Surgical Technology International
32nd Edition
Contains 45 peer-reviewed articles featuring the latest advances in surgical techniques and technologies.
368 pages
May 2018 - ISSN:1090-3941
1 year Institutional Subscription
both electronic and print versions
Managing the Diabetic Foot Ulcer: How Best Practices Fit the Real 2018 United States
Nicole Ilonzo, MD, Resident, Munir Patel, MD, Resident, Surgical Department, Mount Sinai St. Luke’s – West Hospitals, New York, New York, John C. Lantis 2nd, MD, FACS, Chief of Vascular and Endovascular Surgery, Vice Chairman of General Surgery, Director of Surgical Clinical Research, Mount Sinai St. Luke’s – West Hospitals, New York, New York
911
Diabetes Mellitus is a serious systemic illness that has an epidemic-like increasing prevalence in the United States, as well as the rest of the world. With the increasing number of people with diabetes comes the higher incidence of diabetes-related complications. One of these known complications, diabetic foot ulcers (DFU), has an estimated lifetime incidence of 15% in diabetics. Having a DFU increases the risk of infection, amputation, and even death, which is why prompt treatment and surveillance of such ulcers is imperative. Multiple organizations and journals have recently published best practices to heal and close DFU. Despite these guidelines, it is estimated that only 50% of all diabetic foot ulcers close within one year in the United States. To further confuse this picture, many trials include postoperative wounds that behave in a very different way than chronic wounds. The management of diabetic ulcers requires an understanding of not only the pathophysiology along with a multi-modal approach involving local wound care, pressure prevention, infection control, and, in some, revascularization, but also how care is delivered in the United States presently. In this review, we hope to elucidate the current knowledge and modalities used in ulcer management and to focus on key areas and best practices to inform the clinician, both in what they should do and what they can do.
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Practical Application of Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) in Patients with Wounds
Dr. Harold Brem, MD, FACS, Chief, Division of Wound Healing and Regenerative Medicine, Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, Raelina Howell, MD, Clinical Research Fellow, Theresa Criscitelli, EdD, RN, CNOR, Assistant Vice President Administration, Ayelet Senderowicz, Clinical Research Volunteer, Nicolle Siegart, BA, Laboratory Technician,Scott Gorenstein, MD, FACEP, Clinical Assistant Professor, Clinical Director, Brian Gillette, PhD, Research Scientist NYU Winthrop Hospital, Mineola, NY
977
Rapidly evolving advances in wound-care technologies and treatment modalities, including locally injectable granulocyte-macrophage colony-stimulating factor (GM-CSF), are increasingly being used. Based on its role in the stimulation and recruitment of key contributors to wound healing, such as keratinocytes, macrophages, and fibroblasts, GM-CSF is considered to play an essential role in the wound-healing cascade. Synthetic GM-CSF has been shown to have a positive effect on the healing of chronic wounds when given as a local injection in a small number of patients. Subsequent randomized, controlled trials demonstrated that GM-CSF accelerated the healing of chronic wounds. This paper reviews the proposed mechanism of action of GM-CSF in wound healing. We also describe its method of application in the operating room at a tertiary care center for patients with wounds.
Key Messages: Many types of chronic wounds have an altered keratinocyte and macrophage function that can be potentially assuaged by the addition of locally injected growth factor therapy to standard-of-care treatment. Granulocyte-macrophage colony-stimulating factor (GM-CSF) has been shown to be beneficial for the treatment of chronic, non-healing wounds. This article reviews the data on GM-CSF, reports a proposed mechanism of action, and describes its use by a team of wound surgeons.
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Antimicrobial Efficacy of a Silver Impregnated Hydrophilic PU Foam
Steven L. Percival, PhD, CEO and Professor, 5D Health Protection Group Ltd., Liverpool Bio-Innovation Hub, Liverpool, United Kingdom
962
A novel hydrophilic polyurethane (PU) foam dressing which is impregnated with silver chloride, Optifoam® Gentle (OG) Ag+ (Medline Industries Inc., Chicago, Illinois), was evaluated in this study. The aims of this study were to determine the rate of elution of silver from the foam dressing over a period of 168 hours into simulated wound fluid and an evaluation of antimicrobial efficacy using zone of inhibition (ZOI), direct kill, and time-kill viability. Thirty-two microorganisms associated with wounds including Pseudomonas aeruginosa, Methicillin sensitive Staphylococcus aureus (MSSA), Acinetobacter baumannii, Candida albicans, and antibiotic-resistant strains (Methicillin-resistant S. aureus [MRSA] and Vancomycin-resistant Enterococci [VRE]) were evaluated. Silver release from the wound dressing showed an exponential curve with a stable sustained release of 25ppm achieved after 24 hours, which was maintained for the full duration of the study. OG Ag+ caused inhibition zones ranging from 4–16mm after a 24-hour contact time. In the direct kill assay, OG Ag+ reduced the microbial numbers below the limit of detection and reduced viability by a log of four within 24 hours. For the time-kill viability studies, the results support the use of this hydrophilic polyurethane foam as a wound dressing for use in wounds at risk of infection or infected by achieving a four log kill within six hours and a six log kill in 16 hours. In conclusion, OG Ag+ was shown to be an effective wound dressing in the killing of a range of important opportunistic pathogens of relevance to wound healing and infections. Achieving a six log kill against S. aureus and E.coli, within 16 hours in the time kill assay, (ASTM E2315-03) demonstrates that OG Ag+ should be an important addition to the armoury available for the management of acute and chronic wounds at risk of infection or clinically infected.
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Using Multi-Layer Foam Dressing to
Prevent Pressure Injury in a Long-Term Care Setting
Kevin Woo RN, PhD, FAPWCA,
Associate Professor,
Faculty of Health Sciences,
School of Nursing,
Queen’s University, Kingston, Canada
973
Maintaining skin integrity is espoused by several international authorities as a benchmark for patient safety and quality of care. National guidelines advocate the use of prophylactic multi-layer foam dressings over bony prominences for the prevention of pressure ulcers or injuries. The purpose of this study was to evaluate the implementation of best practice guidelines including the use of multi-layer foam dressings for the prevention of pressure injuries. The analysis involved data from a total number of 62 unique patients. The incidence rate prior to the implementation of best practices was 5.2%. The incidence after the implementation was 0%.
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Clinical Prospective Study on the Use of Subcutaneous Carboxytherapy in the Treatment of Diabetic Foot Ulcer
Lynda Khiat, MD, General Practitioner, Faculté de Médecine D'Oran, Oran, Algeria, Gustavo H. Leibaschoff, MD, Specialist in Obstetrics and Gynecology, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
915
Diabetic footfoot ulcer (DFU) is a serious complication of diabetes mellitus, and possibly the major morbidity of the diabetic foot. It is the most common foot injury in diabetic patients and can lead to lower-extremity amputation. Management of DFU requires a systematic knowledge of the major risk factors for amputation, frequent routine evaluation, scrupulous preventive maintenance, and correction of peripheral arterial insufficiency.Carboxytherapy refers to the subcutaneous injection of CO2 to improve the microcirculation and promote wound-healing by stimulating the microcirculation. Since optimal ulcer-healing requires adequate tissue perfusion, it is considered that carboxytherapy could be useful in the treatment of DFU.The present prospective clinical study included 40 patients with different sizes and types of chronic DFU. In addition to cleaning of the wound, antibiotics and debridement as necessary, the treatment protocol included blood sugar control, medication, healthy habits, no weight-bearing, and carboxytherapy. The results showed that this treatment that included carboxytherapy promoted wound-healing and prevented amputation. These positive effects should be confirmed through a complete study that includes different clinical and instrumental parameters.
Open Access
