Incisional Application of Negative Pressure for Nontraumatic Lower Extremity Amputations: A Review
Vikas Kotha, BS, Elliot Walters, MD, Research Fellow, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC, Gregory Stimac, MSc, Paul Kim, DPM, FACFAS, Professor of Plastic Surgery, Georgetown University School of Medicine, Vice Chair of Research for MedStar Plastic and Reconstructive Surgery, Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC
1060
In the environment of diabetes and peripheral vascular disease (PVD), there is a high risk of incisional complications following amputation, including seroma, hematoma, infection, and dehiscence. Incisional negative-pressure wound therapy (iNPWT) is a novel application of negative-pressure wound therapy (NPWT) that may be able to mitigate these complications and reduce the need for revisional surgery (including higher-level major lower-extremity amputations). It may also facilitate an increased rate of healing and earlier return to function. iNPWT has been used successfully in high-risk patients to decrease complications. In highly comorbid patients receiving iNPWT for primary closure of abdominal wall reconstruction, incisional infection rates were reduced from 48% to 7% (p=0.029). Furthermore, the need for revisional surgery was significantly decreased in those treated with iNPWT (48% vs.7%, p<0.001), as was the rate of dehiscence (10.68% vs. 5.32%, p<0.001). Major lower-extremity amputations in the multi-comorbid patient have a 16% incidence of incisional dehiscence. Additionally, the rate of infection has been reported to be as high as 22%. Five-year mortality following major lower-extremity amputation is reported to be 50% or higher. This high mortality rate is due, in part, to wound-healing complications. iNPWT can potentially reduce these healing complications and mortality. As of yet, no prospective, randomized trial has shown reduced morbidity, earlier return to function, or reduced mortality with the use of iNPWT after a lower-extremity amputation. This review presents recent findings regarding the use of iNPWT. Further studies on this topic are needed.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Negative Pressure Therapy (NPWT) for Management of Surgical Wounds: Effects on Wound Healing and Analysis of Devices Evolution
Vincenzo Pappalardo, MD, General Surgeon, Francesco Frattini, MD, General Surgeon, Ospedale di Circolo, ASST Settelaghi, Varese, Italy, Vincenzo Ardita, MD, Vascular Surgeon, San Raffaele Hospital, Vita Salute San Raffaele University, Milan, Italy, Stefano Rausei, MD, PhD, General Surgeon, Ospedale S. Antonio Abate, ASST Valle Olona, Gallarate, Italy
1078
Infection and wound dehiscence are common complications after surgery and open surgical wounds are difficult to manage. Usually surgical incisions are closed by fixing the edges together. However, in case of significant tissue loss, infected surgical field, or particular cases, wounds may be left open. In recent years, negative pressure wound therapy (NPWT) has been widely used for management of various complicated wounds and to support postoperative tissue healing. Another emerging indication for NPWT, applied directly to the closed incisions, is to prevent infections or dehiscences in patients with increased risk of surgical-site complications (iNPWT). Furthermore, the combination of negative pressure with intermittent instillation of solution (NPWTi) seems to be effective in the treatment of a variety of complex wounds. Even if the role of NPWT in promoting wound healing has been largely accepted, there is a lack of evidence (few high-level clinical studies) regarding its effectiveness and further research is needed to better understand the mechanisms of action. This article contains a review of recent scientific and clinical research related to indications, contraindications, and mechanisms of action of NPWT to clarify current knowledge, technological evolutions, and future perspectives of devices.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Management of Non-Reconstructable Critical Limb Ischemia
Munir Patel, MD, Resident, 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
1077
At least 15% of patients with critical limb ischemia are not candidates for standard revascularization. In this day and age, with new techniques—including retrograde access to the foot—and numerous angioplasty and atherectomy techniques available, the critical limb ischemia patient can still be faced without options. Distal bypass surgery may still remain the gold standard, and likely permits the patient to have the best options for healing, but carries significant comorbidities after undergoing the procedure. There are patients who do not have targets of interest in their foot for arterial revascularization and there are patients who have very poor conduit or are very poor candidates due to their medical comorbidities. Guidelines as to who should and should not undergo surgery—or even percutaneous revascularization—are starting to become more widely accepted. We are starting to see the tide change and there is interest in this cohort of patients. There are patients with no distal target that may benefit from an arteriovenous bypass, which is regaining popularity and can be done completely endovascularly. The patient that may be a very poor candidate for intervention may benefit from arterial counterpulsation therapy and/or topical oxygen therapy (which are commercially available). They may also benefit from placental stem cell injection, which is undergoing Phase II trial assessment. We will review the current literature as it surrounds these potential therapeutic interventions for patients with significant lower extremity ischemia who do not have standard revascularization options.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Pain Reduction with Negative Pressure on Surgical Site Incisions
Philip Wrotslavsky, DPM, FACFAS Board Certified Foot and Ankle Reconstruction, American Board of Foot and Ankle Surgery, Scripps Mercy Hospital, San Diego, CA
1044
Postoperative pain management for surgery in the lower extremities has historically been managed mechanically through the use of elevation, ice, compression and drains. Pharmacological management includes the use of nerve blocks and analgesics. Due to the current opioid crisis, new methods are being sought to reduce post-operative pain so that patients are at lower risk for opioid addiction. Postoperative edema control is vital to reduce tension on the incision, since increased incisional tension may cause an increase in pain at the surgical site. Ice, elevation, compression and drains all contribute to edema reduction, and thereby reduce pain and incisional tension. This report introduces a new method for post-operative pain control in lower-extremity surgery. In the author’s present clinical experience with 15 patients, the application of negative pressure at the incision site using the PREVENA™ Incision Management System (KCI USA, Inc., San Antonio, TX) was associated with a decrease in post-operative pain as well as a decrease in the use of narcotics for post-operative pain management.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Comparing the Cumulative Incidence of Pressure Injuries Using Multilayer Foam Dressings in Seriously Ill and Frail Patients: A Quality Improvement Project
Jerra Sullivan, MSN, RN, CWOCN, Skin Care/Diabetes Program Manager, Nursing Practice, Quality & Education, Beverly Hospital, Beverly, Massachusetts, Dr. Kevin Woo, PhD, RN, NSWOC, FAPWCA, Associate Professor, School of Nursing, School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, Ontario
1072
Maintaining skin integrity is benchmarked for patient safety and quality of care. The purpose of this quality improvement project was to evaluate the incidence of pressure ulcers in high-risk, seriously ill patients from critical care areas comparing the number of hospital-acquired pressure injuries (HAPIs) after implementation of a new silicone multi-layer foam dressing with the number of HAPIs developed during a period in the previous year within which other silicone multi-layer foam dressings were used for prevention. This study took place in three intensive care units (ICUs) including 326 patients from three community-based hospitals in Massachusetts. The cumulative incidence during the study period was 0% as opposed to 0.32% from the previous year. Multi-layer foam dressings are beneficial for pressure ulcer prevention, taking into consideration the cost-effectiveness of care and optimal patient outcomes.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Tolerance of Biofilms to Antimicrobials and Significance to Antibiotic Resistance in Wounds
Anne-Marie Salisbury, PhD, Senior Microbiologist/Lab Manager, Steven L. Percival, PhD, CEO, 5D Health Protection Group Ltd, Centre of Excellence in Biofilm Science (CEBS), Liverpool Bio-Innovation Hub, Liverpool, UK, Kevin Woo, PhD, RN, NSWOC, FAPWCA, Associate Professor, School of Nursing, School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Sandip Sarkar FRCS, MA, PhD, Consultant Vascular and Endovascular Surgeon, Barts Health NHS Trust, London, United Kingdom, Greg Schultz, PhD, Director, Institute for Wound Research, University of Florida, Gainesville, Florida, Matthew Malone, FFPM, RCPS (Glasg), Director of Research, High Risk Foot Service, Liverpool Hospital, Liverpool, Australia, Dieter Mayer, MD, Assistant Professor, Head of Wound Care, HFR Fribourg – Cantonal Hospital, Fribourg, Switzerland
1053
A biofilm is a community of microorganisms that adhere to each other and to surfaces and secrete extracellular polymeric substances (EPS) encasing themselves in a matrix. Biofilms are a major healthcare concern, as they can form on medical devices leading to infection. Additionally, there is growing evidence to show their ability to form in chronic wounds, which leads to delayed wound healing and inflammation. Due to a number of reasons, such as formation of the EPS resulting in sub-inhibitory concentrations of antimicrobials reaching the bacterial cells, slow growth rate of bacterial cells rendering some antibiotics ineffective, and the presence of persister cells, biofilms show increased tolerance to many antimicrobials and antibiotics. Additionally, studies have started to emerge showing a link between resistance to antimicrobials and antibiotics. Cross-resistance can be attributed to a number of factors, for example, increased expression of multidrug efflux pumps that efflux a wide range of substrates and horizontal gene transfer of genetic material encoding multiple resistance genes between different species within the polymicrobial biofilm. Antimicrobial resistance is an increasing threat caused by multiple factors including cross-resistance, and it is a global health concern. This review focuses on current research on antimicrobial and antibiotic resistance and cross-resistance found between antimicrobials and antibiotics commonly used in woundcare to evaluate the significance of this acquired antibiotic resistance. Furthermore, the review discusses the significance of antimicrobial tolerance and the role biofilms play in enhancing antibiotic resistance.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Scoping Review of Clinical Outcomes Related to Advanced Training in Wound Care
Veronika Anissimova RN, BMedSc, MCIScWH, CETN(C), Registered Nurse, (Enterostomal Therapist), The Hospital for Sick Children, Toronto, Ontario, Megan Brittain, MClSc, Professor, Deborah Anne Loundes, BSc, DCh, MClSc, Professor, The Michener Institute of Education at UHN, Toronto, Ontario, Kevin Woo, PhD, RN, NSWOC, FAPWCA, Associate Professor, Queen’s University, School of Nursing/School of, Rehabilitation Therapy, Kingston, Ontario
1064
Introduction: There are different levels of wound education which exist amongst healthcare providers treating wounds. It is unknown if advanced wound training can lead to improved clinical outcomes.
Purpose: To review and summarize existing literature focused on the impact of different healthcare professionals with advanced wound care training and the associated effect of clinical outcomes.
Materials and Methods: The methods used to conduct this scoping review are based on the methodological framework developed by Arksey and O’Malley. An electronic search was performed by independent reviewers using Scopus, CINAHL, PubMed, Google, and EWMA. Consensus decision-making amongst the reviewers resulted in relevant final articles being selected for review.
Results: In the literature, there is no universally accepted definition for advanced training in wound care. Seven of the eight selected articles focused on nurses with a specialization in wound healing and their impact on wound healing outcomes. The five main themes identified were wound improvement, cost savings, influence on other nurses, wound recurrence rate, and advanced education.
Conclusion: A minimum level of advanced training or education would be beneficial to ensure consistency in the provision of advanced wound care by professionals practicing wound care.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
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.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
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.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
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.
Order Digital ePrint:
PDF Format - $77.00
Digital Copies:
250 - $1,250.00
500 - $2,240.00
1 Year Subscription
including this article:
Online PDF - $399.00
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%.
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
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.
Order Digital ePrint:
PDF Format - $77.00
Digital Copies:
250 - $1,250.00
500 - $2,240.00
1 Year Subscription
including this article:
Online PDF - $399.00
The Use of Acellular Dermal Matrices (ADM) in Breast Reconstruction: A Review
Christian Eichler, MD, Obstetrician/Gynecologist, Nadine Vogt, MD, Obstetrician/Gynecologist, Mathias Warm, MD, Municipal Hospital Holweide, University of Cologne, Carolin Schulz, Medical Researcher, Municipal Hospital Holweide, Cologne, Germany, University of Bonn, Bonn, Germany
The use of acellular dermal matrices (ADM), sometimes referred to as extracellular matrix (ECM), has become an interesting aspect of breast reconstruction. A great deal of literature is available, totaling over 7000 ADM-based reconstructions. Most often, ADMs are used in a skin sparing mastectomy (SSM) scenario, although heterologous breast augmentation with a sub-pectoral fixation may also require an ADM application. Their use has become an attractive, but expensive option. Available data shows head to head comparisons between individual ADMs to be mostly retrospective in nature with only a few prospective trials available. Points of interest include postoperative hematoma, postoperative skin irritation, infection, red breast syndrome, and revision surgery. This work will, therefore, highlight the individual properties of ADMs used in breast reconstruction and compare the available data on complication rates and costs for these devices.
870
9-07-2017
Order Digital ePrint:
PDF Format - $89.00
1 Year Subscription
including this article:
Online PDF - $399.00
A Pilot Retrospective Study to Evaluate Two Multi-Layer Foam Dressings for the Management of Moderately Exudative Pressure Injuries
Kevin Woo, PhD, RN, FAPWCA, Associate Professor, Jennifer Kasaboski, RN, E, School of Nursing,
Kingston, Ontario
Prevention and treatment of pressure injuries (PI) is a standard benchmark for quality of care, performance, risk reduction, and patient safety. Foam dressings are designed to wick away a large volume of exudate with minimal lateral movement to prevent periwound skin maceration; this renders foam dressings a popular choice for the treatment of chronic wounds with high to moderate amounts of exudate. In addition, multi-layer foam dressings may have added benefits to alleviate pressure and minimize shear as the dressing materials slide against each other. The purpose of this retrospective pilot study was to evaluate the effectiveness and safety of two different multi-layer foam dressings (Optifoam® Gentle, Medline Industries, Inc. Northfield, Illinois; Mepilex® Border, Mölnlycke Health Care, Gothenburg, Sweden) for the management of pressure injuries that produce a moderate amount of exudate. A total of 15 patients and 25 wound treatments were reviewed over a period of 12 months in the study. The difference in the mean surface areas at baseline between the two dressings was not statistically significant (p=.38). All wounds improved over time. There was no difference in healing rate (cm2/day) for wounds that were treated with the Mepilex® Border dressing (M=.12 cm2/day, SD=.19) compared to the Optifoam® Gentle dressing (M=.18 cm2/day; SD=.25); t (23)= .85, p=.40. Findings of this study suggest similar clinical performance between the two foam dressings. Foam dressings were used for the management of several shallow stage 3 and 4 PIs in place of packing. Results of this study challenge the commonly accepted notion that wounds with depth should always be packed with dressing material.
888
3-07-2017
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Noninvasive Vascular Assessment of Lower Extremity Wounds in Diabetics: Are We Able to Predict Perfusion Deficits?
Iram Naz, MD, Research Fellow, Elliot Walters, MD, Research Fellow, Cameron M. Akbari, MD, FACS, Associate Professor of Surgery, Christopher E. Attinger, MD, Professor of Surgery, Paul J. Kim, DPM, MS, Associate Professor, Division of Wound Healing & Hyperbaric Medicine, MedStar Georgetown University Hospital, Washington, DC
Vascular assessment of the lower extremity is a critical step in any patient presenting with lower extremity chronic wounds to predict the likelihood of healing and risk of amputation. This concept is vital in patients with diabetes due to their complex vascular anatomy and disease distribution. Three arteries supply the six angiosomes of the lower extremity (i.e., three-dimensional blocks of tissue fed by a “source” artery in the foot and ankle). In diabetic patients, assessment of adequate blood flow to the lower extremities is complicated by the presence of arterial calcification, associated neuropathy, and inflammation. This review focuses on noninvasive vascular assessment methods to better understand perfusion and direct therapy to improve diabetic wound healing. Clinical examination of pulses and Ankle Brachial Index (ABI) can be supplemented by handheld Doppler assessment of direction of blood flow and pulse volume recordings to understand the site and extent of peripheral arterial disease. Duplex ultrasound has been used, but is operator dependent. CT angiogram has limitations in the presence of calcifications and renal insufficiency, prevalent in the diabetic population. Novel modalities, like hyperspectral imaging, ICG fluorescence angiography, and nuclear imaging are being studied for their potential to overcome some of these challenges, but the data is limited. At present, these newer modalities are not widely available, but once validated by robust data, they may supplant older, less reliable techniques and improve our ability to predict wound healing. This will help reduce healthcare costs and improve outcomes as wound care specialists will be able to more accurately direct patients to the best treatment plan to preserve mobility and reduce mortality.
904
25-09-2017
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
Biofilms, Their role and Treatment Options in the Chronic Non-healing Wound
Michel F. Moore, MD, Doctor of Medicine, Geisinger School of Medicine, Scranton, Pennsylvania
The discovery of the existence of biofilms in the 1970s has resulted in a greater understanding of how bacteria form a synergistic relationship to facilitate their survival by incorporating and sharing the individual attributes that individual bacteria have with the polymicrobial flora that composes the biofilm. Advances in molecular biology have aided in delineating complexity of biofilms, but the abundance and plethora of the microbial world provides an ongoing and daunting task. The enormity of this task is reflected in the chronic non-healing wound, as it is estimated that 60% of all chronic non-healing wounds have a biofilm component. The etiology of the wound, its anatomical location, the chronicity of the wound, and the varying polymicrobial population that exists in the varying clinical settings where treatment occurs, adds to the difficulty of this problem. A review of the present existing knowledge of biofilms in the chronic non-healing wound and their clinical relevance is discussed. The relevance of clinical findings, readily available laboratory tests, and an analysis of the primary mode of action of certain treatment options are also discussed as to their effectiveness in the treatment of chronic non-healing wounds.
916
21-11-2017
Order Digital ePrint:
PDF Format - $77.00
1 Year Subscription
including this article:
Online PDF - $399.00
