Wound Care

OBJECTIVE: The objective of this study was to establish an algorithm for surgical reconstruction of diabetic foot ulcers (DFUs). STUDY DESIGN: Retrospective study MATERIALS AND METHODS: : In this series, 75 patients with diabetic foot ulceration were treated at the Jawaharlal Nehru Medical College from October 2008 to August 2013, and were retrospectively reviewed. All patients in the study underwent surgical reconstruction of the foot in the form of a skin graft, local flaps, or free flaps, depending upon the characteristic of the defect, general condition of the patient, and vascular status of the limb...

BACKGROUND: Wound healing problems of the anterior ankle incision are among the most common complications after total ankle arthroplasty, possibly resulting in exposure of the prostheses and infection. The aim of this study was to investigate the role of negative pressure wound therapy (NPWT) in decreasing the rate of wound healing problems after total ankle arthroplasty. METHODS: This is a retrospective cohort study including consecutive patients who underwent total ankle arthroplasty by a single surgeon at a single institution between 2009 and 2013...

No abstract text is available yet for this article.

Many patients admitted to the hospital have diabetes mellitus-diagnosed or undiagnosed-and others develop hyperglycemia from the stress of hospitalization. This paper discusses the prevalence, outcomes, and evidence for best management of hyperglycemia and diabetes in hospitalized patients outside the critical care setting.

Skin and soft-tissue infections (SSTIs) are a common presenting problem in both inpatients and outpatients. SSTIs have been broadly classified as complicated or uncomplicated, but specific disease processes and patient characteristics are important in guiding clinical management. Early recognition of the extent of infection, close follow-up, and familiarity with local antibiotic susceptibility data are critical to successful treatment.

OBJECTIVE: Bacterial biofilms remain difficult to treat. The biofilm mode of growth enables bacteria to survive antibiotic treatment and the inflammatory reaction. Low-frequency ultrasound has recently been shown to improve healing in a variety of settings. It is hypothesised that ultrasound disrupts the biofilm leaving bacteria more vulnerable to antiseptic or antibiotic treatment. The objective of this study is to develop a realistic model to elucidate the effect of ultrasound on biofilms...

OBJECTIVE: Lower extremity ulcers are caused by multiple disease processes and contribute to a high level of patient morbidity and health-care spending in the US. Negative pressure wound therapy (NPWT) has been used extensively for wound bed preparation. Our aim is to assess the efficacy of an affordable, low-profile single-use NPWT (single-use NPWT) on chronic lower extremity wounds that would usually be deemed too small or superficial for traditional NPWT. METHOD: A prospective pilot study was undertaken in which chronic lower extremity wounds were treated with single-use NPWT...

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.

We report a case of circumferential venous leg ulcer in a rheumatoid arthritis patient. Mesh skin grafting was performed in another hospital, but the graft failed and the patient was referred to our hospital. This ulcer was treated by the combination therapy of a fenestrated-type artificial dermis with negative pressure wound therapy (NPWT) and secondary mesh grafting using our 'grip tape technique'. NPWT was started at -100 mmHg and continued until the formation of dermis-like tissue. A section stained using haematoxylin and eosin and an anti-αSMA (α smooth muscle actin) immunohistological section of the biopsy from dermis-like tissue showed an abundant infiltration of fibroblasts and capillary formation beneath the fenestration of the silicone sheet...

OBJECTIVE: The purpose of this study was to assess the effects of high-voltage electrical stimulation (HVES), continuous short wave diathermy, and physical exercise on arterial blood flow in the lower limbs of diabetic women with peripheral arterial disease. METHODS: A crossover study was carried out involving 15 diabetic women (mean age of 77.87 ± 6.20 years) with a diagnosis of peripheral arterial disease. One session of each therapeutic resource was held, with a 7-day washout period between protocols...

OBJECTIVE: To determine the accuracy of audible arterial foot signals with an audible handheld Doppler ultrasound for identification of significant peripheral arterial disease as a simple, quick, and readily available bedside screening tool. METHODS: Two hundred consecutive patients referred to an interprofessional wound care clinic underwent audible handheld Doppler ultrasound of both legs. As a control and comparator, a formal bilateral lower leg vascular study including the calculation of Ankle Brachial Pressure Index and toe pressure (TP) was performed at the vascular lab...

The heels are the most common site for facility-acquired pressure ulcers (PUs), and are also the most susceptible location for deep tissue injuries. The use of multilayer prophylactic dressings to prevent heel PUs is a relatively new prevention concept, generally aimed at minimizing the risk for heel ulcers (HUs) through mechanical cushioning and reduction of friction at the dressing-support interface. We used 9 finite element model variants of the posterior heel in order to evaluate the biomechanical performance of a multilayer dressing in prevention of HUs during supine lying...

BACKGROUND: We investigated the validity of probe-to-bone testing in the diagnosis of osteomyelitis in a selected subgroup of patients clinically suspected of having diabetic foot osteomyelitis. METHODS: Between January 1, 2007, and December 31, 2008, inpatients and outpatients with a diabetic foot ulcer were prospectively evaluated, and those having a clinical diagnosis of foot infection and at least one of the osteomyelitis clinical suspicion criteria were consecutively included in this study...

OBJECTIVE: To assess a bedside technique for diagnosing osteomyelitis. DESIGN: We prospectively assessed infected pedal ulcers for detectable bone by probing with a sterile, blunt, stainless steel probe. We then examined the relationship between detection of bone and the presence or absence of osteomyelitis that was defined histopathologically and/or clinically. SETTING: A tertiary care center. PATIENTS: Seventy-five hospitalized diabetic patients with a total of 76 infected foot ulcers were studied...

New advances in medicine and technology continually change how clinicians treat patients with the aim of improving outcomes. As technology continues to improve, the ability to treat patients will improve as well. Great progress has been made in diabetic wound healing with BATs and there will continue to be improvement with new products in the future. However, the current literature is replete with small case series and small cohort studies. With the exception of the pivotal trials conducted more than a decade ago, there is a lack of robust evidence for the use of BATs...

BACKGROUND: Lower limb allotransplantation is garnering increasing attention in the vascularized composite allotransplantation community as a potential treatment modality for those suffering from lower limb amputations. Little is known, however, about the level of interest among lower limb amputees regarding this procedure. METHODS: An online survey regarding lower limb allotransplantation was designed in conjunction with and distributed by the Amputee Coalition to lower limb amputees in the United States...

Negative pressure wound therapy (NPWT) is a treatment to reduce oedema, stimulate granulation tissue formation, remove wound exudate and diminish wound area, thus preparing it for secondary healing, skin grafting or coverage with flaps. The association of instillation to NPWT (NPWTi) is a new method for treating severe wounds, in particular, limb lesions at high risk for amputation. This therapy helps to deliver instillation fluid automatically into the contaminated wound, before application of negative pressure...

IMPORTANCE: Acquired soft-tissue injury with resultant volume loss may cause significant deformity in size, shape, and body or facial contour. Current autologous fat transfer techniques have several limitations, including availability, donor site morbidity, and unpredictable rates of resorption. We present an extracellular matrix (ECM) biomaterial derived from human adipose tissue as an off-the-shelf alternative for soft-tissue volume restoration and compare clinically relevant rheologic properties...

No abstract text is available yet for this article.

BACKGROUND: Drawbacks exist with the standard treatment (four-layer compression bandages) for venous leg ulcers. We have therefore compared the clinical effectiveness and cost-effectiveness of two-layer compression hosiery with the four-layer bandage for the treatment of such ulcers. METHODS: We undertook this pragmatic, open, randomised controlled trial with two parallel groups in 34 centres in England and Northern Ireland. The centres were community nurse teams or services, family doctor practices, leg ulcer clinics, tissue viability clinics or services, and wound clinics...