The Effect of Topical Administration of an Ointment Prepared From Trifolium repens Hydroethanolic Extract on the Acceleration of Excisional Cutaneous Wound Healing
Sarah ManningDavid HumphreyWIlliam R. ShillinglawEric CrawfordGaurav PranamiAnkit AgarwalMichael J. Schurr
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Objective The goal of this prospective clinical study was to assess the effectiveness of a novel bioresorbable polymeric matrix impregnated with ionic and metallic silver as a primary wound contact dressing in healing stagnant or deteriorating chronic wounds. Materials and methods Thirty-two patients with a total of 35 chronic wounds undergoing treatment at the Wound Healing and Hyperbaric Center at Mission Hospital were recruited under a protocol approved by the institutional review board. The wounds included venous stasis ulcers, diabetic foot ulcers, postoperative surgical wounds, burn wounds, and chronic, nonpressure lower extremity ulcers. At baseline, all wounds were nonhealing (ie, stagnant or deteriorating) for a median of 39 weeks (range, 3-137 weeks) and suspected of persistent microbial colonization that had not responded to traditional antimicrobial products and/or antibiotics. The aforementioned matrix was applied to wounds once every 3 days and covered with a secondary dressing. Previously prescribed protocols of care, such as debridement or compression wraps, were continued, but prior antimicrobial dressings or antibiotics were replaced with the matrix. Wound assessments at 3 weeks and 12 weeks post intervention are reported. Results Three patients were excluded due to patients lost to follow-up after initial application. At 3 weeks, 72% of wounds (22/32) had significantly improved healing with an average wound area reduction of 66%. By 12 weeks, 91% of wounds (29/32) either healed completely (ie, fully reepithelialized) or improved significantly with an average wound area reduction of 73%. The matrix was well tolerated; no patient reported discomfort with the application of the matrix. Conclusions The micrometer-thick bioresorbable matrix presents a new form factor to wound management, conforming intimately to the underlying wound bed to exert localized and sustained antimicrobial action of noncytotoxic levels of silver. The application of the matrix on the wound surface in protocols of care was safe and well tolerated, and it facilitated improvements in healing of a majority of the stagnant or deteriorating complex chronic wounds.Keywords:
Wound care
Debridement (dental)
Granulation tissue
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Background In India, the high cost of medical treatments and limited resources can deter patients from receiving available care, leading to the development of chronic wounds. We evaluated the use of epidermal grafting in patients with complex, long-term chronic wounds. Methods Eighteen patients with complex wounds were treated with epidermal micrografts between September 2014 and March 2015 at a state-run, community health center in Mahe, Puducherry, India. Wound re-epithelialization was monitored for up to 14 weeks. Results Comorbidities in the patient group (nine females and nine males; mean age 54.1 ± 10.8 years, range 32–70 years) included diabetes mellitus, hypertension, obesity (body mass index (BMI) >30 kg/m2), and peripheral vascular disease. The wound types included diabetic and nondiabetic foot, pressure, and venous leg ulcers. The average wound age prior to treatment was 36.8 ± 48.5 months (range 2–180 months) in the majority of patients. All wounds measured less than 7 cm × 7 cm. The mean time to wound epithelialization was 3.7 ± 1.8 weeks (range 2–9 weeks). The majority of wounds healed following epidermal grafting (n=16, 88.9%). One patient developed infection following removal of the dressing under non-sterile conditions against the advice of the healthcare providers. Another patient developed wound hypergranulation after grafting. Both wounds healed completely after treatment with antibiotic therapy and tissue resection, respectively. All donor sites healed without complications. Conclusion In patients with small- to medium-sized chronic wounds, epidermal grafting offered a viable wound closure option for wounds requiring only the epidermal layer. Additionally, epidermal grafting was performed in the clinic without anesthesia or a surgeon, making the procedure more accessible in resource-challenged regions.
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Wound care
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Fifty-eight chronic nonhealing foot wounds (51 patients) were treated with irrigation, aggressive debridement, and primary tension-free closure. Factors such as wound location, wound size, presence of infection, and healing outcome were recorded. In addition, medical comorbidities and preoperative laboratory test results were reviewed. Thirty-seven (64%) of the 58 wounds healed after primary closure. Of the other 21 wounds, 16 healed after repeat irrigation, debridement, and closure or local wound care; 2 patients were lost to follow-up after initial failed wound healing, 1 patient died after initial failed wound healing, and 2 cases were salvaged with amputation. Failed primary closures were thought not to increase wound size; all but 3 of these closures decreased wound size significantly. Differences between the wounds that healed primarily and the wounds that failed healing were not statistically significant. Diabetes was present in 46% of the patients whose wounds healed primarily versus 71% of the patients whose wounds failed healing (P = .06). Irrigation, debridement, and primary closure of nonhealing foot wounds can be a useful treatment option for most such patients. Complete healing or reduced wound size occurs in 95% of cases.
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Foot (prosody)
Wound care
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In chronic wounds the healing is stagnant, and regenerative surgery is often needed. Many engineered tissues with a conventional bidimensional sheet are ineffective for tunneling wounds, because adherence to the wound bed is not complete. An advanced wound matrix for treating wounds with irregular geometries has been developed (Integra Flowable Wound Matrix, Integra LifeScience Corp, Plainsboro, NJ).Between March 2013 and December 2013 the authors treated 18 patients (11 female) with tunneled or cavity ulcers with the advanced wound matrix at the Unit of General and Geriatric Surgery of the Second University of Naples, Naples, Italy. Two patients (11.1%) had postsurgical wounds, two (11.1%) had post-traumatic wounds, and 14 (77.8%) had neuropathic ulcers. After debridement and antibiotic therapy, the lesions were filled with the wound matrix product. Surgical wound edges were either approximated with stitches or left to heal by secondary intention and covered with wet gauze. During the first week, follow-up visits were carried out every 3 days, then once a week until complete healing was achieved. All patients underwent preoperative and postoperative ultrasonography scans and plain radiograph controls.Twenty-one applications were performed. Engraftment was complete in all but 1 patient who had diabetes and graft failure. Three patients needed repeated applications to complete the filling of the lesions. Median (range) pain Visual Analog Scores-on a scale of 0 to 10, where 0 = no pain, and 10 = intolerable pain-were 6.3 (range 3-8) preoperatively and 0.5 (range 0-2) at first follow-up (P ≤ 0.001). All but 2 patients showed a progressive remodeling of the tissue gap at scheduled radiographic controls.To the author's knowledge, the advanced wound matrix used in this study is the only available biomaterial for the treatment of tunneled lesions. It stimulates tissue regeneration by filling surfaces which cannot be repaired spontaneously or by using conventional biomaterials in the form of sheets. Its application is atraumatic, painless, and safe.
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Chronic Wounds: Factors Influencing Healing Within 3 Months and Nonhealing After 5-6 Months of Care.
Chronic wounds affect approximately 2.5 million to 4.5 million people in the US and are particularly a problem for the elderly. Nonhealing or slow healing wounds represent a major health burden and drain on resources, contributing to substantial disability, morbidity, and costs. This study was conducted to identify factors that influence the healing of chronic wounds within 3 months of starting treatment, compared to factors influencing nonhealing wounds after 5 or 6 months of treatment. A retrospective review of medical records of subjects with chronic pressure, diabetic, or venous ulcers using a structured data collection form and protocol was conducted at 4 sites located in disperse geographic areas. The sample consisted of 400 subjects with at least 3 months of data. Demographic, case mix, wound characteristics, and treatment characteristics were analyzed. Consistent with the literature, wounds that were larger, deeper, infected, draining larger amounts of exudate, and/or covered with slough or eschar were significantly less likely to heal within 3 months and more likely not to heal after 5-6 months of treatment. Medicaid insurance coverage and being non-white were also associated with poorer healing. A lower percentage of antimicrobial dressings was associated with faster healing, while a lower percentage of moisture-management dressings was associated with nonhealing after 5-6 months. The analysis also showed that inappropriate management of wound exudate and necrotic tissue was associated with poorer healing outcomes. While the influence of insurance coverage and race on healing needs further exploration, healing rates could improve in certain centers through better adherence to evidence-based wound management recommendations.
Eschar
Chronic wound
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Abstract Negative pressure wound therapy ( NPWT ) has emerged as a cutting‐edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2 years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT , none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36 ± 4·24 days. Complete healing of wounds occurred by 33·1 ± 10·22 days. There was a statistically significant difference in the volume of the wounds before and after the intervention ( P = 0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement.
Negative-pressure wound therapy
Granulation tissue
Debridement (dental)
Skin grafting
Adjunct
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Objective
To explore the value of moist therapy for delayed wound healing in patients with liver diseases after surgery.
Methods
Clinical data of 54 patients undergoing surgical treatments with delayed wound healing in the Third Affiliated Hospital of Sun Yat-sen University from January 2011 to January 2014 were analyzed retrospectively. There were 45 males and 9 females with the age ranging from 24 to 70 years old and a median of 47 years old. All the patients were complicated with liver diseases. The informed consents of all patients were obtained and the ethical committee approval was received. Moist therapy was used in the dressing changing of the delayed healing wounds. After regional and overall assessment, appropriate cleaning solutions were chosen. According to the activity of wound basal lamina, location and patients' coagulation function, mechanical debridement, conservative sharp debridement or autolytic debridement were chosen. Microenvironment which benefited the wound healing was created through exudates management and wound sealing. Different wound dressings such as silver sulphadiazine impregnated hydrocolloid dressing (Urgotul SSD), sodium chloride impregnated dressing (Mesalt), calcium alginate dressing (Sorbalgon), hydrofiber dressing (Aquacel), silver-containing hydrofiber dressing (Aquacel Ag) were chosen and the wounds were dressed and fixed. The causes of delayed wound healing were explored and the wound healing were observed after giving moist therapy.
Results
The causes of delayed wound healing included subcutaneous fat liquefaction (n=30), incision infection (n=16), subcutaneous hemotoma (n=8). After giving moist therapy for 5 to 21 d, the granulation proliferation of the wounds was observed well in 54 patients. Forty-two cases received second suture and the wounds in 12 cases were compressed and pulled up using 3M steri-strip. All the wounds healed completely with a cure rate of 100%.
Conclusions
Moist therapy can promote the proliferation of granulation tissues of patients with liver diseases and delayed wound healing after surgery, and provides favorable condition for the secondary healing.
Key words:
Moist therapy; Liver diseases; Surgical wound infection; Wound healing; Occlusive dressings; Bandages, hydrocolloid
Silver sulfadiazine
Debridement (dental)
Granulation tissue
Wound care
Occlusive dressing
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Abstract The treatment of chronic wounds represents a major cost to society and has a profound effect on the participant's quality of life. Chronic wounds may have an increased bacterial burden that can impair healing without all the clinical signs of infection. Silver dressings may provide an alternative topical method to control bacterial burden. The primary aim of this study was to evaluate the clinical improvement in chronic wounds through the effect on wound size, maceration, resolution of surface slough and conversion to healthy granulation during a 4‐week application of the silver‐containing Hydrofiber ® dressing. This was a single centre, open‐label case series study which included a total of 30 evaluable participants: four with diabetic neuropathic foot ulcers, 13 venous stasis ulcers, four pressure ulcers and nine miscellaneous wounds that did not fit any of the previous categories. All participants had adequate vascular supply, indicating the potential to heal. The wounds were stalled or had the signs and symptoms consistent with critical colonisation. The underlying cause of the ulceration was identified and corrected, or the symptoms and signs were treated. This was followed by the application of silver‐containing Hydrofiber ® dressings for a period of 4 weeks. The majority of wounds treated decreased in size (70%) with decreased exudate, decreased purulence and resolution of surface slough (75%). There was an increased quality and quantity of healthy granulation tissue. Unlike some silver dressings, the Hydrofiber ® and silver combination dressing was unlikely to cause burning and stinging on application. Peri‐wound maceration was present in 54% of participants at baseline, and 85% of these resolved with this dressing. A desloughing action was seen in those patients with pre‐existing slough at baseline and its removal will lower the bacterial burden of the wound.
Granulation tissue
Silver sulfadiazine
Chronic wound
Maceration (sewage)
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Background: Negative pressure wound therapy in the form of vacuum assisted closure is known to be a useful adjunct in wound healing. It can downstage surgical reconstruction options from large flaps to simpler skin grafts or secondary wound closure. Objective: To compare mean duration of wound healing between conventional dressings and negative pressure wound therapy for management of wounds. Study Design: Randomized Controlled Trial. Settings: Allied Burn and Reconstructive Surgery Centre, Faisalabad, Pakistan. Duration: June 1, 2018 to November 30, 2018. Methodology: All the patients were randomly divided into 2 groups. Group A underwent negative pressure wound therapy while group B underwent conventional dressings. Patients in both groups were observed for a period of maximum two weeks. Results: Comparison of mean duration of wound healing between conventional dressings and negative pressure wound therapy for management of wounds was done. It was 9.83+1.32 days in Group-A and 16.30+1.37 days in Group-B, p value was 0.0001. Conclusion: Mean duration of wound healing was significantly higher in cases with conventional dressings compared with negative pressure wound therapy for management of wounds.
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Objective: This article reports the outcomes of the use of Surgihoney RO (SHRO), topical wound dressing in a multi-centre, international setting. The aims were to explore the clinical effects of SHRO, including a reduction in bacterial load and biofilm and improvement in healing in a variety of challenging non-healing and clinically infected wounds. Method: This was a non-comparative evaluation, where both acute and chronic wounds with established delayed healing were treated with the dressing. Clinicians prospectively recorded wound improvement or deterioration, level of wound exudate, presence of pain, and presence of slough and necrosis. Analysis of this data provided information on clinical performance of the dressing. Semi-quantitative culture to assess bacterial bioburden was performed where possible. Results: We recruited 104 patients, mean age 61 years old, with 114 wounds. The mean duration of wounds before treatment was 3.7 months and the mean duration of treatment was 25.7 days. During treatment 24 wounds (21%) healed and the remaining 90 (79%) wounds improved following application of the dressing. No deterioration in any wound was observed. A reduction in patient pain, level of wound exudate and in devitalised tissue were consistently reported. These positive improvements in wound progress were reflected in the wound cultures that showed a reduction in bacterial load in 39 out of the 40 swabs taken. There were two adverse events recorded: a stinging sensation following application of the dressing was experienced by 2 patients, and 2 elderly patients died of causes unrelated to the dressing or to the chronic wound. These patients' wounds and their response to SHRO have been included in the analysis. Conclusion: SHRO was well tolerated and shows great promise as an effective potent topical antimicrobial in the healing of challenging wounds. Declaration of interest: Matthew Dryden has become a shareholder in Matoke Holdings, the manufacturer of Surgihoney RO, since the completion of this study. Keith Cutting is a consultant to Matoke Holdings.
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This case series aims to study the effectiveness of Renasys-GO™ negative pressure wound therapy system in the healing of diabetic lower limb ulcers.An electronic vacuum pump (Renasys-GO™, Smith & Nephew GmbH) was used to apply negative pressure wound therapy on wounds, with pressure settings determined according to clinical indication. Changes in wound dimension, infection status and duration of treatment were recorded over the course of Renasys-GO™ therapy in 10 patients with diabetic lower limb ulcers.Healing was achieved in all wounds, three by secondary closure and seven by split-thickness skin grafting. Eight wounds showed a reduction in wound size. The average duration of treatment with Renasys-GO™ therapy was 15.9 days, and all wounds showed sufficient granulation and were cleared of bacterial infection at the end of therapy.Renasys-GO™ therapy may be beneficial in the treatment of diabetic lower limb ulcers and wounds. In this study, which included wounds presenting as post-surgery ray amputation, metatarsal excision wounds, post-debridement abscesses and ulcers, the Renasys-GO™ therapy prepared all wounds for closure via split-thickness skin grafting or secondary healing by promoting granulation tissue and reducing bacterial infection in approximately 2 weeks.
Granulation tissue
Negative-pressure wound therapy
Debridement (dental)
Skin grafting
Clearance
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