Abstract


In the current era, there are numerous advanced postoperative dressings. The ideal postoperative dressing is one that is thought to improve patient comfort, manage postoperative drainage, potentially allow for visualization of the wound, improve postoperative healing, and possibly reduce bacterial invasion. However, many advanced surgical dressings have shown increased ease of handling and increased patient comfort, but have not shown true superiority with regard to objective criteria.
To ease the overall evaluation of such products, we have categorized them as standard of care dressings, engineered dressings, antimicrobial engineered dressings, skin glues and adhesives, and closed incisional negative pressure wound therapy. Among these categories, closed incisional negative pressure wound therapy has repeatedly shown superior subjective and objective outcomes. However, due to cost constraints, this therapy is not ideal for everyone. In many cases, the postoperative dressing should be dictated by the type of surgery, the location of the surgery, and the comorbidities of the patient. The authors will review the appropriate indications for the use of all categories of postoperative dressing and identify specific items that have shown great promise. The current guidelines will also be reviewed.

Abstract


Introduction: Posture, temperature, and moisture have been identified as critical modifiable risk factors in pressure injury (PI) development. Microclimate is defined as temperature and humidity at the interface of the support surface and body. To our knowledge, no studies have used sensor technology to measure these parameters simultaneously in real time. Continuous monitoring of repositioning and microclimate provide real-time actionable insights to help deliver personalized care and measure the effectiveness of interventions.
Objective: To evaluate the ability of a smart surface platform to collect and document clinical data on monitoring patients’ movement and microclimate simultaneously and to compare data generated to nursing observations in order to construct an algorithm that is expected to evolve over time:
(1) comparing the blinded data from nurses interacting with the patients and the system; and
(2) data being collected is validating an algorithm that is expected to become more accurate over time.
Materials and Methods: This prospective, descriptive single-site trial was conducted at a tertiary care facility in a large urban centre in Canada. Patients identified at risk of PIs received standard of care while placed on the smart surface for timed intervals. Nurses’ assessment data were collected at three hourly timepoints using a comprehensive tool developed for the study. Sensors monitored patients’ interface pressure moisture and temperature every four seconds. A comparative statistical analysis was conducted between the two datasets retrospectively.
Results: The study included a total of 104 participants; mean age of 59 years (range 21–92, ± 19.15). Sensor monitoring hours (1,407) generated 1,101,780 frames of surface data. A total of 511 nursing assessments were recorded during the study period. Sensor-generated data correlated strongly with nurse-collected data at cross-sectional intervals. There was a high level of agreement between information collected from sensors and nursing assessments: 94.7% for moisture (p<0.05), and 87.1% for temperature (p<0.05). Nurse-recorded posture assessments were compared to the smart surface platform interface pressure visualizations to determine the device’s posture detection, resulting in a 92% accordance (matching 552 out of 600 nurse postures), with a binomial test determining the posture results to be statistically significant (p<0.05) (CI 95%). In addition, moisture events were matched to nurse assessments with 94.7% in accordance, identifying 39 bladder incontinence and 93 non-urinary moisture events (125 total events captured out of 132).
Conclusion: The technology’s ability to capture PI risk factors supports nursing practice. Supplementary data generated has the potential to improve efficiency of professional caregiver workflow and patient outcomes by informing targeted microclimate management strategies and decreasing unnecessary interventions. The large volume of data collected will be used as a basis for artificial intelligence applications with the potential to inform other clinical decision-making areas.

Abstract


The skin is the largest human organ and an important barrier to protect against the environment. Burns damage the skin and thus destroy this anatomical barrier. This makes initially sterile wounds susceptible to colonization by pathogenic germs. In severely burned patients, immune competence decreases as part of the burn disease. Sepsis and multiple organ failure as a result of infection are the main causes of death in this cohort. Therefore, prevention and recognition of infections as well as surgical treatment and targeted anti-infective therapy are of great importance.
In this article, we present up-to-date solutions for the treatment of burn wounds by means of plastic and reconstructive surgery to minimize the risk of infection. We demonstrate the principles of infection defense by the skin barrier. We outline the principles of burns and how to perform an appropriate diagnosis and therapy, from outpatient therapy to intensive care therapy, depending on the severity.
We address the typical bacteria responsible for wound infections in severely burned patients and how to prevent and treat them. We also describe the hygiene measures that must be used in a severe burn unit to reduce the risk of complications such as infection and improve patient survival.

Abstract


The COVID-19 pandemic, which started in March of 2020, and its associated surges have had an immense impact on the ability of medical staff to perform their daily activities. Thus, we sought to direct patients who had gram-positive Acute Bacterial Skin and Skin Structure Infections (ABSSSI) to our Outpatient Department/Wound Care Center for treatment. We met the challenge of the pandemic by shifting care in the treatment of ABSSSI using a new antibiotic delivery system.
We examined the use and cost-effectiveness of Dalbavancin, a unique long-acting lipoglycopeptide antibiotic that is used in the treatment of acute bacterial skin and skin structure infections, during the COVID-19 pandemic. A total of 631 patients were treated in the Outpatient Department/Wound Care Center, with re-evaluation at the Wound Care Center on Day 3 post-infusion. The primary test of cure or major improvement was based on a 4- to 6-week re-assessment by the Wound Care Center Faculty (i.e., Podiatric, Vascular, Plastics, and Infectious Diseases). Treatment effectiveness was determined by examining documentation at follow-up.
We also looked at the number of Outpatient Department treatments at the Wound Care Center for the periods 2018-2019 and 2020-2021.
The shift of patients from the Emergency Department/Inpatient Department to the Outpatient Department/Wound Care Center was made possible by the use of the novel, streamlined, safe, Food and Drug Administration (FDA)-approved, well-tolerated antibiotic Dalbavancin. Dalbavancin is not prescribed for gram-negative infections, or for random prescribing, contamination, colonization, or prophylaxis. Dalbavancin has a low infusion reaction, low toxicity, long half-life, and low incidence of adverse reactions. Use of this medication was helpful for decreasing the inpatient burden in our facility.

Abstract


Background: Keloid is characterized by excessive collagen accumulation and fibroblast growth, which are fibroproliferative disorders of injured skin, causing functional limitations. Studies have shown that adipose-derived stem cells (ADSCs) inhibit the bioactivity and fibrosis of keloid fibroblasts. However, the molecular mechanism of this effect of ADSCs on keloid formation has not been fully elucidated.
Methods: This in vitro study used fibroblasts obtained from keloids. A consensus gene co-expression network was constructed to focus on identifying consensus gene co-expression modules associated with keloid fibroblasts. Differentially expressed genes (DEGs) were identified between keloid fibroblasts and normal dermal fibroblasts. A functional enrichment analysis was also performed with the DAVID database. A weighted gene co-expression network analysis (WGCNA) was used to screen keloid-related modules using the “WGCNA” R package, followed by hub gene selection in modules from the Protein-protein interaction network through the STRING database. Keloid fibroblasts and ADSCs were extracted and cultured. Proliferation and apoptosis were examined using a 5-ethynyl-2-deoxyuridine (Edu) kit and flow cytometry.
Results: We identified 302 DEGs overlapping with a consensus analysis of clusters and a differential expression analysis between keloid fibroblasts and normal dermal fibroblasts. Most of these were involved in collagen binding, extracellular matrix organization, and the PI3K-Akt signaling pathway. WGCNA analysis selected a keloid-associated brown module. ITGA2 was identified as a novel marker in hub genes from the PPI network based on the degree and function of collagen modulation. Furthermore, the proliferation ability of keloid fibroblasts cultured in ADSC medium was inhibited while apoptosis was dramatically increased. Overexpression of ITGA2 reversed the decrease in ADSC-induced apoptosis and increased ADSC-reduced proliferation.
Conclusion: Our study demonstrated that activation of ITGA2 plays a crucial role in ADSC-induced keloid fibroblast apoptosis and anti-proliferation effects. These results also improved our understanding of the molecular mechanism of the pathogenesis of keloid in response to ADSCs and may contribute to the further development of keloid therapy.

Abstract


Hospital-acquired pressure injuries (HAPIs) represent a significant detriment to patient health by increasing mortality risk, negatively impacting quality of life, and increasing risk of complications such as infection. Prophylactic use of sacral foam dressings is known to decrease the occurrence of HAPIs in various patient populations. This retrospective study compared the effect of two multi-layer sacral foam dressings on HAPI incidence in patients admitted to a short-term, acute care hospital during the years 2015 (dressing one: Mepilex® Border Protect sacral dressing [Mölnlycke Healthcare AB, Göteborg, Sweden]) and 2017 (dressing two: Optifoam® Gentle LQ silicone faced foam & border sacral dressing [Medline Industries, LP, Northfield, Illinois]). Patient medical charts were examined for full sample (n=297) and subsample (n=284) analysis, respectively. The HAPI incidence for dressing two was found to be significantly less than dressing one (full sample: 5.12% compared to 10.79% [p=0.0001], and subsample: 4.07% compared to 9.31% [p=0.0001]). The incidence rate ratio (IRR) for dressing two was 0.39 for the full sample and 0.35 for the subsample, indicating that compared to dressing one, the HAPI count was approximately 40% lower for dressing two for the full sample and approximately 35% lower for dressing two for the subsample. These results demonstrate that dressing two performed better than dressing one in HAPI prevention. The results of this study may inform clinicians in their choice of prophylactic dressings.

Abstract


The ability to grow skin has long been a topic of study and therapeutic interest. Currently, the main ways of doing this are 1) by placing tissue-expansion devices in the subcutaneous space and expanding skin over time, which can then be moved to cover contiguous structures, and 2) via processes that require relatively long (30 days) incubation periods to grow the patient’s autogenous skin into laminar sheets. Over the past five years, there have been significant developments in the ability to expand skin cells, either at the bedside or in the laboratory, but much more rapidly than with previous methods. We explore and discuss the current skin cell-expansion techniques, focusing on point-of-care therapeutic interventions that can be used in the burn population as well as the chronic wound population, hair follicle stem-cell incubation techniques and studies supporting this therapy, as well as micro bullae grafting, and morcellated skin cell therapy. The current data supporting these therapeutic interventions and their current direction are outlined in detail.