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Advances in Wound Care

Tatiana V Boyko, Michael T Longaker, George P Yang
Significance: The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately is increasingly important for all professionals in wound care. Recent Advances: Many new dressings and treatment modalities have been developed over the recent years and the goal of this review is to highlight their benefits and drawbacks to help providers choose their tools appropriately. Critical Issues: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming...
February 1, 2018: Advances in Wound Care
Leandra A Barnes, Clement D Marshall, Tripp Leavitt, Michael S Hu, Alessandra L Moore, Jennifer G Gonzalez, Michael T Longaker, Geoffrey C Gurtner
Significance: Excessive scarring is major clinical and financial burden in the United States. Improved therapies are necessary to reduce scarring, especially in patients affected by hypertrophic and keloid scars. Recent Advances: Advances in our understanding of mechanical forces in the wound environment enable us to target mechanical forces to minimize scar formation. Fetal wounds experience much lower resting stress when compared with adult wounds, and they heal without scars. Therapies that modulate mechanical forces in the wound environment are able to reduce scar size...
February 1, 2018: Advances in Wound Care
Clement D Marshall, Michael S Hu, Tripp Leavitt, Leandra A Barnes, H Peter Lorenz, Michael T Longaker
Significance: Scarring of the skin from burns, surgery, and injury constitutes a major burden on the healthcare system. Patients affected by major scars, particularly children, suffer from long-term functional and psychological problems. Recent Advances: Scarring in humans is the end result of the wound healing process, which has evolved to rapidly repair injuries. Wound healing and scar formation are well described on the cellular and molecular levels, but truly effective molecular or cell-based antiscarring treatments still do not exist...
February 1, 2018: Advances in Wound Care
Anna Luan, Michael S Hu, Tripp Leavitt, Elizabeth A Brett, Kevin C Wang, Michael T Longaker, Derrick C Wan
Significance: Wound healing requires a highly orchestrated coordination of processes that are not yet fully understood. Therefore, available clinical therapies are thus far limited in their efficacy in preventing and treating both chronic wounds and scars. Current gene-based therapeutics is largely based on our understanding of the protein-coding genome and proteins involved in known wound healing pathways. Recent Advances: Noncoding RNAs such as microRNAs and long noncoding RNAs have recently been found to be significant modulators of gene expression in diverse cellular pathways...
January 1, 2018: Advances in Wound Care
Michael S Hu, Justin Cheng, Mimi R Borrelli, Tripp Leavitt, Graham G Walmsley, Elizabeth R Zielins, Wan Xing Hong, Alexander T M Cheung, Dominik Duscher, Zeshaan N Maan, Dre M Irizarry, Brad Stephan, Fereydoun Don Parsa, Derrick C Wan, Geoffrey C Gurtner, Hermann Peter Lorenz, Michael T Longaker
Objective: Splinting full-thickness cutaneous wounds in mice has allowed for a humanized model of wound healing. Delineating the epithelial edge and assessing time to closure of these healing wounds via macroscopic visualization have remained a challenge. Approach: Double transgenic mice were created by crossbreeding K14-Cre and ROSAmT/mG reporter mice. Full-thickness excisional wounds were created in K14-Cre/ROSAmT/mG mice (n = 5) and imaged using both normal and fluorescent light on the day of surgery, and every other postoperative day (POD) until wound healing was complete...
January 1, 2018: Advances in Wound Care
Michael S Hu, Mimi R Borrelli, Michael Januszyk, Anna Luan, Samir Malhotra, Graham G Walmsley, Wan Xing Hong, Ruth Tevlin, Geoffrey C Gurtner, Michael T Longaker, Hermann P Lorenz
Objective: Fetuses early in gestation heal skin wounds without forming scars. The biological mechanisms behind this process are largely unknown. Fibroblasts, however, are cells known to be intimately involved in wound healing and scar formation. We examined fibroblasts in different stages of development to characterize differences in gene expression that may result in the switch from regenerative wound repair to repair with scarring. Approach: Fibroblasts were isolated and cultured from the back skin of BALB/c wild-type mouse fetuses at embryonic day (E)14 and E18 (n = 10)...
January 1, 2018: Advances in Wound Care
Maxime J M van der Valk, Eelco J R de Graaf, Pascal G Doornebosch, Maarten Vermaas
Objective: Abdominoperineal resection (APR) is associated with high incidence of surgical wound infections. The use of incisional negative-pressure wound therapy (iNPWT) is known to reduce wound infections for several surgical indications. The aim of this pilot study was to investigate the potential of a new portable negative-pressure therapy device on perineal wound healing in patients undergoing APR. Approach: A new single-use incisional negative-pressure therapy device was applied in 10 patients. A negative pressure of -80 mmHg was continued for 7 days postsurgery...
December 1, 2017: Advances in Wound Care
Anthony J Burand, Lauren Boland, Alex J Brown, James A Ankrum
Objective: Techniques to validate successful delivery of cell products are expensive, time-consuming, and require transport of the animal to imaging facilities, preventing their widespread use as documentation tools. The goal of this study was to determine if a low-cost portable microscope could provide sufficient performance to be used to document delivery of cell products and track retention over time. Approach: A Dino-Lite fluorescence microscope and an Odyssey CLx whole-animal scanner were compared on the basis of resolution, sensitivity, and linearity...
December 1, 2017: Advances in Wound Care
Shahram Paydar, Bijan Ziaeian, Amirreza Dehghanian, Mohsen Heidarpour, Roshanak Alavi Moghadam, Behnam Dalfardi, Abbas Hallaj Karladani
Objective: This experimental work examined the healing effect and probable adverse impact of topical Prolavacid ® solution (a polyhexamethylene biguanide-based wound cleanser) and topical Medihoney ointment in an animal model of cutaneous wound. Approach: We randomly divided 22 adult Sprague-Dawley rats (all were male) in two groups ( n = 11): (1) those for which Prolavacid solution was poured on the skin wound surface; and (2) those animals for which Medihoney ® ointment was applied to the wounds. These two agents were applied daily throughout the study period (21 days)...
December 1, 2017: Advances in Wound Care
Shivananada B Nayak, Kubra Isik, Julien R Marshall
Objective: To evaluate the wound-healing activity of oil of Hypercium perforatum (St. John's wort), in excision wounds of male white rats. Approach: The current methods of wound management involve the use of antibiotic creams. The search for more natural materials for the purpose of healing of wounds has led to the discoveries of potential agents prepared from plant extracts. Hyperforin and Hypericin are important phytochemical constituents found in H. perforatum, which have been highlighted for their antimicrobial, antiviral, and anti-inflammatory properties in recent times...
December 1, 2017: Advances in Wound Care
Sunil Srivastava, Aditya Nanasaheb Patil, Chaitra Prakash, Hiranmayi Kumari
Objective: Despite the myriad options available, there is no universally accepted treatment for keloids. Our objective was to compare three regimens and establish superiority in terms of objective and subjective outcomes. Approach: In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU, and a combination in Group T + F every 3 weeks till 24 weeks or till the keloid resolved...
November 1, 2017: Advances in Wound Care
Ruth S Burk, Mary Jo Grap, Valentina Lucas, Cindy L Munro, Paul A Wetzel, Christine M Schubert
Objective: High-frequency ultrasound (HFUS) images are being researched for use in the prevention, detection, and monitoring of pressure injuries in patients at risk. This seminal longitudinal study in mechanically ventilated adults describes image quality, the incidence of image artifacts, and their effect on image quality in critically ill subjects. Approach: Mechanically ventilated subjects from three adult intensive care units were enrolled, and multiple sacral images from each subject were obtained daily...
November 1, 2017: Advances in Wound Care
Stéphanie F Bernatchez, Joseph Tucker, Gwenael Chiffoleau
Objective: Use test methods to assess the oxygen compatibility of various wound care products. Approach: There are currently no standard test methods specifically for evaluating the oxygen compatibility and safety of materials under hyperbaric oxygen (HBO) conditions. However, tests such as the oxygen index (OI), oxygen exposure (OE), and autogenous ignition temperature (AIT) can provide useful information. Results: The OI test measures the minimum oxygen concentration that will support candle-like burning, and it was used to test 44 materials...
November 1, 2017: Advances in Wound Care
Swati Bhattacharyya, Kim S Midwood, Hang Yin, John Varga
Significance: This review provides current overview of the emerging role of innate immunity in driving fibrosis, and preventing its resolution, in scleroderma (systemic sclerosis, SSc). Understanding the mechanisms of dysregulated innate immunity in fibrosis and SSc will provide opportunities for therapeutic interventions using novel agents and repurposed existing drugs. Recent Advances: New insights from genomic and genetic studies implicate components of innate immune signaling such as pattern recognition receptors (PRRs), downstream signaling intermediates, and endogenous inhibitors, in fibrosis in SSc...
October 1, 2017: Advances in Wound Care
Lin Chen, Luisa A DiPietro
Significance: Inflammation is an integral part of immune response and supports optimal wound healing in adults. Inflammatory cells such as neutrophils, macrophages, dendritic cells, lymphocytes, and mast cells produce important cytokines, chemokines, and growth factors. These immune cells interact with keratinocytes, fibroblasts, and endothelial cells (ECs), as well as the extracellular matrix within a complicated network that promotes and regulates wound healing. Aberrant and persistent inflammation may result in delayed wound healing, scar formation, or chronic wounds...
October 1, 2017: Advances in Wound Care
Peter D'Arpa, Kai P Leung
Significance: Damage-associated molecular patterns (DAMPs) and pathogen-associated molecular patterns (PAMPs) emanate from burn-injured tissue and enter systemic circulation. Locally and systemically, they activate pattern-recognition receptors, including toll-like receptors (TLRs), to stimulate cytokine secretion, which in the severest burns typically results in extreme systemic cytokine levels, a dysfunctioning immune system, infection, impaired healing, and excessive scarring. This system-wide disruption of homeostasis can advance to life-threatening, multiorgan dysfunction syndrome...
October 1, 2017: Advances in Wound Care
Paula J McKeown-Longo, Paul J Higgins
Significance: Chronic inflammation and maladaptive repair contribute to the development of fibrosis that negatively impacts quality of life and organ function. The toll-like receptor (TLR) system is a critical node in the tissue response to both exogenous (pathogen-associated) and endogenous (damage-associated) molecular pattern factors (PAMPs and DAMPs, respectively). The development of novel TLR ligand-, pathway-, and/or target gene-specific therapeutics may have clinical utility in the management of the exuberant inflammatory/fibrotic tissue response to injury without compromising the host defense to pathogens...
October 1, 2017: Advances in Wound Care
Lauren M Valenty, Christine M Longo, Carol Horzempa, Anthony Ambesi, Paula J McKeown-Longo
Objective: Dysfunctional remodeling of the extracellular matrix contributes to the formation of TLR-dependent feed forward loops that drive chronic inflammation. We have previously shown that two Type III domains of Fibronectin, FnEDA and FnIII-1c, cooperate to induce the synergistic release of interleukin 8 (IL-8) from dermal fibroblasts. We now identify steps in the TLR4 pathway where synergy can be demonstrated as well as additional kinases functioning in fibronectin activation of TLR4 signaling. We also evaluate the ligand and cell-type specificity of this synergistic response...
October 1, 2017: Advances in Wound Care
Yuanyuan Li, Jamie Zhang, Jiping Yue, Xuewen Gou, Xiaoyang Wu
Significance: Skin serves as a protective barrier for mammals. Epidermal stem cells are responsible for maintaining skin homeostasis. When cutaneous injuries occur, skin homeostasis and integrity are damaged, leading to dire consequences such as acute, chronic, or infected wounds. Skin wound healing is an intrinsic self-saving chain reaction, which is crucial to facilitating the replacement of damaged or lost tissue. Recent Advances: An immense amount of research has uncovered the underlying mechanisms behind the complex and highly regulated wound healing process...
September 1, 2017: Advances in Wound Care
Mark Ferretti, Akhil A Saji, John Phillips
Objective: The outcome of Fournier's gangrene (FG) may be affected by comorbidities, demographics, and choice of treatment modality. We sought to evaluate our institution's management protocol of FG measured by mortality rate (MR) and length of hospital stay (LHS) in a retrospective cohort study. Approach: A database of 20 FG cases at our institution throughout the 2009-2016 study period was assembled by a retrospective review of medical records. A Fournier's Gangrene Severity Index Score (FGSIS) was calculated for each case...
September 1, 2017: Advances in Wound Care
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