouma
- Department of Medicine, Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Barak Zafrir
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
| | - Emile R. Mohler
- Department of Medicine, Cardiovascular Division, Vascular Medicine Section, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Moshe Y. Flugelman
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport School of Medicine, Technion-IIT, Haifa, Israel
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Huang SP, Huang CH, Shyu JF, Lee HS, Chen SG, Chan JYH, Huang SM. Promotion of wound healing using adipose-derived stem cells in radiation ulcer of a rat model. J Biomed Sci 2013; 20:51. [PMID: 23876213 PMCID: PMC3724586 DOI: 10.1186/1423-0127-20-51] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 07/19/2013] [Indexed: 12/11/2022] Open
Abstract
Background Wound healing is a complex biologic process that involves the integration of inflammation, mitosis, angiogenesis, synthesis, and remodeling of the extracellular matrix. However, some wounds fail to heal properly and become chronic. Although some simulated chronic wound models have been established, an efficient approach to treat chronic wounds in animal models has not been determined. The aim of this study was to develop a modified rat model simulating the chronic wounds caused by clinical radiation ulcers and examine the treatment of chronic wounds with adipose-derived stem cells. Results Sprague–Dawley rats were irradiated with an electron beam, and wounds were created. The rats received treatment with adipose-derived stem cells (ASCs), and a wound-healing assay was performed. The wound sizes after ASC treatment for 3 weeks were significantly smaller compared with the control condition (p < 0.01). Histological observations of the wound edge and immunoblot analysis of the re-epithelialization region both indicated that the treatment with ASCs was associated with the development of new blood vessels. Cell-tracking experiments showed that ASCs were colocalized with endothelial cell markers in ulcerated tissues. Conclusions We established a modified rat model of radiation-induced wounds and demonstrated that ASCs accelerate wound-healing.
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Bellmunt-Montoya S, Escribano JM, Dilme J, Martinez-Zapata MJ. CHIVA method for the treatment of chronic venous insufficiency. Cochrane Database Syst Rev 2013:CD009648. [PMID: 23821413 DOI: 10.1002/14651858.cd009648.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many surgical approaches are available to treat varicose veins secondary to chronic venous insufficiency. One of the least invasive techniques is the ambulatory conservative hemodynamic correction of venous insufficiency method (cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire (CHIVA)), an approach based on venous hemodynamics with deliberate preservation of the superficial venous system. OBJECTIVES To compare the efficacy and safety of the CHIVA method with alternative therapeutic techniques to treat varicose veins. SEARCH METHODS The Trials Search Co-ordinator of the Cochrane Peripheral Vascular Diseases Group searched the Specialised Register (November 2012), CENTRAL (2012, Issue 10) and clinical trials databases. The review authors searched PubMed and EMBASE (December 2012). There was no language restriction. We contacted study authors to obtain more information when necessary. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared the CHIVA method versus any other treatments. Two review authors independently selected and evaluated the studies. One review author extracted data and performed the quantitative analysis. DATA COLLECTION AND ANALYSIS Two independent review authors extracted data from the selected papers. We calculated the risk ratio (RR), mean difference (MD), the number of people needed to treat for an additional beneficial outcome (NNTB), and the number of people needed to treat for an additional harmful outcome (NNTH), with 95% confidence intervals (CI) using Review Manager 5. MAIN RESULTS We included four RCTs with 796 participants (70.5% women) from the 434 publications identified by the search strategy. Three RCTs compared the CHIVA method with vein stripping, and one RCT compared the CHIVA method with compression dressings in people with venous ulcers. We judged the methodological quality of the included studies as low to moderate. The overall risk of bias across studies was high because neither participants nor outcome assessors were blinded to the interventions. The primary endpoint, clinical recurrence, pooled between studies over a follow-up of 3 to 10 years, showed more favorable results for the CHIVA method than for vein stripping (721 people; RR 0.63; 95% CI 0.51 to 0.78; I(2) = 0%, NNTB 6; 95% CI 4 to 10) or compression dressings (47 people; RR 0.23; 95% CI 0.06 to 0.96; NNTB 3; 95% CI 2 to 17). Only one study reported data on quality of life and these results presented graphically significantly favored the CHIVA method.The vein stripping group had a higher risk of side effects than the CHIVA group; specifically, the RR for bruising was 0.63 (95% CI 0.53 to 0.76; NNTH 4; 95% CI 3 to 6) and the RR for nerve damage was 0.05 (95% CI 0.01 to 0.38; I(2) = 0%; NNTH 12; 95% CI 9 to 20). There were no statistically significant differences between groups regarding the incidence of limb infection and superficial vein thrombosis. AUTHORS' CONCLUSIONS The CHIVA method reduces recurrence of varicose veins and produces fewer side effects than vein stripping. However, we based these conclusions on a small number of trials with a high risk of bias as the effects of surgery could not be concealed. New RCTs are needed to confirm these results and to compare CHIVA with approaches other than open surgery.
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Affiliation(s)
- Sergi Bellmunt-Montoya
- Angiology, Vascular and Endovascular Surgery, Hospital de la Santa Creu i Sant Pau, IBB Sant Pau, Barcelona, Spain.
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Chantelau EA. Benefits of hyperbaric oxygen therapy still doubtful. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:372. [PMID: 23795212 DOI: 10.3238/arztebl.2013.0372a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adjunct methods of the standard diabetic foot ulceration therapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:243568. [PMID: 23843866 PMCID: PMC3697296 DOI: 10.1155/2013/243568] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/13/2013] [Accepted: 05/29/2013] [Indexed: 01/28/2023]
Abstract
The outcome of management of diabetic foot ulceration (DFU) is poor and insufficient. DFU therapy includes the standard management as debridement of the wound, revascularization procedures, off-loading of the ulcer and antibacterial actions, and supplementation of growth factors and cytokines, leading to stimulation of granulation, epidermization, and angiogenesis.
The aim of the present review is to summarize the adjunct methods of the standard DFU therapy as hyperbaric oxygen therapy (HBOT), maggot therapy (MT), and platelet-rich plasma therapy (PRPT). The results of preclinical and clinical trials indicated that the methods may reduce time of therapy, short-term morbidity, and the risk of major amputation.
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Richmond NA, Maderal AD, Vivas AC. Evidence-based management of common chronic lower extremity ulcers. Dermatol Ther 2013; 26:187-96. [DOI: 10.1111/dth.12051] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nicholas A. Richmond
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami; Florida
| | - Andrea D. Maderal
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami; Florida
| | - Alejandra C. Vivas
- Department of Dermatology & Cutaneous Surgery; University of Miami Miller School of Medicine; Miami; Florida
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Delasotta LA, Hanflik A, Bicking G, Mannella WJ. Hyperbaric oxygen for osteomyelitis in a compromised host. Open Orthop J 2013; 7:114-7. [PMID: 23730373 PMCID: PMC3664446 DOI: 10.2174/1874325001307010114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/27/2013] [Accepted: 03/28/2013] [Indexed: 11/22/2022] Open
Abstract
Post-traumatic osteomyelitis is a rare but debilitating complication of closed fractures. Most infections can be resolved with aggressive debridement, intravenous antibiotics, and hardware removal. However, the eradication of infection can be challenging in a patient with multiple comorbidities. Refractory infection may require suppressive therapy or amputation to control the disease. Improvements in care have led to improved survival for this population, posing new challenges in their post-traumatic care. We report on the successful use of hyperbaric oxygen therapy as an adjunct in a compromised host with recurrent post-traumatic osteomyelitis despite aggressive debridement, removal of instrumentation, and several courses of intravenous antibiotic therapy. Hyperbaric oxygen may be considered as an adjunct to standard treatment protocols for refractory osteomyelitis in compromised hosts.
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Affiliation(s)
- Lawrence A Delasotta
- Kingsbrook Jewish Medical Center, Department of Orthopedic Surgery, Brooklyn, NY 11203, USA
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Delaney KMH, Axelrod KC, Buscetta A, Hassell KL, Adams-Graves PE, Seamon C, Kato GJ, Minniti CP. Leg ulcers in sickle cell disease: current patterns and practices. Hemoglobin 2013; 37:325-32. [PMID: 23600469 PMCID: PMC3864012 DOI: 10.3109/03630269.2013.789968] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Leg ulcers are a debilitating complication of patients with sickle cell disease, and their frequency in North America was reported to be 2.5% by the Cooperative Study of Sickle Cell Disease more than 20 years ago. We sought to determine if the frequency of leg ulcers in sickle cell patients in the United States had declined and to assess which treatments providers use most commonly. We sent an e-mail survey to health professionals belonging to the national Sickle Cell Adult Provider Network. Responses were obtained from 31 of them (26.0%). Most of them (96.0%) reported having some patients with leg ulcers. Providers reported a total of 185 patients with active leg ulcers and 224 in the previous 5 years, for a total of 409 patients. Hb SS (homozygous sickle cell anemia) was the most common genotype of affected individuals, followed by Hb SC (double heterozygote for Hb S [β6(A3)Glu→Val, GAG>GTG; HBB: c.20A>T] and Hb C [β6(A3)Glu→Lys, GAG>AAG; HBB: c.19G>A]). Males showed a 2:1 predominance. Two-thirds of patients were treated with either hydroxyurea (HU) or transfusion therapy and most used compression stockings and topical therapies as directed by wound care services. We conclude that leg ulcers continue to be a debilitating complication of young adults with sickle cell disease, despite improved supportive care and the widespread use of disease modifying agents such HU and transfusion. While some providers offer office-based ulcer care, the majority prefer specialty consultation including podiatry, plastic surgery and dermatology. Despite their frequency, there is no clear consensus among providers as to the best treatment.
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Affiliation(s)
| | - Karen C. Axelrod
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Ashley Buscetta
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | | | - Catherine Seamon
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Gregory J. Kato
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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Feldman-Idov Y, Melamed Y, Linn S, Ore L. Prognostic factors predicting ischemic wound healing following hyperbaric oxygenation therapy. Wound Repair Regen 2013; 21:418-27. [PMID: 23590699 DOI: 10.1111/wrr.12038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 02/06/2013] [Indexed: 11/26/2022]
Abstract
Identifying patients who benefit from hyperoxygenation therapy is important, because treatment is time-consuming and involves high costs and complications (minor). Our objective was to develop a model for predicting therapy outcome based on population of patients with and without diabetes. A retrospective cohort study was carried out in a major hospital in Israel. All 385 patients treated between 1/1/1998 and 1/1/2007 for ischemic nonhealing lower extremities wounds were included. Data on medical history, demographic, transcutaneous oximetry, wounds, treatment, and outcome characteristics were collected. Eight factors were identified to optimally predict wound healing: (1) number of hyperbaric oxygenation treatments (odds ratio [OR] = 1.034, p < 0.001), (2) transcutaneous oximetry values at hyperbaric conditions (OR = 1.001, p = 0.019), (3) wound duration (OR = 0.988, p = 0.022), (4) absence of heart disease (OR = 3.304, p < 0.001), (5) being employed (OR = 3.16, p = 0.008), (6) low socioeconomic status (OR = 2.50, p = 0.004), (7a) good/partial granulation wound appearance (OR = 2.73, p = 0.022), (7b) wounds covered with fibrin (OR = 3.16, p = 0.015), and (8) absence of anemia (OR = 2.13, p = 0.016). The model's sensitivity is 78.7%, specificity is 62.9%, and accuracy is 71.8%. We suggest using our model as an adjunct to patients' clinical evaluation. Also, we recommend initiating hyperoxygenation therapy no later than 2 months after wound appearance.
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Affiliation(s)
- Yulie Feldman-Idov
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
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46
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47
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Rüttermann M, Maier-Hasselmann A, Nink-Grebe B, Burckhardt M. Local treatment of chronic wounds: in patients with peripheral vascular disease, chronic venous insufficiency, and diabetes. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:25-31. [PMID: 23413377 DOI: 10.3238/arztebl.2013.0025] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 10/17/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND A chronic wound is defined as an area where the skin is not intact that fails to heal within eight weeks. Such wounds usually develop on the lower limbs as a complication of diabetes, venous insufficiency, or inadequate arterial perfusion. Most of the roughly 45,000 limb amputations performed in Germany each year are necessitated by non-healing chronic wounds. METHODS In the development of this S3 guideline, a systematic search was performed that yielded 4998 references including 38 randomized, controlled trials and 26 systematic reviews, which were used as the basis for the recommendations and statements made in the guideline. Twelve member societies of the umbrella Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF), as well as the German Association of Nursing Science (Deutsche Gesellschaft für Pflegewissenschaft, and patient representatives participated in the consensus rounds in which the guideline's recommendations and statements were agreed upon. RESULTS This guideline contains seven evidence-based recommendations and 30 good clinical practice (GCP) recommendations. Evidence-based recommendations are given in favor of hydrogel, hyperbaric oxygenation, and integrated care, and against the use of medicinal honey and growth factors. Terms are defined precisely in order to ease communication and to specify what is meant by "wound debridement" (a procedure performed by a physician) as opposed to cleansing a wound. Under the premise of preventing pain, exudation, and maceration, local therapeutic agents can be chosen on the basis of the scientific evidence, the patient's preference, the physician's experience, and the wound situation. Costs should also be considered. CONCLUSION Scant evidence is available to answer many of the relevant questions about chronic wounds. There are valid data in support of hyperbaric oxygen and integrated care. More research is needed.
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Affiliation(s)
- Mike Rüttermann
- German Society for Wound Healing and Wound Treatment, Gießen.
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Castilla DM, Liu ZJ, Velazquez OC. Oxygen: Implications for Wound Healing. Adv Wound Care (New Rochelle) 2012; 1:225-230. [PMID: 24527310 DOI: 10.1089/wound.2011.0319] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Oxygen is vital for healing wounds. It is intricately involved in numerous biological processes including cell proliferation, angiogenesis, and protein synthesis, which are required for restoration of tissue function and integrity. Adequate wound tissue oxygenation can trigger healing responses and favorably influence the outcomes of other treatment modalities. THE PROBLEM Chronic ischemic wounds fail to heal appropriately secondary to extreme hypoxia that leads to cellular demise. Wound tissue hypoxia is typically greater at the center of the wound. Accordingly, oxygen requirements of the regenerating tissue will vary. BASIC/CLINICAL SCIENCE ADVANCES As oxygen levels decrease within the wound, cell response mechanisms (hypoxia inducible factor [HIF]) trigger the transcription of genes that promote cell survival and angiogenesis. HIF stabilizers are currently being tested to determine wound healing potential. Clinically, topical oxygen therapy (TOT) has been proved as an effective therapeutic modality for chronic wounds. TOT is reputed to have several advantages over hyperbaric oxygen therapy. Namely, TOT has a lower risk of oxygen toxicity, it is less expensive and is relatively easy to apply to target areas. CLINICAL CARE RELEVANCE Wound tissue oxygen is necessary for appropriate wound healing; however, the relative complexity of the healing process requires a multifaceted approach for successful healing outcomes. A key component of this multifaceted approach should be specific oxygen dosing as a function of tissue hypoxia. CONCLUSION New treatment approaches that exploit cell hypoxia sensing and response mechanisms and that enable the precise application of oxygen therapy to hypoxic areas of regenerating tissue are very promising.
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Affiliation(s)
- Diego M. Castilla
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Zhao-Jun Liu
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
| | - Omaida C. Velazquez
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida
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Karl T. [Hydroactive stage-adapted wound management]. Unfallchirurg 2012; 115:783-91. [PMID: 22935896 DOI: 10.1007/s00113-012-2211-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The treatment of subacute and chronic wounds is not only a major medical challenge but because of demographic developments and the concurrent increase in predisposing diseases, such as diabetes mellitus and arterial occlusive disease is also a relevant socioeconomic challenge. The principle of modern, moist wound care can now be regarded as established. In daily practice there are nevertheless significant treatment problems which are, among other things due to the vast variety of products available. As evidence-based guidelines for the treatment of chronic wounds were until recently lacking and many question were left unanswered, standards of care represent an appropriate means of orientation. In addition to improved quality of care in this way costs can also be reduced. Furthermore, criteria can be illustrated by which the selection of appropriate wound dressings can be facilitated and established.
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Affiliation(s)
- T Karl
- Abteilung für Gefäß-und Endovascularchirurgie, Klinik Rotes Kreuz, Königswarterstraße 16, 60316, Frankfurt am Main, Deutschland.
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50
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Abstract
Pressure ulcers (PrUs) are a challenging health concern for both the clinician and the patient. The exact incidence and prevalence of PrUs varies widely among specific clinical populations, from 0.4% to 38% in acute care, from 2.2% to 24% in long-term care and from 0% to 17% in home care. The economic impact of these wounds is impressive with an estimated cost of $11 to $17.2 billion annually in the USA. Guidelines from the National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel have provided recommendations for the prevention and treatment of PrUs. Negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF; V.A.C.® Therapy, KCI USA, Inc. San Antonio, TX) has been successfully used for managing PrUs. This review combines expert opinion with scientific evidence to describe the use of NPWT/ROCF in patients with PrUs.
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Affiliation(s)
- Subhas Gupta
- Department of Plastic Surgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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