Search Results
Wound Care
The Role of Advanced Wound-healing Technologies
Wound repair and regeneration is a highly complex combination of matrix destruction and reorganization. Although major hurdles remain, advances during the past generation have improved the clinician’s armamentarium in the medical and surgical management of this problem. The purpose of this article is to review the current literature regarding the pragmatic use of three of the most commonly used advanced therapies: bioengineered tissue, negative-pressure wound therapy, and hyperbaric oxygen therapy, with a focus on the near-term future of wound healing, including stem cell therapy. (J Am Podiatr Med Assoc 100(5): 385–394, 2010)
Abstract
Backgrounds: Skin wounds are a kind of refractory disease frequently encountered in clinic, which brings enormous burden to patients. Great efforts to address the dilemma of wound healing have yielded some encouraging results, but they are still unsatisfactory. 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) has been developed as a promising noninvasive treatment for skin wounds. A systematic review was performed to determine the existing evidence base for the clinical use of ALA-PDT on refractory wounds.
Methods: We conducted a PubMed search for English literature related to the clinical treatment of human skin ulcers by ALA-PDT published from 2012 to 2022, and performed a systematic review.
Results: 25 studies were ultimately selected in the present review and summarized, including six studies of skin cancer, five studies of chronic leg ulcers, three studies of erosive pustular skin diseases, and two studies of erosive oral lichen planus symptoms. A total of 335 patients had approximately 355 ulcers, of which 315 ulcers received photodynamic therapy and 276 improved with ALA-PDT. 20% ALA solution, wavelength between 600 nm and 670 nm, energy density of 120 J/cm2, frequency of once per week and 3 sessions were the most selected therapeutic parameters. Generally, ALA-PDT for wounds was effective with main adverse events of mild to moderate pain, and follow-up was generally conducted within 1 year.
Conclusions: This systematic review summarized the commonly used therapeutic parameters for ALA-PDT in the clinical treatment of skin wounds. After ALA-PDT alone or ALA-PDT combined with curettage, antibacterial and surgical treatment, all wounds healed well, and the adverse reactions were mainly mild to moderate pain, which could be relieved by cooling. ALA-PDT had proven to be a promising wound treatment modality through evidence of safety and efficacy.
The utility of wound debridement has expanded to include the management of all chronic wounds, even in the absence of infection and gross necrosis. Biofilms, metalloproteases on the wound base, and senescent cells at the wound edge irreversibly change the physiologic features of wound healing and contribute to a pathologic, chronic inflammatory environment. The objective of this review is to provide surgeons with a basic understanding of the processes of debridement in the noninfected wound. (J Am Podiatr Med Assoc 100(5): 353–359, 2010)
The concept of moist wound healing has been examined and gradually accepted by wound care clinicians during the last 40 years, and has led to the development of hundreds of dressings that support a moist wound environment. This article discusses the characteristics of an ideal dressing in an effort to assist clinicians in making appropriate dressing choices from common categories, including transparent films, hydrocolloids, foams, absorptive wound fillers, hydrogels, collagens, and gauzes. Reimbursement issues are also discussed. (J Am Podiatr Med Assoc 92(1): 24-33, 2002)
Cutaneous squamous cell carcinoma is the second most common form of skin cancer and accounts for 20% of cutaneous malignancies. We report the case of a patient who presented with a complaint of nonhealing wounds following radiation therapy for the treatment of noninvasive squamous cell carcinoma of both lower extremities. Initial biopsies of the wounds were benign. However, a second biopsy performed approximately 2 months later was found to be positive for invasive squamous cell carcinoma. This case uniquely exemplifies that all nonhealing wounds should be viewed with a critical eye for possible malignancy even in the presence of previous negative biopsy. This is especially true for radiation wounds that may be prone to malignant transformation or recurrence. (J Am Podiatr Med Assoc 101(4): 360–362, 2011)
Cellular Senescence and Matrix Metalloproteinase Activity in Chronic Wounds
Relevance to Debridement and New Technologies
A prolonged inflammatory response may adversely affect wound closure. Delayed wound closure and extended exposure to chronic wound fluid may also affect cellular activity in a wound bed and result in cellular senescence. Prolonged inflammation and cellular senescence may adversely affect the efficacy of topically-applied biological agents, including growth factors. Appropriate wound bed preparation and debridement are necessary to improve clinical outcomes of new technologies.(J Am Podiatr Med Assoc 92(1): 34-37, 2002)
New drugs and tissue replacements are currently being approved and integrated into treatment regimens for chronic wounds. This article focuses on a standardized procedure for the use of specific growth factor, a recombinant human platelet-derived growth factor (rhPDGF-BB) manufactured for topical administration. The recommendations made in this article may not reflect product recommendations made by the manufacturer of the drug. Clinicians must be able to support any off-label indication for use of a product. (J Am Podiatr Med Assoc 92(1): 7-11, 2002)
An Assessment of Intralesional Epidermal Growth Factor for Treating Diabetic Foot Wounds
The First Experiences in Turkey
Background:
Intralesional epidermal growth factor (EGF) has been available as a medication in Turkey since 2012. We present the results of our experience using intralesional EGF in Turkey for patients with diabetic foot wounds.
Methods:
A total of 174 patients from 25 Turkish medical centers were evaluated for this retrospective study. We recorded the data on enrolled individuals on custom-designed patient follow-up forms. Patients received intralesional injections of 75 μg of EGF three times per week and were monitored daily for adverse reactions to treatment. Patients were followed up for varying periods after termination of EGF treatments.
Results:
Median treatment duration was 4 weeks, and median frequency of EGF administration was 12 doses. Complete response (granulation tissue >75% or wound closure) was observed in 116 patients (66.7%). Wounds closed with only EGF administration in 81 patients (46.6%) and in conjunction with various surgical interventions after EGF administration in 65 patients (37.3%). Overall, 146 of the wounds (83.9%) were closed at the end of therapy. Five patients (2.9%) required major amputation. Adverse effects were reported in 97 patients (55.7%).
Conclusions:
In patients with diabetic foot ulcer who received standard care, additional intralesional EGF application after infection control provided high healing rates with low amputation rates.
The purpose of this article is to present reference guidelines to assist clinicians when treating diabetic patients with foot wounds. Diabetic patients with limb-threatening foot ulcers often have multiple coexisting medical conditions that frequently become impediments to the resolution of foot wounds. Each foot wound is unique and its etiology is multifactorial; therefore, each foot wound should be managed differently. The treatment algorithm presented in this article is divided into three categories: Algorithm I describes the treatment of septic foot wounds, which may be considered true podiatric surgical emergencies; Algorithm II describes the treatment of ischemic foot ulcers or gangrene with or without underlying osteomyelitis; and Algorithm III describes the treatment of neuropathic foot ulcers with or without underlying osteomyelitis. (J Am Podiatr Med Assoc 92(6): 336-349, 2002)
Background:
Integra bilayer wound matrix (IBWM) is a bilayer skin replacement system composed of a dermal regeneration layer and a temporary epidermal layer. It is used to treat various types of deep, large wounds via an inpatient procedure in an operating room. We sought to determine ease of use and effectiveness of IBWM in an outpatient clinical setting when treating diabetic foot ulcers. In addition, no epidermal autografting was performed in conjunction with the IBWM after silicone release, as is common in the inpatient setting.
Methods:
This 12-week, single-arm, prospective pilot study was conducted in three outpatient clinics. Weekly evaluations included monitoring the wound for signs of infection during the 12-week follow-up phase.
Results:
Eleven patients with diabetic foot ulcers who met the inclusion and exclusion criteria were enrolled. One patient was discontinued from the study owing to noncompliance leading to a serious adverse event. Therefore, ten patients who received the study intervention were included in the per-protocol population reported herein. The mean patient age was 60.6 years, with an average 11-year history of diabetes mellitus. Each ulcer was located on the plantar aspect of the foot. No infection was reported during the study. Patients treated with IBWM showed progressive wound healing over time: the greatest mean wound reduction was approximately 95% in week 12. Seven of ten patients (70%) achieved complete wound closure by week 12. No recurrent ulcers were reported during follow-up.
Conclusions:
These results are consistent with the hypothesis that IBWM is easy to use, safe, and effective when used on diabetic foot ulcers in an outpatient clinical setting without the secondary procedure of autografting for closure. (J Am Podiatr Med Assoc 103(4): 274–280, 2013)
