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Advances in Wound Care

Ian L Valerio, Jennifer M Sabino, Christopher L Dearth
Background: A large volume of service members have sustained complex injuries during Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF). These injuries are complicated by contamination with particulate and foreign materials, have high rates of bacterial and/or fungal infections, are often composite-type defects with massive soft tissue wounds, and usually have multisystem involvement. While traditional treatment modalities remain a mainstay for optimal wound care, traditional reconstruction approaches alone may be inadequate to fully address the scope and magnitude of such massive complex wounds...
September 1, 2016: Advances in Wound Care
Jennifer M Sabino, Julia Slater, Ian L Valerio
Scope and Significance: Reconstruction of traumatic injuries requiring tissue transfer begins with aggressive resuscitation and stabilization. Systematic advances in acute casualty care at the point of injury have improved survival and allowed for increasingly complex treatment before definitive reconstruction at tertiary medical facilities outside the combat zone. As a result, the complexity of the limb salvage algorithm has increased over 14 years of combat activities in Iraq and Afghanistan. Problem: Severe poly-extremity trauma in combat casualties has led to a large number of extremity salvage cases...
September 1, 2016: Advances in Wound Care
Cynthia Yu-Wai-Man, Peng Tee Khaw
Significance: Fibrosis-related events play a part in the pathogenesis or failure of treatment of virtually all the blinding diseases around the world, and also account for over 40% of all deaths. It is well established that the eye and other tissues of some group of patients, for example Afro-Caribbean people, scar worse than others. However, there is a current lack of reliable biomarkers to stratify the risk of scarring and postsurgical fibrosis in the eye. Recent Advances: Recent studies using genomics, proteomics, metabolomics, clinical phenotyping, and high-resolution in vivo imaging techniques have revealed potential novel biomarkers to identify and stratify patients at risk of scarring in different fibrotic eye diseases...
September 1, 2016: Advances in Wound Care
Sanjay Maurya, Prem Singh Bhandari
Significance: Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Recent Advances: Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results...
September 1, 2016: Advances in Wound Care
Jeffrey E Thatcher, John J Squiers, Stephen C Kanick, Darlene R King, Yang Lu, Yulin Wang, Rachit Mohan, Eric W Sellke, J Michael DiMaio
Significance: Burn assessments, including extent and severity, are some of the most critical diagnoses in burn care, and many recently developed imaging techniques may have the potential to improve the accuracy of these evaluations. Recent Advances: Optical devices, telemedicine, and high-frequency ultrasound are among the highlights in recent burn imaging advancements. We present another promising technology, multispectral imaging (MSI), which also has the potential to impact current medical practice in burn care, among a variety of other specialties...
August 1, 2016: Advances in Wound Care
Maanasa Jayachandran, Suset Rodriguez, Elizabeth Solis, Jiali Lei, Anuradha Godavarty
Significance: Noninvasive imaging approaches can provide greater information about a wound than visual inspection during the wound healing and treatment process. This review article focuses on various optical imaging techniques developed to image different wound types (more specifically ulcers). Recent Advances: The noninvasive optical imaging approaches in this review include hyperspectral imaging, multispectral imaging, near-infrared spectroscopy (NIRS), diffuse reflectance spectroscopy, optical coherence tomography, laser Doppler imaging, laser speckle imaging, spatial frequency domain imaging, and fluorescence imaging...
August 1, 2016: Advances in Wound Care
Moumita Dutta, Amar S Bhalla, Ruyan Guo
Significance: This review article puts together all the studies performed so far in realizing terahertz (THz) spectra as a probing mechanism for burn evaluation, summarizing their experimental conditions, observations, outcomes, merits, and demerits, along with a comparative discussion of other currently used technologies to present the state of art in a condensed manner. The key features of this noncontact investigation technique like its precise burn depth analysis and the approaches it follows to convert the probed data into a quantitative measure have also been discussed in this article...
August 1, 2016: Advances in Wound Care
Wan Qin, Yuandong Li, Jingang Wang, Xiaoli Qi, Ruikang K Wang
Objective: Optical microangiography (OMAG)-based optical coherence tomography is a noninvasive technique capable of imaging functional microvasculature innervating scanned tissue volume. In this study, we utilize OMAG to investigate dynamic changes of microcirculation during the healing process of a burn. Approach: A soft-contact superficial burn injury was induced on a mouse ear with 1 μL 70°C hot water. Microangiograms were generated by using OMAG before and after the burn. Results: Vessel recruitment and remodeling were observed in the healing process...
August 1, 2016: Advances in Wound Care
Ralph S DaCosta, Kathryn Ottolino-Perry, Jaideep Banerjee
An effective, scientifically validated, diagnostic tool helps clinicians make better, timely, and more objective medical decisions in the care of their patients. Today, the need for such tools is especially urgent in the field of wound care where patient-centric care is the goal, under ever tightening clinical budget constraints. In an era of countless "innovative" treatment options, that is, advanced dressings, negative pressure devices, and various debridement instruments available to the wound care clinical team, one area that has arguably languished in the past decade has been innovation in wound diagnostics...
August 1, 2016: Advances in Wound Care
Geoffrey C Gurtner, Mary Ann Chapman
Significance: Chronic wounds are a prevalent and costly problem in the United States. Improved treatments are needed to heal these wounds and prevent serious complications such as infection and amputation. Recent Advances: In wound healing, as in other areas of medicine, technologies that have the potential to regenerate as opposed to repair tissue are gaining ground. These include customizable nanofiber matrices incorporating novel materials; a variety of autologous and allogeneic cell types at various stages of differentiation (e...
July 1, 2016: Advances in Wound Care
Saad M Alrobaiea, Jie Ding, Zengshuan Ma, Edward E Tredget
Objective: Hypertrophic scar (HTS) is a dermal form of fibroproliferative disorder that develops following deep skin injury. HTS can cause deformities, functional disabilities, and aesthetic disfigurements. The pathophysiology of HTS is not understood due to, in part, the lack of an ideal animal model. We hypothesize that human skin with deep dermal wounds grafted onto athymic nude mice will develop a scar similar to HTS. Our aim is to develop a representative animal model of human HTS. Approach: Thirty-six nude mice were grafted with full thickness human skin with deep dermal scratch wound before or 2 weeks after grafting or without scratch...
July 1, 2016: Advances in Wound Care
Philippe Foubert, Andreina D Gonzalez, Stephan Teodosescu, Felipe Berard, Melanie Doyle-Eisele, Krishna Yekkala, Mayer Tenenhaus, John K Fraser
Objective: The use of noncultured autologous stromal vascular fraction or clinical grade adipose-derived regenerative cells (ADRCs) is a promising strategy to promote wound healing and tissue repair. Nevertheless, issues regarding the optimal mode of administration remain unclear. The purpose of this study was to compare the effects of local injection and topical spray delivery of ADRCs in a porcine model of thermal burns. Approach: Full-thickness thermal burns were created on the dorsum of 10 Gottingen minipigs...
July 1, 2016: Advances in Wound Care
Caroline E Fife, Susan D Horn, Randall J Smout, Ryan S Barrett, Brett Thomson
Objective: To develop a healing index for patients with diabetic foot ulcers (DFUs) for use in clinical practice, research analysis, and clinical trials. Approach: U.S. Wound Registry data were examined retrospectively and assigned a clear outcome (healed, amputated, etc.). Significant variables were identified with bivariate analyses. A multivariable logistic regression model was created based on significant factors (p < 0.05) and tested on a hold-out sample of data. Out of 13,266 DFUs from the original dataset, 6,440 were eligible for analysis...
July 1, 2016: Advances in Wound Care
Vicki P Losick
Significance: All organs suffer wounds to some extent during an animal's lifetime and to compensate for cell loss, tissues often rely on cell division. However, many organs are made up of differentiated cells with only a limited capacity to divide. It is not well understood how cells are replaced in the absence of cell division. Recent Advances: Recent studies in the model organism Drosophila melanogaster have proven that wound-induced polyploidy (WIP) is an essential mechanism to replace tissue mass and restore tissue integrity in the absence of cell division...
June 1, 2016: Advances in Wound Care
Michelle T Juarez
While many studies have established a paradigm for tissue repair at the level of cellular remodeling, it is not clear how an organism restricts a response only to the injured region of a damaged tissue. Skin, the largest organ in the human body, is prone to injury, and repair of epidermal tissue represents a medically relevant system to investigate. Significance: Studies in Drosophila melanogaster provide a robust genetic system to identify molecular components that will positively impact repair and healing...
June 1, 2016: Advances in Wound Care
Rachel Smith-Bolton
Significance: The Drosophila larval imaginal discs, which form the adult fly during metamorphosis, are an established model system for the study of epithelial tissue damage. The disc proper is a simple columnar epithelium, but it contains complex patterning and cell-fate specification, and is genetically tractable. These features enable unbiased genetic screens to identify genes involved in all aspects of the wound response, from sensing damage to wound closure, initiation of regeneration, and re-establishment of proper cell fates...
June 1, 2016: Advances in Wound Care
Yutaka Matsubayashi, Tom H Millard
Significance: The epidermis provides the main barrier function of skin, and therefore its repair following wounding is an essential component of wound healing. Repair of the epidermis, also known as reepithelialization, occurs by collective migration of epithelial cells from around the wound edge across the wound until the advancing edges meet and fuse. Therapeutic manipulation of this process could potentially be used to accelerate wound healing. Recent Advances: It is difficult to analyze the cellular and molecular mechanisms of reepithelialization in human tissue, so a variety of model organisms have been used to improve our understanding of the process...
June 1, 2016: Advances in Wound Care
Rajesh L Thangapazham, Shashwat Sharad, Radha K Maheshwari
Significance: Traditional therapies, including the use of dietary components for wound healing and skin regeneration, are very common in Asian countries such as China and India. The increasing evidence of health-protective benefits of phytochemicals, components derived from plants is generating a lot of interest, warranting further scientific evaluation and mechanistic studies. Recent Advances: Phytochemicals are non-nutritive substances present in plants, and some of them have the potential to provide better tissue remodeling when applied on wounds and to also act as proangiogenic agents during wound healing...
May 1, 2016: Advances in Wound Care
Rúben F Pereira, Paulo J Bártolo
Significance: The regeneration of healthy and functional skin remains a huge challenge due to its multilayer structure and the presence of different cell types within the extracellular matrix in an organized way. Despite recent advances in wound care products, traditional therapies based on natural origin compounds, such as plant extracts, honey, and larvae, are interesting alternatives. These therapies offer new possibilities for the treatment of skin diseases, enhancing the access to the healthcare, and allowing overcoming some limitations associated to the modern products and therapies, such as the high costs, the long manufacturing times, and the increase in the bacterial resistance...
May 1, 2016: Advances in Wound Care
Janne J Jokinen, Arno Sipponen
Significance: The treatment of chronic wounds results in an enormous drain on healthcare resources in terms of workload, costs, frustration, and impaired quality of life, and it presents a clinical challenge for physicians worldwide. Effective local treatment of a chronic wound has an important role, particularly in patients who are-because of their poor general condition, diminished life expectancy, or unacceptable operative risk-outside of surgical treatment. Recent Advances: Since 2002, our multidisciplinary research group has investigated the properties of Norway spruce (Picea abies) resin in wound healing and its therapeutic applications in wound care...
May 1, 2016: Advances in Wound Care
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