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Advanced Wound Healing

Potential Future Applications for Negative Pressure Wound Therapy and Installation Devices
Reuben A. Falola, MPH, Medical Student Research Scholar, Caitlin M. Ward, BA, Student, Madison J. Kim, Student, Tammer Elmarsafi, DPM, MBBCh, Diabetic Limb Salvage Fellow, John S. Steinberg, DPM, Attending Physician, Karen K. Evans, MD, Attending Physician, Christopher E. Attinger, MD, Attending Physician, Paul J. Kim, DPM, MS, Attending Physician, Department of Plastic Surgery, Center for Wound Healing, Georgetown University Hospital, Washington, DC

 

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Abstract


Negative-pressure wound therapy (NPWT) applies vacuum pressure to a wound bed sealed by an adhesive dressing to improve wound healing. A cleansing solution, often antibiotics or saline, may be instilled into the wound bed concurrently and removed via suction, thus enhancing the therapeutic effect. The therapeutic effect results from improved blood flow and removal of inflammatory factors. Since 1995, the FDA has approved NPWT for medical use. Since then, this technology has been applied to different types of wounds, including diabetic and decubitus ulcers and postsurgical incisional wounds. There are many applications for NPWT that remain to be explored. In this article, we postulate on novel and future uses for NPWT, including application in targeted drug delivery, stem cell therapy, and the prospect of combination with filtration devices, adaptable smart dressings, and remote monitoring.

 

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Use of an Ovine Collagen Dressing with Intact Extracellular Matrix to Improve Wound Closure Times and Reduce Expenditures in a US Military Veteran Hospital Outpatient Wound Center
Daniel T. Ferreras, DPM, FAPWCA, AAWC, Chief/Lead Podiatrist, Surgical Services, Carl Vinson VA Medical Center, Dublin, Georgia, Sean Craig, RN, CWCN, Wound Care Nurse, Nursing, Alexandria VA Health Care System, Pineville, Louisiana, Rebecca Malcomb, RN, RN Care Manager for Primary Care, Nursing, Alexandria VA Health Care System, Pineville, Louisiana

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Abstract

A novel, comprehensive decision-making and treatment algorithm was established within a US government-run military veteran hospital in an attempt to standardize the process of outpatient wound care and streamline costs. All patients were systematically evaluated and treated using the comprehensive algorithm over a span of nine months. After three months of adherence to the algorithm, the algorithm was modified to include ovine-based collagen extracellular matrix (CECM) dressings as a first-line conventional treatment strategy for all appropriate wounds. The purpose of this retrospective analysis was to evaluate the hospital’s change in cellular and/or tissue-based graft usage and cost, as well as wound healing outcomes following modification of the wound care standardization algorithm. Data from the first quarter (Q1; three months) of protocol implementation were compared to the subsequent two quarters (six months), during which time the first-line dressing modification of the protocol was implemented. Results showed that between quarters 1 and 3, the percentage of wounds healed increased by 95.5% (24/64 to 80/109), and the average time to heal each wound decreased by 22.6% (78.8 days to 61.0 days). Cellular and/or tissue-based graft unit usage decreased by 59.7% (144 units to 58 units), and expenditures on cellular and/or tissue-based grafts decreased by 66.0% ($212,893 to $72,412). Results of this analysis displayed a trend toward decreased expenditures, faster healing times, and a greater number of healed wounds following modification of an evidence-based algorithm to incorporate CECM dressings as a first-line treatment strategy in managing chronic wounds.

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Total Contact Cast System to Heal Diabetic Foot Ulcers
Brock Liden, DPM , Lead Podiatrist, Surgical Services, Circleville Foot & Ankle and Berger Health System, Circleville, Ohio

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Abstract

Off-loadinga diabetic foot ulcer is a cornerstone of quality wound care for diabetic patients to allow cellular growth in the wound bed. While total contact casts (TCC) have been described as the gold standard for off-loading the wound, the complexity of application and the time commitment for both application and drying have discouraged health professionals from using them.
This retrospective case series, conducted in a podiatric practice, evaluated using a TCC system that helps address the three components in which guidelines should be addressed when caring for a diabetic foot: V – vascular management, I – infection management and prevention, and P – pressure relief. This studied TCC system can be applied in approximately seven minutes and the patient can ambulate immediately without waiting for drying.
Of the 20 wounds treated with this TCC, 18/20 (90%) healed in a mean of 22.3 days. The mean number of TCC treatments was 2.8. When compared to evidence published in the scientific literature documenting healing outcomes using various TCCs, this system has the fastest observational healing rate.
In this case series, this TCC system for off-loading was found to be clinically beneficial for the patient in a physician’s office practice.

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Venous Intervention Improves Patient Outcomes
Wayne J. Caputo, DPM, Wound Center Podiatrist, Wound Care Center, Michael D. Kaplan, MD, Interventional Radiologist, Vein Center, Robert E. Kamieniecki, MD, Interventional Radiologist, Vein Center, Melissa Hawkins, PA, Wound Care & Limb Salvage Physician Assistant, Wound Care Center, Patricia Monterosa, RN, BSN, Director, Wound Care Center, Kelly Eagen, RN, Registered Nurse, Vein Center, Tracy Ike, BS, Vascular Technician,  Amy Iannitelli, HSDG, Coordinator, Wound Care Center

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Abstract

Introduction: The healing of venous ulcers is difficult, and several sources indicate a multidisciplinary plan of care as the best approach to the healing of these wounds.
Materials and Methods: Seventy-five patients with suspected venous disease being treated at Northern New Jersey Medical Center were assessed by dedicated interventional radiology physicians as part of Wound Center protocol. Of those patients, 27 required diagnostic testing, such as CT venogram or venography. Of these patients, 11 were determined to be appropriate candidates and underwent surgical intervention, such as venous ablation or vein stenting.
Results: Results support continued referral for venous interventions. Of the 75 patients referred for assessment, 27 required diagnostic testing, and 11 of those patients met criteria for intervention and treatment. Of the 11 patients who underwent surgical intervention, 100% experienced success in reduction of one or more cardinal signs of inflammation, and all patients with open wounds experienced either reduction in wound size and, more commonly, complete wound closure.
Conclusion: Adding venous evaluation referral to wound center protocol in patients with suspected venous disease improved healing outcomes, thus improving quality of life.

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