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1

[Characteristics of war wound infection].  

PubMed

War wounds are the most complex type of non-targeted injuries due to uncontrolled tissue damage of varied and multifold localizations, exposing sterile body areas to contamination with a huge amount of bacteria. Wound contamination is caused by both the host microflora and exogenous agents from the environment (bullets, cloth fragments, dust, dirt, water) due to destruction of the host protective barriers. War wounds are the consequence of destructive effects of various types of projectiles, which result in massive tissue devitalization, hematomas, and compromised circulation with tissue ischemia or anoxia. This environment is highly favorable for proliferation of bacteria and their invasion in the surrounding tissue over a relatively short period of time. War wounds are associated with a high risk of local and systemic infection. The infection will develop unless a timely combined treatment is undertaken, including surgical intervention within 6 hours of wounding and antibiotic therapy administered immediately or at latest in 3 hours of wound infliction. Time is a crucial factor in this type of targeted combined treatment consisting of surgical debridement, appropriate empirical antimicrobial therapy, and specific antitetanic prophylaxis. Apart from exposure factors, there are a number of predisposing factors that favor the development of polymicrobial aerobic-anaerobic infection. These are shock, pain, blood loss, hypoxia, hematomas, type and amount of traumatized tissue, age, and comorbidity factors in the wounded. The determinants that define the spectrum of etiologic agents in contaminated war wounds are: wound type, body region involved, time interval between wounding and primary surgical treatment, climate factors, season, geographical area, hygienic conditions, and patient habits. The etiologic agents of infection include gram-positive aerobic cocci, i. e. Staphylococcus spp, Streptococcus spp and Enterococcus spp, which belong to the physiological flora of the human skin and mucosa; gram-negative facultative aerobic rods; members of the family Enterobacteriacea (Escherichia coil, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter cloacae), which predominate in the physiological flora of the intestines, transitory flora of the skin and environment; gram-negative bacteria, i. e. Pseudomonas aeruginosa, Serratia marcescens, Acinetobacter calcoaceticus - A. baumanii complex; environmental bacteria associated with humid environment and dust; anaerobic gram-positive sporogeneous rods Clostridium spp, gram-negative asporogeneous rods Bacteroides spp and gram-positive anaerobic cocci; Peptostreptococcus spp and Peptococcus spp. The latter usually colonize the intestine, primarily the colon, and the skin, while clostridium spores are also found in the environment. Early empirical antibiotic therapy is used instead of standard antibiotic prophylaxis. Empirical antimicrobial therapy is administered to prevent the development of systemic infection, gas gangrene, necrotizing infection of soft tissue, intoxication and death. The choice of antibiotics is determined by the presumed infective agents and localization of the wound. It is used in all types of war wounds over 5-7-10 days. The characteristics of antibiotics used in war wounds are the following: broad spectrum of activity, ability to penetrate deep into the tissue, low toxicity, long half-life, easy storage and application, and cost effectiveness. The use of antibiotics is not a substitution for surgical treatment. The expected incidence of infection, according to literature data, is 35%-40%. If the time elapsed until surgical debridement exceeds 12 hours, or the administration of antibiotics exceeds 6 hours of wound infliction, primary infection of the war wound occurs (early infection) in more than 50% of cases. The keys for the prevention of infection are prompt and thorough surgical exploration of the wound, administration of antibiotics and antitetanic prophylaxis, awareness of the probable pathogens with respect to localization of the wound, and optimal choi

Kucisec-Tepes, Nastja; Bejuk, Danijela; Kosuta, Dragutin

2006-09-01

2

Surgical wound infections after peripheral vascular surgery.  

PubMed

Surgical wound infection is one of the most common complications after peripheral vascular surgery. It increases the affected patient's risk for major amputation as well as mortality. Furthermore, surgical wound infection is an additional cost. Wound infections after vascular surgery are of multifactorial nature and generally result from the interplay of patient- and procedure-related factors. The use of systemic antibiotic prophylaxis may be the most important method in preventing surgical wound infections. In this review article, we report the current literature of surgical wound infections after peripheral vascular surgery. PMID:24737857

Turtiainen, J; Hakala, T

2014-12-01

3

Topical antimicrobial toolkit for wound infection.  

PubMed

Increased bacterial burden and formation of biofilm has been recognized as one of the key factors contributing to delayed wound healing. There is a toolbox of topical antimicrobial wound dressings that incorporate silver, iodine, polyhexamethylene biguanide, methylene blue/gentian violet, and honey. This article reviews a diverse range of evidence to discuss the advantages and disadvantage of topical antimicrobial dressings. Discussion will provide guidance on when and how to use topical antimicrobial dressings to achieve optimal outcomes and cost-effective wound care. Chronic wounds do not follow a predictable and expected healing trajectory, and they may persist for months or years due to underlying disease processes, recurrent injury, and comorbidities.1 With an aging population and increased prevalence of chronic diseases, the majority of wounds are refractory to healing, placing a significant burden on the health system and individual patients. Bacterial burden and biofilm have been recognized as key factors contributing to persistent inflammation, tissue destruction, delayed wound healing, and other serious complications (especially in individuals who are frail and immune-compromised).2 It has been demonstrated that when bacterial growth reaches a critical threshold of 105 bacteria per gram of tissue, bacterial toxins can cause tissue damage in the superficial wound compartment, delaying healing.2 In the literature, this phenomenon is referred to as critical colonization, increased bacterial burden, superficial infection, or localized infection. According to a recent review, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized infection.3. PMID:25433174

Woo, Kevin Y; Alam, Tarik; Marin, Joseph

2014-11-01

4

Delayed Presentation of Deep Sternal Wound Infection  

PubMed Central

Deep sternal wound infections (DSWI) are infections of the sternum, mediastinum, or the muscle, fascia and soft tissue that overlie the sternum, typically occurring within a month of cardiac surgery. They are infrequent though severe complications of cardiac surgery. Diagnosis is made by the clinical presentation of fever, chest pain, or sternal instability in the setting of wound drainage, positive wound cultures, or chest radiographic findings. We describe the case of an elderly man presenting 6 months after cardiac surgery with DSWI. Due to the atypical nature of such a late presentation, definitive therapy was delayed. Given a severely ill patient with multiple risk factors for poor wound healing, the clinician must maintain a high index of suspicion for DSWI despite a delayed presentation. PMID:24672598

Joseph, Linda; Jeanmonod, Rebecca K.

2014-01-01

5

Microbiology of Animal Bite Wound Infections  

PubMed Central

Summary: The microbiology of animal bite wound infections in humans is often polymicrobial, with a broad mixture of aerobic and anaerobic microorganisms. Bacteria recovered from infected bite wounds are most often reflective of the oral flora of the biting animal, which can also be influenced by the microbiome of their ingested prey and other foods. Bacteria may also originate from the victim's own skin or the physical environment at the time of injury. Our review has focused on bite wound infections in humans from dogs, cats, and a variety of other animals such as monkeys, bears, pigs, ferrets, horses, sheep, Tasmanian devils, snakes, Komodo dragons, monitor lizards, iguanas, alligators/crocodiles, rats, guinea pigs, hamsters, prairie dogs, swans, and sharks. The medical literature in this area has been made up mostly of small case series or case reports. Very few studies have been systematic and are often limited to dog or cat bite injuries. Limitations of studies include a lack of established or inconsistent criteria for an infected wound and a failure to utilize optimal techniques in pathogen isolation, especially for anaerobic organisms. There is also a lack of an understanding of the pathogenic significance of all cultured organisms. Gathering information and conducting research in a more systematic and methodical fashion through an organized research network, including zoos, veterinary practices, and rural clinics and hospitals, are needed to better define the microbiology of animal bite wound infections in humans. PMID:21482724

Abrahamian, Fredrick M.; Goldstein, Ellie J. C.

2011-01-01

6

Postoperative wound infection in colorectal surgery.  

PubMed

Postoperative wound infection is one of common problems in a surgical ward. In our surgical department, from 1988 to December 1992, 254 cases were operated on for colorectal diseases. The indications for these operations were as follows; colorectal carcinoma (191 cases), inflammatory bowel diseases (22 cases), diverticulitis (14 cases), and others (27 cases). Of these 254 cases, 119 were males (46.85%) and 135 were females (53.15%), 211 cases (83.1%) were operated on as elective surgery, 43 cases (16.9%) as emergencies. Of these 254 cases, 36 (14.2%) had postoperative wound infection, 25 cases (11.8%) after elective surgery, and 11 cases (25.6%) postemergency operations. Of these 36 cases, 22 cases (61.11%) were males and 14 cases (38.88%) were females. In our study, postoperative wound infection was mostly noted in patients operated on for colorectal carcinoma (27 cases, 14.1%), as compared with 5 cases operated on for diverticulitis (35.7%), 2 cases for I.B.D. (9.1%) and 2 cases for other indications (7.4%). Most of these wound infections were treated with drainage and frequent dressing while 10 cases received antibiotics. PMID:8935193

Bielecki, K; Badi, H; Kami?ski, P; Kubiak, J

1995-01-01

7

Incisional Negative Pressure Wound Therapy for Prevention of Postoperative Infections Following Caesarean Section  

ClinicalTrials.gov

Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

2014-10-15

8

Cobra bite wound infection caused by Shewanella algae.  

PubMed

Shewanella wound infections after snake bites are rare. We report the case of a Shewanella algae wound infection associated with a cobra bite in a 27-year-old woman. The isolate was confirmed by sequencing of the 16S ribosomal DNA gene. This case expands the reported spectrum of infection caused by S. algae and raises the possibility that S. algae could be a causative pathogen in wound infections resulting from snake bites. PMID:24602312

Liu, Po-Yu; Shi, Zhi-Yuan; Shyu, Ching-Lin; Wu, Zong-Yen; Lai, Kuo-Lung; Chang, Chih-Yen; Chen, Ying-Ju; Huang, Jin-An; Mao, Yan-Chiao; Tung, Kwong-Chung

2014-03-01

9

Efficacy of the designer antimicrobial peptide SHAP1 in wound healing and wound infection.  

PubMed

Infected wounds cause delay in wound closure and impose significantly negative effects on patient care and recovery. Antimicrobial peptides (AMPs) with antimicrobial and wound closure activities, along with little opportunity for the development of resistance, represent one of the promising agents for new therapeutic approaches in the infected wound treatment. However, therapeutic applications of these AMPs are limited by their toxicity and low stability in vivo. Previously, we reported that the 19-amino-acid designer peptide SHAP1 possessed salt-resistant antimicrobial activities. Here, we analyzed the wound closure activities of SHAP1 both in vitro and in vivo. SHAP1 did not affect the viability of human erythrocytes and keratinocytes up to 200 ?M, and was not digested by exposure to proteases in the wound fluid, such as human neutrophil elastase and Staphylococcus aureus V8 proteinase for up to 12 h. SHAP1 elicited stronger wound closure activity than human cathelicidin AMP LL-37 in vitro by inducing HaCaT cell migration, which was shown to progress via transactivation of the epidermal growth factor receptor. In vivo analysis revealed that SHAP1 treatment accelerated closure and healing of full-thickness excisional wounds in mice. Moreover, SHAP1 effectively countered S. aureus infection and enhanced wound healing in S. aureus-infected murine wounds. Overall, these results suggest that SHAP1 might be developed as a novel topical agent for the infected wound treatment. PMID:24952727

Jung Kim, Da; Lee, Young Woong; Park, Myung Keun; Shin, Ju Ri; Lim, Ki Jung; Cho, Ju Hyun; Kim, Sun Chang

2014-10-01

10

Level of training, wound care practices, and infection rates  

Microsoft Academic Search

This prospective, nonrandomized descriptive study compares the traumatic wound infection rates in patients based on level of training of emergency department (ED) practitioners. Wounds were evaluated in 1,163 patients. A wound registry data sheet was prospectively completed on all patients sutured in the ED. All practitioners were assigned a unique identification number. Follow-up data was obtained at the time of

Adam J Singer; Judd E Hollander; Guy Cassara; Sharon M Valentine; Henry C Thode; Mark C Henry

1995-01-01

11

Carboxymethylcellulose film for bacterial wound infection control and healing.  

PubMed

Infection control and wound healing profiles of sodium carboxymethylcellulose (SCMC) films were investigated as a function of their anti-bacterial action, physical structures, polymer molecular weights and carboxymethyl substitution degrees. The films were prepared with in vitro polymer/film and in vivo microbe-colonized wound healing/systemic infection profiles examined. Adhesive high carboxymethyl substituted SCMC films aided healing via attaching to microbes and removing them from wound. Pseudomonas aeruginosa was removed via encapsulating in gelling low molecular weight SCMC film, whereas Staphylococcus aureus was trapped in tight folds of high molecular weight SCMC film. Incomplete microbe removal from wound did not necessary translate to inability to heal as microbe remnant at wound induced fibroblast migration and aided tissue reconstruction. Using no film nonetheless will cause systemic blood infection. SCMC films negate infection and promote wound healing via specific polymer-microbe adhesion, and removal of S. aureus and P. aeruginosa requires films of different polymer characteristics. PMID:25129756

Wong, Tin Wui; Ramli, Nor Amlizan

2014-11-01

12

Manuka honey dressing: An effective treatment for chronic wound infections.  

PubMed

The battle against methicillin-resistant Staphylococcus aureus (MRSA) wound infection is becoming more difficult as drug resistance is widespread and the incidence of MRSA in the community increases. Manuka honey dressing has long been available as a non-antibiotic treatment in the management of chronic wound infections. We have been using honey-impregnated dressings successfully in our wound care clinic and on the maxillofacial ward for over a year. PMID:17113690

Visavadia, Bhavin G; Honeysett, Jan; Danford, Martin H

2008-01-01

13

Profiling wound healing with wound effluent: Raman spectroscopic indicators of infection  

NASA Astrophysics Data System (ADS)

The care of modern traumatic war wounds remains a significant challenge for clinicians. Many of the extremity wounds inflicted during Operation Enduring Freedom and Operation Iraqi Freedom are colonized or infected with multi-drug resistant organisms, particularly Acinetobacter baumannii. Biofilm formation and resistance to current treatments can significantly confound the wound healing process. Accurate strain identification and targeted drug administration for the treatment of wound bioburden has become a priority for combat casualty care. In this study, we use vibrational spectroscopy to examine wound exudates for bacterial load. Inherent chemical differences in different bacterial species and strains make possible the high specificity of vibrational spectroscopy.

Crane, Nicole J.; Elster, Eric A.

2012-01-01

14

The laparoscopically harvested omental flap for deep sternal wound infection  

Microsoft Academic Search

Objective: To report our experience with the laparoscopically harvested omental flap in the treatment of deep sternal wound infection, and to present a modification and introduce two supportive techniques in the perioperative management. Methods: Between June 2005 and September 2007, six patients with grade IV (El Oakley–Wright classification) deep sternal wound infection following a median sternotomy for coronary artery bypass

Jan J. van Wingerden; Matijn E. H. Coret; Christianne A. van Nieuwenhoven; Eric R. Totté

2010-01-01

15

Negative-pressure wound therapy enhances local inflammatory responses in acute infected soft-tissue wound.  

PubMed

Clinical studies found that negative-pressure wound therapy (NPWT) displayed significant clinical benefits in the healing of infected wounds. However, the effect of NPWT on local inflammatory responses in acute infected soft-tissue wound has not been investigated thoroughly. The purpose of this study was to test the impact of NPWT on local expression of proinflammatory cytokines, amount of neutrophils, and bacterial bioburden in wound from acute infected soft-tissue wounds. Full-thickness wounds were created on the back of rabbits, and were inoculated with Staphylococcus aureus strain ATCC29213. The wounds were treated with sterile saline-moistened gauze dressings and NPWT with continuous negative pressure (-125 mmHg). Wound samples were harvested on days 0 (6 h after bacterial inoculation), 2, 4, 6, and 8 at the center of wound beds before irrigation for real-time PCR analysis of gene expression of IL-1?, IL-8, and TNF-?. Wound biopsies were examined histologically for neutrophil quantification in different layers of tissue. Quantitative bacterial cultures at the same time point were analyzed for bacterial clearance. Application of NPWT to acute infected wounds in rabbits was compared with treatment with sterile saline-moistened gauze, over an 8-day period. NPWT-treated wounds exhibited earlier and greater peaking of IL-1? and IL-8 expression and decrease in TNF-? expression over the early 4 days (P < 0.05). Furthermore, histologic examination revealed that significantly increased neutrophil count was observed in the shallow layer in wound biopsies of NPWT treatment at day 2 (P < 0.001). In addition, there was a statistically significant decrease of bacteria load from baseline (day 0) at days 2 and 8 in NPWT group (P < 0.05). In conclusion, this study demonstrates that NPWT of acute infected soft-tissue wounds leads to increased local IL-1? and IL-8 expression in early phase of inflammation, which may trigger accumulation of neutrophils and thus accelerate bacterial clearance. Meanwhile, the success of NPWT in the treatment of acute wounds can attenuate the expression of TNF-?, and the result may partly explain how NPWT can avoid significantly impairing wound healing. PMID:24748178

Liu, Daohong; Zhang, Lihai; Li, Tongtong; Wang, Guoqi; Du, Hailong; Hou, Hongping; Han, Li; Tang, Peifu

2014-09-01

16

Effect of chitosan acetate bandage on wound healing in infected and noninfected wounds in mice  

PubMed Central

HemCon® bandage is an engineered chitosan acetate preparation designed as a hemostatic dressing, and is under investigation as a topical antimicrobial dressing. We studied its effects on healing of excisional wounds that were or were not infected with Staphylococcus aureus, in normal mice or mice previously pretreated with cyclophosphamide (CY). CY significantly suppressed wound healing in both the early and later stages, while S. aureus alone significantly stimulated wound healing in the early stages by preventing the initial wound expansion. CY plus S. aureus showed an advantage in early stages by preventing expansion, but a significant slowing of wound healing in later stages. In order to study the conflicting clamping and stimulating effects of chitosan acetate bandage on normal wounds, we removed the bandage from wounds at times after application ranging from 1 hour to 9 days. Three days application gave the earliest wound closure, and all application times gave a faster healing slope after removal compared with control wounds. Chitosan acetate bandage reduced the number of inflammatory cells in the wound at days 2 and 4, and had an overall beneficial effect on wound healing especially during the early period where its antimicrobial effect is most important. PMID:18471261

Burkatovskaya, Marina; Castano, Ana P.; Demidova-Rice, Tatiana N.; Tegos, George P.; Hamblin, Michael R.

2010-01-01

17

Effectively Managing Infected Wounds with Hydrofera BlueTM and Negative Pressure Wound Therapy  

Microsoft Academic Search

SUMMARY: CASE #1: This 45-year-old female presented following surgical debridement of an infected wound that was closed in the Emergency Department following a traumatic event. Hydrofera BlueTM and NPWT was initiated immediately post-operatively.

Debra J. Peterson; Karre Hermann; Jeffrey A. Niezgoda

2005-01-01

18

Dermal wound transcriptomic responses to Infection with Pseudomonas aeruginosa versus Klebsiella pneumoniae in a rabbit ear wound model  

PubMed Central

Background Bacterial infections of wounds impair healing and worsen scarring. We hypothesized that transcriptome analysis of wounds infected with Klebsiella pneumoniae (K.p.) or Pseudomonas aeruginosa (P.a.) would indicate host-responses associated with the worse healing of P.a.- than K.p.-infected wounds. Methods Wounds created on post-operative day (POD) 0 were infected during the inflammatory phase of healing on POD3 and were harvested on POD4 for microarray and transcriptome analysis. Other wounds received topical antibiotic after infection for 24 hours to promote biofilm development, and were harvested on POD6 or POD12. Results Wounds infected for 24 hours, relative to uninfected wounds, elevated transcripts of immune-response functions characteristic of infiltrating leukocytes. But P.a.-infected wounds elevated many more transcripts and to higher levels than K.p.-infected wounds. Coincidently, suppressed transcripts of both wounds enriched into stress-response pathways, including EIF2 signaling; however, this was more extensive for P.a.-infected wounds, including many-fold more transcripts enriching in the ‘cell death’ annotation, suggesting resident cutaneous cell toxicity in response to a more damaging P.a. inflammatory milieu. The POD6 wounds were colonized with biofilm but expressed magnitudes fewer immune-response transcripts with no stress-response enrichments. However, elevated transcripts of P.a.-infected wounds were inferred to be regulated by type I interferons, similar to a network unique to P.a.-infected wounds on POD4. On POD12, transcripts that were more elevated in K.p.-infected wounds suggested healing, while transcripts more elevated in P.a.-infected wounds indicated inflammation. Conclusions An extensive inflammatory response of wounds was evident from upregulated transcripts 24 hours after infection with either bacterium, but the response was more intense for P.a.- than K.p.-infected wounds. Coincidently, more extensive down-regulated transcripts of P.a.-infected wounds indicated a stronger “integrated stress response” to the inflammatory milieu that tipped more toward cutaneous cell death. Unique to P.a.-infected wounds on POD4 and POD6 were networks inferred to be regulated by interferons, which may result from intracellular replication of P.a. These data point to specific downregulated transcripts of cells resident to the wound as well as upregulated transcripts characteristic of infiltrating leukocytes that could be useful markers of poorly healing wounds and indicators of wound-specific treatments for improving outcomes. PMID:25035691

2014-01-01

19

Successful treatment of an infected wound in infants by a combination of negative pressure wound therapy and arginine supplementation  

Microsoft Academic Search

ObjectiveWound dehiscence caused by surgical site infection (SSI) presents a complicated problem. Negative pressure wound therapy (NPWT) was developed to treat wound dehiscence. Nutritional treatment using arginine has also been recently shown to be effective for the treatment of pressure ulcers. Therefore, wound complications due to SSI were treated using NPWT combined with nutritional therapy with an arginine-rich supplement (ARS).

Kouji Masumoto; Kouji Nagata; Yoichiro Oka; Hiroki Kai; Sadako Yamaguchi; Mika Wada; Tsuyoshi Kusuda; Toshiro Hara; Shin-ichi Hirose; Akinori Iwasaki; Tomoaki Taguchi

2011-01-01

20

Should infected laparotomy wounds be treated with negative pressure wound therapy?  

PubMed

A best evidence topic in surgery was written according to a structured protocol. The question addressed whether there is any benefit in treating infected laparotomy wounds with negative pressure wound therapy (NPWT). Forty-five papers were found using the reported search; of which 4 represented the best evidence to answer the question. The evidence on this subject is limited; there is a single non-randomised controlled trial, 2 prospective cohort studies, and 1 retrospective cohort study discussed in this paper. From the available literature, the use of NPWT in infected laparotomy wounds does reduce the length of hospital stay, the number of dressing changes required and promote faster wound healing. PMID:24246173

Tan, A; Gollop, N D; Klimach, S G; Maruthappu, M; Smith, S F

2014-01-01

21

Negative pressure wound therapy for the treatment of sternal wound infections after cardiac surgery.  

PubMed

We retrospectively collected and analysed data from patients with sternal wound infections between 1995 and 2001, which were treated with different wound management strategies, and compared them with our patients from 2002 to 2011, who were treated with the sternal negative pressure wound therapy (NPWT). From 1995 to 2001, a total of 198 patients (group A) with a mean age of 65 ± 10 years developed sternal wound infection (67% deep) after cardiac surgery. Wound management consisted of surgical debridement and immediate sternal closure or open packing. From 2002 to 2011, a total of 326 patients (group B) (71% deep) were managed with NPWT at the time of surgical debridement. Total mortality was 10% in group A and 3·6% in group B. Recurrence rates were 34 and 8·5%, respectively, for the groups A and B. The meantime of NPWT was 11 days. In group B patients, 75% proceeded to sternal closure. With the introduction of NPWT, the treatment of sternal wound infections could be substantially improved. Particularly, the high recurrence rates could be minimised; furthermore, the goal to salvage the sternal bone is facilitated. PMID:22943741

Fleck, Tatjana; Fleck, Michael

2014-06-01

22

Oxygen, wound healing and the development of infection. Present status.  

PubMed

Wounds do not heal in tissue that does not bleed and almost always heal in tissue that bleeds extensively. A continuous supply of oxygen to the tissue is vital for the healing process and to resist infection. External factors may decrease the peripheral oxygen supply, but supplementary perioperative oxygen reduces the surgical wound infection rate to half in patients having colorectal resections. Hyperbaric oxygen may be beneficial when the flow and oxygen supply to the healing tissue are compromised by local injury and particularly if anaerobic infection is present. Assessment of perfusion and oxygenation is essential during and after surgery. PMID:12375606

Gottrup, Finn

2002-01-01

23

Negative Pressure Wound Therapy of Chronically Infected Wounds Using 1% Acetic Acid Irrigation  

PubMed Central

Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix. PMID:25606491

Lee, Byeong Ho; Lee, Hye Kyung; Kim, Hyoung Suk; Moon, Min Seon; Suh, In Suck

2015-01-01

24

Management of human and animal bite wound infection: An overview  

Microsoft Academic Search

Animal and human bite wounds can lead to serious infections. The organisms recovered generally originate from the biter’s\\u000a oral cavity and the victim’s skin flora. Anaerobes were isolated from more than two thirds of human and animal bite infections.\\u000a Streptococcus pyogenes is often recovered in human bites, Pasteurella multocida in animal bites, Eikenella corrodens in animal and human, Capnocytophaga spp,

Itzhak Brook

2009-01-01

25

Topical antimicrobials for burn wound infections.  

PubMed

Throughout most of history, serious burns occupying a large percentage of body surface area were an almost certain death sentence because of subsequent infection. A number of factors such as disruption of the skin barrier, ready availability of bacterial nutrients in the burn milieu, destruction of the vascular supply to the burned skin, and systemic disturbances lead to immunosuppression combined together to make burns particularly susceptible to infection. In the 20th century the introduction of antibiotic and antifungal drugs, the use of topical antimicrobials that could be applied to burns, and widespread adoption of early excision and grafting all helped to dramatically increase survival. However the relentless increase in microbial resistance to antibiotics and other antimicrobials has led to a renewed search for alternative approaches to prevent and combat burn infections. This review will cover patented strategies that have been issued or filed with regard to new topical agents, preparations, and methods of combating burn infections. Animal models that are used in preclinical studies are discussed. Various silver preparations (nanocrystalline and slow release) are the mainstay of many approaches but antimicrobial peptides, topical photodynamic therapy, chitosan preparations, new iodine delivery formulations, phage therapy and natural products such as honey and essential oils have all been tested. This active area of research will continue to provide new topical antimicrobials for burns that will battle against growing multidrug resistance. PMID:20429870

Dai, T; Huang, Y Y; Sharma, S K; Hashmi, J T; Kurup, D B; Hamblin, M R

2010-06-01

26

Topical Antimicrobials for Burn Wound Infections  

PubMed Central

Throughout most of history, serious burns occupying a large percentage of body surface area were an almost certain death sentence because of subsequent infection. A number of factors such as disruption of the skin barrier, ready availability of bacterial nutrients in the burn milieu, destruction of the vascular supply to the burned skin, and systemic disturbances lead to immunosuppression combined together to make burns particularly susceptible to infection. In the 20th century the introduction of antibiotic and antifungal drugs, the use of topical antimicrobials that could be applied to burns, and widespread adoption of early excision and grafting all helped to dramatically increase survival. However the relentless increase in microbial resistance to antibiotics and other antimicrobials has led to a renewed search for alternative approaches to prevent and combat burn infections. This review will cover patented strategies that have been issued or filed with regard to new topical agents, preparations, and methods of combating burn infections. Animal models that are used in preclinical studies are discussed. Various silver preparations (nanocrystalline and slow release) are the mainstay of many approaches but antimicrobial peptides, topical photodynamic therapy, chitosan preparations, new iodine delivery formulations, phage therapy and natural products such as honey and essential oils have all been tested. This active area of research will continue to provide new topical antimicrobials for burns that will battle against growing multi-drug resistance. PMID:20429870

Dai, Tianhong; Huang, Ying-Ying; Sharma, Sulbha K.; Hashmi, Javad T.; Kurup, Divya B.; Hamblin, Michael R.

2010-01-01

27

G-CSF enhances resolution of Staphylococcus aureus wound infection in an age-dependent manner.  

PubMed

This study tested the hypothesis that heightened bacterial colonization and delayed wound closure in aged mice could be attenuated by granulocyte colony-stimulating factor (G-CSF) treatment. Previously, we reported that aged mice had elevated bacterial levels, protracted wound closure, and reduced wound neutrophil accumulation after Staphylococcus aureus wound infection relative to young mice. In aseptic wound models, G-CSF treatment improved wound closure in aged mice to rates observed in young mice. Given these data, our objective was to determine if G-CSF could restore age-associated differences in wound bacterial burden and closure by increasing wound neutrophil recruitment. Young (3- to 4-month) and aged (18- to 20-month) BALB/c mice received three dorsal subcutaneous injections of G-CSF (250 ng/50 ?L per injection) or saline control (50 ?L per injection) 30 min after wound infection. Mice were killed at days 3 and 7 after wound infection, and bacterial colonization, wound size, wound leukocyte accumulation, and peripheral blood were evaluated. At days 3 and 7 after wound infection, bacterial colonization was significantly reduced in G-CSF-treated aged mice to levels observed in saline-treated young animals. Wound size was reduced in G-CSF-treated aged animals, with no effect on wound size in G-CSF-treated young mice. Local G-CSF treatment significantly enhanced neutrophil wound accumulation in aged mice, whereas there was no G-CSF-induced change in young mice. These data demonstrate that G-CSF enhances bacterial clearance and wound closure in an age-dependent manner. Moreover, G-CSF may be of therapeutic potential in the setting of postoperative wound infection or chronic nonhealing wounds in elderly patients. PMID:23856924

Brubaker, Aleah L; Kovacs, Elizabeth J

2013-10-01

28

Spacecraft bacterium, Paenibacillus pasadenensis, causing wound infection in humans  

PubMed Central

In a patient with mediastinitis after cardiac surgery Paenibacillus pasadenensis was detected in his sternal wound. Paenibacilli are gram-positive, aerobic, bacteria related to bacilli. Until recently these organisms were not known to cause human disease. A few cases of human infection caused by another member of this genus, P alvei, have been reported. The authors describe the first infection with P pasadenensis in humans. P pasadenensis was detected by broad-range bacterial 16S rRNA PCR. Treatment consisted of surgical debridement and antibiotics, vancomycin and ciprofloxacin followed by clindamycin and ciprofloxacin, resulting in complete recovery. PMID:22802471

Anikpeh, Y Flammer; Keller, P; Bloemberg, GV; Grünenfelder, J; Zinkernagel, A S

2010-01-01

29

Postoperative wound infection in 32,000 clean operations.  

PubMed

The frequencies of postoperative wound infection in clean operations have been registered at a county hospital (Falun, Sweden) during a 15-year period (1958-1972). A total of 64,000 operations were done and about 32,000 of these have been registered as clean operations. In 1968 the wards were transformed from 12-bed rooms to 5-bed rooms and the operating theatres were rebuilt. All premises were equipped with high pressure air ventilation including lock system. Furthermore, a new intensive care unit and a new awakening unit were built. The overall postoperative wound infection (sepsis) rate during this 15-year period was 1.7 percent. The infection rates in the 5-year period before and in the 5-year period after opening of the new buildings were the same: 1.6 percent. After adding postoperative infections (sepsis) and postoperative inflammatory reactions, the total rates were almost the same: 4.1 percent before and 4.2 percent after. A slight rise in staphylococcal infections has been registered. This rise might suggest that the expected positive effects of the new buildings have been counteracted by other exogenous and endogenous factors. Some of these factors have been discussed (rise in mean age etc.). On the basis of this investigation it seems likely that the management (in all respects) of the surgical patients is still of the greatest importance, regardless of fine new buildings. PMID:1007788

Leissner, K H

1976-01-01

30

Supplemental Intravenous Crystalloid Administration Does Not Reduce the Risk of Surgical Wound Infection  

PubMed Central

Wound perfusion and oxygenation are important determinants of the development of postoperative wound infections. Supplemental fluid administration significantly increases tissue oxygenation in surrogate wounds in the subcutaneous tissue of the upper arm in perioperative surgical patients. We tested the hypothesis that supplemental fluid administration during and after elective colon resections decreases the incidence of postoperative wound infections. Patients undergoing open colon resection were randomly assigned to small (n=124, 8 mL·kg-1·h-1) or large volume (n=129, 16-18 mL·kg-1·h-1) fluid management. Our major outcomes were two distinct criteria for diagnosis of surgical wound infections: 1) purulent exudate combined with a culture positive for pathogenic bacteria and 2) Center for Disease Control criteria for diagnosis of surgical wound infections. All wound infections diagnosed using either criterion by a blinded observer in the 15 days following surgery were considered in the analysis. Wound healing was evaluated with the ASEPSIS scoring system. Of the patients given small fluid administration, 14 had surgical wound infections; 11 given large fluid therapy had infections, P=0.46. ASEPSIS wound healing scores were similar in both groups: 7±16 (small volume) vs. 8±14 (large volume), P=0.70. Our results suggest that supplemental hydration in the range tested does not impact wound infection rate. PMID:16244030

Kabon, Barbara; Akça, Ozan; Taguchi, Akiko; Nagele, Angelika; Jebadurai, Ratnaraj; Arkilic, Cem F.; Sharma, Neeru; Ahluwalia, Arundhathi; Galandiuk, Susan; Fleshman, James; Sessler, Daniel I.; Kurz, Andrea

2005-01-01

31

Dynamics of Neutrophil Infiltration during Cutaneous Wound Healing and Infection Using Fluorescence Imaging  

E-print Network

Dynamics of Neutrophil Infiltration during Cutaneous Wound Healing and Infection Using Fluorescence wound healing under condition that promotes excessive or impaired infiltration. For instance, prolonged recruitment is also associated with delayed wound healing (Devalaraja et al., 2000; Mori et al., 2004; Miller

Simon, Scott I.

32

Investigation of lysine acrylate containing poly(N-isopropylacrylamide) hydrogels as wound dressings in normal and infected wounds.  

PubMed

The design of materials for cutaneous wound dressings has advanced from passive wound covers to bioactive materials that promote skin regeneration and prevent infection. Crosslinked poly(N-isopropylacrylamide) (PNIPAAm)-based hydrogels have been investigated for a number of biomedical applications. While these materials can be used for drug delivery, limited cell interactions restrict their biological activity. In this article, acryoyl-lysine (A-Lys) was incorporated into poly(ethylene glycol) crosslinked PNIPAAm to enhance biological activity. A-Lys could be incorporated into the hydrogels to improve cellular interaction in vitro, while maintaining swelling properties and thermoresponsive behavior. Polyhexamethylene biguanide, an antimicrobial agent, could be encapsulated and released from the hydrogels and resulted in decreased bacteria counts within 2 hours. Two in vivo animal wound models were used to evaluate the hydrogel wound dressing. First, application of the hydrogels to a rodent cutaneous wound healing model resulted in significant increase in healing rate when compared with controls. Moreover, the hydrogels were also able to decrease bacteria levels in an infected wound model. These results suggest that PNIPAAm hydrogels containing A-Lys are promising wound dressings due to their ability to promote healing and deliver active antimicrobial drugs to inhibit infection. PMID:22121043

Jiang, Bin; Larson, Jeffery C; Drapala, Pawel W; Pérez-Luna, Víctor H; Kang-Mieler, Jennifer J; Brey, Eric M

2012-04-01

33

Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures  

Microsoft Academic Search

Background. Diabetes mellitus is a risk factor for deep sternal wound infection after open heart surgical procedures. We previously showed that elevated postoperative blood glucose levels are a predictor of deep sternal wound infection in diabetic patients. Therefore, we hypothesized that aggressive intravenous pharmacologic control of postoperative blood glucose levels would reduce the incidence of deep sternal wound infection.Methods. In

Anthony P Furnary; Kathryn J Zerr; Gary L Grunkemeier; Albert Starr

1999-01-01

34

Experimental phage therapy of burn wound infection: difficult first steps  

PubMed Central

Antibiotic resistance has become a major public health problem and the antibiotics pipeline is running dry. Bacteriophages (phages) may offer an ‘innovative’ means of infection treatment, which can be combined or alternated with antibiotic therapy and may enhance our abilities to treat bacterial infections successfully. Today, in the Queen Astrid Military Hospital, phage therapy is increasingly considered as part of a salvage therapy for patients in therapeutic dead end, particularly those with multidrug resistant infections. We describe the application of a well-defined and quality controlled phage cocktail, active against Pseudomonas aeruginosa and Staphylococcus aureus, on colonized burn wounds within a modest clinical trial (nine patients, 10 applications), which was approved by a leading Belgian Medical Ethical Committee. No adverse events, clinical abnormalities or changes in laboratory test results that could be related to the application of phages were observed. Unfortunately, this very prudent ‘clinical trial’ did not allow for an adequate evaluation of the efficacy of the phage cocktail. Nevertheless, this first ‘baby step’ revealed several pitfalls and lessons for future experimental phage therapy and helped overcome the psychological hurdles that existed to the use of viruses in the treatment of patients in our burn unit. PMID:25356373

Rose, Thomas; Verbeken, Gilbert; Vos, Daniel De; Merabishvili, Maya; Vaneechoutte, Mario; Lavigne, Rob; Jennes, Serge; Zizi, Martin; Pirnay, Jean-Paul

2014-01-01

35

Preventing Deep Wound Infection after Coronary Artery Bypass Grafting  

PubMed Central

The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include prolonged perfusion time, the use of one or more internal mammary arteries as grafts, blood transfusion, and mechanical circulatory assistance. The chief postoperative risk factor is reoperation, usually for bleeding. Unresolved issues include the optimal approach to Staphylococcus aureus nasal colonization and the choice of a prophylactic antibiotic regimen. We recommend that cardiac surgery programs supplement their audit processes and ongoing vigilance for infections with periodic, multidisciplinary reviews of best-practice standards for preoperative, intraoperative, and postoperative patient care. PMID:23678210

Bryan, Charles S.; Yarbrough, William M.

2013-01-01

36

The use of collatamp g, local gentamicin-collagen sponge, in reducing wound infection.  

PubMed

Abstract We conducted a retrospective study to examine the role of Collatamp G in reducing postoperative surgical site infection (SSI) in patients with different wound classes. Ninety-two patients (62 men and 30 women; mean age, 58 years; range, 29-88 years) who had undergone surgery between December 2009 and November 2011 in Tan Tock Seng Hospital and who had application of Collatamp G in their wound before closure were included in the study. The primary endpoint was the development of any superficial wound infection within 1 month postoperatively. Of 92 patients studied, 9 (10%) developed a superficial wound infection. Two of 43 patients with clean-contaminated wounds (5%), 2 of 19 with contaminated wounds (11%), and 5 of 30 with dirty-infected wounds (16%) developed infection. Use of the larger size Collatamp G (10 × 10 cm) also appears to have a lower incidence of SSI compared with the smaller Collatamp G (5 × 5 cm); 4% and 12%, respectively. Our data suggest that postoperative SSI was reduced in the group of patients with dirty-infected wound class. SSI appears to be decreased with use of the larger size Collatamp G. PMID:25216422

Chia, Clement L K; Shelat, Vishal G; Low, Wilson; George, Sheena; Rao, Jaideepraj

2014-01-01

37

Thermal injury induces impaired function in polymorphonuclear neutrophil granulocytes and reduced control of burn wound infection  

PubMed Central

Severe thermal injury induces immunosuppression, involving all parts of the immune system, especially when large fractions of the total body surface area are affected. An animal model was established to characterize the burn-induced immunosuppression. In our novel mouse model a 6% third-degree burn injury was induced in mice with a hot-air blower. The third-degree burn was confirmed histologically. The mice were allocated into five groups: control, shave, burn, infection and burn infection group. At 48 h, a decline in the concentration of peripheral blood leucocytes was observed in the group of mice with burn wound. The reduction was ascribed to the decline in concentration of polymorphonuclear neutrophil leucocytes and monocytes. When infecting the skin with Pseudomonas aeruginosa, a dissemination of bacteria was observed only in the burn wound group. Histological characterization of the skin showed a more polymorphonuclear neutrophil granulocytes (PMNs)-dominated inflammation in the group of mice with infected burn wound compared with the with burn wound group. In contrast, a higher degree of inflammation was observed in the burn wound group compared with the group of mice with infected burn wound. Furthermore, the oxidative burst and the phagocytic capacity of the PMNs were reduced in the group of mice with burn wound. Using this novel mouse model of thermal injury a decline of peripheral leucocytes was observed, whereas the increased local inflammatory response at the site of infection showed reduced capacity to contain and eliminate the infection. PMID:19210518

Calum, H; Moser, C; Jensen, P Ø; Christophersen, L; Maling, D S; van Gennip, M; Bjarnsholt, T; Hougen, H P; Givskov, M; Jacobsen, G K; Høiby, N

2009-01-01

38

Combined treatment with chlorhexidine and 0·9% saline in a newborn infant with an infected surgical wound.  

PubMed

Newborns are more susceptible to infection; this makes proper wound care extremely important in them. Unfortunately, in spite of successful surgery, patients can die as a result of wound area infections. Herein, we report a case in which a combined therapy of chlorhexidine (a disinfectant) and saline (a cleansing agent used in wound care) was used effectively to treat the wound in a newborn infant with an antibiotic-resistant, Gram-negative, bacteria-related surgical site infection. PMID:25483281

Tekgündüz, Kadir ?erafettin; Kepenekli, Eda; Demirelli, Ya?ar; Caner, Ibrahim; Kara, Mustafa

2014-12-01

39

A Rat Model of Diabetic Wound Infection for the Evaluation of Topical Antimicrobial Therapies  

PubMed Central

Diabetes mellitus is an epidemic multisystemic chronic disease that frequently is complicated by complex wound infections. Innovative topical antimicrobial therapy agents are potentially useful for multimodal treatment of these infections. However, an appropriately standardized in vivo model is currently not available to facilitate the screening of these emerging products and their effect on wound healing. To develop such a model, we analyzed, tested, and modified published models of wound healing. We optimized various aspects of the model, including animal species, diabetes induction method, hair removal technique, splint and dressing methods, the control of unintentional bacterial infection, sampling methods for the evaluation of bacterial burden, and aspects of the microscopic and macroscopic assessment of wound healing, all while taking into consideration animal welfare and the ‘3Rs’ principle. We thus developed a new wound infection model in rats that is optimized for testing topical antimicrobial therapy agents. This model accurately reproduces the pathophysiology of infected diabetic wound healing and includes the current standard treatment (that is, debridement). The numerous benefits of this model include the ready availability of necessary materials, simple techniques, high reproducibility, and practicality for experiments with large sample sizes. Furthermore, given its similarities to infected-wound healing and treatment in humans, our new model can serve as a valid alternative for applied research. PMID:22330650

Mendes, João J; Leandro, Clara I; Bonaparte, Dolores P; Pinto, Andreia L

2012-01-01

40

Novel technique for avoidance of pressure competition between a negative pressure wound therapy device and chest drains in the management of deep sternal wound infections.  

PubMed

In recent years, the use of negative pressure wound therapy (NPWT) devices has changed the way sternal wound infections are being managed. It is not uncommon for deep sternal wound infections to occur together with mediastinal or even pleural collections requiring underwater seal drainage. In these patients in whom there is a communication between the pleural and mediastinal cavities, the concomitant use of an NPWT device negates the pressure gradient within the pleural and mediastinal drains, allowing suppurative fluid to stagnate. We present a novel technique to address this limitation of NPWT devices in patients with sternal wound infections that communicate with a pleural collection. PMID:25415315

Davis, James S; Kourliouros, Antonios; Deshpande, Ranjit; Cavale, Naveen

2014-11-18

41

Binge Ethanol Leads to Decreased Macrophage Accumulation in Infected Cutaneous Wounds  

Microsoft Academic Search

Trauma patients who consumed alcohol prior to sustaining injuries have higher rates of morbidity and mortality than those with comparable injuries who did not drink. Additionally, those who drank had impaired wound healing and increased susceptibility to infection. Despite these clinical observations, few studies have explored the effect of ethanol on the innate immune cell function in a healing wound

Sara Hlavin

2012-01-01

42

The Healing Effect of Scrophularia Striata on Experimental Burn Wounds Infected to Pseudomonas Aeruginosa in Rat  

PubMed Central

BACKGROUND The cause of death in burn patients after 48 hours of hospitalization has been reported to be bacterial infections. Recently, due to the compounds accelerating the healing process and the intense reduction of treatment side effects, medicinal plants are used to cure burn wound infections. This study aims to investigate the medicinal effect of the ethanolic extract of Scrophularia striata on burn wound infection in in-vivo and in-vitro in comparison with silver sulfadiazine (SSD). METHODS One hundred and fifty male Sprague Dawley rats were divided into 3 equal groups. A hot plate of 1×1cm was used to create second degree burn wounds. The ethanolic extract of S. striata was provided through percolation method. Group 1 was treated with SSD, group 2 with S. striata, and group 3 was considered as control group. All animals were infected to Pseudomonas aeruginosa. On days 3, 7, 10, 14, and 21 after burn wound injury, the animals were euthanized and were evaluated histologically. The MIC and MBC were determined using the micro dilution method. RESULTS The rate of wound healing was significantly greater in S. striata group in comparison to SSD and control groups. CONCLUSION S. striata contains was shown to have anti-bacterial and wound healing effects while this effect was significantly more than SSD denoting to its use when needed for burn wounds infected to P. aeruginosa. PMID:25606472

Tanideh, Nader; Haddadi, Mohammad Hossein; Rokni-Hosseini, Mohammad Hossein; Hossienzadeh, Masood; Mehrabani, Davood; Sayehmiri, Kourosh; Koohi-Hossienabadi, Omid

2015-01-01

43

Burn Wound Infections and Antibiotic Susceptibility Patterns at Pakistan Institute of Medical Sciences, Islamabad, Pakistan  

PubMed Central

BACKGROND Burn wound infections carry considerable mortality and morbidity amongst burn injury victims who have been successfully rescued through the initial resuscitation. This study assessed the prevalent microrganisms causing burn wound infections among hospitalized patients; their susceptibility pattern to commonly used antibiotics; and the frequency of infections with respect to the duration of the burn wounds. METHODS This study was carried out at Burn Care Centre, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan over a period of two years (i.e. from June 2010 to May 2012). The study included all wound-culture-positive patients of either gender and all ages, who had sustained deep burns and underwent definitive management with wound excisions and skin auto-grafting. Patients with negative cultures of the wounds were excluded. Tissue specimens for culture and sensitivity were collected from burn wounds using standard collection techniques and analyzed at microbiological laboratory. RESULTS Out of a total of 95 positive microbial growths, 36 were Pseudomonas aeruginosa (35.29%) as the most frequent isolate found, followed by 21 Klebsiella pneumoniae (20.58%), 19 Staphylococcus aureaus (18.62%), 10 Proteus (9.80%), 7 E. coli (6.86%), 7 Acinetobacter (6.86%), and 4 Candida (3.92%). A variable antibiotic susceptibility pattern was observed among the grown microbes. Positive cultures were significantly more frequent among patients with over two weeks duration of burn wounds. CONCLUSION P. aeruginosa, K. pneumoniae and S. aureus constituted the most common bacterial microbes of burn wounds in our in-patients cases. Positive cultures were more frequent among patients with over two weeks duration of burn wounds. Early excision and skin grafting of deep burns and adherence to infection control measures can help to effectively reduce the burden of these infections. PMID:25606471

Saaiq, Muhammad; Ahmad, Shehzad; Zaib, Muhammad Salman

2015-01-01

44

Incidence and risk factors for caesarean wound infection in Lagos Nigeria  

PubMed Central

Background Post caesarean wound infection is not only a leading cause of prolonged hospital stay but a major cause of the widespread aversion to caesarean delivery in developing countries. In order to control and prevent post caesarean wound infection in our environment there is the need to access the relative contribution of each aetiologic factor. Though some studies in our environment have identified factors associated with post caesarean wound infection, none was specifically designed to address these issues prospectively or assess the relative contribution of each of the risk factors. Findings Prospective multicentre study over a period of 56 months in Lagos Nigeria. All consecutive and consenting women scheduled for caesarean section and meeting the inclusion criteria were enrolled into the study. Cases were all subjects with post caesarean wound infection. Those without wound infection served as controls. Data entry and analysis were performed using EPI-Info programme version 6 and SPSS for windows version 10.0. Eight hundred and seventeen women were enrolled into the study. Seventy six (9.3%) of these cases were complicated with wound infection. The proportion of subjects with body mass index greater than 25 was significantly higher among the subjects with wound infection (51.3%) than in the subjects without wound infection (33.9%) p = 0.011. There were also significantly higher proportions of subjects with prolonged rupture of membrane (p = 0.02), prolonged operation time (p = 0.001), anaemia (p = 0.031) and multiple vaginal examinations during labour (0.021) among the women that had wound infection compared to the women that did not have wound infection. After adjustment for confounders only prolonged rupture of membrane (OR = 4.45), prolonged operation time (OR = 2.87) and body max index > 25 (2.34) retained their association with post caesarean wound infection. Conclusion Effort should be geared towards the prevention of prolonged rupture of fetal membrane and the reduction of prolonged operation time by the use of potent antibiotics, early intervention and use of good surgical technique. In obese women improved surgical technique and use of non absorbable sutures may suffice. PMID:19772612

Ezechi, Oliver C; Edet, Asuquo; Akinlade, Hakim; Gab-Okafor, Chidinma V; Herbertson, Ebiere

2009-01-01

45

Postoperative wound dealing and superficial surgical site infection in open radical prostatectomy.  

PubMed

The number of open radical prostatectomy (RP) surgeries has been decreasing owing to the spread of laparoscopic and robotic surgery, which has implications for postoperative wound healing. The purpose of this study was to investigate and document the current status of postoperative wound healing and superficial surgical site infection (SSI) in open RPs. One hundred and seventy-five antegrade RPs with the same or similar kinds of prophylactic antibiotic administration were divided into two groups: (i) 'no intervention' (wound covering group) and (ii) 'washing', using a washing solution from the second postoperative day to the day of skin staple removal (wound washing group). We compared these groups for the occurrence of superficial SSI. The wound covering group had three (3·03%) cases of superficial SSI, with one case caused by methicillin sensitive Staphylococcus aureus (MSSA). The wound washing group had nine (11·8%) cases of superficial SSI, with three cases caused by MSSA, two cases caused by methicillin resistant Staphylococcus aureus (MRSA) and one by Pseudomonas aeruginosa. The wound covering group showed a significantly lower ratio of superficial SSI (P?=?0·0472). In conclusion, the postoperative wound status data in this study suggests that no wound intervention after RP resulted in a comparatively lower ratio of superficial SSI than in the wound washing group. PMID:25186077

Yamamichi, Fukashi; Shigemura, Katsumi; Yamashita, Mauso; Tanaka, Kazushi; Arakawa, Soishi; Fujisawa, Masato

2014-09-01

46

Definition of infection in chronic wounds by Dutch nursing home physicians.  

PubMed

This study investigated the number and type of chronic wounds actually treated by Dutch nursing home physicians (NHPs). It was also the goal to know how many of the treated chronic wounds they considered infected. The NHPs were asked to choose and rank their top five out of several provided criteria for chronic wound infection. After this, the ranking was compared with the choices an international multidisciplinary Delphi group of wound experts made in 2005. A cross-sectional descriptive survey was conducted using the information from a self-reported questionnaire in a representative sample of Dutch NHPs. About 361 NHPs (25%) were sent a questionnaire. Of the 361 physicians, 139 (38.5%) filled in and returned the questionnaire of which 121 were valid. Of the NHPs, 73.5% actually treated at least one chronic pressure ulcers (PU), whereas 26.5% did not treat any. Of the responding NHPs,31.6 % treated at least one, but never more than two chronic post surgical wounds , whereas 68.4% of the NHPs treated none [corrected]. Chronic venous leg ulcers, arterial ulcers and diabetic ulcers scored infrequently and less than the other two sorts of chronic wounds. Of the Dutch NHPs, 53% considered that none of the PU infected. The other chronic wounds were judged far less frequently to be infected. Dutch NHPs appeared to use more 'traditional' criteria such as 'puss/abscess' and 'malodour' to identify infection and did not change their criteria by wound type. According to this study, NHPs do not frequently see many chronic wounds. The most frequent type of wounds treated was PU. For NHPs, the identification of infection of all types of chronic wounds is difficult. The use of criteria that is not in line with consensus documents may lead to ineffective treatment and even seriously damage patients: the clinical identification of infection is still dependent on experts' opinion. Further research on triggers for the suspicion of wound infection and the development of an evidence-based guideline is necessary. PMID:19719523

Rondas, A A L M; Schols, J M G A; Stobberingh, E E; Price, P E

2009-08-01

47

The Human Cathelicidin Antimicrobial Peptide LL-37 as a Potential Treatment for Polymicrobial Infected Wounds  

PubMed Central

Diabetic patients often have ulcers on their lower-limbs that are infected by multiple biofilm-forming genera of bacteria, and the elimination of the biofilm has proven highly successful in resolving such wounds in patients. To that end, antimicrobial peptides have shown potential as a new anti-biofilm approach. The single human cathelicidin peptide LL-37 has been shown to have antimicrobial and anti-biofilm activity against multiple Gram-positive and Gram-negative human pathogens, and have wound-healing effects on the host. The combination of the anti-biofilm effect and wound-healing properties of LL-37 may make it highly effective in resolving polymicrobially infected wounds when topically applied. Such a peptide or its derivatives could be a platform from which to develop new therapeutic strategies to treat biofilm-mediated infections of wounds. This review summarizes known mechanisms that regulate the endogenous levels of LL-37 and discusses the anti-biofilm, antibacterial, and immunological effects of deficient vs. excessive concentrations of LL-37 within the wound environment. Here, we review recent advances in understanding the therapeutic potential of this peptide and other clinically advanced peptides as a potential topical treatment for polymicrobial infected wounds. PMID:23840194

Duplantier, Allen J.; van Hoek, Monique L.

2013-01-01

48

Biofilms and persistent wound infections in United States military trauma patients: a case–control analysis  

PubMed Central

Background Complex traumatic injuries sustained by military personnel, particularly when involving extremities, often result in infectious complications and substantial morbidity. One factor that may further impair patient recovery is the persistence of infections. Surface-attached microbial communities, known as biofilms, may play a role in hindering the management of infections; however, clinical data associating biofilm formation with persistent or chronic infections are lacking. Therefore, we evaluated the production of bacterial biofilms as a potential risk factor for persistent infections among wounded military personnel. Methods Bacterial isolates and clinical data from military personnel with deployment-related injuries were collected through the Trauma Infectious Disease Outcomes Study. The study population consisted of patients with diagnosed skin and soft-tissue infections. Cases (wounds with bacterial isolates of the same organism collected 14 days apart) were compared to controls (wounds with non-recurrent bacterial isolates), which were matched by organism and infectious disease syndrome. Potential risk factors for persistent infections, including biofilm formation, were examined in a univariate analysis. Data are expressed as odds ratios (OR; 95% confidence interval [CI]). Results On a per infected wound basis, 35 cases (representing 25 patients) and 69 controls (representing 60 patients) were identified. Eight patients with multiple wounds were utilized as both cases and controls. Overall, 235 bacterial isolates were tested for biofilm formation in the case–control analysis. Biofilm formation was significantly associated with infection persistence (OR: 29.49; CI: 6.24-infinity) in a univariate analysis. Multidrug resistance (OR: 5.62; CI: 1.02-56.92), packed red blood cell transfusion requirements within the first 24 hours (OR: 1.02; CI: 1.01-1.04), operating room visits prior to and on the date of infection diagnosis (OR: 2.05; CI: 1.09-4.28), anatomical location of infected wound (OR: 5.47; CI: 1.65-23.39), and occurrence of polymicrobial infections (OR: 69.71; CI: 15.39-infinity) were also significant risk factors for persistent infections. Conclusions We found that biofilm production by clinical strains is significantly associated with the persistence of wound infections. However, the statistical power of the analysis was limited due to the small sample size, precluding a multivariate analysis. Further data are needed to confirm biofilm formation as a risk factor for persistent wound infections. PMID:24712544

2014-01-01

49

Validation of a Novel Murine Wound Model of Acinetobacter baumannii Infection  

PubMed Central

Patients recovering from traumatic injuries or surgery often require weeks to months of hospitalization, increasing the risk for wound and surgical site infections caused by ESKAPE pathogens, which include A. baumannii (the ESKAPE pathogens are Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species). As new therapies are being developed to counter A. baumannii infections, animal models are also needed to evaluate potential treatments. Here, we present an excisional, murine wound model in which a diminutive inoculum of a clinically relevant, multidrug-resistant A. baumannii isolate can proliferate, form biofilms, and be effectively treated with antibiotics. The model requires a temporary, cyclophosphamide-induced neutropenia to establish an infection that can persist. A 6-mm-diameter, full-thickness wound was created in the skin overlying the thoracic spine, and after the wound bed was inoculated, it was covered with a dressing for 7 days. Uninoculated control wounds healed within 13 days, whereas infected, placebo-treated wounds remained unclosed beyond 21 days. Treated and untreated wounds were assessed with multiple quantitative and qualitative techniques that included gross pathology, weight loss and recovery, wound closure, bacterial burden, 16S rRNA community profiling, histopathology, peptide nucleic acid-fluorescence in situ hybridization, and scanning electron microscopy assessment of biofilms. The range of differences that we are able to identify with these measures in antibiotic- versus placebo-treated animals provides a clear window within which novel antimicrobial therapies can be assessed. The model can be used to evaluate antimicrobials for their ability to reduce specific pathogen loads in wounded tissues and clear biofilms. Ultimately, the mouse model approach allows for highly powered studies and serves as an initial multifaceted in vivo assessment prior to testing in larger animals. PMID:24342634

Thompson, Mitchell G.; Black, Chad C.; Pavlicek, Rebecca L.; Honnold, Cary L.; Wise, Matthew C.; Alamneh, Yonas A.; Moon, Jay K.; Kessler, Jennifer L.; Si, Yuanzheng; Williams, Robert; Yildirim, Suleyman; Kirkup, Benjamin C.; Green, Romanza K.; Hall, Eric R.; Palys, Thomas J.

2014-01-01

50

Effectiveness of Electrolyzed Oxidized Water Irrigation in a Burn-Wound Infection Model  

Microsoft Academic Search

Objective: The purpose of the study was to determine whether electrolyzed ox- idized water (EOW) functions as a bacte- ricide in burn injury with Pseudomonas aeruginosa infection in a rat burn-wound model. Methods: Anesthetized Sprague- Dawley rats (n 5 31) were subjected to third-degree burns to 30% of total body surface area. Two days after injury, all rats were infected

Hajime Nakae; Hideo Inaba

2000-01-01

51

Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation  

Microsoft Academic Search

Objective: To provide a definition for recurrent sternal infection (RSI), analyse the risk factors and describe the management of this complication following treatment of deep sternal wound infection (DSWI) with horizontal titanium sternal osteosynthesis and coverage with pectoralis major myocutaneous flaps. Methods: Between 2002 and 2007, 10665 patients were submitted to open-heart surgery (OHS) in our institution, of whom 149

Geneviève Gaudreau; Victor Costache; Chanel Houde; Daniel Cloutier; Livia Montalin; Pierre Voisine; Richard Baillot

2010-01-01

52

Wound management with vacuum-assisted closure in postoperative infections after surgery for spinal stenosis  

PubMed Central

Objective To evaluate the results of negative-pressure wound therapy (NPWT) in the treatment of surgical spinal site infections. Materials and methods The use of NPWT in postoperative infections after dorsal spinal surgery (transforaminal lumbar interbody fusion plus posterior instrumentation) was studied retrospectively. From February 2011 to January 2012, six patients (females) out of 317 (209 females; 108 males) were readmitted to our clinic with surgical site infections on postoperative day 14 (range 9–19) and were treated with debridement, NPWT, and antibiotics. We evaluated the clinical and laboratory data, including the ability to retain the spinal hardware and recurrent infections. Results The incidence of deep postoperative surgical site infection was six (1.89%) patients (females) out of 317 patients (209 females; 108 males) at 1 year. All patients completed their wound NPWT regimen successfully. An average of 5.1 (range 3–8) irrigation and debridement sessions was performed before definitive wound closure. The mean follow-up period was 13 (range 12–16) months. No patient had a persistent infection requiring partial or total hardware removal. The hospital stay infection parameters normalized within an average of 4.6 weeks. Conclusion The study illustrates the usefulness of NPWT as an effective adjuvant treatment option for managing complicated deep spinal surgical wound infections.

Karaaslan, Fatih; Erdem, ?evki; Mermerkaya, Musa U?ur

2015-01-01

53

Polypragmasia in the therapy of infected wounds – conclusions drawn from the perspectives of low temperature plasma technology for plasma wound therapy  

PubMed Central

As long as a wound is infected, the healing process cannot begin. The indication for wound antiseptic is dependent on the interaction between the wound, the causative micro-organisms, and the host immune system. An uncritical colonisation is a condition whereby micro-organisms on a wound will proliferate, yet the immune system will not react excessively. Wound antiseptic is most often not necessary unless for epidemiologic reasons like colonisation with multi-resistant organisms. In most instances of a microbial contamination of the wound and colonisation, thorough cleaning will be sufficient. Bacterial counts above 105 to 106 cfu per gram tissue (critical colonisation) might decrease wound healing due to release of toxins, particularly in chronic wounds. Traumatic and heavily contaminated wounds therefore will require anti-infective measures, in particular wound antiseptic. In such situations, even a single application of an antiseptic compound will significantly reduce the number of pathogens, and hence, the risk of infection. If a wound infection is clinically manifest, local antiseptics and systemic antibiotics are therapeutically indicated. The prophylactic and therapeutic techniques for treatment of acute and chronic wounds (chemical antiseptics using xenobiotics or antibiotics, biological antiseptic applying maggots, medical honey or chitosan, physical antiseptic using water-filtered infrared A, UV, or electric current) mostly have been empirically developed without establishing a fundamental working hypothesis for their effectiveness. The most important aspect in controlling a wound infection and achieving healing of a wound is meticulous debridement of necrotic material. This is achieved by surgical, enzymatic or biological means e.g. using maggots. However, none of these methods (with some exception for maggots) is totally gentle to vital tissue and particularly chemical methods possess cytotoxicity effects. Derived from the general principles of antiseptic wound treatment, the following working hypothesis is postulated: the most ideal constellation for treatment of wounds is the superficial destruction of microbial layers without deep tissue alteration, like it is caused by antiseptics, in order not to endanger the regenerative granulation tissue. At the same time, it is desirable to support and increase cell proliferation and granulation capacities. These two aspects might be achieved by using low temperature plasma technology. PMID:20204115

Kramer, Axel; Hübner, Nils-Olaf; Weltmann, Klaus-Dieter; Lademann, Jürgen; Ekkernkamp, Axel; Hinz, Peter; Assadian, Ojan

2008-01-01

54

A Case of Continuous Negative Pressure Wound Therapy for Abdominal Infected Lymphocele after Kidney Transplantation  

PubMed Central

Lymphocele is a common complication after kidney transplantation. Although superinfection is a rare event, it generates a difficult management problem; generally, open surgical drainage is the preferred method of treatment but it may lead to complicated postoperative course and prolonged healing time. Negative pressure wound therapy showed promising outcomes in various surgical disciplines and settings. We present a case of an abdominal infected lymphocele after kidney transplantation managed with open surgery and negative pressure wound therapy. PMID:25374744

Franchin, Marco; Tozzi, Matteo; Soldini, Gabriele; Piffaretti, Gabriele

2014-01-01

55

Towards understanding Pseudomonas aeruginosa burn wound infections by profiling gene expression  

Microsoft Academic Search

Pseudomonas aeruginosa is a key opportunistic pathogen causing severe acute and chronic nosocomial infections in immunocompromised or catheterized\\u000a patients. It is prevalent in burn wound infections and it is generally multi-drug resistant. Understanding the genetic programs\\u000a underlying infection is essential to develop highly needed new strategies for prevention and therapy. This work reviews expression\\u000a profiling efforts conducted worldwide towards gaining

Piotr Bielecki; Justyna Glik; Marek Kawecki; Vítor A. P. Martins dos Santos

2008-01-01

56

Analysis of blood flow and local expression of angiogenesis?associated growth factors in infected wounds treated with negative pressure wound therapy.  

PubMed

Angiogenesis is involved in the wound healing process. Increased angiogenesis and blood flow constitute a major mechanism of negative pressure wound therapy (NPWT), which has been shown to facilitate the healing of infected wounds. However, the effect on the expression of angiogensis?related growth factor remains unknown. The goal of the current study was to investigate the angiogenic factor levels prior to and following NPWT in infected wounds. A total of 20 patients with infected wounds treated with NPWT were included in the study. Patients acted as their own control; the postoperative measurements of patients were considered as the experimental group, while preoperative measurements were considered as the controlled group. Blood flow was recorded prior to and during NPWT. A total of 10 angiogensis?related growth factors were detected using a protein biochip array to analyze the change in protein levels prior to NPWT, and on the third day during NPWT. All wounds were successfully reconstructed by skin grafting or using local flaps following NPWT. NPWT resulted in significantly increased blood flow in the wound. There was a significant increase in vascular endothelial growth factor (VEGF), EGF, platelet?derived growth factor and angiotesin?2 following NPWT, while basic fibroblast growth factor decreased significantly. NPWT affects the local expression of angiogenesis?associated growth factors, which represents another mechanism to explain how NPWT accelerates wound healing. PMID:24584462

Xia, Cheng-Yan; Yu, Ai-Xi; Qi, Baiwen; Zhou, Min; Li, Zong-Huan; Wang, Wei-Yang

2014-05-01

57

Collagen bilayer dressing with ciprofloxacin, an effective system for infected wound healing.  

PubMed

Bacterial wound infection is a major problem, which hinders the normal healing process. In this study, a collagen bilayer dressing with ciprofloxacin was prepared from succinylated type-I collagen; FT-IR spectroscopy, SEM analysis, in vitro drug release pattern, antimicrobial activity and in vivo efficacy of the dressing were studied. The healing pattern was analyzed on days 3, 5, 7, 14 and 21 by wound healing rate, bacterial population, biochemical and histological examinations of tissue samples. FT-IR spectra showed the succinylation of collagen and ionic binding of ciprofloxacin to succinylated collagen. SEM analysis showed uniform drug distribution in collagen sponge and in vitro drug release pattern showed a release profile for 3 days with effective drug concentration confirmed by zone of inhibition. Ciprofloxacin counter-acted the effect of invading bacteria, as could be seen by considerable reduction in total bacterial population of the wound. In vivo analysis showed significant wound closure, biochemical analysis, such as protein, DNA, hydroxyproline, SOD, catalase, hexosamine and uronic acid from the granulation tissue, showed enhanced healing in the group treated with collagen bilayer dressing with ciprofloxacin. Histological analysis and wound closure further confirmed proper healing. Our results suggest that sustained release of ciprofloxacin from a collagen bilayer dressing eliminates bacteria at the site of infection, leaving a pathogen-free wound environment, and it can be used as a dressing for an on-site delivery system. PMID:17471769

Sripriya, Ramasamy; Kumar, Muthusamy Senthil; Ahmed, Mohamed Rafiuddin; Sehgal, Praveen Kumar

2007-01-01

58

Prevena™, negative pressure wound therapy applied to closed Pfannenstiel incisions at time of caesarean section in patients deemed at high risk for wound infection.  

PubMed

The aim of our retrospective study is to report on our experience using the Prevena™ wound system in obese patients undergoing caesarean section delivery. A total of 26 cases were identified from July 2012 to October 2013. The median BMI of these women was 45.3 kg/m(2). Elective caesarean sections were performed in 20 women (77%). There were four cases (15%) of superficial dehiscence. Factors associated with wound breakdown were wound infection (p = 0.03), increasing BMI (p < 0.001) and emergency LSCS (p = 0.04). In a logistic regression model the presence of infection was the only factor which remained associated with wound breakdown. Wound disruption is a major cause of morbidity following caesarean section in morbidly obese patients. The wound complication rate in our experience was low with the Prevena™ dressing with no cases of sheath dehiscence, and no patient required a second operation. The presence of infection is the most important factor in wound breakdown and should be the focus for management protocols. PMID:25383909

Anglim, B; O'Connor, H; Daly, S

2014-11-10

59

A rare cause of wound infection after an open fracture: Shewanella putrefaciens  

PubMed Central

An elderly gentleman presented with an open fracture of the calcaneum and ankle, following a boating accident. Despite treatment with repeated surgical debridement, delayed closure, prolonged antibiotics and strict adherence to national guidelines on the management of open fractures, he developed a wound infection with a rare organism, Shewanella putrefaciens, that appears to be increasing in prevalence. PMID:23417948

Prinja, Aditya; Singh, Jagwant; Davis, Nwaka; Urwin, Gillian

2013-01-01

60

Burn wounds infected by contaminated water: case reports, review of the literature and recommendations for treatment.  

PubMed

First-aid education for the management of burns advocates cool running water over burnt skin to limit soft tissue damage. However, the water used may itself constitute a risk. We report three cases of severe invasive and necrotizing infection in patients who used or immersed themselves in contaminated water in an attempt to extinguish the fire following acute major burns. Wound cultures from all patients yielded Aeromonas hydrophila and two yielded Bacillus cereus. One patient had a complex polymicrobial infection, including zygomycosis with Rhizomucor variabilis. All patients were treated aggressively with wound débridement, including one patient who required bilateral lower limb amputations to control progressive infection. All infections were successfully treated and all patients survived their burn injuries. We review the management of burns complicated by exposure to contaminated water leading to burn wound infections. We describe commonly reported organisms from various water sources, the appropriate initial empirical antimicrobial chemotherapy and present the clinician with a proposed algorithm for managing these serious infections. PMID:19501977

Ribeiro, Noel F F; Heath, Christopher H; Kierath, Jessica; Rea, Suzanne; Duncan-Smith, Mark; Wood, Fiona M

2010-02-01

61

IL-33 promotes Staphylococcus aureus-infected wound healing in mice.  

PubMed

Interleukin (IL)-33, a newly identified member of IL-1 family of cytokines, plays a crucial role in polarizing Th2-associated immune responses. Recently growing evidence indicates that IL-33 also represents an important mediator of mucosal healing and epithelial restoration. In this study, we investigated the effect of IL-33 on antimicrobial infection and wound healing using a Staphylococcus aureus-infected incision model in mice. Our findings showed that the expression of IL-33 mRNA and protein was promptly increased in cutaneous wound tissues when challenged by methicillin-resistant S. aureus (MRSA). At the same time, exogenous IL-33 administration profoundly inhibited MRSA colonization and accelerated cutaneous wound repair. IL-33 upregulation promoted the proliferation of neutrophils and CXCR2 expression, which is related to augmented neutrophil trafficking into infectious sites for bactericidal effect. In addition, the beneficial effect of IL-33 is also implicated in enhancement of collagen deposition and the expression of extracellular matrix (ECM)-associated genes such as fibronectin and collagen IIIa, which implies a potential effect of IL-33 on matrix synthesis and reepithelialization during the wound repair process. All together, these findings reveal that IL-33 plays an essential effect in maintenance of cutaneous homeostasis and improvement of infectious wound healing. PMID:23892028

Yin, Hui; Li, Xiangyong; Hu, Shilian; Liu, Tao; Yuan, Baohong; Ni, Qian; Lan, Fang; Luo, Xiaochun; Gu, Hongbiao; Zheng, Fang

2013-10-01

62

Combination of photodynamic and ultrasonic therapy for treatment of infected wounds in animal model  

NASA Astrophysics Data System (ADS)

One of the important problems of modern medicine is treatment of infected wounds. There are many diversified expedients of treatment, but none of them obey the modern physician completely. The aim of this study is to develop and test a new combined method of photodynamic ultrasonic therapy (PDUST) for treatment of infected wounds with focus on experimental trials. PDUST is based on a combination of two methods: photodynamic (PD) therapy (PDT) with photosensitizer and low frequency ultrasonic (US) therapy with antibiotic as tools for treatment of wounds and effectively killing bacteria. The main parameters are: US frequency - 26.5 kHz; US tip elongation - 40+/-20 ?m wavelength of light emitting diodes (LED) array - 660+/-10 nm; light intensity on biotissue surface - 1-2 mW/cm2; photosensitizer - an aluminum disulfonated phtalocyanine dissolved in a physiological solution in concentration 10 mg/l. The experiments were carried out with 70 male chinchilla rabbits divided into 7 groups, thus the dynamics of wounds healing were studied in different modes of PDUST. The PD and US methods supplement each other and in conjunction provide additive and especially synergetic effects. The experimental data demonstrated advantages of new technology in comparison with conventional methods in cases of treatment of extended suppurative inflammatory and profound wounds. The more detailed study of PDUST method's mechanism, which is based on low intensity of LED light, PD therapy and US influence is required.

Menyaev, Yulian A.; Zharov, Vladimir P.

2006-02-01

63

Fungus gnat feeding and mechanical wounding inhibit Pythium aphanidermatum infection of geranium seedlings.  

PubMed

ABSTRACT A series of laboratory tests were conducted to investigate potential effects of fungus gnat (Bradysia impatiens) feeding damage on susceptibility of geranium seedlings (Pelargonium x hortorum) to infection by the root rot pathogen Pythium aphanidermatum. Effects were compared with those from similar tests in which the seedlings were mechanically wounded by severing the root tip with a scalpel. Assays of geranium seedlings in petri dishes revealed a pronounced negative fungus gnat-Pythium interaction, with exposure to fungus gnat larvae 24 h prior to inoculation with P. aphanidermatum zoospores resulting in up to 47% fewer seedling deaths than would have been expected if the two agents had acted independently. Similar results were observed when seedlings were subjected to mechanical wounding 24 h prior to zoospore inoculation. In contrast, no interaction occurred when seedlings were mechanically wounded immediately prior to inoculation. The degree of plant damage inflicted by the feeding activities of the larval fungus gnats had no significant effect on the combined damage from fungus gnats and Pythium in petri dishes. Ancillary studies showed that Pythium development on V8 agar was not inhibited by the presence of fungus gnat-associated microorganisms, nor were seedlings inoculated with these microbes less susceptible to Pythium infection. The precise mechaism or mechanisms underlying the observed interactions were not elucidated; however, the results strongly suggest that both fungus gnat feeding and mechanical wounding activated systemic defenses that made the seedlings more resistant to Pythium infection. PMID:19900009

Braun, S E; Sanderson, J P; Nelson, E B; Daughtrey, M L; Wraight, S P

2009-12-01

64

Elevated testosterone and reduced 5-HIAA concentrations are associated with wounding and hantavirus infection in male Norway rats  

PubMed Central

Among rodents that carry hantaviruses, males are more likely to engage in aggression and to be infected than females. One mode of hantavirus transmission is via the passage of virus in saliva during wounding. The extent to which hantaviruses cause physiological changes in their rodent host that increase aggression and, therefore, virus transmission has not been fully documented. To assess whether steroid hormones and neurotransmitters contribute to the correlation between aggression and Seoul virus infection, Norway rats were trapped in Baltimore, Maryland and wounding, infection status, steroid hormones, and concentrations of neurotransmitters, including norepinephrine (NE), dopamine (DA), 3,4-dihydroxyphenol acetic acid (DOPAC), serotonin (5-HT), and 5-hydroxyindole-3-acetic acid (5-HIAA) in select brain regions were examined. Older males and males with high-grade wounds were more likely to have anti-Seoul virus IgG and viral RNA in organs than either juveniles or adult males with less severe wounds. Wounded males had higher circulating testosterone, lower hypothalamic 5-HIAA, and lower NE in the amygdala than males with no wounds. Infected males had higher concentrations of testosterone, corticosterone, NE in the hypothalamus, and DOPAC in the amygdala than uninfected males, regardless of wounding status. In the present study, wounded males that were infected with Seoul virus had elevated testosterone and reduced 5-HIAA concentrations, suggesting that these neuroendocrine mechanisms may contribute to aggression and the likelihood of transmission of hantavirus in natural populations of male Norway rats. PMID:17719050

Easterbrook, Judith D.; Kaplan, Jenifer B.; Glass, Gregory E.; Pletnikov, Mikhail V.; Klein, Sabra L.

2007-01-01

65

Effect of hBD2 genetically modified dermal multipotent stem cells on repair of infected irradiated wounds.  

PubMed

Deficiencies in repair cells and infection are two of the main factors that can hinder the process of wound healing. In the present study, we investigated the ability of human beta-defensin-2 (hBD2) genetically modified dermal multipotent stem cells (dMSCs) to accelerate the healing irradiated wounds complicated by infections. An hBD2 adenovirus expression vector (Adv-hBD2) was firstly constructed and used to infect dMSCs. The antibacterial activity of the supernatant was determined by Kirby-Bauer method and macrodilution broth assay. Time to complete wound healing, residual percentage of wound area, and the number of bacteria under the scar were measured to assess the effects of Adv-hBD2-infected dMSC transplantation on the healing of irradiated wounds complicated by Pseudomonas aeruginosa infection. Results showed that the supernatant from Adv-hBD2-infected dMSCs had obvious antibacterial effects. Transplantation of Adv-hBD2-infected dMSCs killed bacteria in the wound. The complete wound healing time was 19.8 ± 0.45 days, which was significantly shorter than in the control groups (P < 0.05). From 14 days after transplantation, the residual wound area was smaller in the experimental group than in the control groups (P < 0.05). In conclusion, we found that transplantation of hBD2 genetically modified dMSCs accelerated the healing of wounds complicated by P. aeruginosa infection in whole body irradiated rats. PMID:20921824

Zong, Zhao-Wen; Li, Nan; Xiao, Tao-Yuan; Su, Yong-Ping; Dong, Shi-Wu; Wang, Jun-Ping; Zhang, Lian-Yang; Shen, Yue; Shi, Chun-Meng; Cheng, Tian-Min

2010-01-01

66

The Healing Effect of Licorice on Pseudomonas aeruginosa Infected Burn Wounds in Experimental Rat Model  

PubMed Central

BACKGROUND Burn is still one of the most devastating injuries in emergency medicine while improvements in wound healing knowledge and technology have resulted into development of new dressings. This study was undertaken to evaluate the healing effect of licorice in Pseudomonas aeruginosa infected burn wounds of experimental rat model. METHODS One hundred and twenty female Sprague-Dawley rats were randomly allocated to 4 equal groups. Group A received silver sulfadiazine ointment, Group B received 10% licorice extract and Group C was considered as control group and received gel base as the base of medication. Group D did not receive any medication and just underwent burn injury. A standard 3rd degree burn wound was produced by a hot plate with similar size about 20% of total body surface area (TBSA) and at identical temperature. After 24 h of burn production, 108 colony forming units (CFU) of toxigenic strains of P. aeruginosa (PA 103) were inoculated subcutaneously into the burnt area. After 3, 7, 14, 21 and 28 days of therapy, the animals were sacrificed and burn areas were macroscopically examined and histologically evaluated. RESULTS Decrease in size of the burn wounds, in inflammation and re-epithelialization were poor in groups B-D. Infection to P. aeruginosa was still visible in groups B-D but was absent in Group A. The mean histological score, tensile strength, maximum stress, yield strength and stiffness in groups B-D were lower compared with Group A. CONCLUSION Licorice extract in 10% concentration was shown not to be effective in healing of P. aeruginosa infected burn wounds. PMID:25489532

Tanideh, Nader; Rokhsari, Pedram; Mehrabani, Davood; Mohammadi Samani, Soleiman; Sabet Sarvestani, Fatemeh; Ashraf, Mohammad Javad; Koohi Hosseinabadi, Omid; Shamsian, Shahram; Ahmadi, Nasrollah

2014-01-01

67

The influence of absorbable subcuticular staples, continuous subcuticular absorbable suture, and percutaneous metal skin staples on infection in contaminated wounds.  

PubMed

Wound infection is a threatening, troublesome, and costly complication contributing to increased mortality and morbidity. The methods and materials used to close a wound significantly influence the quality of the repair process and the risk of surgical site infection. Six pigs were used to evaluate the influence of four separate skin-closure modalities on the potentiation of infection in contaminated wounds. Full-thickness skin wounds on the abdomen were contaminated with S. aureus and then closed with one of four devices: a novel absorbable staple (InsorbTM) placed in the subcuticular tissue; a braided absorbable suture (VicrylTM); a monofilament absorbable suture (MonocrylTM); percutaneous metal staples. Wound infection was assessed 7 days after closure by clinical signs and quantitative bacterial swabs. InsorbTM staples had significantly lower infection rates than continuous VicrylTM (39% vs. 100%, p=0.002) or MonocrylTM suture (39% vs. 89%, p=0.014). The InsorbTM subcuticular staple and the metal percutaneous skin staple were statistically equivalent in wound infection rate and parameters of inflammation. The combined data for both interrupted staple modalities documented less inflammation compared to the combined data for continuous sutures. These lower levels of inflammatory metrics were statistically significant for edema (p=0.018), gauze exudate observed (p=0.007) and purulent exudate in wound (p<0.0001). In conclusion, InsorbTM staples were shown to be an acceptable choice for the closure of contaminated wounds because they had a significantly lower incidence of wound infection and inflammation when compared to continuous intradermal suture. PMID:23428250

Pineros-Fernandez, Angela; Salopek, Lisa S; Rodeheaver, Pamela F; Rodeheaver, George

2012-01-01

68

A prospective, randomized pilot evaluation of topical triple antibiotic versus mupirocin for the prevention of uncomplicated soft tissue wound infection.  

PubMed

Little data exists comparing the safety and efficacy of triple antibiotic ointment (TAO) and mupirocin for prevention of uncomplicated soft tissue wound infections. The purpose of this investigation was to conduct a pilot study of the relative safety, efficacy, and cost effectiveness of the 2 preparations. This was a randomized, prospective, interventional study to determine the difference in infection rates of uncomplicated soft tissue wounds between subjects treated with TAO and mupirocin ointment after standard wound care and suturing. Subjects were enrolled at presentation to the ED if they met the study inclusion criteria and were required to make one follow-up visit to the ED to determine the status of their wound (infected vs. not infected). A total of 99 patients were enrolled and assessed at the follow-up visit. The groups had similar rates of self-reported compliance with wound care and dressing changes. Patients in the mupirocin group had a greater rate of signs of infection (12% vs. 6.1%), and infection (4% vs. 0%) compared with patients in the TAO group, although neither difference achieved statistical significance. There were no serious adverse effects in either group. This pilot study found a similar rate of wound infection and adverse events between TAO and mupirocin ointments. Results should be confirmed in a larger equivalency trial. PMID:14724869

Hood, Robert; Shermock, Kenneth M; Emerman, Charles

2004-01-01

69

Dual-functional polyurea microcapsules for chronic wound care dressings: sustained drug delivery and non-leaching infection control.  

E-print Network

??A new design of dual-functional polyurea microcapsules was proposed for chronic wound dressings to provide both non-leaching infection control and sustained topical drug delivery functionalities.… (more)

He, Wei

2012-01-01

70

The Physiology of Suberization: Roles in Resistance to Infection During Wound-Healing and in the Pink Eye Syndrome  

Technology Transfer Automated Retrieval System (TEKTRAN)

The suberized cells of potato native periderm and wound periderm provide broad and durable protection against infection, dehydration and other problems affecting tuber market quality. Suberization and maintenance of the resulting suberin barrier involve complex processes of great economic importanc...

71

Use of chitosan bandage to prevent fatal infections developing from highly contaminated wounds in mice  

Microsoft Academic Search

HemCon® bandage is an engineered chitosan acetate preparation used as a hemostatic control dressing, and its chemical structure suggests that it should also be antimicrobial. We tested its ability to rapidly kill bacteria in vitro and in mouse models of infected wounds. We used the Gram-negative species Pseudomonas aeruginosa and Proteus mirabilis and the Gram-positive Staphylococcus aureus that had all

Marina Burkatovskaya; George P Tegos; Emilia Swietlik; Tatiana N Demidova; Ana P Castano; Michael R. Hamblin

2006-01-01

72

Contribution of Quorum Sensing to the Virulence of Pseudomonas aeruginosa in Burn Wound Infections  

Microsoft Academic Search

The Pseudomonas aeruginosa quorum-sensing systems, las and rhl, control the production of numerous virulence factors. In this study, we have used the burned-mouse model to examine the contribution of quorum-sensing systems to the pathogenesis of P. aeruginosa infections in burn wounds. Different quorum- sensing mutants of P. aeruginosa PAO1 that were defective in the lasR, lasI ,o rrhlI gene or

KENDRA P. RUMBAUGH; JOHN A. GRISWOLD; BARBARA H. IGLEWSKI; ABDUL N. HAMOOD

1999-01-01

73

Honey as an Antimicrobial Agent Against Pseudomonas Aeruginosa Isolated from Infected Wounds  

PubMed Central

Background: As natural products garner attention in the medical field due to emergence of antibiotic resistant strains of bacteria, honey is valued for its antibacterial activity. Objective: Fifty strains of Pseudomonas aeruginosa isolated from infected wounds were evaluated for their antibacterial action using honey in comparison with different antibiotics and Dettol. Methodology and Results: All the strains were found to be sensitive to honey at a minimum inhibitory concentration of 20% in comparison with Dettol at 10% using agar dilution method. In the second step, the time kill assay was performed on five isolates of P. aeruginosa to demonstrate the bactericidal activity of honey at different dilutions of honey ranging from 20% to 100% at regular time intervals. All the isolates of P. aeruginosa tested were killed in 12-24 h depending on the dilutions of the honey tested. Thus, honey could prevent the growth of P. aeruginosa even if it was diluted by deionized water by fivefolds in vitro. Honey had almost uniform bactericidal activity against P. aeruginosa irrespective of their susceptibility to different classes of antibiotics. Conclusion: Honey which is a natural, non-toxic, and an inexpensive product has activity against the P. aeruginosa isolated from infected wounds may make it an alternative topical choice in the treatment of wound infections. PMID:22754244

Shenoy, Vishnu Prasad; Ballal, Mamatha; Shivananda, PG; Bairy, Indira

2012-01-01

74

Soft Tissue and Wound Infections Due to Enterococcus spp. Among Hospitalized Trauma Patients in a Developing Country  

PubMed Central

Soft tissue and wound infections due to Enterococcus spp. are increasing worldwide with current need to understand the epidemiology of the Enterococcal infections of wounds. Hence, we have looked into the distribution of Enterococcus spp. responsible for causing wound and soft tissue infections among trauma patients, its antibiotic resistance pattern and how it affects the length of hospital stay and mortality. A laboratory cum clinical-based study was performed over a period of 3 years at a level I trauma center in New Delhi, India. Patients with Enterococcal wound and soft tissue infections were identified using the hospital data base, their incidence of soft tissue/wound infections calculated, drug resistance pattern and their possible risk factors as well as outcomes analyzed. A total of 86 non-repetitive Enterococcus spp. was isolated of which E. faecium were maximally isolated 48 (56%). High level of resistance was seen to gentamicin HLAR in all the species of Enterococcus causing infections whereas a low level resistance to vancomycin and teicoplanin was observed among the isolates. Longer hospital stay, repeated surgical procedure, prior antibiotic therapy and ICU stay were observed to associate with increased morbidity (P < 0.05) and hence, more chances of infections with VRE among the trauma patients. The overall rate of wound and soft tissue infections with Enterococcus sp. was 8.6 per 1,000 admissions during the study period. Enterococcal wound infection is much prevalent in trauma care facilities especially in the ICUs. Here, a microbiologist can act as a sentinel, help in empirical therapeutic decisions and also in preventing such infections.

Rajkumari, Nonika; Mathur, Purva; Misra, Mahesh Chandra

2014-01-01

75

Efficiency of controlled topical delivery of silver sulfadiazine in infected burn wounds.  

PubMed

The present study is designed to assess the potential benefits of controlled delivery of silver sulfadiazine from collagen scaffold (SSDM-CS) in infected deep partial thickness burn wounds in which epidermis is lost completely and the entire papillary dermis and most of the recticular layer of the dermis is lost. Infection induced by inoculating 10(7) colony forming units (cfu) of Pseudomonas aeruginosa caused significant increase in wound size (20%) till day 15, which decreased significantly from day 9 by SSDM-CS treatment, showing complete healing by day 27 (control > or = 37 days). Early subsidence of infection (<10(2) cfu, day 9) by SSDM-CS resulted in faster epidermal resurfacing and fibroplasia, whereas heavy microbial load (>10(7) cfu, day 9) in controls caused severe inflammatory cellular infiltration. Persistent infection triggered early expression of proinflammatory cytokines intereukin-6, intereukin 1-beta, and tumor necrosis factor-alpha, lasting until day 9, whereas cytokine level decreased in SSDM-CS-treated group by day 6. Infection exacerbated expression of active matrix metalloproteinases (MMPs)-2 and -9 in controls (day 15), while SSDM-CS positively modulated MMP-2 and -9 with faster decline in their levels (day 12). Inherent nature of the dressing to maintain drug level at equilibrium therapeutic concentration (51.2 microg/mL) for prolonged time (72 h), below systemic toxic limits (20 microg/dL, serum level), accelerated the magnitude and sequence of reparative events. PMID:18431769

Shanmugasundaram, N; Uma, T S; Ramyaa Lakshmi, T S; Babu, Mary

2009-05-01

76

Pexiganan-incorporated collagen matrices for infected wound-healing processes in rat.  

PubMed

The use of peptide-based drugs is limited by their rapid degradability and toxicity at high concentration during their therapeutic application. These problems could be managed by the use of a peptide delivery agent for sustained release in the site of action. Collagen is one of the most proven biomaterials of good biocompatibility with an exceptional ligand encapsulating property. In this work, we have shown that pexiganan, an antimicrobial, 22-amino-acid peptide could be incorporated and delivered to the wound-healing site against bacterial strains Pseudomonas aeruginosa and Staphylococcus aureus. The release profiles of pexiganan collagen films with different collagen concentration were studied. The release of pexiganan from 2.5% w/w of collagen film showed a sustainable activity over 72 h with effective antimicrobial concentrations. Pexiganan-incorporated collagen (PIC)-treated groups were compared with open wound (OW)- and collagen film (CF)-treated rats. PIC-treated animals showed a diminishing level of bacterial growth as compared with OW- and CF-treated animals. The biochemical parameters such as hydroxyproline, protein, DNA, uronic acid, hexosamine, SOD, and catalase content in the granulation tissue of the healing wound revealed increased proliferation of cells involved in tissue reconstruction in PIC-treated groups when compared with OW- and CF-treated groups. Furthermore, spectroscopic studies suggested that collagen structure is not perturbed by pexiganan incorporation. This study provides rationale for application of collagen membrane for antimicrobial peptide delivery in infected wounds. PMID:15800884

Gopinath, D; Kumar, M Senthil; Selvaraj, D; Jayakumar, R

2005-06-01

77

Scars and Wounds  

MedlinePLUS

... more References Previous Topic Prostheses Next Topic Seizures Scars and wounds A wound is a physical injury ... protect it from infection and help it heal. Scars are healed wounds. What to look for Redness ...

78

Wound surgery.  

PubMed

The purpose of this article is to review the concepts behind, and practice of, wound surgery. The techniques of wound surgery, born of necessity in the art of military surgeons, have found their renaissance in the modern age of wound care driven by the economic and functional considerations inherent to the outcome-based management of chronic disease. Over 300 years of literature on wound healing has shown an innate ability of the wound (in the absence of infection and repeated trauma) to control its progress, largely through the local inflammatory cells. This article discusses several historical works on wound surgery and healing, topical wound therapy, minimal intervention, and emphasizes the closure of chronic wounds. PMID:21074031

Caldwell, Michael D

2010-12-01

79

Antibacterial Efficacy of Silver-Impregnated Polyelectrolyte Multilayers Immobilized on a Biological Dressing in a Murine Wound Infection Model  

PubMed Central

Objective To investigate the antibacterial effect of augmenting a biological dressing with polymer films containing silver nanoparticles. Background Biological dressings, such as Biobrane, are commonly used for treating partial-thickness wounds and burn injuries. Biological dressings have several advantages over traditional wound dressings. However, as many as 19% of wounds treated with Biobrane become infected, and, once infected, the Biobrane must be removed and a traditional dressing approach should be employed. Silver is a commonly used antimicrobial in wound care products, but current technology uses cytotoxic concentrations of silver in these dressings. We have developed a novel and facile technology that allows immobilization of bioactive molecules on the surfaces of soft materials, demonstrated here by augmentation of Biobrane with nanoparticulate silver. Surfaces modified with nanometer-thick polyelectrolyte multilayers (PEMs) impregnated with silver nanoparticles have been shown previously to result in in vitro antibacterial activity against Staphylococcus epidermidis at loadings of silver that are noncytotoxic. Methods We demonstrated that silver-impregnated PEMs can be nondestructively immobilized onto the surface of Biobrane (Biobrane-Ag) and determined the in vitro antibacterial activity of Biobrane-Ag with Staphylococcus aureus. In this study, we used an in vivo wound infection model in mice induced by topical inoculation of S aureus onto full-thickness 6-mm diameter wounds. After 72 hours, bacterial quantification was performed. Results Wounds treated with Biobrane-Ag had significantly (P < 0.001) fewer colony-forming units than wounds treated with unmodified Biobrane (more than 4 log10 difference). Conclusions The results of our study indicate that immobilizing silver-impregnated PEMs on the wound-contact surface of Biobrane significantly reduces bacterial bioburden in full-thickness murine skin wounds. Further research will investigate whether this construct can be considered for human use. PMID:22609841

Guthrie, Kathleen M.; Agarwal, Ankit; Tackes, Dana S.; Johnson, Kevin W.; Abbott, Nicholas L.; Murphy, Christopher J.; Czuprynski, Charles J.; Kierski, Patricia R.; Schurr, Michael J.; McAnulty, Jonathan F.

2012-01-01

80

Vacuum-assisted closure of necrotic and infected cranial wound with loss of dura mater: A technical note  

PubMed Central

Background: Complex cranial wounds can be a problematic occurrence for surgeons. Vacuum-assisted closure devices have a wide variety of applications and have recently been used in neurosurgical cases involving complex cranial wounds. There is only one report regarding the use of a vacuum-assisted closure device with loss of dura mater. We report a complicated case of a necrotic cranial wound with loss of dura mater. Case Description: A 68-year-old female underwent an evacuation of a subdural hematoma. Postoperatively, the patient developed a wound infection that required removal of the bone flap. The wound developed a wedge-shaped necrosis of the scalp with exposure of brain tissue due to loss of dura mater from previous surgeries. She underwent debridement and excision of the necrotic tissue with placement of a synthetic dural graft (Durepair®, Medtronic, Inc.) and placement of a wound vac. The patient underwent a latissismus dorsi muscle flap reconstruction that subsequently failed. After the wound vac was replaced, the synthetic dural graft was replaced with a fascia lata graft and an anterolateral thigh free flap reconstruction. We describe the technical nuances of this complicated case, how the obstacles were handled, and the literature that discusses the utility. Conclusion: We describe a case of a complex cranial wound and technical nuances on how to utilize a wound-vac with loss of dura mater.

Ahmed, Osama; Storey, Christopher M.; Zhang, Shihao; Chelly, Marjorie R.; Yeoh, Melvin S.; Nanda, Anil

2015-01-01

81

Some Virulence Factors of Staphylococci Isolated From Wound and Skin Infections in Shahrekord, IR Iran  

PubMed Central

Background: Staphylococci release a large number of enzymes. Some of these, such as coagulase, beta- lactamase, hemolysins and biofilms are considered indices of pathogenicity. Objectives: The aim of the current study was based on the isolation and identification of Staphylococcus aureus and coagulase negative Staphylococci (CNS) strains from various skin lesions and examining their biofilms, beta- lactamase, hemolysins production and antibiotic resistance pattern. Materials and Methods: Sixty one infected wounds and 39 skin infections samples were collected and examined. After the culture and identification, examination for production of hemolysins, beta- lactamase, biofilm and susceptibility toward 9 antimicrobials was performed. Results: Out of 75 isolated Staphylococci, sixty (80%) were biofilm producers. Two overall prevalence of 28.5% and 100% of ß-lactamase production were recorded for isolated S. aureus and CNS, respectively. Twenty out of 49 (40.8%), the same number of ?- and ?- hemolytic S. aureus, were isolated while six (12.24%) were ? -hemolysin producers. Twenty two of Twenty six (84.6%) isolates of CNS, were hemolysin producers that all were ? type. The S. aureus isolates from wound infections, show a high sensitivity pattern to all examined antibiotics, this sensitivity pattern for isolates from skin dermatitis is relatively low, though. Conclusions: High percentage of hemolysins, biofilm and beta lactamase production by isolated Staphylococci, suggests an important role of these virulence factors in the pathogenesis of isolated Staphylococci from dermatitis lesions. The S. aureus isolates from wound infections, show a high sensitivity pattern to all examined antibiotics. Only ciprofloxacin was found to be active against all isolates from dedermatitis lesions. PMID:25147697

Ebrahimi, Azizollah; Ghasemi, Maryam; Ghasemi, Bahram

2014-01-01

82

Eradication of a chronic wound and driveline infection after redo-LVAD implantation  

PubMed Central

A 48 year old patient with dilated cardiomyopathy and chronic acne inversa underwent implantation of a LVAD system (Heartmate II, Thoratec, USA) March 2011. During 2011 and 2012 the patient was repeatedly readmitted for treatment of driveline infection with MRSA. Colonization was controlled with Linezolid and Rifampicin however reoccurred after discontinuation. In August 2012 the LVAD-system was exchanged due to pump dysfunction (HVAD, HeartWare Inc., USA). Postoperatively, the patient presented with ascites which secreted through the driveline exit. Consequently, the abdominal wall was surgically corrected to prevent exit of peritoneal fluid through the driveline, and the patient was discharged with sterile wound swabs. However 6 weeks after discharge the driveline exit wound started secreting pus showing abundant growth of multi resistant staphylococcus aureus (MRSA). With clinical signs of increasing liver failure with regular need for paracentesis, and clinical signs of local infection, a CT scan of the abdomen was performed revealing an enrichment of contrast medium along the driveline and an abscess-like formation on the abdominal wall. Patient was admitted receiving regular dose Daptomycin and Rifampicin. The latter was discontinued after ten days. The abscess, surrounding driveline exit and abdominal wall cavity was excised and vacuum treatment initiated. Total duration of Daptomycin therapy was 3 weeks. While first week skin and wound swabs were still positive for MRSA, all samples were sterile after the second week. Inflammation was monitored by leucocyte count and IL6. The secretion of pus along the driveline ceased, the wound cavity was closed subsequently. After discharge and stop of antibiotics skin and driveline swabs remained negative for MRSA (10 weeks). PMID:24685284

2014-01-01

83

Eradication of a chronic wound and driveline infection after redo-LVAD implantation.  

PubMed

A 48 year old patient with dilated cardiomyopathy and chronic acne inversa underwent implantation of a LVAD system (Heartmate II, Thoratec, USA) March 2011. During 2011 and 2012 the patient was repeatedly readmitted for treatment of driveline infection with MRSA. Colonization was controlled with Linezolid and Rifampicin however reoccurred after discontinuation. In August 2012 the LVAD-system was exchanged due to pump dysfunction (HVAD, HeartWare Inc., USA). Postoperatively, the patient presented with ascites which secreted through the driveline exit. Consequently, the abdominal wall was surgically corrected to prevent exit of peritoneal fluid through the driveline, and the patient was discharged with sterile wound swabs. However 6 weeks after discharge the driveline exit wound started secreting pus showing abundant growth of multi resistant staphylococcus aureus (MRSA). With clinical signs of increasing liver failure with regular need for paracentesis, and clinical signs of local infection, a CT scan of the abdomen was performed revealing an enrichment of contrast medium along the driveline and an abscess-like formation on the abdominal wall. Patient was admitted receiving regular dose Daptomycin and Rifampicin. The latter was discontinued after ten days. The abscess, surrounding driveline exit and abdominal wall cavity was excised and vacuum treatment initiated. Total duration of Daptomycin therapy was 3 weeks. While first week skin and wound swabs were still positive for MRSA, all samples were sterile after the second week. Inflammation was monitored by leucocyte count and IL6. The secretion of pus along the driveline ceased, the wound cavity was closed subsequently. After discharge and stop of antibiotics skin and driveline swabs remained negative for MRSA (10 weeks). PMID:24685284

Walter, Veronika; Stock, Ulrich A; Soriano-Romero, Mauricio; Schnitzbauer, Andreas; Moritz, Anton; Beiras-Fernandez, Andres

2014-01-01

84

A Prospective Audit of Complex Wound and Graft Infections in Great Britain and Ireland: the Emergence of MRSA  

Microsoft Academic Search

Background a number of studies have examined the outcome of complex wound and graft infections, but most include small numbers of patients collected over a prolonged period of time. To date, there is little information on the clinical outcome of infections involving methicillin-resistant Staphylococcus aureus (MRSA). Methods between February 1998 and January 1999, two prospective multi-centre audits were performed in

A. R. Naylor; P. D. Hayes; S. Darke

2001-01-01

85

Spectrum and Prevalence of Fungi Infecting Deep Tissues of Lower-Limb Wounds in Patients with Type 2 Diabetes ?  

PubMed Central

The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5- × 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further. PMID:20410345

Chellan, Gopi; Shivaprakash, Shashikala; Karimassery Ramaiyar, Sundaram; Varma, Ajit Kumar; Varma, Narendra; Thekkeparambil Sukumaran, Mangalanandan; Rohinivilasam Vasukutty, Jayakumar; Bal, Arun; Kumar, Harish

2010-01-01

86

Prevention of abdominal wound infection (PROUD trial, DRKS00000390): study protocol for a randomized controlled trial  

PubMed Central

Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390). PMID:22103965

2011-01-01

87

Antimicrobial effect of continuous lidocaine infusion in a Staphylococcus aureus-induced wound infection in a mouse model.  

PubMed

Continuous infusion of local anesthetics in surgical wounds has been shown to be an effective technique for postoperative analgesia. To investigate the potential antimicrobial effect of continuous local anesthetic infusion, we adapted a mouse model of surgical wound infection to examine effects on antibacterial response. Forty male BALB/c mice were randomized into 2 groups. An incision wound was made over the dorsal flank and instilled with Staphylococcus aureus. An osmotic pump was then implanted to deliver either 0.9% NaCl or 2% lidocaine continuously. Each wound was cultured postoperatively at 2 days, and the colony count of S. aureus was determined. Results showed that the number of colony-forming units of S. aureus measured in wounds treated with lidocaine displayed a nearly 10-fold reduction compared to the wounds in the saline group (P=0.009). The demonstrated antibacterial activity indicates that local anesthetic infusion may play a role in prophylaxis for surgical wound infections. PMID:25310128

Lu, Cheng-Wei; Lin, Tzu-Yu; Shieh, Jiann-Shing; Wang, Ming-Jiuh; Chiu, Kuan-Ming

2014-11-01

88

Surgical wound infection by mannitol-nonfermenting Staphylococcus aureus after lumbar microdiscectomy  

PubMed Central

Purulent infection of a surgical wound developed after discectomy, and a mannitol-nonfermenting Staphylococcus aureus isolate was cultivated as the etiologic agent. Nonfermenting S. aureus strains are exceedingly rare and may be erroneously mistaken and dismissed as contaminants. This report then emphasizes that pure and massive cultures must be carefully evaluated, even if preliminary examination does not suggest a pathogenic organism. Also, although mannitol-negative, the studied strain was correctly detected as S. aureus by both the-FISH test (AdvanDx, USA) and the Liofilchem ‘Chromatic Staph aureus’, highlighting that additional diagnostic methods may support recognition of uncommon, nonfermenting S. aureus strains in the daily practice. PMID:24966984

Savini, Vincenzo; Nigro, Raffaele; Marrollo, Roberta; Polilli, Ennio; Campitelli, Irma; Buonaguidi, Roberto; Fazii, Paolo; Carretto, Edoardo

2014-01-01

89

The effect of a honey based gel and silver sulphadiazine on bacterial infections of in vitro burn wounds.  

PubMed

Bacterial contamination remains a constant threat in burn wound care. Topical treatments to combat contaminations have good bactericidal effects but can have detrimental effects for the healing process. Treatments with for example silver can increase healing times. Honey based products can be a good alternative as it is antibacterial and patient-friendly. We evaluated the bactericidal and cytotoxic effects of a honey based gel and silver sulphadiazine in a human burn wound model with Pseudomonas aeruginosa. After adding 10(5)colony forming units of P. aeruginosa, topical treatments were applied on the burn wound models. After 2, 12, 24, 28 and 70 h, bacteria were dislodged and counted by plating dilutions. Cytotoxic effects were evaluated histologically in samples of burn wound models treated topically for 3 weeks, without bacteria. L-Mesitran Soft significantly reduced the bacterial load (5-log reduction) up to 24h but did not completely eliminate bacteria from the burn wounds. After Flammazine(®) treatment, only a few colony forming units were observed at all time points. In contrast, re-epithelialization was significantly reduced after application of Flammazine(®) compared to L-Mesitran Soft or control. This in vitro model of burn wound infection can be used to evaluate topical treatments. L-Mesitran Soft is a good alternative for treating burn wounds but the slightly lower bactericidal activity in the burn wound model warrants a higher frequency of application. PMID:23036845

Boekema, B K H L; Pool, L; Ulrich, M M W

2013-06-01

90

A Study of Post-Caesarean Section Wound Infections in a Regional Referral Hospital, Oman  

PubMed Central

Objectives: The aim of this study was to determine the incidence of surgical site infections (SSI) in patients undergoing a Caesarean section (CS) and to identify risk factors, common bacterial pathogens and antibiotic sensitivity. SSI significantly affect the patient’s quality of life by increasing morbidity and extending hospital stays. Methods: A retrospective cross-sectional study was conducted in Nizwa Hospital, Oman, to determine the incidence of post-Caesarean (PCS) SSI from 2001 to 2012. This was followed by a case-control study of 211 PCS cases with SSI. Controls (220) were randomly selected cases, at the same hospital in the same time period, who had undergone CS without any SSI. Data was collected on CS type, risk factors, demographic profile, type of organism, drug sensitivity and date of infection. Results: The total number of PCS wound infections was 211 (2.66%). There was a four-fold higher incidence of premature rupture of the membranes (37, 17.53%) and a three-fold higher incidence of diabetes (32, 15.16%) in the PCS cases compared with controls. The most common organisms responsible for SSI were Staphylococcus aureus (66, 31.27%) and the Gram-negative Escherichia coli group (40, 18.95%). The most sensitive antibiotics were aminoglycoside and cephalosporin. Polymicrobial infections were noted in 42 (19.90%), while 47 (22.27%) yielded no growth. A high incidence of associated risk factors like obesity, hypertension, anaemia and wound haematoma was noted. Conclusion: Measures are recommended to reduce the incidence of SSI, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with rigorous surgical techniques. PMID:24790744

Dhar, Hansa; Al-Busaidi, Ibrahim; Rathi, Bhawna; Nimre, Eman A.; Sachdeva, Vibha; Hamdi, Ilham

2014-01-01

91

Efficacy and safety of negative pressure wound therapy for Szilagyi grade III peripheral vascular graft infection.  

PubMed

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether it is safe and effective to use negative pressure wound therapy (NPWT) for Szilagyi grade III (i.e. the arterial implant proper involved in the infection) peripheral vascular graft infection. Altogether, 69 papers were found using the reported search. From the search results, reference lists of potentially eligible studies and related citations in PubMed, seven papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In the only randomized, controlled trial that compared NPWT (n = 10) and alginate dressing change (n = 10), the NPWT group demonstrated shorter time to full skin epithelialization (median 57 vs 104 days; P = 0.026). In the other six case series, the recruited case number ranged from 12 to 72. The mode of NPWT varied among the included studies, with the majority using a continuous negative pressure of 125 mmHg. One study combined NPWT and sartorius myoplasty, another used sartorius myoplasty in selected cases and others did not. The mean duration of using NPWT ranged from 14.2 to 43 days. The mean duration to achieve complete wound healing ranged from 24 (the study with sartorius myoplasty) to 51 days. The NPWT treatment failure rate ranged from 0 (the study with sartorius myoplasty) to 25%. The major complication of NPWT was bleeding and the incidence rate was reported to be <10%. We conclude that the amount of evidence for recommending NPWT alone as the first-line treatment for Szilagyi grade III peripheral vascular graft infection is small with only one small-sized randomized controlled trial demonstrating that NPWT alone is superior to alginate dressing change in shortening the time to complete wound healing by 2 months. Limited evidence (case series with >1 year of follow-up) showed that NPWT with a continuous negative pressure of 125 mmHg, or combined NPWT and sartorius myoplasty, may shorten the time to complete wound healing by 2 months, have a >70% success rate, and have a <10% NPWT-related complication rate. PMID:25185571

Cheng, Hsu-Tang; Hsu, Yung-Chang; Wu, Chao-I

2014-12-01

92

[Treatment of the infected wound with exposed silver-ring vascular graft and delayed Thiersch method of skin transplant covering ].  

PubMed

Although the incidence of prosthetic infection is low (1%-6%), the consequences (limb loss or death) are dramatic for a patient, with high mortality rate (25%-75%) and limb loss in 40%-75% of cases. In case of Szilagyi's grade III infection, standard procedure consists of the excision of prosthesis and wound debridement. Alternative method is medical treatment. This is a case report of a patient with prosthetic infection of Silver-ring graft, used for femoropopliteal reconstruction, in whom an extreme skin necrosis developed in early postoperative period. This complication was successfully treated medically. After repeated debridement and wound-packing, the wound was covered using Thiersch skin graft. PMID:16053180

Nenezi?, Dragoslav; Pandaitan, Simon; Ilijevski, Nenad; Mati?, Predrag; Gajin, Predag; Radak, Dorde

2005-01-01

93

Chitosan-hyaluronic acid/nano silver composite sponges for drug resistant bacteria infected diabetic wounds.  

PubMed

The aim of this work was to develop an antimicrobial sponge composed of chitosan, hyaluronic acid (HA) and nano silver (nAg) as a wound dressing for diabetic foot ulcers (DFU) infected with drug resistant bacteria. nAg (5-20 nm) was prepared and characterized. The nanocomposite sponges were prepared by homogenous mixing of chitosan, HA and nAg followed by freeze drying to obtain a flexible and porous structure. The prepared sponges were characterized using SEM and FT-IR. The porosity, swelling, biodegradation and haemostatic potential of the sponges were also studied. Antibacterial activity of the prepared sponges was analysed using Escherichia coli, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Klebsiella pneumonia. Chitosan-HA/nAg composite sponges showed potent antimicrobial property against the tested organisms. Sponges containing higher nAg (0.005%, 0.01% and 0.02%) concentrations showed antibacterial activity against MRSA. Cytotoxicity and cell attachment studies were done using human dermal fibroblast cells. The nanocomposite sponges showed a nAg concentration dependent toxicity towards fibroblast cells. Our results suggest that this nanocomposite sponges could be used as a potential material for wound dressing for DFU infected with antibiotic resistant bacteria if the optimal concentration of nAg exhibiting antibacterial action with least toxicity towards mammalian cells is identified. PMID:24060281

Anisha, B S; Biswas, Raja; Chennazhi, K P; Jayakumar, R

2013-11-01

94

Synergistic interaction of Helichrysum pedunculatum leaf extracts with antibiotics against wound infection associated bacteria.  

PubMed

The effect of combinations of the crude methanolic extract of the leaves of Helichrysum pedunculatum and eight first-line antibiotics were investigated by time kill assays against a panel of bacterial strains that have been implicated in wound infections. The plant extract showed appreciable antibacterial activities against the test bacteria with zones of inhibition ranging between 18 and 27 mm, and minimum inhibitory concentrations (MICs) varying between 0.1 and 5.0 mg/ml. The MICs of the test antibiotics range between 0.001 and 0.412 mg/ml, and combination of the plant extract and the antibiotics resulted in reduction of bacterial counts by between 0 and 6.63 Log10 cfu/ml. At V2 MIC, 56.81% synergy; 43.19% indifference and no antagonism were observed, and at MIC levels, 55.68% synergy; 44.32% indifference and no antagonism were observed when the extracts were combined with eight different antibiotics. In all, 60% of the interactions were synergistic. All combination regimes on Staphylococcus aureus ATCC 6538 yielded no synergy, neither was antagonism detected in any of the assays. We propose that extracts of the leaves of Helichrysum pedunculatum could be of relevance in combination therapy and as a source of resistance modifying principies that could be useful as treatment options for persistent wound infections. PMID:19915741

Aiyegoro, Olayinka A; Afolayan, Anthony J; Okoh, Anthony I

2009-01-01

95

Dual delivery of chlorhexidine and platelet-derived growth factor-BB for enhanced wound healing and infection control.  

PubMed

Wound treatment can require molecules that both enhance healing and control infection. As in many biomedical applications, the options for therapeutic molecules may include both hydrophilic and hydrophobic molecules. The goal of this study was to investigate a polymer system for drug delivery that simultaneously delivers platelet-derived growth factor (PDGF)-BB, a hydrophilic protein known to promote wound healing, and chlorhexidine (CHX), a hydrophobic antimicrobial agent for infection treatment. Poly(lactic-co-glycolic acid) (PLGA) microspheres were prepared using different polymer formulations in a double emulsion process. CHX encapsulation efficiency was 19.6±0.8% and 28.9±1.5% for PLGA 50:50 and 85:15, respectively. The presence of CHX significantly increased PDGF-BB encapsulation efficiency relative to PDGF-BB alone. Both molecules could be released for up to 50 days and exhibited bioactivity for greater than 3 (PLGA 85:15) or 8 (PLGA 50:50) weeks using in vitro bacteria and cellular assays. An infected wound model was used to evaluate the system in vivo. Wounds treated with the dual delivery system showed decreased levels of infection and increased healing. Vascular analysis of wound tissues also showed higher levels of mature vasculature with the delivery of PDGF-BB. In conclusion, we have evaluated a drug delivery system for simultaneous delivery of hydrophobic and hydrophilic molecules and have shown that this system can improve healing and reduce bacteria levels in an infected wound model. This system could be applied to other therapeutic applications where sustained delivery of hydrophobic and hydrophilic molecules is required. PMID:23063555

Jiang, Bin; Zhang, Gehan; Brey, Eric M

2013-02-01

96

Isolation and characterization of two hemolytic phenotypes of Vibrio damsela associated with a fatal wound infection.  

PubMed Central

Two hemolytic phenotypes of Vibrio damsela, isolated from the tissue of a patient with a fatal wound infection, were characterized. The patient had underlying disease, and the wound was associated with an injury inflicted during the handling of a catfish. The phenotypes were morphologically and biochemically similar except for their lecithinase, lipase, and hemolytic activities. When grown on rabbit blood agar, one phenotype (LZ) produced a large zone of hemolysis (10 mm) around the colony, whereas the other type (SZ) produced only a small zone (1 to 2 mm). On sheep blood agar, the differences in hemolytic activity were more subtle. By a modified CAMP test in which V. damsela was streaked perpendicularly to Staphylococcus aureus, it was determined that a factor elaborated by the LZ phenotype (but not the SZ phenotype) protected sheep erythrocytes from the hemolysis normally caused by S. aureus toxins. Cell-free filtrates of broth cultures of each phenotype had the same effects on erythrocytes as did the organisms themselves. Images PMID:3980686

Clarridge, J E; Zighelboim-Daum, S

1985-01-01

97

Monitoring of bactericidal action of laser by in vivo imaging of bioluminescent E. coli in a cutaneous wound infection  

Microsoft Academic Search

The worldwide rise in antibiotic resistance necessitates the development of novel antimicrobial strategies. This study aimed to evaluate the bactericidal action of an 810-nm diode laser in a cutaneous wound infection. An Escherichia coli strain was transformed with a shuttle vector (pRB474) containing firefly luciferase gene from Photinus pyralis resulting in a bioluminescent phenotype. Because firefly luciferase is an enzyme

Samir Jawhara; Serge Mordon

2006-01-01

98

Evaluation of Antibacterial Activity of Some Medicinal Plants Used in Sudanese Traditional Medicine for Treatment of Wound Infections  

Microsoft Academic Search

The ethanolic, petroleum ether, ethyl acetate, methanolic and water extracts of some medicinal plants (Acacia nilotica ssp. nilotica pods, Lawsonia inermis leaves, Azadirachta indica leaves, Trigonella foenum- graecum seeds and Cordia sinensis stem bark) were investigated for their antibacterial activity against six standard bacterial strains commonly associated with wound infections (Staphylococcus aureus (ATCC 25923), Bacillus subtilis (NCTC 8236), Escherichia coli

Hatil Hashim El-Kamali; Ehsan Musa; Awad EL-Karim

2009-01-01

99

'This wound has spoilt everything': emotional capital and the experience of surgical site infections.  

PubMed

In this article we explore the experience of suffering from a surgical site infection, a common complication of surgery affecting around 5 per cent of surgical patients, via an interview study of 17 patients in the Midlands in the UK. Despite their prevalence, the experience of surgical site infections has received little attention so far. In spite of the impairment resulting from these iatrogenic problems, participants expressed considerable stoicism and we interpret this via the notion of emotional capital. This idea derives from the work of Pierre Bourdieu, Helga Nowotny and Diane Reay and helps us conceptualise the emotional resources accumulated and expended in managing illness and in gaining the most from healthcare services. Participants were frequently at pains not to blame healthcare personnel or hospitals, often discounting the infection's severity, and attributing it to chance, to 'germs' or to their own failure to buy and apply wound care products. The participants' stoicism was thus partly afforded by their refusal to blame healthcare institutions or personnel. Where anger was described, this was either defused or expressed on behalf of another person. Emotional capital is associated with deflecting the possibility of complaint and sustaining a deferential and grateful position in relation to the healthcare system. PMID:25470322

Brown, Brian; Tanner, Judith; Padley, Wendy

2014-11-01

100

Evidence-based management of deep wound infection after spinal instrumentation.  

PubMed

In this study, evidence-based medicine is used to assess optimal surgical and medical management of patients with post-operative deep wound infection following spinal instrumentation. A computerized literature search of the PubMed database was performed. Twenty pertinent studies were identified. Studies were separated into publications addressing instrumentation retention versus removal and publications addressing antibiotic therapy regimen. The findings were classified based on level of evidence (I-III) and findings were summarized into evidentiary tables. No level I or II evidence was identified. With regards to surgical management, five studies support instrumentation retention in the setting of early deep infection. In contrast, for delayed infection, the evidence favors removal of instrumentation at the time of initial debridement. Surgeons should be aware that for deformity patients, even if solid fusion is observed, removal of instrumentation may be associated with significant loss of correction. A course of intravenous antibiotics followed by long-term oral suppressive therapy should be pursued if instrumentation is retained. A shorter treatment course may be appropriate if hardware is removed. PMID:25308619

Lall, Rishi R; Wong, Albert P; Lall, Rohan R; Lawton, Cort D; Smith, Zachary A; Dahdaleh, Nader S

2014-10-01

101

Negative-pressure wound therapy induces endothelial progenitor cell mobilization in diabetic patients with foot infection or skin defects.  

PubMed

Non healing chronic wounds are difficult to treat in patients with diabetes and can result in severe medical problems for these patients and for society. Negative-pressure wound therapy (NPWT) has been adopted to treat intractable chronic wounds and has been reported to be effective. However, the mechanisms underlying the effects of this treatment have not been elucidated. To assess the vasculogenic effect of NPWT, we evaluated the systemic mobilization of endothelial progenitor cells (EPCs) during NPWT. Twenty-two of 29 consecutive patients who presented at the clinic of Seoul National Universty Hospital between December 2009 and November 2010 who underwent NPWT for diabetic foot infections or skin ulcers were included in this study. Peripheral blood samples were taken before NPWT (pre-NPWT) and 7-14 days after the initiation of NPWT (during-NPWT). Fluorescence-activated cell sorting (FACS) analysis showed that the number of cells in EPC-enriched fractions increased after NPWT, and the numbers of EPC colony forming units (CFUs) significantly increased during NPWT. We believe that NPWT is useful for treating patients with diabetic foot infections and skin ulcers, especially when these conditions are accompanied by peripheral arterial insufficiency. The systemic mobilization of EPCs during NPWT may be a mechanism for healing intractable wounds in diabetic patients with foot infections or skin defects via the formation of increased granulation tissue with numerous small blood vessels. PMID:24232261

Seo, Sang Gyo; Yeo, Ji Hyun; Kim, Ji Hye; Kim, Ji-Beom; Cho, Tae-Joon; Lee, Dong Yeon

2013-01-01

102

Does preoperative scalp shaving result in fewer postoperative wound infections when compared with no scalp shaving? A systematic review.  

PubMed

Preoperative scalp shaving has been a well-established practice among neurosurgeons based on the belief that hair removal prevents postoperative infections. Apart from aiding in improved visualization of the incision line, ease of closure, and dressing application, there are concerns that the presence of hair at the surgical site may interfere with the surgical procedure. Preoperative scalp shaving is a controversial practice, and many neurosurgeons are moving toward not removing any hair or clipping minimal hair along the incision line rather than shaving the scalp. The following is a systematic review of articles related to preoperative scalp shaving before cranial surgeries and the implications for postoperative wound infections. Eighteen articles were identified as potentially relevant based on the search criteria. These articles were selected based on the inclusion and exclusion criteria to provide concise background information and an explanation of scalp-shaving practices in neurosurgery leading to the clinical question posed. An evidence table was compiled to organize the study data and identify key points. The review brings strong evidence that preoperative scalp shaving does not confer any benefit against postoperative wound infection and, paradoxically, may lead to higher rates of infection. Because hair removal neither contributes benefits to the surgery itself nor decreases the risk of wound infection but has considerable cosmetic value for the patient, many of the authors recommended that cranial surgeries should be done without hair shaving. PMID:22555352

Sebastian, Sherly

2012-06-01

103

Complex wounds.  

PubMed

Complex wound is the term used more recently to group those well-known difficult wounds, either chronic or acute, that challenge medical and nursing teams. They defy cure using conventional and simple "dressings" therapy and currently have a major socioeconomic impact. The purpose of this review is to bring these wounds to the attention of the health-care community, suggesting that they should be treated by multidisciplinary teams in specialized hospital centers. In most cases, surgical treatment is unavoidable, because the extent of skin and subcutaneous tissue loss requires reconstruction with grafts and flaps. New technologies, such as the negative pressure device, should be introduced. A brief review is provided of the major groups of complex wounds--diabetic wounds, pressure sores, chronic venous ulcers, post-infection soft-tissue gangrenes, and ulcers resulting from vasculitis. PMID:17187095

Ferreira, Marcus Castro; Tuma, Paulo; Carvalho, Viviane Fernandes; Kamamoto, Fábio

2006-12-01

104

Dynamic Role of Host Stress Responses in Modulating the Cutaneous Microbiome: Implications for Wound Healing and Infection  

PubMed Central

Significance: Humans are under constant bombardment by various stressors, including psychological anxiety and physiologic injury. Understanding how these stress responses influence the innate immune system and the skin microbiome remains elusive due to the complexity of the neuroimmune and stress response pathways. Both animal and human studies have provided critical information upon which to further elucidate the mechanisms by which mammalian stressors impair normal wound healing and/or promote chronic wound progression. Recent Advances: Development of high-throughput genomic and bioinformatic approaches has led to the discovery of both an epidermal and dermal microbiome with distinct characteristics. This technology is now being used to identify statistical correlations between specific microbiota profiles and clinical outcomes related to cutaneous wound healing and the response to pathogenic infection. Studies have also identified more prominent roles for typical skin commensal organisms in maintaining homeostasis and modulating inflammatory responses. Critical Issues: It is well-established that stress-induced factors, including catecholamines, acetylcholine, and glucocorticoids, increase the risk of impaired wound healing and susceptibility to infection. Despite the characterization of the cutaneous microbiome, little is known regarding the impact of these stress-induced molecules on the development and evolution of the cutaneous microbiome during wound healing. Future Directions: Further characterization of the mechanisms by which stress-induced molecules influence microbial proliferation and metabolism in wounds is necessary to identify altered microbial phenotypes that differentially influence host innate immune responses required for optimal healing. These mechanisms may yield beneficial as targets for manipulation of the microbiome to further benefit the host after cutaneous injury. PMID:25566412

Holmes, Casey J.; Plichta, Jennifer K.; Gamelli, Richard L.; Radek, Katherine A.

2015-01-01

105

Ability of Bacteriophage in Resolving Wound Infection Caused by Multidrug-Resistant Acinetobacter baumannii in Uncontrolled Diabetic Rats.  

PubMed

Acinetobacter baumannii, a substantial nosocomial pathogen, has developed resistance to almost all available antimicrobial drugs. Bacteriophage therapy is a possible alternative treatment for multidrug-resistant (MDR) bacterial infections. In this study, we have successfully isolated bacteriophage active against clinical strains of A. baumannii by enrichment from hospital sewage sludge using representatives of those strains. The bacteriophage isolated against A. baumannii formed plaques against beta-lactamases producing strains of A. baumannii. The utility of bacteriophage specific for A. baumannii to resolve wound infection in uncontrolled diabetic rats was evaluated. Five groups of uncontrolled diabetic rats were used. Group I was noninfected (Control), Group II was infected with MDR A. baumannii and challenged with bacteriophage, Group III was infected with MDR A. baumannii, Group IV was infected with MDR A. baumannii and challenged with antibiotic colistin, and Group V consisted of noninfected rats and sprayed with phage (Phage control). A significant decrease in infection, period of epithelization, and wound contraction was observed in the phage-challenged group when compared with antibiotic-treated uncontrolled diabetic rats and the control group. To conclude the study, new insights are provided into the biology of the broad host range of A. baumannii phage, demonstrating that A. baumannii phage has prospects for the treatment of infections caused by the MDR A. baumannii. PMID:25411824

Chickmangalure Shivaswamy, VinodKumar; Kalasuramath, Suneeta Basavaraj; Kumar Sadanand, Chethan; Kilagere Basavaraju, Abhishek; Ginnavaram, Varsha; Bille, Sumanth; Ukken, Sanjay Saju; Nandini Pushparaj, Usha

2014-11-20

106

A clinical study on the efficacy of Panchavalkala cream in Vrana Shodhana w.s.r to its action on microbial load and wound infection  

PubMed Central

Background: The science of wound healing is advancing rapidly, particularly as a result of new therapeutic approaches. The wound healing effect of different herbal ointments have been enormous and are in wide practice these days. Aim: To evaluate the efficacy of Panchavalkala cream over wound debridement (wound infection and microbial load). Materials and Methods: Ghanasatwa (water extract) of the individual drugs of Panchavalkala was prepared and the extract formulated as herbal ointment. This was used to treat patients of infected chronic non healing wounds. The signs and symptoms of infection were graded before and during the course of treatment. Tissue biopsy to estimate the microbial load prior to and during the course of treatment was done. Results: The clinical symptoms like Slough, swelling, redness, pain, discharge, tenderness, and malodor in wounds showed statistically significant reduction following treatment. The microbial load of the wounds was also reduced significantly. Conclusion: In most of the cases, there was a progressive reduction in the microbial load with time, during the course of treatment indicating the efficacy of the formulation in reducing the microbial load and thus controlling infection, facilitating wound healing.

Bhat, K. Shobha; Vishwesh, B. N.; Sahu, Manoranjan; Shukla, Vijay Kumar

2014-01-01

107

Microbial Profiling of Combat Wound Infection through Detection Microarray and Next-Generation Sequencing  

PubMed Central

Combat wound healing and resolution are highly affected by the resident microbial flora. We therefore sought to achieve comprehensive detection of microbial populations in wounds using novel genomic technologies and bioinformatics analyses. We employed a microarray capable of detecting all sequenced pathogens for interrogation of 124 wound samples from extremity injuries in combat-injured U.S. service members. A subset of samples was also processed via next-generation sequencing and metagenomic analysis. Array analysis detected microbial targets in 51% of all wound samples, with Acinetobacter baumannii being the most frequently detected species. Multiple Pseudomonas species were also detected in tissue biopsy specimens. Detection of the Acinetobacter plasmid pRAY correlated significantly with wound failure, while detection of enteric-associated bacteria was associated significantly with successful healing. Whole-genome sequencing revealed broad microbial biodiversity between samples. The total wound bioburden did not associate significantly with wound outcome, although temporal shifts were observed over the course of treatment. Given that standard microbiological methods do not detect the full range of microbes in each wound, these data emphasize the importance of supplementation with molecular techniques for thorough characterization of wound-associated microbes. Future application of genomic protocols for assessing microbial content could allow application of specialized care through early and rapid identification and management of critical patterns in wound bioburden. PMID:24829242

Allen, Jonathan E.; Brown, Trevor S.; Gardner, Shea N.; McLoughlin, Kevin S.; Forsberg, Jonathan A.; Kirkup, Benjamin C.; Chromy, Brett A.; Luciw, Paul A.; Elster, Eric A.

2014-01-01

108

Dual-functional Polyurea Microcapsules for Chronic Wound Care Dressings: Sustained Drug Delivery and Non-leaching Infection Control  

NASA Astrophysics Data System (ADS)

A new design of dual-functional polyurea microcapsules was proposed for chronic wound dressings to provide both non-leaching infection control and sustained topical drug delivery functionalities. Quaternary ammonium functionalized polyurea microcapsules (MCQs) were synthesized under mild conditions through an interfacial crosslinking reaction between branched polyethylenimine (PEI) and 2,4-toluene diisocyanate (TDI) in a dimethylformamide/cyclohexane emulsion. An in-situ modification method was developed to endow non-leaching surface antimicrobial properties to MCQs via bonding antimicrobial surfactants to surface isocyanate residues on the polyurea shells. The resultant robust MCQs with both non-leaching antimicrobial properties and sustained drug releasing properties have potential applications in medical textiles, such as chronic wound dressings, for infection control and drug delivery.

He, Wei

109

A semi-stochastic cell-based model for in vitro infected 'wound' healing through motility reduction: a simulation study.  

PubMed

We consider the migration and viability of individual cells in bacterial-infected cell colonies. Cell movement is assumed to take place as a result of sensing the strain energy density as a mechanical stimulus. The model is based on tracking the motion and viability of each individual cell in a cell colony, and the formalism was published in an earlier paper. The present innovations are an application to a simulation of a 'wound healing assay' in which bacteria infect the wound through impairing the motility of cells and an extension with effects from inertia. Though based on simple principles, the model is based on experiments on living fibroblasts on a flat substrate. PMID:23147230

Vermolen, F J; Gefen, A

2013-02-01

110

Prognostic significance of wound infections following major head and neck cancer surgery: an open non-comparative prospective study  

Microsoft Academic Search

ObjectiveWe evaluated the incidence, risk factors and consequences of wound infection (WI) following major head and neck cancer surgery in an open non-comparative study.Patients and methodsThe study group, comprising 95 patients who underwent clean-contaminated procedures with opening of the upper aerodigestive tract for biopsy-proven squamous cell cancer, were studied over a 1-year period. Antibiotic prophylaxis was amoxicillin and clavulanic acid.

Nicolas Penel; Charles Fournier; Micheline Roussel-Delvallez; Danièle Lefebvre; Ahmed Kara; Yann Mallet; Jean-Charles Neu; Jean-Louis Lefebvre

2004-01-01

111

Differential induction of acquired resistance and PR gene expression in tobacco by virus infection, ethephon treatment, UV light and wounding  

Microsoft Academic Search

Genes for acidic, extracellular and basic, intracellular pathogenesis-related (PR) proteins of tobacco were studied for their response to tobacco mosaic virus (TMV) infection, ethephon treatment, wounding and UV light. The genes encoding the acidic PR proteins (PR-1, PR-2, PR-3, PR-4 and PR-5) responded similarly to the different forms of stress. They appeared to be highly inducible by TMV, moderately inducible

Frans Th. Brederode; Huub J. M. Linthorst; John F. Bol

1991-01-01

112

A cluster of sternal wound infections requiring muscle flap repair: problems in epidemiologic investigation.  

PubMed

A cluster of sternal wound infections (SWI) requiring muscle flap closure occurred in a California hospital in 1988. Review of SWI rates by surgical team revealed that a single team (Team A) was associated with a cluster of SWI requiring muscle flap repair (MFR). Team A's rate of SWI requiring MFR was 2.27% in 441 heart operations. A case/control study was conducted to determine if the higher rate of SWI requiring MFR could be attributed to disproportionately large numbers of patients at high risk treated by Team A. Data on major risk factors for SWI collected for case and control groups included the following: age at operation, weight, body surface area, history of obesity, diabetes mellitus, or cigarette smoking, duration of cardiopulmonary bypass, use of internal mammary artery graft, number of coronary arteries bypassed, use of prostheses, operating room staffing, and emergent nature of operation. No statistically significant differences between Team A cases requiring MFR and control cases were observed for predisposing risk factors. Surgical technique remains a principal suspected risk factor for SWI requiring MFR in this cluster. PMID:1763824

Gellert, G A; Gordon, S M; Gordon, R S; Strassburg, M; Brenner, W I; Fannin, S L

1991-12-01

113

A Genetic Approach to the Development of New Therapeutic Phages to Fight Pseudomonas Aeruginosa in Wound Infections  

PubMed Central

Pseudomonas aeruginosa is a frequent participant in wound infections. Emergence of multiple antibiotic resistant strains has created significant problems in the treatment of infected wounds. Phage therapy (PT) has been proposed as a possible alternative approach. Infected wounds are the perfect place for PT applications, since the basic condition for PT is ensured; namely, the direct contact of bacteria and their viruses. Plenty of virulent (“lytic”) and temperate (“lysogenic”) bacteriophages are known in P. aeruginosa. However, the number of virulent phage species acceptable for PT and their mutability are limited. Besides, there are different deviations in the behavior of virulent (and temperate) phages from their expected canonical models of development. We consider some examples of non-canonical phage-bacterium interactions and the possibility of their use in PT. In addition, some optimal approaches to the development of phage therapy will be discussed from the point of view of a biologist, considering the danger of phage-assisted horizontal gene transfer (HGT), and from the point of view of a surgeon who has accepted the Hippocrates Oath to cure patients by all possible means. It is also time now to discuss the possible approaches in international cooperation for the development of PT. We think it would be advantageous to make phage therapy a kind of personalized medicine. PMID:23344559

Krylov, Victor; Shaburova, Olga; Krylov, Sergey; Pleteneva, Elena

2012-01-01

114

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial.  

PubMed

The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open, controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units at a university hospital undergoing chemotherapy for haematological or oncological malignancies requiring central venous catheters (CVCs) expected to remain in place for at least 5 days. Six hundred and one patients with 9,731 catheterization days were studied between January 2004 and January 2006. Patients admitted for chemotherapy received chlorhexidine and silver sulfadiazine-impregnated triple-lumen CVCs under standardized conditions and were randomized to the groups receiving a chlorhexidine gluconate-impregnated wound dressing or a standard sterile dressing. Daily routine included clinical assessment of the insertion site (swelling, pain, redness), temperature, white blood count and C-reactive protein. Catheters remained in place until they were no longer needed or when a CVC-related infection was suspected. Infection was confirmed with blood cultures via the catheter lumina and peripheral blood cultures according to the time-to-positivity method. Six hundred and one patients were included. The groups were comparable with respect to demographic and clinical data. The incidence of CVC-related infections were 11.3% (34 of 301) and 6.3% (19 of 300) in the control and chlorhexidine-impregnated wound dressing groups, respectively (p=0.016, relative risk 0.54; confidence interval 0.31-0.94). Especially, catheter-related infections at internal jugular vein insertions could be reduced (p=0.018). No adverse effects related to the intervention were observed. The use of chlorhexidine-impregnated wound dressings significantly reduced the incidence of CVC-related infections in patients receiving chemotherapy. PMID:18679683

Ruschulte, Heiner; Franke, Matthias; Gastmeier, Petra; Zenz, Sebastian; Mahr, Karl H; Buchholz, Stefanie; Hertenstein, Bernd; Hecker, Hartmut; Piepenbrock, Siegfried

2009-03-01

115

Sternal Reconstruction of Deep Sternal Wound Infections Following Median Sternotomy by Single-stage Muscle Flaps Transposition.  

PubMed

Objective To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection (DSWI) following median sternotomy. Methods Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males (73.7%) and 5 females (26.3%), aged 55±13 (18-78) years. According to the Pairolero classification of infected median sternotomies, 3 (15.8%) patients were type II, and the other 16 (84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage. Results There were no intraoperative deaths. In 15 patients (78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients (21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients (10.5%) presented with subcutaneous infection, and 3 patients (15.8%) had hematoma. They recovered following local debridement and medication. 17 patients (89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months. Conclusion DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition. PMID:25429744

Wu, Song; Wan, Feng; Gao, Yong-Shun; Zhang, Zhe; Zhao, Hong; Cui, Zhong-Qi; Ji-Yan Xie, And

2014-11-28

116

The Duration of Negative Pressure Wound Therapy Can Be Reduced Using the HeartShield Device in Patients With Deep Sternal Wound Infection  

PubMed Central

Background: Heart rupture resulting in lethal bleeding is a devastating complication associated with negative pressure wound therapy (NPWT) in patients with deep sternal wound infection (DSWI). We have previously reported that the use of a protective HeartShield device in combination with NPWT decreases the risk of damage to the heart. This article presents a retrospective analysis of NPWT duration with and without the HeartShield device. Subjects and patients: The study included 6 patients treated with the HeartShield device in combination with NPWT and 6 patients treated with conventional NPWT during the same time period. The duration of active treatment time was measured. Results: The median duration of NPWT was 8 days (range: 6-14 days) in the HeartShield device NPWT group and 14 days in the conventional group (range: 10-18 days). The difference was statistically significant (P < .05). Conclusions: It appears that the treatment of patients with DSWI with the HeartShield device reduces the duration of NPWT. PMID:24741387

Ingemansson, Richard; Malmsjö, Malin; Lindstedt, Sandra

2014-01-01

117

Bacterial growth and wound infection following saphenous vein harvesting in cardiac surgery: a randomized controlled trial of the impact of microbial skin sealant.  

PubMed

The aim of the present study was to compare microbial skin sealant versus bare skin on the leg regarding intraoperative bacterial presence in the surgical wound and time to recolonization of the adjacent skin at the saphenous vein harvesting site. A second aim was to evaluate the incidence of leg wound infection 2 months after surgery. In this randomized controlled trial, 140 patients undergoing coronary artery bypass grafting (CABG) between May 2010 and October 2011 were enrolled. Bacterial samples were taken preoperatively and intraoperatively at multiple time points and locations. OF the patients, 125 (92.6 %) were followed up 2 months postoperatively regarding wound infection. Intraoperative bacterial growth did not differ between the bare skin (n?=?68) and the microbial skin sealant group (n?=?67) at any time point. At 2 months postoperatively, 7/61 patients (11.5 %) in the skin sealant versus 14/64 (21.9 %) in the bare skin group (p?=?0.120) had been treated with antibiotics for a verified or suspected surgical site infection (SSI) at the harvest site. We found almost no intraoperative bacterial presence on the skin or in the subcutaneous tissue, irrespective of microbial skin sealant use. In contrast, we observed a relatively high incidence of late wound infection, indicating that wound contamination occurred postoperatively. Further research is necessary to determine whether the use of microbial skin sealant reduces the incidence of leg wound infection at the saphenous vein harvest site. PMID:24907853

Falk-Brynhildsen, K; Söderquist, B; Friberg, O; Nilsson, U

2014-11-01

118

Number of Virus Particles in Insects and Plants Infected with Wound Tumor Virus  

PubMed Central

A new procedure for counting virus particles was employed to measure the concentration of wound tumor virus in purified virus preparations, in plant tumors, and in the insect vector. Partially purified wound tumor virus was used to establish the quantitative features of the method. A 1-g amount of plant tumor tissue contained an average of 5 × 1010 virus particles and 1 g of insect tissue contained 2 × 1010 particles. Images PMID:5742043

Streissle, Gert; Bystricky, Vojtech; Granados, Robert R.; Strohmaier, Karl

1968-01-01

119

[Importance of modern treatment procedures for infected and colonized wounds in dermatology].  

PubMed

In the coming years increasing numbers of patients with chronic ulcers and tumor wounds are to be expected, both of which are typically multifaceted diseases requiring complex and increasingly long-term ambulatory therapy. Therefore, in recent years special medical emphasis has been placed on efficacious therapies with good tolerability and also suitability regarding feasibility for outpatient treatment. Some of these methods, such as cold plasma therapy, extracorporeal shock wave therapy (ESWT), water-filtered infrared therapy (wIRA), electrostimulation (ES) and low level laser therapy (LLLT) have a good chance of success when applied as an adjuvant method in the multimodal treatment concept for patients with recalcitrant wounds. All of these methods have at least indirect antimicrobial properties which can be advantageous in cases of microbial infiltration of wounds. As for all other methods for treating recalcitrant wounds, the promising application of the aforementioned methods requires great expertise in wound healing together with a broad and continuous interdisciplinary diagnostics and therapy (wound center). PMID:25336295

Daeschlein, G; Lutze, S; Arnold, A; von Podewils, S; Jünger, M

2014-11-01

120

Severe Wound Infection with Photobacterium damselae ssp. damselae and Vibrio harveyi, following a Laceration Injury in Marine Environment: A Case Report and Review of the Literature  

PubMed Central

Marine microorganisms are uncommon etiologies of skin and skin structure infections, that is, wound infections. We report a case of severe wound infection, caused by the marine Photobacterium damselae (Vibrionaceae), in a 64-year-old male patient, returning from Australia. The isolate tested positive for pPHDD1, a plasmid conferring high-level virulence. Furthermore, the wound was coinfected with Vibrio harveyi, a halophile bacterium, which has never been reported from human infections before. Identification was achieved by use of Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry (MALDI-TOF) and confirmed by 16S rDNA sequencing. Data retrieval from bibliography was complicated since P. damselae has been renamed often with a number of synonyms present in the literature: Photobacterium damsela, Vibrio damselae, Vibrio damsela, Pasteurella damselae, and Listonella damsela. With all synonyms used as query terms, a literature search provided less than 20 cases published worldwide. A majority of those cases presenting as severe wound infection are even fatal following progression into necrotizing fasciitis. Management with daily wound dressing and antibiotic therapy (ofloxacin empirically, followed by doxycycline after availability of microbiology) led in the reported case to a favorable outcome, which seems to be, however, the exception based on a review of the available literature. PMID:24171004

Hundenborn, Jörg; Thurig, Steffi

2013-01-01

121

Late presentation of a deep sternal wound infection and left breast abscess.  

PubMed

In this paper, we present a case review of a 58-year-old female who presented to our emergency department with pyrexia, dyspnoea, dehydration and pain in her left breast six months following coronary artery bypass grafting (CABG). Although her sternotomy wound had healed well, examination revealed fluctuance of the whole precordium and left breast. She underwent antibiotic treatment and subsequent surgical debridement, followed by the application of vacuum-assisted dressings. Surgical reconstruction was deemed unsuitable and therefore the patient continued to be managed with vacuum dressings followed by routine dressings to allow the wound to heal by secondary intention. The patient was discharged three months after initial presentation in a good condition. The wound had completely healed four months later. PMID:24526171

Mustafa, A; Carr, C; Alkhafagi, S; Mughal, N; Omer, M; Alkhulaifi, A

2014-02-01

122

How wounds heal  

MedlinePLUS

... as various veins. Obesity increases the risk of infection after surgery. Being overweight can also put tension on stitches, ... drugs can slow healing. Smoking can delay healing after surgery. ... such as infection and wounds breaking open. Slow-to-heal wounds ...

123

Study of photodynamic therapy in the control of isolated microorganisms from infected wounds--an in vitro study.  

PubMed

The effective treatment of infected wounds continues to be a serious challenge, mainly due to the rise of antibiotic-resistant bacteria. Photodynamic therapy (PDT) refers to the topical or systemic administration of a non-toxic, photosensitizing agent (PS), followed by irradiation with visible light of a suitable wavelength. The possibility of applying the PDT locally is what makes it so favorable to the treatment of infected wounds. The goal of this study was to evaluate the action of the PDT in the inactivation in vitro of microorganisms coming from infected wounds, using methylene blue (MB) and photodithazine (PDZ) as the PS and comparing the efficacy of these two compounds for PDT on bacteria. For the application of PDT, isolated microorganisms identified from material collected from wounds were suspended in a saline solution containing 10(6) viable cells/ml. Each isolated microorganism was submitted to PDT with MB and with PDZ in accordance with the following treatment groups: N/T--no treatment; T1--PDT with PDZ; T2--PDT with MB; T3--irradiation without PS; T4--treatment with PDZ without light; and T5--treatment with MB without light. As a light source, an LED-based device was used (Biopdi/Irrad-Lead 660), composed of 54 LEDs, each with 70 mW of power in the 660 nm region of the electromagnetic spectrum. Each tray of 96 wells was irradiated with an intensity of 25 mW/cm(2) and a dose of light of 50 J/cm(3) for 33 min. All the tests were made in duplicate. It was then concluded that the PDT with PDZ was capable of inhibiting the growth of gram-positive bacteria samples, however it did not have the same effect on gram-negative bacteria, which showed growth greater than 100,000 CFU; the PDT with MB showed an effectiveness on gram-positive as well as gram-negative bacteria, for it was able to inhibit bacterial growth in both cases. PMID:23455656

Pereira de Lima Carvalho, Denise; Guerra Pinto, Juliana; Di Paula Costa Sorge, Camila; Rodrigues Benedito, Fabiana Regis; Khouri, Sonia; Ferreira Strixino, Juliana

2014-01-01

124

In Vivo Bioluminescence Imaging To Evaluate Systemic and Topical Antibiotics against Community-Acquired Methicillin-Resistant Staphylococcus aureus-Infected Skin Wounds in Mice  

PubMed Central

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infected wounds and ulcers. Uncomplicated CA-MRSA skin infections are typically managed in an outpatient setting with oral and topical antibiotics and/or incision and drainage, whereas complicated skin infections often require hospitalization, intravenous antibiotics, and sometimes surgery. The aim of this study was to develop a mouse model of CA-MRSA wound infection to compare the efficacy of commonly used systemic and topical antibiotics. A bioluminescent USA300 CA-MRSA strain was inoculated into full-thickness scalpel wounds on the backs of mice and digital photography/image analysis and in vivo bioluminescence imaging were used to measure wound healing and the bacterial burden. Subcutaneous vancomycin, daptomycin, and linezolid similarly reduced the lesion sizes and bacterial burden. Oral linezolid, clindamycin, and doxycycline all decreased the lesion sizes and bacterial burden. Oral trimethoprim-sulfamethoxazole decreased the bacterial burden but did not decrease the lesion size. Topical mupirocin and retapamulin ointments both reduced the bacterial burden. However, the petrolatum vehicle ointment for retapamulin, but not the polyethylene glycol vehicle ointment for mupirocin, promoted wound healing and initially increased the bacterial burden. Finally, in type 2 diabetic mice, subcutaneous linezolid and daptomycin had the most rapid therapeutic effect compared with vancomycin. Taken together, this mouse model of CA-MRSA wound infection, which utilizes in vivo bioluminescence imaging to monitor the bacterial burden, represents an alternative method to evaluate the preclinical in vivo efficacy of systemic and topical antimicrobial agents. PMID:23208713

Guo, Yi; Ramos, Romela Irene; Cho, John S.; Donegan, Niles P.; Cheung, Ambrose L.

2013-01-01

125

In vivo bioluminescence imaging to evaluate systemic and topical antibiotics against community-acquired methicillin-resistant Staphylococcus aureus-infected skin wounds in mice.  

PubMed

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infected wounds and ulcers. Uncomplicated CA-MRSA skin infections are typically managed in an outpatient setting with oral and topical antibiotics and/or incision and drainage, whereas complicated skin infections often require hospitalization, intravenous antibiotics, and sometimes surgery. The aim of this study was to develop a mouse model of CA-MRSA wound infection to compare the efficacy of commonly used systemic and topical antibiotics. A bioluminescent USA300 CA-MRSA strain was inoculated into full-thickness scalpel wounds on the backs of mice and digital photography/image analysis and in vivo bioluminescence imaging were used to measure wound healing and the bacterial burden. Subcutaneous vancomycin, daptomycin, and linezolid similarly reduced the lesion sizes and bacterial burden. Oral linezolid, clindamycin, and doxycycline all decreased the lesion sizes and bacterial burden. Oral trimethoprim-sulfamethoxazole decreased the bacterial burden but did not decrease the lesion size. Topical mupirocin and retapamulin ointments both reduced the bacterial burden. However, the petrolatum vehicle ointment for retapamulin, but not the polyethylene glycol vehicle ointment for mupirocin, promoted wound healing and initially increased the bacterial burden. Finally, in type 2 diabetic mice, subcutaneous linezolid and daptomycin had the most rapid therapeutic effect compared with vancomycin. Taken together, this mouse model of CA-MRSA wound infection, which utilizes in vivo bioluminescence imaging to monitor the bacterial burden, represents an alternative method to evaluate the preclinical in vivo efficacy of systemic and topical antimicrobial agents. PMID:23208713

Guo, Yi; Ramos, Romela Irene; Cho, John S; Donegan, Niles P; Cheung, Ambrose L; Miller, Lloyd S

2013-02-01

126

A peptide-morpholino oligomer conjugate targeting Staphylococcus aureus gyrA mRNA improves healing in an infected mouse cutaneous wound model.  

PubMed Central

Management of skin wound infections presents a serious problem in the clinic, in the community, and in both civilian and military clinical treatment centers. Staphylococcus aureus is one of the most common microbial pathogens in cutaneous wounds. Peptide-morpholino oligomer (PMO) conjugates targeted to S. aureus gyrase A mRNA have shown the ability to reduce bacterial viability by direct site-specific mRNA cleavage via RNase P. As a treatment, these conjugates have the added advantages of not being susceptible to resistance due to genetic mutations and are effective against drug resistant strains. While this strategy has proven effective in liquid culture, it has yet to be evaluated in an animal model of infected surface wounds. In the present study, we combined PMO conjugates with a thermoresponsive gel delivery system to treat full-thickness mouse cutaneous wounds infected with S. aureus. Wounds treated with a single dose of PMO conjugate displayed improved healing that was associated with increased epithelialization, reduced bacterial load, and increased matrix deposition. Taken together, our findings demonstrate the efficacy and flexibility of the PMO conjugate drug delivery system and make it an attractive and novel topical antimicrobial agent. PMID:23727592

Sawyer, Andrew J; Wesolowski, Donna; Gandotra, Neeru; Stojadinovic, Alexander; Izadjoo, Mina; Altman, Sidney; Kyriakides, Themis R

2013-01-01

127

Intervention for Postpartum Infections Following Caesarean Section  

ClinicalTrials.gov

Surgical Wound Infection; Infection; Cesarean Section; Cesarean Section; Dehiscence; Complications; Cesarean Section; Complications; Cesarean Section, Wound, Dehiscence; Wound; Rupture, Surgery, Cesarean Section

2014-10-15

128

Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital, South-West Ethiopia  

PubMed Central

Background Wound infection is one of the health problems that are caused and aggravated by the invasion of pathogenic organisms. Information on local pathogens and sensitivity to antimicrobial agents, and topical agents like acetic acid is crucial for successful treatment of wounds. Objectives To determine antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital. Methods A cross sectional study was conducted among patients with wound infection visiting Jimma University Specialized Hospital, from May to September 2013. Wound swab was collected using sterile cotton swabs and processed for bacterial isolation and susceptibility testing to antimicrobial agents, acetic acid, hydrogen peroxide and dabkin solution following standard bacteriological techniques. Biochemical tests were done to identify the species of the organisms. Sensitivity testing was done using Kirby- Baur disk diffusion method. Minimum inhibitory and bactericidal concentration was done using tube dilution method. Results In this study 145 bacterial isolates were recovered from 150 specimens showing an isolation rate of 87.3%. The predominant bacteria isolated from the infected wounds were Staphylococcus aureus 47 (32.4%) followed by Escherichia coli 29 (20%), Proteus species 23 (16%), Coagulase negative Staphylococci 21 (14.5%), Klebsiella pneumoniae 14 (10%) and Pseudomonas aeruginosa 11 (8%). All isolates showed high frequency of resistance to ampicillin, penicillin, cephalothin and tetracycline. The overall multiple drug resistance patterns were found to be 85%. Acetic acid (0.5%), Dabkin solution (1%) and 3% hydrogen peroxide were bactericidal to all isolated bacteria and lethal effect observed when applied for 10 minutes. Conclusions On in vitro sensitivity testing, ampicillin, penicillin, cephalothin and tetracycline were the least effective. Gentamicin, norfloxacin, ciprofloxacin, vancomycin and amikacin were the most effective antibiotics. Acetic acid (0.5%), dabkin solution (1%) and H2O2 (3%) were bactericidal to all isolates. PMID:24731394

2014-01-01

129

Intraoperative subcutaneous wound closing culture sample: a predicting factor for periprosthetic infection after hip- and knee-replacement?  

Microsoft Academic Search

Introduction  It is unknown whether intraoperative subcutaneous wound closing culture samples (WCCS) are useful to predict periprosthetic\\u000a joint infection (PJI).\\u000a \\u000a \\u000a \\u000a \\u000a Method  Here we prospectively followed 167 out of a total of 175 consecutive patients with primary total hip (THR) or knee replacement\\u000a (TKR) between 01\\/2002 and 12\\/2002 for a mean follow-up period of 5 years; of those patients, n = 159 (96.8%) underwent WCCS.\\u000a \\u000a \\u000a \\u000a \\u000a Results  The

Christian B. Frank; Martin Adams; Markus Kroeber; Andreas Wentzensen; Volkmar Heppert; Dietrich Schulte-Bockholt; Thorsten Guehring

130

cDNA cloning of carrot extracellular beta-fructosidase and its expression in response to wounding and bacterial infection.  

PubMed Central

We isolated a full-length cDNA for apoplastic (extracellular or cell wall-bound) beta-fructosidase (invertase), determined its nucleotide sequence, and used it as a probe to measure changes in mRNA as a result of wounding of carrot storage roots and infection of carrot plants with the bacterial pathogen Erwinia carotovora. The derived amino acid sequence of extracellular beta-fructosidase shows that it is a basic protein (pl 9.9) with a signal sequence for entry into the endoplasmic reticulum and a propeptide at the N terminus that is not present in the mature protein. Amino acid sequence comparison with yeast and bacterial invertases shows that the overall homology is only about 28%, but that there are short conserved motifs, one of which is at the active site. Maturing carrot storage roots contain barely detectable levels of mRNA for extracellular beta-fructosidase and these levels rise slowly but dramatically after wounding with maximal expression after 12 hours. Infection of roots and leaves of carrot plants with E. carotovora results in a very fast increase in the mRNA levels with maximal expression after 1 hour. These results indicate that apoplastic beta-fructosidase is probably a new and hitherto unrecognized pathogenesis-related protein [Van Loon, L.C. (1985). Plant Mol. Biol. 4, 111-116]. Suspension-cultured carrot cells contain high levels of mRNA for extracellular beta-fructosidase and these levels remain the same whether the cells are grown on sucrose, glucose, or fructose. PMID:2152110

Sturm, A; Chrispeels, M J

1990-01-01

131

Negative Pressure Wound Therapy  

PubMed Central

Executive Summary Objective This review was conducted to assess the effectiveness of negative pressure wound therapy. Clinical Need: Target Population and Condition Many wounds are difficult to heal, despite medical and nursing care. They may result from complications of an underlying disease, like diabetes; or from surgery, constant pressure, trauma, or burns. Chronic wounds are more often found in elderly people and in those with immunologic or chronic diseases. Chronic wounds may lead to impaired quality of life and functioning, to amputation, or even to death. The prevalence of chronic ulcers is difficult to ascertain. It varies by condition and complications due to the condition that caused the ulcer. There are, however, some data on condition-specific prevalence rates; for example, of patients with diabetes, 15% are thought to have foot ulcers at some time during their lives. The approximate community care cost of treating leg ulcers in Canada, without reference to cause, has been estimated at upward of $100 million per year. Surgically created wounds can also become chronic, especially if they become infected. For example, the reported incidence of sternal wound infections after median sternotomy is 1% to 5%. Abdominal surgery also creates large open wounds. Because it is sometimes necessary to leave these wounds open and allow them to heal on their own (secondary intention), some may become infected and be difficult to heal. Yet, little is known about the wound healing process, and this makes treating wounds challenging. Many types of interventions are used to treat wounds. Current best practice for the treatment of ulcers and other chronic wounds includes debridement (the removal of dead or contaminated tissue), which can be surgical, mechanical, or chemical; bacterial balance; and moisture balance. Treating the cause, ensuring good nutrition, and preventing primary infection also help wounds to heal. Saline or wet-to-moist dressings are reported as traditional or conventional therapy in the literature, although they typically are not the first line of treatment in Ontario. Modern moist interactive dressings are foams, calcium alginates, hydrogels, hydrocolloids, and films. Topical antibacterial agents—antiseptics, topical antibiotics, and newer antimicrobial dressings—are used to treat infection. The Technology Being Reviewed Negative pressure wound therapy is not a new concept in wound therapy. It is also called subatmospheric pressure therapy, vacuum sealing, vacuum pack therapy, and sealing aspirative therapy. The aim of the procedure is to use negative pressure to create suction, which drains the wound of exudate (i.e., fluid, cells, and cellular waste that has escaped from blood vessels and seeped into tissue) and influences the shape and growth of the surface tissues in a way that helps healing. During the procedure, a piece of foam is placed over the wound, and a drain tube is placed over the foam. A large piece of transparent tape is placed over the whole area, including the healthy tissue, to secure the foam and drain the wound. The tube is connected to a vacuum source, and fluid is drawn from the wound through the foam into a disposable canister. Thus, the entire wound area is subjected to negative pressure. The device can be programmed to provide varying degrees of pressure either continuously or intermittently. It has an alarm to alert the provider or patient if the pressure seal breaks or the canister is full. Negative pressure wound therapy may be used for patients with chronic and acute wounds; subacute wounds (dehisced incisions); chronic, diabetic wounds or pressure ulcers; meshed grafts (before and after); or flaps. It should not be used for patients with fistulae to organs/body cavities, necrotic tissue that has not been debrided, untreated osteomyelitis, wound malignancy, wounds that require hemostasis, or for patients who are taking anticoagulants. Review Strategy The inclusion criteria were as follows: Randomized controlled trial (RCT) with a sample size of 20 or more Human s

2006-01-01

132

The protective effect of topical rifamycin treatment against sternal wound infection in diabetic patients undergoing on-pump coronary artery bypass graft surgery  

PubMed Central

Summary Objectives The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients, 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores, patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery, and the control group (n = 73) received no topical treatment. Results Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73, p = 1.0). No superficial sternal wound infection was observed in the rifamycin group, however, it did occur in one patient in the control group (0/78 vs 1/73, p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant, locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI. PMID:24687038

Aygun, Fatih; Kuzgun, Ahmet; Ulucan, Seref; Keser, Ahmet; Akpek, Mahmut; Kaya, Mehmet G

2014-01-01

133

Common questions about wound care.  

PubMed

Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. There is no evidence that antiseptic irrigation is superior to sterile saline or tap water. Occlusion of the wound is key to preventing contamination. Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site. Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Although patients are often instructed to keep their wounds covered and dry after suturing, they can get wet within the first 24 to 48 hours without increasing the risk of infection. There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. Severe burns and wounds that cover large areas of the body or involve the face, joints, bone, tendons, or nerves should generally be referred to wound care specialists. PMID:25591209

Worster, Brooke; Zawora, Michelle Q; Hsieh, Christine

2015-01-15

134

Surgical wound care - closed  

MedlinePLUS

... Skin glue Proper wound care can help prevent infection and reduce scarring as your surgical wound heals. ... When you come home after surgery, you may have a dressing on your ... don't catch on clothing Protect the area as it heals Soak ...

135

Notes from the field: rapidly growing nontuberculous Mycobacterium wound infections among medical tourists undergoing cosmetic surgeries in the Dominican Republic--multiple states, March 2013-February 2014.  

PubMed

In August 2013, the Maryland Department of Health and Mental Hygiene (MDHMH) was notified of two persons with rapidly growing nontuberculous mycobacterial (RG-NTM) surgical-site infections. Both patients had undergone surgical procedures as medical tourists at the same private surgical clinic (clinic A) in the Dominican Republic the previous month. Within 7 days of returning to the United States, both sought care for symptoms that included surgical wound abscesses, clear fluid drainage, pain, and fever. Initial antibiotic therapy was ineffective. Material collected from both patients' wounds grew Mycobacterium abscessus exhibiting a high degree of antibiotic resistance characteristic of this organism. PMID:24598597

Schnabel, David; Gaines, Joanna; Nguyen, Duc B; Esposito, Douglas H; Ridpath, Alison; Yacisin, Kari; Poy, Joe A; Mullins, Jocelyn; Burns, Rachel; Lijewski, Virginia; McElroy, Nora P; Ahmad, Nina; Harrison, Cassandra; Parinelli, Ellen J; Beaudoin, Amanda L; Posivak-Khouly, Leah; Pritchard, Scott; Jensen, Bette J; Toney, Nadege C; Moulton-Meissner, Heather A; Nyangoma, Edith N; Barry, Anita M; Feldman, Katherine A; Blythe, David; Perz, Joseph F; Morgan, Oliver W; Kozarsky, Phyllis; Brunette, Gary W; Sotir, Mark

2014-03-01

136

Diabetic Wound Care  

MedlinePLUS

... foot, poor circulation, foot deformities, irritation (such as friction or pressure), and trauma, as well as duration ... Appropriate debridement of wounds Treating any infection Reducing friction and pressure Restoring adequate blood flow Additional information ...

137

Factors Affecting Wound Healing  

PubMed Central

Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. This article reviews the recent literature on the most significant factors that affect cutaneous wound healing and the potential cellular and/or molecular mechanisms involved. The factors discussed include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. A better understanding of the influence of these factors on repair may lead to therapeutics that improve wound healing and resolve impaired wounds. PMID:20139336

Guo, S.; DiPietro, L.A.

2010-01-01

138

Optimising wound care in a child with an infected gastrostomy exit site.  

PubMed

The percutaneous endoscopic gastrostomy (PEG) tube has become a widely used feeding tube for long-term delivery of fluids, liquid feed and medicines. PEG tube insertion can be considered a minimally invasive technique, associated with rapid recovery and early discharge from hospital but is not without risk (Vervloessem et al 2009; Naiditch et al 2010). A lack of nationally agreed, evidence-based clinical practice guidelines makes PEG exit site care a matter of local clinical practice and clinical judgement. In paediatric practice, children experience care shared across several healthcare settings, meeting clinical teams with varying levels of knowledge and experience of PEG care. This can lead to conflicting advice, which can have a negative effect on patient safety and experience. The case history in this article demonstrates how PEG tube insertion is never a minor procedure for a child and family (Vervloessem et al 2009; Khattak et al 1998). It highlights areas of potential conflict in clinical management of PEG exit sites, and it shows how application of wound care principles, along with a range of modern products can have a positive outcome. PMID:24335863

Rollins, Hazel; Nathwani, Nisha; Morrison, Denise

139

Single dose cefotaxime plus metronidazole versus three dose cefuroxime plus metronidazole as prophylaxis against wound infection in colorectal surgery: multicentre prospective randomised study.  

PubMed Central

OBJECTIVE--To establish whether a single preoperative dose of cefotaxime plus metronidazole was as effective as a standard three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery. DESIGN--Prospective randomised allocation to one of two prophylactic antibiotic regimens in a parallel group trial. Group sequential analyses of each 250 patients were performed. SETTING--14 District general and teaching hospitals. PATIENTS--1018 Adults having colorectal operations were randomised, of whom 943 were evaluated. Demographic features, conditions requiring surgery, and operative procedures were similar in the two groups. Most patients had surgery for carcinoma of the colon or rectum. INTERVENTIONS--Group 1 received cefotaxime 1 g intravenously plus metronidazole 500 mg intravenously preoperatively. Group 2 received cefuroxime 1.5 g intravenously plus metronidazole 500 mg intravenously preoperatively, followed by cefuroxime 750 mg intravenously plus metronidazole 500 mg intravenously eight hours and 16 hours postoperatively. MAIN OUTCOME MEASURES--Development of surgical wound infection (as evidenced by the presence of pus), death, or discharge from hospital. RESULTS--Wound condition was scored on a five point scale on alternate days until discharge or for up to 20 days postoperatively. Wound infection rates were: group 1, 32/453 (7.1%; 95% confidence interval 4.7% to 9.4%); group 2, 33/454 (7.3%; 95% confidence interval 4.9% to 9.6%). Death rates (group 1: 26/470 (5.5%); group 2: 31/471 (6.6%], the incidence of postoperative complications, the median duration of hospital stay (12 days), and antibiotic tolerance were all similar in the two groups. Pooled data from groups 1 and 2 showed that wound infections were more frequent when minor faecal contamination had occurred at operation and when the duration of operation exceeded 90 minutes (greater than 90 min 11.2% of cases; less than 90 min 4.8%) and were associated with an extended hospital stay. CONCLUSIONS--A single preoperative dose of cefotaxime plus metronidazole is an efficacious as a three dose regimen of cefuroxime plus metronidazole in preventing wound infection after colorectal surgery and has practical advantages in eliminating the need for postoperative antibiotics. PMID:2105115

Rowe-Jones, D C; Peel, A L; Kingston, R D; Shaw, J F; Teasdale, C; Cole, D S

1990-01-01

140

Surgical Site Infection Following Surgery for Inflammatory Bowel Disease in Patients with Clean-Contaminated Wounds  

Microsoft Academic Search

Background  It is generally believed that the accompanying conditions in patients with inflammatory bowel disease (IBD) are associated\\u000a with a high incidence of surgical site infection (SSI), and sometimes these patients are classified as compromised hosts without\\u000a definitive clinical evidence. The aim of this study was to clarify the impact of IBD on the occurrence and features of SSI\\u000a in patients

Motoi Uchino; Hiroki Ikeuchi; Toshie Tsuchida; Kazuhiko Nakajima; Naohiro Tomita; Yoshio Takesue

2009-01-01

141

Negative pressure wound therapy for post-sternotomy mediastinitis reduces mortality rate and sternal re-infection rate compared to conventional treatment  

Microsoft Academic Search

Objective: Negative pressure wound therapy (NPWT) is a recently introduced treatment modality for post-sternotomy mediastinitis. The aim of this study was to compare the mortality rate, the sternal re-infection rate and the length of hospital stay in patients with post-sternotomy mediastinitis after NPWT and conventional treatment. Methods: We retrospectively analysed 118 patients with post-sternotomy mediastinitis after cardiac surgery. One group

Rainer Petzina; Julia Hoffmann; Artashes Navasardyan; Malin Malmsjö; Christof Stamm; Axel Unbehaun; Roland Hetzer

2010-01-01

142

Brassica napus possesses an expanded set of polygalacturonase inhibitor protein genes that are differentially regulated in response to Sclerotinia sclerotiorum infection, wounding and defense hormone treatment  

Microsoft Academic Search

Most plants encode a limited set of polygalacturonase inhibitor (PGIP) genes that may be involved in aspects of plant development,\\u000a but more importantly in the inactivation of polygalacturonases (PG) secreted by pathogens. Previously, we characterized two\\u000a Brassica napus PGIP genes, BnPgip1 and BnPgip2, which were differentially expressed in response to pathogen infection and wounding. Here we report that the B.

Dwayne D. Hegedus; Rugang Li; Lone Buchwaldt; Isobel Parkin; Steve Whitwill; Cathy Coutu; Diana Bekkaoui; S. Roger Rimmer

2008-01-01

143

Brassica napus possesses an expanded set of polygalacturonase inhibitor protein genes that are differentially regulated in response to Sclerotinia sclerotiorum infection, wounding and defense hormone treatment.  

PubMed

Most plants encode a limited set of polygalacturonase inhibitor (PGIP) genes that may be involved in aspects of plant development, but more importantly in the inactivation of polygalacturonases (PG) secreted by pathogens. Previously, we characterized two Brassica napus PGIP genes, BnPgip1 and BnPgip2, which were differentially expressed in response to pathogen infection and wounding. Here we report that the B. napus genome encodes a set of at least 16 PGIP genes that are similar to BnPgip1 or BnPgip2. This is the largest Pgip gene family reported to date. Comparison of the BnPGIPs revealed several sites within the xxLxLxx region of leucine rich repeats that form beta-sheets along the interacting face of the PGIP that are hypervariable and represent good candidates for generating PGIP diversity. Characterization of the regulatory regions and RT-PCR studies with gene-specific primers revealed that individual genes were differentially responsive to pathogen infection, mechanical wounding and signaling molecules. Many of the BnPgip genes responded to infection by the necrotic pathogen, Sclerotinia sclerotiorum; however, these genes were also induced either by jasmonic acid, wounding and salicylic acid or some combination thereof. The large number of PGIPs and the differential manner in which they are regulated likely ensures that B. napus can respond to attack from a broad spectrum of pathogens and pests. PMID:18431596

Hegedus, Dwayne D; Li, Rugang; Buchwaldt, Lone; Parkin, Isobel; Whitwill, Steve; Coutu, Cathy; Bekkaoui, Diana; Rimmer, S Roger

2008-07-01

144

Wound Microbiology and Associated Approaches to Wound Management  

PubMed Central

The majority of dermal wounds are colonized with aerobic and anaerobic microorganisms that originate predominantly from mucosal surfaces such as those of the oral cavity and gut. The role and significance of microorganisms in wound healing has been debated for many years. While some experts consider the microbial density to be critical in predicting wound healing and infection, others consider the types of microorganisms to be of greater importance. However, these and other factors such as microbial synergy, the host immune response, and the quality of tissue must be considered collectively in assessing the probability of infection. Debate also exists regarding the value of wound sampling, the types of wounds that should be sampled, and the sampling technique required to generate the most meaningful data. In the laboratory, consideration must be given to the relevance of culturing polymicrobial specimens, the value in identifying one or more microorganisms, and the microorganisms that should be assayed for antibiotic susceptibility. Although appropriate systemic antibiotics are essential for the treatment of deteriorating, clinically infected wounds, debate exists regarding the relevance and use of antibiotics (systemic or topical) and antiseptics (topical) in the treatment of nonhealing wounds that have no clinical signs of infection. In providing a detailed analysis of wound microbiology, together with current opinion and controversies regarding wound assessment and treatment, this review has attempted to capture and address microbiological aspects that are critical to the successful management of microorganisms in wounds. PMID:11292638

Bowler, P. G.; Duerden, B. I.; Armstrong, D. G.

2001-01-01

145

[Negative pressure wound therapy - review].  

PubMed

Negative pressure wound therapy (NPWT) is a new therapeutic option in wound healing and was first described in its present form in 1997. A vacuum source is used to create sub-atmospheric pressure in the local wound environment to promote healing. This is achieved by connecting a vacuum pump to a tube that is threaded into a wound gauze or foam filler dressing covered with a drape. This concept in wound treatment has been shown to be useful in treating different wound infections, including diabetic wounds as well as complex infections of the abdomen and thorax. NPWT has been used in Iceland for over a decade and its use is steadily increasing. This review describes the indications and outcome of NPWT and is aimed at a broad group of doctors and nurses where recent Icelandic studies on the subject are covered. PMID:24713539

Gudmundsdottir, Ingibjorg; Steingrimsson, Steinn; Valsdottir, Elsa; Gudbjartsson, Tomas

2014-04-01

146

Effects of inoculum density and wounding on stem infection of three Eastern U.S. forest species by Phytophthora ramorum  

Technology Transfer Automated Retrieval System (TEKTRAN)

Seedlings of three Eastern US forest species (red maple, northern red oak, and chestnut oak) were inoculated by applying Phytophthora ramorum sporangia to stems at different inoculum densities with and without wounding. Disease occurred in all treatments involving wounds, and no disease was observe...

147

Antimicrobial photodynamic therapy with RLP068 kills methicillin-resistant Staphylococcus aureus and improves wound healing in a mouse model of infected skin abrasion PDT with RLP068/Cl in infected mouse skin abrasion.  

PubMed

Photodynamic therapy (PDT) is an alternative treatment for infections that can kill drug resistant bacteria without damaging host-tissue. In this study we used bioluminescent methicillin-resistant Staphylococcus aureus, in a mouse skin abrasion model, to investigate the effect of PDT on bacterial inactivation and wound healing. RLP068/Cl, a tetracationic Zn(II)phthalocyanine derivative and toluidine blue (TBO) were used. The light-dose response of PDT to kill bacteria in vivo and the possible recurrence in the days post-treatment were monitored by real-time bioluminescence imaging, and wound healing by digital photography. The results showed PDT with RLP068/Cl (but not TBO) was able to kill bacteria, to inhibit bacterial re-growth after the treatment and to significantly accelerate the wound healing process (© 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim). PMID:22987338

Vecchio, Daniela; Dai, Tianhong; Huang, Liyi; Fantetti, Lia; Roncucci, Gabrio; Hamblin, Michael R

2013-09-01

148

Comparison of silver nylon wound dressing and silver sulfadiazine in partial burn wound therapy.  

PubMed

The study aims to perform a comparative assessment of two types of burn wound treatment. To do the assessment, patients with partial thickness burn wounds with total body surface area <40% were simple randomised to treat with nanocrystalline silver nylon wound dressing or silver sulfadiazine cream. Efficacy of treatment, use of analgesics, number of wound dressing change, wound infection and final hospitalisation cost were evaluated. The study showed silver nylon wound dressing significantly reduced length of hospital stay, analgesic use, wound infection and inflammation compared with silver sulfadiazine. PMID:22734483

Abedini, Fereydoon; Ahmadi, Abdollah; Yavari, Akram; Hosseini, Vahid; Mousavi, Sarah

2013-10-01

149

Skin tissue engineering for the infected wound site: biodegradable PLA nanofibers and a novel approach for silver ion release evaluated in a 3D coculture system of keratinocytes and staphylococcus aureus.  

PubMed

Wound infection presents a challenging and growing problem. With the increased prevalence and growth of multidrug-resistant bacteria, there is a mounting need to reduce and eliminate wound infections using methodologies that limit the ability of bacteria to evolve into further drug-resistant strains. A well-known strategy for combating bacterial infection and preventing wound sepsis is through the delivery of silver ions to the wound site. High surface area silver nanoparticles (AgNPs) allowing extensive silver ion release have therefore been explored in different wound dressings and/or skin substitutes. However, it has been recently shown that AgNPs can penetrate into the stratum corneum of skin or diffuse into the cellular plasma membrane, and may interfere with a variety of cellular mechanisms. The goal of this study was to introduce and evaluate a new type of high surface area metallic silver in the form of highly porous silver microparticles (AgMPs). Polylactic acid (PLA) nanofibers were successfully loaded with either highly porous AgMPs or AgNPs and the antimicrobial efficacy and cytotoxicity of the two silver-based wound dressings were assessed and compared. To better mimic the physiological environment in vivo where both human cells and bacteria are present, a novel coculture system combining human epidermal keratinocytes and Staphylococcus aureus bacteria was designed to simultaneously evaluate human skin cell cytotoxicity with antimicrobial efficacy in a three-dimensional environment. We found that highly porous AgMPs could be successfully incorporated in nanofibrous wound dressings, and exhibited comparable antimicrobial efficacy and cytotoxicity to AgNPs. Further, PLA nanofibers containing highly porous AgMPs exhibited steady silver ion release, at a greater rate of release, than nanofibers containing AgNPs. The replacement of AgNPs with the newly introduced AgMPs overcomes concerns regarding the use of nanoparticles and holds great promise as skin substitutes or wound dressings for infected wound sites. PMID:24494739

Mohiti-Asli, Mahsa; Pourdeyhimi, Behnam; Loboa, Elizabeth G

2014-10-01

150

Octylcyanoacrylate tissue adhesive versus suture wound repair in a contaminated wound model  

Microsoft Academic Search

Background. Octylcyanoacrylate tissue adhesive is a topical wound closure that precludes the need for foreign bodies (sutures) to close wounds. It also has an in vitro antimicrobial effect when standard disc sensitivity tests are used.Methods. To determine whether contaminated wounds closed with octylcyanoacrylate tissue adhesive will have a lower infection rate compared with wounds dosed with 5-0 monofilament sutures, we

Jim Quinn; Jennifer Maw; Karam Ramotar; Georg Wenckebach; George Wells

1997-01-01

151

Management of "difficult" wounds.  

PubMed

Pressure sores (PSs) and wounds in immunocompromised children are rather rare conditions. No doubt, their management is often complex and difficult, even for experienced pediatric plastic surgeons. As there are no algorithms for standard care, the therapeutic approach is individual.Successful PS management always implies primary and secondary prevention. With a PS present, rapid relief of pressure is crucial. If local wound care fails to restore skin integrity within a short period of time, surgical defect closure is mandatory. Overall, full-thickness skin grafts and local flap surgery are the most suitable methods regarding result quality, procedure complexity, and risks. Negative pressure wound therapy (NPWT) plays an instrumental role in wound bed preparation before definitive coverage. Recurrence rate is high (the complication). It does not much depend on the surgical technique employed, but rather depends on whether the various pathogenic factors leading to PS can be eliminated or alleviated.In both temporarily and permanently immunocompromised children, wound healing is significantly impaired. At the same time, these patients have no or low host defense activity. Thus, they are at high risk not only for local wound infection but also for potentially life threatening septic complications. Rapid and definitive wound closure is therefore essential. When conservative therapy fails, simple surgical techniques granting rapid and definitive wound closure should be used. PMID:24008551

Neuhaus, Kathrin; Meuli, Martin; Koenigs, Ingo; Schiestl, Clemens

2013-10-01

152

Puncture Wounds  

MedlinePLUS

... of determining the severity of a puncture wound. Depth of the wound is one way to evaluate ... Reserved. | Privacy Statement | Disclaimer | Terms and Conditions | Site Map | Información en Español | 8725 West Higgins Road, Suite ...

153

A novel technique for the treatment of infected metalwork in orthopaedic patients using skin closure over irrigated negative pressure wound therapy dressings  

PubMed Central

Introduction There has been recent interest in the use of negative pressure wound therapy (NWPT) as an adjunct to parenteral antibiotics in the treatment of infection in orthopaedic patients with metalwork in situ. To address some of the limitations of standard NPWT in this situation, the senior author has developed a modified method of treatment for infected metalwork (excluding arthroplasty) in orthopaedic patients that includes irrigation and skin closure over the standard NPWT dressing. Methods This retrospective study examined the outcome of a case series of 16 trauma and orthopaedic patients with deep infection involving metalwork in whom this modified form of NPWT was used. In conjunction with standard parenteral antibiotic therapy and a multidisciplinary approach, this modified technique included serial debridements in theatre, irrigation and negative pressure dressings over a white polyvinyl alcohol foam (KCI, Kidlington, UK) as well as closure of the skin over the foam. Results Among the 16 patients, there was a variety of upper and lower limb as well as spinal trauma and elective cases. In all 16 patients, there was successful resolution of the infection with no early or unplanned removal of any metalwork required. Conclusions Patients with infected metalwork are a heterogeneous group, and often suffer high morbidity and mortality. The modified NPWT technique shows potential as an adjunct in the treatment of complex orthopaedic patients with infected metalwork. PMID:23484994

Chapman, AWP; Krikler, S; Krkovic, M

2013-01-01

154

Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial  

PubMed Central

Introduction Among surgical oncology patients, incisional surgical site infection is associated with substantially increased morbidity, mortality and healthcare costs. Moreover, while adults undergoing pancreaticoduodenectomy with preoperative placement of an intrabiliary stent have a high risk of this type of infection, and wound protectors may significantly reduce its risk, no relevant studies of wound protectors yet exist involving this patient population. This study will evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among adults undergoing pancreaticoduodenectomy with preoperatively-placed intrabiliary stents. Methods and analysis This study will be a parallel, dual-arm, randomised controlled trial that will utilise a more explanatory than pragmatic attitude. All adults (?18?years) undergoing a pancreaticoduodenectomy at the Foothills Medical Centre in Calgary, Alberta, Canada with preoperative placement of an intrabiliary stent will be considered eligible. Exclusion criteria will include patient age <18?years and those receiving long-term glucocorticoids. The trial will employ block randomisation to allocate patients to a commercial dual-ring wound protector (the Alexis Wound Protector) or no wound protector and the current standard of care. The main outcome measure will be the rate of surgical site infection as defined by the Centers for Disease Control and Prevention criteria within 30?days of the index operation date as determined by a research assistant blinded to treatment allocation. Outcomes will be analysed by a statistician blinded to allocation status by calculating risk ratios and 95% CIs and compared using Fisher's exact test. Ethics and dissemination This will be the first randomised trial to evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among patients undergoing pancreaticoduodenectomy. Results of this study are expected to be available in 2016/2017 and will be disseminated using an integrated and end-of-grant knowledge translation strategy. Trial registration number ClinicalTrials.gov identifier NCT01836237. PMID:25146716

Bressan, Alexsander K; Roberts, Derek J; Edwards, Janet P; Bhatti, Sana U; Dixon, Elijah; Sutherland, Francis R; Bathe, Oliver; Ball, Chad G

2014-01-01

155

One year ago not business as usual: Wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia  

PubMed Central

Introduction Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. Methods This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities). Results Multiple large flap lacerations (2 × 3 to 60 × 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response. Conclusion Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory. PMID:16584527

Maegele, Marc; Gregor, Sven; Yuecel, Nedim; Simanski, Christian; Paffrath, Thomas; Rixen, Dieter; Heiss, Markus M; Rudroff, Claudia; Saad, Stefan; Perbix, Walter; Wappler, Frank; Harzheim, Andreas; Schwarz, Rosemarie; Bouillon, Bertil

2006-01-01

156

Polyhexamethylene biguanide dressings in wound management.  

PubMed

This article describes wound management using polyhexamethylene biguanide dressings in two patients experiencing multiple comorbidities. Wound bed debridement and bioburden management were important factors in achieving positive results in terms of promoting wound healing and reducing infection and malodour. PMID:21894678

Fumarola, Sian

157

Clinician perceptions of wound biofilm.  

PubMed

In wound care today, biofilm is a subject area of great interest and debate. There is an increasing awareness that biofilm exists in the majority of non-healing wounds, and that it is implicated in both recalcitrance and infection. Together with the presence of devitalised host tissue, biofilm is recognised as a component of the wound environment that requires removal to enable wound progression. However, uncertainty exists among wound care practitioners regarding confirmation of the presence of biofilm, and how best to remove biofilm from a non-healing wound. While recent efforts have been taken to assist practitioners in signs and symptoms of wound biofilm, continuing research is required to characterise and confirm wound biofilm. This research was conducted as part of a market research process to better understand the knowledge levels, experiences, clinical awareness and impact of biofilm in wound care, which was undertaken across the USA and Europe. While knowledge levels and experiences vary from country to country, certain wound characteristics were consistently associated with the presence of biofilm. PMID:25196188

Metcalf, Daniel G; Bowler, Philip G

2014-09-01

158

The use of silver-based dressings in wound care  

Microsoft Academic Search

summaryss Chronic wounds such as leg ulcers and pressure ulcers are often slow to heal. One of the causes of delayed wound healing is the presence of micro-organisms in the wound. A strategy for the prevention and treatment of wound colonisation or infection, which is receiving renewed attention, is the use of silver-based dressings. Silver has been used as an

Caroline Dowsett

159

Diabetic foot wounds: the value of negative pressure wound therapy with instillation.  

PubMed

Chronic wounds such as diabetic foot wounds are a tremendous burden to the health care system and often require a multidisciplinary approach to prevent amputations. Advanced technologies such as negative pressure wound therapy (NPWT) and bioengineered tissues have been successfully used in the treatment of these types of complex wounds. However, the introduction of NPWT with instillation (NPWTi) has provided an alternative treatment for treating complex and difficult-to-heal wounds. This article provides an overview of NPWT and the new NPWTi system and describes preliminary experience using NPWTi on patients with complicated infected diabetic foot wounds after surgical debridement and in a multidisciplinary setting. PMID:24251841

Dalla Paola, Luca

2013-12-01

160

supply (i.e., diabetic foot ulcers) as well as in the prevention of postsurgical wound infections (Daum, 2007). Furthermore,  

E-print Network

of these models, euthanasia is required to determine the ex vivo bacterial burden using colony counts and longitudinally monitor the bacterial burden and infection induced inflammation without the need for euthanasia

Simon, Scott I.

161

STUDY PROTOCOL Open Access Use of biological mesh versus standard wound  

E-print Network

STUDY PROTOCOL Open Access Use of biological mesh versus standard wound care in infected incisional, controlled trial comparing the use of a biological mesh versus traditional wound care in patients with an IVH. The primary end point is 6-month infectious and/or wound morbidity. Secondary end points are wound infection

Boyer, Edmond

162

Antimicrobial and antiseptic strategies in wound management.  

PubMed

Wounds, especially chronic wounds, represent a global problem costing millions of dollars per year in developed countries and are characterised by microbial complications including local or overt infection, delayed healing and spread of multiresistant germs. Therefore, antimicrobial wound management is a major challenge that continues to require new solutions against microbes and their biofilms. As systemic antibiotics can barely penetrate into wound biofilms and topically applied ones can easily lead to sensitisation, antisepsis is the method of choice to treat germs in wounds. This brief review discusses the role of antiseptics in reducing bioburden in chronic wounds. Balancing antimicrobial potency and tolerability of antiseptic procedures is critical in wound therapy. However, antiseptics alone may not be able to achieve wound healing without addressing other factors regarding the patient's general health or the wound's physical environment. Although the precise role of bioburden in chronic wounds remains to be evaluated, planktonic as well as biofilm-bound microbes are indications for antiseptic intervention. Octenidine dihydrochloride and polyhexanide are the most effective, as well as best tolerated, antiseptics in wound management today, and new strategies to reduce bacterial wound burden and support the body's immune response are being developed. PMID:24251838

Daeschlein, Georg

2013-12-01

163

Fungus gnat (Bradysia impatiens) feeding and mechanical wounding inhibit Pythium aphanidermatum infection of geranium seedlings (Pelargonium x hortorum)  

Technology Transfer Automated Retrieval System (TEKTRAN)

A series of laboratory tests were conducted to investigate potential effects of fungus gnat (Bradysia impatiens) feeding damage on susceptibility of geranium seedlings (Pelargonium x hortorum) to infection by the root rot pathogen Pythium aphanidermatum. Effects were compared to those from similar t...

164

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial  

Microsoft Academic Search

The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related\\u000a infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open,\\u000a controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units\\u000a at a university hospital undergoing chemotherapy for haematological or oncological malignancies

Heiner Ruschulte; Matthias Franke; Petra Gastmeier; Sebastian Zenz; Karl H. Mahr; Stefanie Buchholz; Bernd Hertenstein; Hartmut Hecker; Siegfried Piepenbrock

2009-01-01

165

Combination of Silver Nanoparticles and Drosera binata Extract as a Possible Alternative for Antibiotic Treatment of Burn Wound Infections Caused by Resistant Staphylococcus aureus  

PubMed Central

Staphylococcus aureus is the most common infectious agent involved in the development of skin infections that are associated with antibiotic resistance, such as burn wounds. As drug resistance is a growing problem it is essential to establish novel antimicrobials. Currently, antibiotic resistance in bacteria is successfully controlled by multi-drug therapies. Here we demonstrate that secondary metabolites present in the extract obtained from Drosera binata in vitro cultures are effective antibacterial agents against S. aureus grown in planktonic culture and in biofilm. Moreover, this is the first report demonstrating the synergistic interaction between the D. binata extract and silver nanoparticles (AgNPs), which results in the spectacular enhancement of the observed bactericidal activity, while having no cytotoxic effects on human keratinocytes. Simultaneous use of these two agents in significantly reduced quantities produces the same effect, i.e. by killing 99.9% of bacteria in inoculum or eradicating the staphylococcal biofilm, as higher amounts of the agents used individually. Our data indicates that combining AgNPs with either the D. binata extract or with its pure compound (3-chloroplumbagin) may provide a safe and highly effective alternative to commonly used antibiotics, which are ineffective towards the antibiotic-resistant S. aureus. PMID:25551660

Krychowiak, Marta; Grinholc, Mariusz; Banasiuk, Rafal; Krauze-Baranowska, Miroslawa; G?ód, Daniel; Kawiak, Anna; Królicka, Aleksandra

2014-01-01

166

Reconstruction of infected and denuded scrotum and penis by combined application of negative pressure wound therapy and split-thickness skin grafting.  

PubMed

Trauma to the genital region and perineum can leave behind lifelong sequelae and pose significant challenges to surgeons in the restoration of functional ability and aesthetic status. Effective methods and techniques are indispensable during the treatment period. Negative pressure wound therapy (NPWT) is a widely accepted technique that is becoming a commonplace treatment in many clinical settings. The purpose of this case report was to introduce the efficacy of the concurrent usage of NPWT and split-thickness skin grafting (STSG) in the reconstruction of genital injuries. A man suffered a traffic accident that caused necrosis of the scrotum and penis associated with a severe infection caused by Pseudomonas aeruginosa and Enterobacter cloacea. After debridement, we adopted NPWT during the postoperative dressing changes and the application of meshed STSG. The outcomes showed that combination of NPWT and split-thickness skin grafts is safe, well-tolerated and efficient in the reconstruction of penoscrotal defects. This could be a versatile tool for reconstruction after perineal and penoscrotal trauma. PMID:22672131

Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai

2013-08-01

167

Bacterial Strain Diversity Within Wounds  

PubMed Central

Significance: Rare bacterial taxa (taxa of low relative frequency) are numerous and ubiquitous in virtually any sample—including wound samples. In addition, even the high-frequency genera and species contain multiple strains. These strains, individually, are each only a small fraction of the total bacterial population. Against the view that wounds contain relatively few kinds of bacteria, this newly recognized diversity implies a relatively high rate of migration into the wound and the potential for diversification during infection. Understanding the biological and medical importance of these numerous taxa is an important new element of wound microbiology. Recent Advances: Only recently have these numerous strains been discovered; the technology to detect, identify, and characterize them is still in its infancy. Multiple strains of both gram-negative and gram-positive bacteria have been found in a single wound. In the few cases studied, the distribution of the bacteria suggests microhabitats and biological interactions. Critical Issues: The distribution of the strains, their phenotypic diversity, and their interactions are still largely uncharacterized. The technologies to investigate this level of genomic detail are still developing and have not been largely deployed to investigate wounds. Future Directions: As advanced metagenomics, single-cell genomics, and advanced microscopy develop, the study of wound microbiology will better address the complex interplay of numerous individually rare strains with both the host and each other. PMID:25566411

Kirkup, Benjamin C.

2015-01-01

168

[Traumatic wound botulism].  

PubMed

Botulism is a rare illness caused by a potent neurotoxin produced by the bacterium of the Clostridium family. Clostridium botulinum is the most frequent one, but Clostridium baratti and Clostridium butyricum are also neurotoxins producers. There are seven neurotoxins types, A to G; A, B, E, F and G cause human botulism. Every neurotoxin type blocks cholinergic transmission at the myoneural junction. The least frequent syndrome results from Clostridium botulinum colonization of a wound and it is clinically similar to the other botulism syndromes, but with fever due to an infected wound. Disease should be suspected in lucid patient with a symmetric descending, flaccid paralysis. This syndrome appears within the first twenty days, but it could be present for weeks or months before the disease is diagnosed. This disease is poorly known, so to be diagnosed it requires a high index of suspicion. The treatment is a supportive one; administration of the specific antitoxin must be early in order to neutralize the toxin before the debridement and cleaning of the infected wound. PMID:24584800

Moreno, Emilia; Pannocchia, Cecilia; Carricondo, Concepción

2014-04-01

169

Chemokine changes during oral wound healing  

Microsoft Academic Search

The oral mucosa is susceptible to tissue injury from many causes, including infection, autoimmune disorders, surgical and accidental trauma, and gingival and periodontal inflammation; however, little is known about the events that influence wound healing in the mouth. Recent studies in non-oral tissues have implicated immune system-derived factors, in particular chemokines, in the wound healing process. Tissues from mice with

Kevin McGrory; Catherine M. Flaitz; John R. Klein

2004-01-01

170

Management of Sports-Induced Skin Wounds  

PubMed Central

Skin wounds are common in sports but are rarely documented by the certified athletic trainer. The literature is unclear about wound types, and none of the articles reviewed reported frequencies. The purpose of this paper is to discuss the frequency of common athletic skin wounds and their specific management. Management of skin wounds can sometimes be problematic. Hydrogen peroxide has been used on wounds since 1947, yet some researchers report that hydrogen peroxide and iodophor solution can delay or interfere with wound healing, or cause damage to the wounded area if use is intense and prolonged. Occlusive dressings have been reported to have considerable advantage in maintaining a moist wound bed and in decreasing healing time. Infection rates beneath occlusive dressings, however, are similar to those associated with other types of dressings. Complications to wounds, with or without the use of occlusive dressings, such as keloids and seborrheic dermatitis, occur in low frequencies. Due to a lack of specific information about sports-induced skin wounds and their management, we recommend that standardized documentation for common wounds be developed along with further study of techniques for management. PMID:16558324

Foster, Danny T.; Rowedder, Laura J.; Reese, Steven K.

1995-01-01

171

GhWRKY40, a Multiple Stress-Responsive Cotton WRKY Gene, Plays an Important Role in the Wounding Response and Enhances Susceptibility to Ralstonia solanacearum Infection in Transgenic Nicotiana benthamiana  

PubMed Central

WRKY transcription factors form one of the largest transcription factor families and function as important components in the complex signaling processes that occur during plant stress responses. However, relative to the research progress in model plants, far less information is available on the function of WRKY proteins in cotton. In the present study, we identified the GhWRKY40 gene in cotton (Gossypium hirsutum) and determined that the GhWRKY40 protein is targeted to the nucleus and is a stress-inducible transcription factor. The GhWRKY40 transcript level was increased upon wounding and infection with the bacterial pathogen Ralstonia solanacearum. The overexpression of GhWRKY40 down-regulated most of the defense-related genes, enhanced the wounding tolerance and increased the susceptibility to R. solanacearum. Consistent with a role in multiple stress responses, we found that the GhWRKY40 transcript level was increased by the stress hormones salicylic acid (SA), methyl jasmonate (MeJA) and ethylene (ET). Moreover, GhWRKY40 interacted with the MAPK kinase GhMPK20, as shown using yeast two-hybrid and bimolecular fluorescence complementation systems. Collectively, these results suggest that GhWRKY40 is regulated by SA, MeJA and ET signaling and coordinates responses to wounding and R. solanacearum attack. These findings highlight the importance of WRKYs in regulating wounding- and pathogen-induced responses. PMID:24747610

Wang, Xiuling; Yan, Yan; Li, Yuzhen; Chu, Xiaoqian; Wu, Changai; Guo, Xingqi

2014-01-01

172

Regulatory involvement of ABA in potato tuber wound-healing  

Technology Transfer Automated Retrieval System (TEKTRAN)

Rapid wound-healing is crucial in protecting potato tubers from infection and dehydration. Wound-induced suberization and the accumulation of hydrophobic barriers to reduce water vapor conductance/loss are principle protective wound-healing processes. However, little is known about the biological ...

173

[Environmental hygiene of the surgery suites for the control of surgical wound infection: Italian legislation and international guidelines].  

PubMed

Aim of the study is to describe the application of surgical site infection (SSI) control procedures in general surgery operating rooms of Piedmont region hospitals. A specific data collection form was designed to record information. 54 questionnaires were compiled. Piedmont legislation related to operating rooms' equipment is obeyed in more than 90% of hospitals. Nevertheless, there are some critical aspects than could be risk factors for SSI or that are not useful in order to prevent them: use of UV radiation (11.3%), use of tacky mats at the entrance of the operating room (5.7%), special cleaning of operating rooms after contaminated or dirty operations (73.6%) and routine environmental sampling (10%) that is strongly recommended by ISPESL guideline in disagreement with international recommendations. Steam autoclave is used for surgical instruments sterilization by 100% of hospitals, but only 50% of them performs an annual validation of both autoclave performance and sterilization procedures. The study gave useful information in order to promote some structural modifications and personnel education for efficacious SSI prevention and control. PMID:17228607

Charrier, L; Castella, A; Di Legami, V; Pastorino, F; Farina, E C; Argentero, P A; Zotti, C M

2006-01-01

174

Simultaneous irrigation and negative pressure wound therapy enhances wound healing and reduces wound bioburden in a porcine model.  

PubMed

Infected foot wounds are one of the most common reasons for hospitalization and amputation among persons with diabetes. The objective of the study was to investigate a new wound therapy system that employs negative pressure wound therapy (NPWT) with simultaneous irrigation therapy. For this study, we used a porcine model with full-thickness excisional wounds, inoculated with Pseudomonas aeruginosa. Wounds were treated for 21 days of therapy with either NPWT, NPWT with simultaneous irrigation therapy using normal saline or polyhexanide biguanide (PHMB) at low or high flow rates, or control. Data show that NPWT with either irrigation condition improved wound healing rates over control-treated wounds, yet did not differ from NPWT alone. NPWT improved bioburden over control-treated wounds. NPWT with simultaneous irrigation further reduced bioburden over control and NPWT-treated wounds; however, flow rate did not affect these outcomes. Together, these data show that NPWT with simultaneous irrigation therapy with either normal saline or PHMB has a positive effect on bioburden in a porcine model, which may translate clinically to improved wound healing outcomes. PMID:24134060

Davis, Kathryn; Bills, Jessica; Barker, Jenny; Kim, Paul; Lavery, Lawrence

2013-01-01

175

Use of a Bioluminescent Pseudomonas aeruginosa Strain within an In Vitro Microbiological System, as a Model of Wound Infection, To Assess the Antimicrobial Efficacy of Wound Dressings by Monitoring Light Production?  

PubMed Central

A bioluminescent Pseudomonas aeruginosa was incorporated into an in vitro static diffusion method to determine whether light output could be used as a measure of wound dressing efficacy. A significant linear correlation was observed between viable counts and bioluminescence during exponential growth in planktonic culture (r2 = 0.969). Exponential-phase cells were used to inoculate cellulose discs for integration into an in vitro wound model that incorporated a reservoir of serum. A significant linear correlation was found between bioluminescence (photon counts monitored by a low-light camera) and viable counts in this growth environment (r2 = 0.982). Three antimicrobial wound dressings were applied to the surface of freshly prepared sample discs within the wound model, and the kill kinetics were codetermined by photon and viable counts. Quantifiable kill rates gave the same order of efficacy for the three wound dressings using both types of measurement, and a significant linear correlation was shown between photon and viable counts (r2 = 0.873) within this killing environment. Under all defined conditions, a significant linear correlation between bioluminescence and viable counts was shown but the actual slope of the correlation was different, depending on the physicochemical environment of the cells. Hence, significantly more light per cell (P < 0.0001) was produced when cells in discs were exposed to a killing environment compared to a growing environment. As long as defined conditions are employed, the resulting linear correlation enables the state of the system to be continually monitored without disturbance, allowing more immediate and accurate calculations of kill rates without the need for viable counting. PMID:17638701

Thorn, R. M. S.; Nelson, S. M.; Greenman, J.

2007-01-01

176

Antimicrobial blue light therapy for multidrug-resistant Acinetobacter baumannii infection in a mouse burn model: implications for prophylaxis and treatment of combat-related wound infections.  

PubMed

In this study, we investigated the utility of antimicrobial blue light therapy for multidrug-resistant Acinetobacter baumannii infection in a mouse burn model. A bioluminescent clinical isolate of multidrug-resistant A. baumannii was obtained. The susceptibility of A. baumannii to blue light (415 nm)-inactivation was compared in vitro to that of human keratinocytes. Repeated cycles of sublethal inactivation of bacterial by blue light were performed to investigate the potential resistance development of A. baumannii to blue light. A mouse model of third degree burn infected with A. baumannii was developed. A single exposure of blue light was initiated 30 minutes after bacterial inoculation to inactivate A. baumannii in mouse burns. It was found that the multidrug-resistant A. baumannii strain was significantly more susceptible than keratinocytes to blue light inactivation. Transmission electron microscopy revealed blue light-induced ultrastructural damage in A. baumannii cells. Fluorescence spectroscopy suggested that endogenous porphyrins exist in A. baumannii cells. Blue light at an exposure of 55.8 J/cm(2) significantly reduced the bacterial burden in mouse burns. No resistance development to blue light inactivation was observed in A. baumannii after 10 cycles of sublethal inactivation of bacteria. No significant DNA damage was detected in mouse skin by means of a skin TUNEL assay after a blue light exposure of 195 J/cm(2). PMID:24381206

Zhang, Yunsong; Zhu, Yingbo; Gupta, Asheesh; Huang, Yingying; Murray, Clinton K; Vrahas, Mark S; Sherwood, Margaret E; Baer, David G; Hamblin, Michael R; Dai, Tianhong

2014-06-15

177

Topical antimicrobial agents for the treatment of chronic wounds.  

PubMed

Chronic wounds are commonly observed in acute and community settings. The management of chronic wounds represents a significant proportion of health-care resources and makes up a substantial amount of contact time with community-based nurses spending approximately 25% to 50% of their time treating wounds. Chronic wounds often exhibit increased bacterial burden that can negatively impact upon patients, reduce their quality of life and substantially increase treatment costs for health care providers. Antibiotic resistance has become a major medical and public health problem, and interest has been generated in the use of topical therapies to manage wound infection. This article presents an overview of the historical use of honey, silver and iodine for the treatment of infected wounds progressing through to modern day use and the current evidence base for the use of these antimicrobial agents in the management of infected wounds. PMID:19749669

Ousey, Karen; McIntosh, Caroline

2009-09-01

178

Integrated negative pressure wound therapy system with volumetric automated fluid instillation in wounds at risk for compromised healing.  

PubMed

Nearly all wounds are at risk for compromised healing due to excessive exudation, oedema, contaminants and presence of inflammatory mediators. Compromised wounds have the potential to develop complications, such as infection, which may lead to delayed wound healing, prolonged hospitalisation and more frequent readmissions. It is generally believed that the wound advances from contamination to colonisation when the bacteria on the wound's surface begin to replicate and increase their metabolic activity. Heavy bacterial bioburden increases the metabolic requirements, stimulates a proinflammatory environment and encourages the in-migration of monocytes, macrophages and leukocytes - all of which can negatively impact wound healing. Bacteria also secrete harmful cytokines which can lead to vasoconstriction and decreased blood flow. Thus, controlling or preventing infections is essential for normal wound healing process to occur. While the mainstay of treating wound infection has historically included intravenous, oral and/or topical antimicrobials in addition to frequent gauze dressing changes, a shift towards wound management with advanced modalities, such as negative pressure wound therapy (NPWT), has occurred during the past decade. This review will provide expert opinion and scientific support for the use of NPWT with instillation (NPWTi; V.A.C. Instill® Wound Therapy and V.A.C. VeraFlo™ Therapy, KCI USA, Inc., San Antonio, TX) for the treatment of at-risk and complicated wounds. PMID:22727137

Gabriel, Allen

2012-08-01

179

Impregnation of silver nanoparticles into bacterial cellulose for antimicrobial wound dressing  

Microsoft Academic Search

Bacterial cellulose was produced by Acetobacter xylinum (strain TISTR 975). Bacterial cellulose is an interesting material for using as a wound dressing since it provides moist environment to a wound resulting in a better wound healing. However, bacterial cellulose itself has no antimicrobial activity to prevent wound infection. To achieve antimicrobial activity, silver nanoparticles were impregnated into bacterial cellulose by

Thawatchai Maneerung; Seiichi Tokura; Ratana Rujiravanit

2008-01-01

180

Wound care centers  

MedlinePLUS

A wound care center, or clinic, is a medical facility for treating wounds that don't heal. You have a ... a team of health care providers trained in wound care. Your team may include: Physicians who oversee your ...

181

Proper Care for Wounds  

MedlinePLUS Videos and Cool Tools

... Motor Vehicle Safety En Español About Emergencies Wound Care Proper Care For Wounds Most cuts are minor but it is still important to properly care for them. Wound Care Dr. David Ross, emergency ...

182

Comparação da atividade de ácidos graxos essenciais e biomembrana na microbiota de feridas crônicas infectadas1 Comparison of the activity of fatty essential acids and biomembrane in the microbiota of infected chronic wounds Comparación de la actividad de ácidos grasosos esenciales y biomembrana en la microbiota de heridas crónicas infectadas  

Microsoft Academic Search

For patients cured of leprosy, low-limb ulcers represent a challenge to healthcare workers, for being chronic, infected, and recurrent. This study aimed to compare the latex biomembrane (Biocure™) and an EFA-based product (Dersani™) action on the microbiota of infected chronic wounds, in patients discharged from the treatment of leprosy. This is a research carried out at Hospital de Dermatologia Sanitária,

Geovana Eloisa Quege; Maria Márcia Bachion; Ruy de Souza; Lino Junior III; Ana Beatriz; Mori Lima; Priscila Santos Ferreira; Fabiana Cristina Pimenta

183

Efficacy of topical silver against fungal burn wound pathogens  

Microsoft Academic Search

Background: Fungal infections of burn wounds have become an important cause of burn-associated morbidity and mortality. The nature of fungal infections dictates aggressive treatment to minimize the morbidity associated with these infections. Persons with large total body surface area burns are particularly susceptible to fungal infections and are treated in such a manner as to minimize their risk of infection.

J. B. Wright; K. Lam; D. Hansen; R. E. Burrell

1999-01-01

184

A Look at Bioengineering: Wound Dressings  

E-print Network

A Look at Bioengineering: Wound Dressings................................................................................................................................................. 3 Wound dressing kit contents ............................................................................................................. 4 INTRODUCTION Wounds and Wound Dressings 101

Virginia Tech

185

Practices in Wound Healing Studies of Plants  

PubMed Central

Wounds are the result of injuries to the skin that disrupt the other soft tissue. Healing of a wound is a complex and protracted process of tissue repair and remodeling in response to injury. Various plant products have been used in treatment of wounds over the years. Wound healing herbal extracts promote blood clotting, fight infection, and accelerate the healing of wounds. Phytoconstituents derived from plants need to be identified and screened for antimicrobial activity for management of wounds. The in vitro assays are useful, quick, and relatively inexpensive. Small animals provide a multitude of model choices for various human wound conditions. The study must be conducted after obtaining approval of the Ethics Committee and according to the guidelines for care and use of animals. The prepared formulations of herbal extract can be evaluated by various physicopharmaceutical parameters. The wound healing efficacies of various herbal extracts have been evaluated in excision, incision, dead space, and burn wound models. In vitro and in vivo assays are stepping stones to well-controlled clinical trials of herbal extracts. PMID:21716711

Thakur, Rupesh; Jain, Nitika; Pathak, Raghvendra; Sandhu, Sardul Singh

2011-01-01

186

Wound Healing Essentials: Let There Be Oxygen  

PubMed Central

The state of wound oxygenation is a key determinant of healing outcomes. From a diagnostic standpoint, measurements of wound oxygenation are commonly used to guide treatment planning such as amputation decision. In preventive applications, optimizing wound perfusion and providing supplemental O2 in the peri-operative period reduces the incidence of post-operative infections. Correction of wound pO2 may, by itself, trigger some healing responses. Importantly, approaches to correct wound pO2 favorably influence outcomes of other therapies such as responsiveness to growth factors and acceptance of grafts. Chronic ischemic wounds are essentially hypoxic. Primarily based on the tumor literature, hypoxia is generally viewed as being angiogenic. This is true with the condition that hypoxia be acute and mild to modest in magnitude. Extreme near-anoxic hypoxia, as commonly noted in problem wounds, is not compatible with tissue repair. Adequate wound tissue oxygenation is required but may not be sufficient to favorably influence healing outcomes. Success in wound care may be improved by a personalized health care approach. The key lies in our ability to specifically identify the key limitations of a given wound and in developing a multifaceted strategy to specifically address those limitations. In considering approaches to oxygenate the wound tissue it is important to recognize that both too little as well as too much may impede the healing process. Oxygen dosing based on the specific need of a wound therefore seems prudent. Therapeutic approaches targeting the oxygen sensing and redox signaling pathways are promising. PMID:19152646

Sen, Chandan K.

2009-01-01

187

JAMA Patient Page: Wound Infections  

MedlinePLUS

... occur in persons with medical problems may require hospitalization and intravenous (through a vein directly into the bloodstream) antibiotics. In the case of sepsis or septic shock, intensive care and life support may be needed. Redness ...

188

Wound care with antibacterial honey (Medihoney) in pediatric hematology–oncology  

Microsoft Academic Search

The physiologic process of wound healing is impaired and prolonged in pediatric patients receiving chemotherapy. Due to profound immunosuppression, wound infection can easily spread and act as the source of sepsis. Referring to in vitro studies, which confirmed the antibacterial potency of special honey preparations against typical isolates of nosocomially acquired wound infections (including Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci)

Arne Simon; Kai Sofka; Gertrud Wiszniewsky; Gisela Blaser; Udo Bode; Gudrun Fleischhack

2006-01-01

189

Study of two techniques for midline laparotomy fascial wound closure.  

PubMed

To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted fascial wound closure technique. PMID:24891770

Gurjar, Vipul; Halvadia, B M; Bharaney, R P; Ajwani, Vicky; Shah, S M; Rai, Samir; Trivedi, Mitesh

2014-04-01

190

Clinical evaluation of gauze-based negative pressure wound therapy in challenging wounds.  

PubMed

The aim of this randomised clinical study was to evaluate the effectiveness and safety of gauze-based negative pressure wound therapy (NPWT) in patients with challenging wounds. A total of 50 consecutive patients who had wound drainage for more than 5 days, required open wound management and had existence of culture positive infection were included the study. In this study, gauze-based NPWT was compared with conventional dressing therapy in the treatment of patients with difficult-to-heal wounds. The patients were randomly divided into two groups. Group I (n = 25) was followed by conventional antiseptic (polyhexanide solution) dressings, and group II (n = 25) was treated with saline-soaked antibacterial gauze-based NPWT. The wounds' sizes, number of debridement, bacteriology and recurrence were compared between group I and group II. The mean age of the patients was 59·50 years (range 23-97). In group I, average wound sizes of pre- and post-treatment periods were 50·60 ± 55·35 and 42·50 ± 47·92 cm(2), respectively (P < 0·001). Average duration of treatment was 25·52 ± 16·99 days, and average wound size reduction following the treatment was 19·99% in this group. In group II, the wounds displayed considerable shrinkage, accelerated granulation tissue formation, decreased and cleared away exudate. The average wound sizes in the pre- and post-treatment periods were 98·44 ± 100·88 and 72·08 ± 75·78 cm(2) , respectively (P < 0·001). Average duration of treatment was 11·96 ± 2·48 days, and average wound size reduction following the treatment was 32·34%. The patients treated with antibacterial gauze-based NPWT had a significantly reduced recurrence (2 wounds versus 14 wounds, P = 0·001), and increased number of the culture-negative cases (22 wounds versus 16 wounds, P < 0·047) in a follow-up period of 12 months. There was a statistically significant difference between two groups in all measurements. As a result, we can say that the gauze-based NPWT is a safe and effective method in the treatment of challenging infective wounds when compared with conventional wound management. PMID:22420837

Tuncel, Umut; Erkorkmaz, Ünal; Turan, Ayd?n

2013-04-01

191

Topical phytochemicals: applications for wound healing.  

PubMed

To maximize the effectiveness of any complementary therapy in treating chronic wounds, the clinician must fully appreciate the scientific basis in which this treatment modality influences wound healing. The biological changes influenced by phytochemical compounds can have a positive effect on wound healing, which often depends on extract selection and clinical application. A sound understanding of the physiological changes that are associated with phytochemical compounds will help the clinician to make an appropriate extract selection and guide treatment decisions.Tissue adhesion has long been considered a key step in determining a bacterium's pathogenicity. The process of preventing infections by decreasing bacterial-tissue adhesion has been reported in the literature, with particular focus on the antibacterial effects of ingested cranberry juice. Cranberry juice has been studied primarily as a "home remedy" in the treatment of urinary tract infection with its antiadhesion and/or antibacterial effects in a chronic wound needing further investigation. PMID:24932954

Walton, Edward W

2014-07-01

192

[Application of topical drugs in burn wound].  

PubMed

For burn patients, topical treatment is as important as systemic treatment. Reasonable and timely wound treatment will influence the homeostatic equilibrium, and the progression, the prognosis, and the outcome of the disease. The therapeutic principle should be varied for wounds with different depth of injury. But avoiding or at least alleviating infection, and accelerating healing period, were the common principles. In common, the medication for local wound treatment includes: topical antiseptic, surgical dressing products, artificial skins, and so on. Ideal topical antiseptic should have the following characteristics: the antimicrobial spectrum is broad, including Pseudomonas aeruginosa and MRSA; be able to penetrate necrotic tissue; does not induce drug resistance easily; no local irritating effect and not painful; no side effect to body;can be applied easily; low cost. The functions of surgical dressing include: protect the wounds, keep the microcirculation open, and accelerate wound healing. Artificial skin has been used as the autoskin carrier in skin transplantation operation for large burn area to protect the autoskin grafts, accelerate wound healing, and cover the wounds temporarily. Burns therapy has developed for 50 years in China, the study of local treatment for burn wounds has also experienced a tortuous path of trial and error. This review might contribute some ideas future research. PMID:19103013

Zhang, Guo-an

2008-10-01

193

Gunshot Wounds  

PubMed Central

Penetrating chest trauma can cause a wide variety of cardiac injuries, including myocardial contusion, damage to the interventricular septum, laceration of the coronary arteries, and free-wall rupture. Herein, we describe the case of a 21-year-old man who presented with congestive heart failure, which was secondary to an old myocardial infarction and complicated by the delayed formation of a ventricular septal defect. All of these conditions were attributable to multiple gunshot wounds that the patient had sustained 6 months earlier. Left ventricular angiography showed an apical aneurysm; a large, muscular, ventricular septal defect; and 19 gunshot pellets in the chest wall. Three months after aneurysmectomy and surgical closure of the septal defect, the patient had recovered fully and was asymptomatic. This case reaffirms the fact that substantial cardiac injuries can appear months after chest trauma. The possibility of traumatic ventricular septal defect should be considered in all multiple-trauma patients who develop a new heart murmur, even when overt chest-wall injury is absent. PMID:22412248

Kumar, Sudeep; Moorthy, Nagaraja; Kapoor, Aditya; Sinha, Nakul

2012-01-01

194

Silk sericin ameliorates wound healing and its clinical efficacy in burn wounds.  

PubMed

The aim of this study was to evaluate the effect of silk sericin, a protein from silkworm cocoon, on scratch wound healing in vitro. For applicable result in clinical use, we also study the efficacy of sericin added to a standard antimicrobial cream, silver zinc sulfadiazine, for open wound care in the treatment of second-degree burn wounds. In vitro scratch assays show that sericin at concentration 100 ?g/mL can promote the migration of fibroblast L929 cells similar to epidermal growth factor (positive control) at 100 ?g/mL. After 1 day of treatment, the length of scratch in wounds treated with sericin was significantly shorter than the length of negative control wounds (culture medium without sericin). For clinical study, a total of 29 patients with 65 burn wounds which covered no less than 15 % of total body surface area were randomly assigned to either control (wounds treated with silver zinc sulfadiazine cream) or treatment (wounds treated with silver zinc sulfadiazine with added sericin cream) group in this randomized, double-blind, standard-controlled study. The results showed that the average time to reach 70 % re-epithelialization of the burned surface and complete healing in the treatment group was significantly shorter, approximately 5-7 days, than in the control group. Regarding time for complete healing, control wounds took approximately 29.28 ± 9.27 days, while wounds treated with silver zinc sulfadiazine with added sericin cream took approximately 22.42 ± 6.33 days, (p = 0.001). No infection or severe reaction was found in any wounds. This is the first clinical study to show that silk sericin is safe and beneficial for burn wound treatment when it is added to silver sulfadiazine cream. PMID:23748948

Aramwit, Pornanong; Palapinyo, Sirinoot; Srichana, Teerapol; Chottanapund, Suthat; Muangman, Pornprom

2013-09-01

195

Induction and accumulation of caffeine in young, actively growing leaves of cocoa ( Theobroma cacao L.) by wounding or infection with Crinipellis perniciosa  

Microsoft Academic Search

Crinipellis perniciosa, the causal agent of witches' broom disease, attacks young actively growing shoots, flowers and developing fruits of cocoa (Theobroma cacao L.). Infected shoots become fasciated and a profusion of hypertrophic shoots with small leaves develop from the lateral buds. This is followed by desiccation and death of the infected stem and leaves. Infected stem tissue contains significant amounts

Madhu Aneja; Thomas Gianfagna

2001-01-01

196

Intraoperative handling and wound healing of arthroscopic portal wounds: a clinical study comparing nylon suture with wound closure strips.  

PubMed

This prospective, single-centre study compared wound closure methods in patients undergoing arthroscopy. Closure of arthroscopic portal wounds with sterile adhesive strips is effective and convenient for wound management. The method was associated with a reduced potential for infection, faster renewal of tensile strength, greater cost effectiveness, and better cosmetic effects comparing with suture closure. This method of wound closure may also reduce the incidence of needle stick injury in the theatre environment. Thereby the incidence of percutaneous exposure following a surgical procedure may not facilitate transmission of blood borne pathogens such as human immunodeficiency virus (HIV), hepatitis C virus and hepatitis B virus. As a result it may reduce litigation in today's changing healthcare climate. PMID:18578357

Bhattacharyya, Mayukh; Bradley, Helen

2008-05-01

197

Joint Infection (Beyond the Basics)  

MedlinePLUS

... medications. Artificial joint infection symptoms — People who develop infections immediately after joint replacement surgery typically have pain, redness, and swelling at the joint or drainage from the wound. Those who develop infections later usually notice a ...

198

Wound Healing Finally Enters the Age of Molecular Diagnostic Medicine  

PubMed Central

Background Many wounds are difficult to heal because of the large, complex community of microbes present within the wound. The Problem Classical laboratory culture methods do not provide an accurate picture of the microbial interactions or representation of microorganisms within a wound. There is an inherent bias in diagnosis based upon classical culture stemming from the ability of certain organisms to thrive in culture while others are underrepresented or fail to be identified in culture altogether. Chronic wounds also contain polymicrobial infections existing as a cooperative community that is resistant to antibiotic therapy. Basic/Clinical Science Advances New methods in molecular diagnostic medicine allow the identification of nearly all organisms present in a wound irrespective of the ability of these organisms to be grown in culture. Advances in DNA analyses allow absolute identification of microorganisms from very small clinical specimens. These new methods also provide a quantitative representation of all microorganisms contributing to these polymicrobial infections. Clinical Care Relevance Technological advances in laboratory diagnostics can significantly shorten the time required to heal chronic wounds. Identification of the genetic signatures of organisms present within a wound allows clinicians to identify and treat the primary organisms responsible for nonhealing wounds. Conclusion Advanced genetic technologies targeting the specific needs of wound care patients are now accessible to all wound care clinicians. PMID:24527290

Tatum, Owatha L.; Dowd, Scot E.

2012-01-01

199

Negative pressure wound therapy  

Microsoft Academic Search

iabetic foot disease is a major global burden. Foot ulcers frequently develop complications and become chronic, representing a considerable challenge as these are typically very difficult to treat. New therapies are needed to address these wounds and there is an increasing focus on negative pressure wound therapy (NPWT). This technique has been shown to accelerate wound healing and although its

Michael Kirby

2007-01-01

200

Negative pressure wound therapy  

Microsoft Academic Search

D iabetic foot disease is a major global burden. Foot ulcers frequently develop complications and become chronic, representing a considerable challenge as these are typically very difficult to treat. New therapies are needed to address these wounds and there is an increasing focus on negative pressure wound therapy (NPWT). This technique has been shown to accelerate wound healing and although

MICHAEL KIRBY

2010-01-01

201

Aging and Wound Healing  

Microsoft Academic Search

Impaired wound healing in the elderly presents a major clinical and economic problem. With the aging population growing in both number and percentage, the importance of understanding the mechanisms underlying age-related impairments in healing is increased. Normal skin exhibits characteristic changes with age that have implications for wound healing. Additionally, the process of wound healing is altered in aged individuals.

Ankush Gosain; Luisa A. DiPietro

2004-01-01

202

Clinical experience with the negative pressure wound dressing  

Microsoft Academic Search

Between 1997 and 1999, more than 300 patients have been treated using negative pressure wound dressings. The technique has been used successfully to prepare various acute, chronic or infected wounds to accept a skin graft or flap, and to promote graft take at difficult donor sites. The advantages include rapid healing by secondary intention, reduced time to skin grafting, an

C. Avery; J. Pereira; A. Moody; I. Whitworth

2000-01-01

203

Involvement of ABA in potato tuber wound-healing  

Technology Transfer Automated Retrieval System (TEKTRAN)

Rapid suberization of tubers wounded during harvest, handling and seed cutting is crucial in protecting against infections, dehydration and defect development. Research at this laboratory is directed at determining the biological factors that regulate wound-healing and which may facilitate the deve...

204

Value of incisional negative pressure wound therapy in orthopaedic surgery.  

PubMed

Soft tissue and wound treatment after orthopaedic interventions (especially after trauma) is still an enormously challenging situation for every surgeon. Since development of negative pressure wound therapy (NPWT), new indications have been consistently added to the original field of application. Recently, NPWT has been applied directly over high-risk closed surgical incisions. Review of the literature indicates that this therapy has shown positive effects on incisions after total ankle replacement or calcaneal fractures, preventing haematoma and wound dehiscence. In those cases reduced swelling, decreased pain and healing time of the wound were seen. Additionally, NPWT applied on incisions after acetabular fractures showed a decreased rate of infection and wound healing problems compared with published infection rates. Even after total hip arthroplasty, incisional NPWT reduced incidence of postoperative seroma and improved wound healing. In patients with tibial plateau, pilon or calcaneus fractures requiring surgical stabilisation after blunt trauma, reduced risk of developing acute and chronic wound dehiscence and infection was observed when using incisional NPWT. To conclude, incisional NPWT can help to reduce risk of delayed wound healing and infection after severe trauma and orthopaedic interventions. PMID:24851728

Brem, Matthias H; Bail, Hermann J; Biber, Roland

2014-06-01

205

Wound contraction effects and antibacterial properties of Tualang honey on full-thickness burn wounds in rats in comparison to hydrofibre  

PubMed Central

Background Full-thickness burn wounds require excision and skin grafting. Multiple surgical procedures are inevitable in managing moderate to severe full-thickness burns. Wound bed preparations prior to surgery are necessary in order to prevent wound infection and promote wound healing. Honey can be used to treat burn wounds. However, not all the honey is the same. This study aims to evaluate the wound contraction and antibacterial properties of locally-produced Tualang honey on managing full-thickness burn wounds in vivo. Methods Thirty-six female Sprague Dawley rats were randomly divided into three groups. Under anaesthesia, three full-thickness burn wounds were created on the dorsum of the rats. The full-thickness burn wounds were inoculated with a specific organism (104), namely Pseudomonas aeruginosa (n = 12), Klebsiella pneumoniae (n = 12), or Acinetobacter baumannii (n = 12). The three burn wounds were dressed with Tualang honey, hydrofibre and hydrofibre silver respectively. Swab samples were obtained every 3 days (day 3, 6, 9, 12, 15, 18 and 21) for quantitative and semi-quantitative microbiological analyses. Clinical assessments, including observations concerning the appearance and wound size, were measured at the same time. Results There was a rapid 32.26% reduction in wound size by day 6 (p = 0.008) in the Tualang honey-treated wounds, and 49.27% by day 15 (p = 0.005). The wounds remained smaller by day 18 (p < 0.032). Tualang honey-treated rats demonstrated a reduction in bacterial growth in Pseudomonas aeruginosa inoculated wounds (p = 0.005). However, hydrofibre silver and hydrofibre-treated wounds are superior to honey-treated wounds with Acinetobacter baumannii (p = 0.035). There was no statistical significant of antibacterial property in Klebsiella pneumonia inoculated wounds. Conclusions Tualang honey has better results with regards to its control of Pseudomonas aeruginosa and its wound contraction effects on full-thickness burn wound in vivo. PMID:20815896

2010-01-01

206

Infections  

MedlinePLUS

... Ear (Otitis Externa) Syphilis Tetanus Tonsillitis Toxic Shock Syndrome Toxic Synovitis Tuberculosis Urinary Tract Infections Vaginal Yeast Infections Warts West Nile Virus What Is "PANS"? Whooping Cough (Pertussis) ...

207

Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO): study protocol for a randomized controlled trial  

PubMed Central

Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45?days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided) and sample size (n?=?258 per group) is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010 PMID:22587425

2012-01-01

208

Improved wound management by regulated negative pressure-assisted wound therapy and regulated, oxygen- enriched negative pressure-assisted wound therapy through basic science research and clinical assessment.  

PubMed

Regulated negative pressure-assisted wound therapy (RNPT) should be regarded as a state-of-the-art technology in wound treatment and the most important physical, nonpharmaceutical, platform technology developed and applied for wound healing in the last two decades. RNPT systems maintain the treated wound's environment as a semi-closed, semi-isolated system applying external physical stimulations to the wound, leading to biological and biochemical effects, with the potential to substantially influence wound-host interactions, and when properly applied may enhance wound healing. RNPT is a simple, safe, and affordable tool that can be utilized in a wide range of acute and chronic conditions, with reduced need for complicated surgical procedures, and antibiotic treatment. This technology has been shown to be effective and safe, saving limbs and lives on a global scale. Regulated, oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) is an innovative technology, whereby supplemental oxygen is concurrently administered with RNPT for their synergistic effect on treatment and prophylaxis of anaerobic wound infection and promotion of wound healing. Understanding the basic science, modes of operation and the associated risks of these technologies through their fundamental clinical mechanisms is the main objective of this review. PMID:23162229

Topaz, Moris

2012-05-01

209

Modified NPWT using round channel drain for pacemaker pocket non-healing complex wound: a case report.  

PubMed

Infection of cardiovascular implantable electronic devices poses a serious medical problem. Management of infected pocket wounds may be challenging for the physician and cause prolonged morbidity for the patient. The mainstay of treatment for infected cardiovascular implantable electronic devices is complete removal of the infected device and appropriate antibiotic therapy. In contrast, removal is not required for superficial or incisional infection at the pocket site if there is no involvement of the device. Here, we describe a modified negative pressure wound therapy (NPWT) technique using a round channel drain for pacemaker pocket non-healing complex wound, which started as a superficial incisional wound infection. PMID:25284298

Petit-Clair, N; Smith, M; Chernev, I

2014-09-01

210

WOUND DRESSINGS ON RED MAPLE AND AMERICAN ELM: EFFECTIVENESS AFTER FIVE YEARS  

Microsoft Academic Search

1 Abstract. Closure and internal compartmentalization of wounds on red maple and American elm were not stimulated by dressings of an asphalt-based material, orange shellac, or polyurethane varnish. After 5 years, decay fungi had infected many treated and control wounds. Some trees closed woun- ds rapidly; others closed wounds slowly regardless of the treatments.

Alex L. Shigo; Charles L. Wilson

211

Evaluation of antimicrobial, antioxidant and wound-healing potentials of Holoptelea integrifolia  

Microsoft Academic Search

The methanolic extracts of Holoptelea integrifolia (Roxb.) (Urticaceae) leaves (MLE) and stem bark (MSBE) were studied for the wound-healing potential. Since wound healing is severely hampered by microbial infection and reactive oxygen species (ROS), this study was undertaken to evaluate antimicrobial and antioxidant activity apart from wound-healing activity. The antimicrobial property of the Holoptelea was studied against the six bacterial

Boreddy Srinivas Reddy; R. Kiran Kumar Reddy; V. G. M. Naidu; K. Madhusudhana; Sachin B. Agwane; Sistla Ramakrishna; Prakash V. Diwan

2008-01-01

212

Wound Healing Activity of Rubus sanctus Schreber (Rosaceae): Preclinical Study in Animal Models  

Microsoft Academic Search

Young shoots of Rubus species have been used for healing of wounds, infected insect bites and pimples in folk medicine for ages. In order to evaluate the wound healing activity of Rubus sanctus, four different extracts were prepared from the whole aerial parts of the plant by using n-hexane, chloroform, ethyl acetate and methanol, respectively. Incision wound healing model by

Ipek Pesin; Ufuk Koca; Hikmet Keles; Esra Kupeli Akkol

2009-01-01

213

Multifunctional activities of KSLW synthetic antimicrobial decapeptide: Implications for wound healing  

Microsoft Academic Search

Wound healing is a complex process leading to the maintenance of skin integrity. Stress is known to increase susceptibility to bacterial infection, alter proinflammatory cytokine expression, and delay wound closure. Recently, antimicrobial peptides have generated interest due to their prokaryotic selectivity, decreased microbial resistance and multifunctional roles in wound healing, including fibroblast stimulation, keratinocyte migration and leukocyte migration. The objective

Richard Leroy Williams

2010-01-01

214

3M: Monocots, Mechanical wounding, and Mass spectrometry.  

Technology Transfer Automated Retrieval System (TEKTRAN)

Mechanical wounding, one of the first steps in both pathogen infection and herbivore attack, activates signal transduction pathways dedicated to defense and recovery. The signaling pathways include reversible protein phosphorylation, changes in intracellular calcium levels, alarmone production, and...

215

Wound currents and wound healing in the newt, Notophthalmus viridescens  

Microsoft Academic Search

Wounded amphibian skin heals initially by a migration of epithelial cells from the cut edge towards the center of the wound. The density of currents leaving wounds made in Notophthalmus viridescens skin was manipulated in order to determine whether electrical fields associated with these currents might have a significant role in promoting this cell migration during wound healing. Wounds were

Lynette R. Robinson Rhodes; John J. Turek; Edward J. Cragoe Jr; Joseph W. Vanable Jr

1990-01-01

216

Signals Involved in Tuber Wound-Healing  

Technology Transfer Automated Retrieval System (TEKTRAN)

The induction and regulation of wound-healing (WH) processes in potato tubers and other vegetables are of great nutritional and economic importance. The rapid accumulation of waxes to restrict water vapor loss and formation of suberin barriers to block infection are crucial components of WH. Recen...

217

Extended negative pressure wound therapy-assisted dermatotraction for the closure of large open fasciotomy wounds in necrotizing fasciitis patients  

PubMed Central

Background Necrotizing fasciitis (NF) is a rapid progressive infection of the subcutaneous tissue or fascia and may result in large open wounds. The surgical options to cover these wounds are often limited by the patient condition and result in suboptimal functional and cosmetic wound coverage. Dermatotraction can restore the function and appearance of the fasciotomy wound and is less invasive in patients with comorbidities. However, dermatotraction for scarred, stiff NF fasciotomy wounds is often ineffective, resulting in skin necrosis. The authors use extended negative pressure wound therapy (NPWT) as an assist in dermatotraction to close open NF fasciotomy wounds. The authors present the clinical results, followed by a discussion of the clinical basis of extended NPWT-assisted dermatotraction. Methods A retrospective case series of eight patients with NF who underwent open fasciotomy was approved for the study. After serial wound preparation, dermatotraction was applied in a shoelace manner using elastic vessel loops. Next, the extended NPWT was applied over the wound. The sponge was three times wider than the wound width, and the transparent covering drape almost encircled the anatomical wound area. The negative pressure of the NPWT was set at a continuous 100 mmHg by suction barometer. The clinical outcome was assessed based on wound area reduction after treatment and by the achievement of direct wound closure. Results After the first set of extended NPWT-assisted dermatotraction procedures, the mean wound area was significantly decreased (658.12 cm2 to 29.37 cm2; p?=?0.002), as five out of eight patients achieved direct wound closure. One patient with a chest wall defect underwent latissimus dorsi musculocutaneous flap coverage, with primary closure of the donor site. Two Fournier’s gangrene patients underwent multiple sets of treatment and finally achieved secondary wound closure with skin grafts. The patients were followed up for 18.3 months on average and showed satisfactory results without wound recurrence. Conclusions Extended NPWT-assisted dermatotraction advances scarred, stiff fasciotomy wound margins synergistically in NF and allows direct closure of the wound without complications. This method can be another good treatment option for the NF patient with large open wounds whose general condition is unsuitable for extensive reconstructive surgery. PMID:24731449

2014-01-01

218

Combined laser and photodynamic treatment in extensive purulent wounds  

NASA Astrophysics Data System (ADS)

Recently, photodynamic therapy (PDT) has been used for the treatment of festering wounds and trophic ulcers. An important advantage of PDT is its ability to affect bacterial cultures that are resistant to antibiotics. However the use of PDT alone does not usually guarantee a stable antiseptic effect and cannot prevent an external infection of wounds and burns. In this work attention is focused on the healing of the extensive soft tissues wounds with combined laser therapy (LT) and PDT treatment. At the first stage of this process festering tissues (for example spacious purulent wounds with area more than 100 cm2) were illuminated with high-energy laser beam (with power 20 W) in continues routine. The second stage involves “softer” PDT affect, which along with the completion stages of destruction pathological cells, stimulating the process of wound granulation and epithelization. Also, according to our previous results, photosensitizer (photoditazin) is introduced inside the wound with different amphiphilic polymers for increasing the PDT efficacy.

Solovieva, A. B.; Tolstih, P. I.; Melik-Nubarov, N. S.; Zhientaev, T. M.; Kuleshov, I. G.; Glagolev, N. N.; Ivanov, A. V.; Karahanov, G. I.; Tolstih, M. P.; Timashev, P. S.

2010-05-01

219

Comparative Study of Antibacterial Effects and Bacterial Retentivity of Wound Dressings  

PubMed Central

Objectives: We are often confused on selecting a suitable wound dressing for the treatment of infected wounds from huge number of available wound dressings. Then, to help clinicians easily select a wound dressing, we compared the antibacterial effects and bacterial retentivity (ie, potency of keeping absorbed bacteria inside wound dressings and preventing them from leaking out) of wound dressings. Methods: Five wound dressings with antibacterial constituents were compared to research antibacterial effects against nonpathogenic Escherichia coli using an in vitro model. The 5 other wound dressings with no antibacterial constituent were compared to research bacterial retentivity. The relative amount of E coli was determined using cell proliferation reagent WST-1 (11644807001, Roche Applied Science, United States) with time. Results: The results have shown that the antibacterial effects and bacterial retentivity differed among various wound dressings. Silver ions quickly exerted a very strong antibacterial effect, and hydrofibers had a high potency of bacterial retentivity by gelling the absorbed bacteria in wound dressings. Conclusions: The present study indicated the differences of antibacterial strength, time of onset and duration of the antibacterial effect, and bacterial retentivity between each wound dressing. Clinicians should use appropriate wound dressings according the wound condition in consideration of the different characteristics of wound dressings. The present results are helpful for clinicians to select appropriate wound dressing. PMID:23372860

Fujiwara, Toshihiro; Hosokawa, Ko; Kubo, Tateki

2013-01-01

220

Novel in vitro Approaches for the Simulation and Analysis of Human Skin Wounds.  

PubMed

Considering the increasing incidence of chronic wounds and severe wound infections, effective drug delivery to wounded skin is of high importance. The rational development of novel therapeutic systems requires appropriate in vitro testing methodologies. In this context, suitable and reliable in vitro models simulating human wounds and advanced analytical techniques for precise wound characterization are urgently needed. In this study, we introduce a novel in vitro model based on excised human skin. In contrast to the established wound models, our novel approach has a coffin-shaped, linear, rectangular geometry with defined wound edges exhibiting consistent appearance along the entire wound bed. In addition, we introduce optical profilometry as a novel technique for nondestructive wound analysis. We successfully demonstrate the applicability of this optical imaging method based on white light reflection for three-dimensional visualization of different wound models. Furthermore, we create virtual noninvasive cross sections of these wounds to assess wound geometry in direct comparison to conventional histological analysis. Imaging analysis of our novel coffin-shaped model resulted in reproducible virtual sections along the entire wound bed. Our findings indicate the potential of our novel in vitro model for improved simulation of human wounds. Further, we successfully overcome the limitations of conventional histological analysis by the employment of optical profilometry for nondestructive three-dimensional wound characterization. © 2014 S. Karger AG, Basel. PMID:25341368

Planz, Viktoria; Franzen, Lutz; Windbergs, Maike

2015-01-01

221

Insulin and wound healing.  

PubMed

Skin is a dynamic and complex organ that relies on the interaction of different cell types, biomacromolecules and signaling molecules. Injury triggers a cascade of events designed to quickly restore skin integrity. Depending on the size and severity of the wound, extensive physiological and metabolic changes can occur, resulting in impaired wound healing and increased morbidity resulting in higher rates of death. While wound dressings provide a temporary barrier, they are inherently incapable of significantly restoring metabolic upsets, post-burn insulin resistance, and impaired wound healing in patients with extensive burns. Exogenous insulin application has therefore been investigated as a potential therapeutic intervention for nearly a century to improve wound recovery. This review will highlight the important achievements that demonstrate insulin's ability to stimulate cellular migration and burn wound recovery, as well as providing a perspective on future therapeutic applications and research directions. PMID:24810536

Hrynyk, Michael; Neufeld, Ronald J

2014-12-01

222

PHMB: an effective antimicrobial in wound bioburden management.  

PubMed

The effective management of bacterial bioburden is an essential element of wound care. Recent years have seen the increased use of topical antimicrobial dressings to control colonisation and infection, yet there is concern that some may inhibit wound healing and may have systemic sequelae (World Union of Wound Healing Societies (WUWHS), 2008). This article focuses on the safety and effectiveness of PHMB, an antimicrobial compound that is relatively underused in the UK, and argues that it is an effective option for the management of bacterial colonisation and infection. PMID:22875372

Butcher, Martyn

223

Telemedicine for wound management  

PubMed Central

The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process. PMID:23162242

Chittoria, Ravi K.

2012-01-01

224

Chitosan preparations for wounds and burns: antimicrobial and wound-healing effects.  

PubMed

Since its discovery approximately 200 years ago, chitosan, as a cationic natural polymer, has been widely used as a topical dressing in wound management owing to its hemostatic, stimulation of healing, antimicrobial, nontoxic, biocompatible and biodegradable properties. This article covers the antimicrobial and wound-healing effects of chitosan, as well as its derivatives and complexes, and its use as a vehicle to deliver biopharmaceuticals, antimicrobials and growth factors into tissue. Studies covering applications of chitosan in wounds and burns can be classified into in vitro, animal and clinical studies. Chitosan preparations are classified into native chitosan, chitosan formulations, complexes and derivatives with other substances. Chitosan can be used to prevent or treat wound and burn infections not only because of its intrinsic antimicrobial properties, but also by virtue of its ability to deliver extrinsic antimicrobial agents to wounds and burns. It can also be used as a slow-release drug-delivery vehicle for growth factors to improve wound healing. The large number of publications in this area suggests that chitosan will continue to be an important agent in the management of wounds and burns. PMID:21810057

Dai, Tianhong; Tanaka, Masamitsu; Huang, Ying-Ying; Hamblin, Michael R

2011-07-01

225

Chitosan preparations for wounds and burns: antimicrobial and wound-healing effects  

PubMed Central

Since its discovery approximately 200 years ago, chitosan, as a cationic natural polymer, has been widely used as a topical dressing in wound management owing to its hemostatic, stimulation of healing, antimicrobial, nontoxic, biocompatible and biodegradable properties. This article covers the antimicrobial and wound-healing effects of chitosan, as well as its derivatives and complexes, and its use as a vehicle to deliver biopharmaceuticals, antimicrobials and growth factors into tissue. Studies covering applications of chitosan in wounds and burns can be classified into in vitro, animal and clinical studies. Chitosan preparations are classified into native chitosan, chitosan formulations, complexes and derivatives with other substances. Chitosan can be used to prevent or treat wound and burn infections not only because of its intrinsic antimicrobial properties, but also by virtue of its ability to deliver extrinsic antimicrobial agents to wounds and burns. It can also be used as a slow-release drug-delivery vehicle for growth factors to improve wound healing. The large number of publications in this area suggests that chitosan will continue to be an important agent in the management of wounds and burns. PMID:21810057

Dai, Tianhong; Tanaka, Masamitsu; Huang, Ying-Ying; Hamblin, Michael R

2011-01-01

226

Understanding methods of wound debridement.  

PubMed

Autolytic debridement describes the body's natural method of wound-bed cleansing, helping it to prepare the wound bed for healing. In acute wounds, autolytic debridement occurs automatically and often does not require intervention, as during the inflammatory stage of a wound, neutrophils and macrophages digest and removes devitalised tissue, cell debris and contaminants, clearing the wound of any cellular barriers to healing. In chronic wounds, by contrast, healing is often delayed, frequently because of inadequate debridement. The autolytic process becomes overwhelmed by high levels of endotoxins released from damaged tissue (Broadus, 2013). Therefore wound debridement becomes an integral part of chronic-wound management and practitioners involved in wound care must be fully competent at wound-bed assessment and have an awareness of the options available for debridement. This article will review wound-bed assessment, highlighting variations in devitalised tissue, and explore options available for wound debridement, taking into consideration patients’ pain and quality of life. PMID:25075385

Atkin, Leanne

227

Wound repair and regeneration  

Microsoft Academic Search

The repair of wounds is one of the most complex biological processes that occur during human life. After an injury, multiple biological pathways immediately become activated and are synchronized to respond. In human adults, the wound repair process commonly leads to a non-functioning mass of fibrotic tissue known as a scar. By contrast, early in gestation, injured fetal tissues can

Geoffrey C. Gurtner; Sabine Werner; Yann Barrandon; Michael T. Longaker

2008-01-01

228

The prevalence, aetiology and management of wounds in a community care area in Ireland.  

PubMed

This study aimed to establish the prevalence and aetiology of wounds, allowing an insight into the management of wound care, the use of dressings and the nursing time allocated to the provision of wound care in a community setting in Ireland. A cross-sectional survey was used, with data collected on all clients in the community who received treatment from public health nurses or community registered general nurses for wound care over a 1-week period in April 2013. A 98.9% response rate was realised, and 188 people were identified as having wounds, equating to a crude prevalence of 5% of the active community nursing caseload. A total of 60% (n=112) had leg ulcers, 22% (n=42) had pressure ulcers, 16% (n=30) had an acute wound (surgical or traumatic wounds), 1% (n=2) had a diabetic foot wound and a further 1% (n=2) had wounds of other aetiologies. The mean duration of wounds was 5.41 months. A total of 18% of wounds were identified as infected; however, 60% (n=112) of wounds had antimicrobial products in use as either a primary or secondary dressing. The study established that there is a significant prevalence of wounds in this community care area. There was absence of a clinical diagnosis in many cases, and evidence of inappropriate dressing use, risking an increase in costs and a decrease in good clinical outcomes. It also highlighted the importance of ongoing education and auditing in the provision of wound care. PMID:24912830

Skerritt, Louise; Moore, Zena

2014-06-01

229

[Stab wounds in children].  

PubMed

Injuries are the most serious health risk in children. Injuries are the main cause of death and long term disabilities in children. Fortunately, stab wounds in children are very rare in our country, but they are, in most cases, very serious injuries. Presenting 3 case reports, this article aims to show the danger of stab wounds and how easily sharp objects can penetrate human tissue. In two out of the three case reports, a foreign object was remained inside the wound. When dealing with such injuries, this possibility must be considered the wound must be carefully inspected. When a revision is necessary, it should be carried out using minimally invasive methods in order to save the child from suffering extensive wounding which would result from the classical open approach revision. PMID:22746076

Kucera, A; Zeman, L; Vyhnánek, M; Petr?, O; Kavalcová, L; Snajdauf, J

2012-01-01

230

Wound biofilms: lessons learned from oral biofilms  

PubMed Central

Biofilms play an important role in the development and pathogenesis of many chronic infections. Oral biofilms, more commonly known as dental plaque,are a primary cause of oral diseases including caries, gingivitis and periodontitis. Oral biofilms are commonly studied as model biofilm systems as they are easily accessible, thus biofilm research in oral diseases is advanced with details of biofilm formation and bacterial interactions being well-elucidated. In contrast, wound research has relatively recently directed attentionto the role biofilms have in chronic wounds. This review discusses the biofilms in periodontal disease and chronic wounds with comparisons focusing on biofilm detection, biofilm formation, the immune response to biofilms, bacterial interaction and quorum sensing. Current treatment modalities used by both fields as well as future therapies are also discussed. PMID:23551419

Mancl, Kimberly A.; Kirsner, Robert S.; Ajdic, Dragana

2013-01-01

231

Wound care in the geriatric client  

PubMed Central

With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings. PMID:19554098

Gist, Steve; Tio-Matos, Iris; Falzgraf, Sharon; Cameron, Shirley; Beebe, Michael

2009-01-01

232

Negative pressure wound therapy with saline instillation: 131 patient case series.  

PubMed

Negative pressure wound therapy combined with timed, cyclical instillation (NPWTi) of topical wound solutions has been recently presented as a new adjunctive modality for treating wounds with signs of infection. Normal saline, antiseptics and antimicrobials all have been proposed in scientific and clinical studies as potentially effective when used with NPWTi for treating heavily infected wounds. This is a prospective clinical study of 131 patients with 131 wounds treated with NPWTi using saline between January 2012 and December 2012 in two orthopaedic centres and one surgical wound healing centre in France. Saline was exclusively used. Results were favourable: in 98% of the cases, the wounds could be closed after debridement and following the use of NPWTi. Mean duration of NPWTi was 12·19 days. This does not preclude the need for treating the biofilm appropriately with more active antibacterial products when biofilm has been documented. PMID:24251845

Brinkert, David; Ali, Mazen; Naud, Magali; Maire, Nicolas; Trial, Chloé; Téot, Luc

2013-12-01

233

Nanocrystalline silver dressings in wound management: a review.  

PubMed

This paper describes the properties of nanocrystalline silver products (Acticoat) and their applications and examines available evidence supporting their use in wound management. Acticoat utilizes nanotechnology to release nanocrystalline silver crystals. Acticoat releases 30 times less silver cations than silversulfadiazine cream or 0.5% silver nitrate solution but more of the silver released (by Acticoat). Silver-impregnated slow-release dressings release minute concentrations of silver which are quickly bound up by the chloride in the wound exudate. While extrapolations from in vitro and animal studies are cautious, evidence from these studies suggests Acticoat is: effective against most common strains of wound pathogens; can be used as a protective covering over skin grafts; has a broader antibiotic spectrum activity; and is toxic to keratinocytes and fibroblasts. Animal studies suggest a role for nanocrystalline silver in altering wound inflammatory events and facilitation of the early phase of wound healing. Quality human clinical trials into nanocrystalline silver are few. However, evidence suggests using Acticoat in wound management is cost effective, reduces wound infection, decreases the frequency of dressing changes and pain levels, decreases matrix metalloproteinase activity, wound exudate and bioburden levels, and promotes wound healing in chronic wounds. Although there is no in vivo evidence to suggest nanocrystalline silver is toxic to human keratinocytes and fibroblasts, there is in vitro evidence to suggest so; thus these dressings should be used cautiously over epithelializing and proliferating wounds. Future clinical research, preferably randomized controlled trials into nanocrystalline silver technology, may provide clinicians a better understanding of its applications in wound management. PMID:17722278

Fong, Joy; Wood, Fiona

2006-01-01

234

Nanocrystalline silver dressings in wound management: a review  

PubMed Central

This paper describes the properties of nanocrystalline silver products (Acticoat™) and their applications and examines available evidence supporting their use in wound management. Acticoat utilizes nanotechnology to release nanocrystalline silver crystals. Acticoat releases 30 times less silver cations than silversulfadiazine cream or 0.5% silver nitrate solution but more of the silver released (by Acticoat). Silver-impregnated slow-release dressings release minute concentrations of silver which are quickly bound up by the chloride in the wound exudate. While extrapolations from in vitro and animal studies are cautious, evidence from these studies suggests Acticoat is: effective against most common strains of wound pathogens; can be used as a protective covering over skin grafts; has a broader antibiotic spectrum activity; and is toxic to keratinocytes and fibroblasts. Animal studies suggest a role for nanocrystalline silver in altering wound inflammatory events and facilitation of the early phase of wound healing. Quality human clinical trials into nanocrystalline silver are few. However, evidence suggests using Acticoat in wound management is cost effective, reduces wound infection, decreases the frequency of dressing changes and pain levels, decreases matrix metalloproteinase activity, wound exudate and bioburden levels, and promotes wound healing in chronic wounds. Although there is no in vivo evidence to suggest nanocrystalline silver is toxic to human keratinocytes and fibroblasts, there is in vitro evidence to suggest so; thus these dressings should be used cautiously over epithelializing and proliferating wounds. Future clinical research, preferably randomized controlled trials into nanocrystalline silver technology, may provide clinicians a better understanding of its applications in wound management. PMID:17722278

Fong, Joy; Wood, Fiona

2006-01-01

235

Evaluation of wound healing activity of ferulic acid in diabetic rats.  

PubMed

In diabetic patients, there is impairment in angiogenesis, neovascularisation and failure in matrix metalloproteineases (MMPs), keratinocyte and fibroblast functions, which affects wound healing mechanism. Hence, diabetic patients are more prone to infections and ulcers, which finally result in gangrene. Ferulic acid (FA) is a natural antioxidant found in fruits and vegetables, such as tomatoes, rice bran and sweet corn. In this study, wound healing activity of FA was evaluated in streptozotocin-induced diabetic rats using excision wound model. FA-treated wounds were found to epithelise faster as compared with diabetic wound control group. The hydroxyproline and hexosamine content increased significantly when compared with diabetic wound control. FA effectively inhibited the lipid peroxidation and elevated the catalase, superoxide dismutase, glutathione and nitric oxide levels along with the increase in the serum zinc and copper levels probably aiding the wound healing process. Hence, the results indicate that FA significantly promotes wound healing in diabetic rats. PMID:23236955

Ghaisas, Mahesh M; Kshirsagar, Shashank B; Sahane, Rajkumari S

2014-10-01

236

Integrins in Wound Healing.  

PubMed

Significance: Regulation of cell adhesions during tissue repair is fundamentally important for cell migration, proliferation, and protein production. All cells interact with extracellular matrix proteins with cell surface integrin receptors that convey signals from the environment into the nucleus, regulating gene expression and cell behavior. Integrins also interact with a variety of other proteins, such as growth factors, their receptors, and proteolytic enzymes. Re-epithelialization and granulation tissue formation are crucially dependent on the temporospatial function of multiple integrins. This review explains how integrins function in wound repair. Recent Advances: Certain integrins can activate latent transforming growth factor beta-1 (TGF-?1) that modulates wound inflammation and granulation tissue formation. Dysregulation of TGF-?1 function is associated with scarring and fibrotic disorders. Therefore, these integrins represent targets for therapeutic intervention in fibrosis. Critical Issues: Integrins have multifaceted functions and extensive crosstalk with other cell surface receptors and molecules. Moreover, in aberrant healing, integrins may assume different functions, further increasing the complexity of their functionality. Discovering and understanding the role that integrins play in wound healing provides an opportunity to identify the mechanisms for medical conditions, such as excessive scarring, chronic wounds, and even cancer. Future Directions: Integrin functions in acute and chronic wounds should be further addressed in models better mimicking human wounds. Application of any products in acute or chronic wounds will potentially alter integrin functions that need to be carefully considered in the design. PMID:25493210

Koivisto, Leeni; Heino, Jyrki; Häkkinen, Lari; Larjava, Hannu

2014-12-01

237

Maximizing wound healing with silver-impregnated porcine xenograft.  

PubMed

1. Grossly contaminated or chronically infected wounds require adequate debridement of dead tissue and wound coverage or closure. 2. Porcine xenograft is a temporary wound covering that prevents evaporation and thereby creates an environment for new cells to propagate instead of being sacrificed by desiccation. 3. The addition of silver ions to the porcine xenograft provides a potent antimicrobial agent that is only active at the surface where it is needed, has no systemic effects, and allows epithelialization to proceed in half the time of uncovered or unsilvered methods. 4.Silver-impregnated porcine xenograft provides a temporary wound covering that is antimicrobial, physiologic, and allows even the most massive and chronically contaminated wounds of years duration to be healed by careful, consistent dressing changes without skin grafts or flaps. PMID:2256136

Ersek, R A; Navarro, J A

1990-12-01

238

Wound Care After Radiation Therapy  

Microsoft Academic Search

More than 50% of all cancer patients receive some form of radiotherapy for tumor control preoperatively, postoperatively, or as sole treatment. Radiation-induced wounds are a concern for patients and practitioners. Current research investigating alternative treatment strategies offers the hope of improved wound healing and enhanced quality of life for patients with these wounds. This paper reviews the pathophysiology of wounds

Felicia A. Mendelsohn; Celia M. Divino; Ernane D. Reis; Morris D. Kerstein

2002-01-01

239

New advances in instillation therapy in wounds at risk for compromised healing.  

PubMed

Combined use of adjunctive negative pressure wound therapy (NPWT) and instillation of topical wound solutions and suspensions (NPWTi) has proven to be an effective next-generation NPWT technique for wounds at risk for compromised healing. Fluid instillation has been shown to enhance exudate and debris removal, provide regular cleansing of the wound bed, and add moisture to the wound. Positive results have been demonstrated with NPWTi in assisting healing of stalled wounds and treating painful wounds as well as wounds at high risk for amputation. NPWTi has been used instead of conventional NPWT in wounds with thick exudate and slough content, acute traumatic wounds, wounds acutely debrided due to infected soft tissue, large areas of post-debrided exposed bone, and cases of critical bacterial colonization. Instilled solutions have included topical solutions such as saline, topical wound cleansers, and antiseptics. While various systems that combine instillation or irrigation with NPWT have been commercialized during the past decade, until very recently these have been relatively cumbersome to use and limited in their ability to regulate solution volume delivery. Recent advances in NPWTi technology (V.A.C. VeraFlo™ Therapy, KCI, San Antonio, TX) include automated volumetrically controlled delivery of fluids and upgraded foam dressing technology to provide better control and delivery of solutions to the wound bed. This article describes the latest NPWTi technology and provides recommendations for successful application of NPWTi in an effort to inform clinicians about product decision-making and practice. PMID:24700215

Gabriel, Allen; Kahn, Kevin M

2014-03-01

240

Effects of cerium oxide nanoparticles on the growth of keratinocytes, fibroblasts and vascular endothelial cells in cutaneous wound healing.  

PubMed

Rapid and effective wound healing requires a coordinated cellular response involving fibroblasts, keratinocytes and vascular endothelial cells (VECs). Impaired wound healing can result in multiple adverse health outcomes and, although antibiotics can forestall infection, treatments that accelerate wound healing are lacking. We now report that topical application of water soluble cerium oxide nanoparticles (Nanoceria) accelerates the healing of full-thickness dermal wounds in mice by a mechanism that involves enhancement of the proliferation and migration of fibroblasts, keratinocytes and VECs. The Nanoceria penetrated into the wound tissue and reduced oxidative damage to cellular membranes and proteins, suggesting a therapeutic potential for topical treatment of wounds with antioxidant nanoparticles. PMID:23266256

Chigurupati, Srinivasulu; Mughal, Mohamed R; Okun, Eitan; Das, Soumen; Kumar, Amit; McCaffery, Michael; Seal, Sudipta; Mattson, Mark P

2013-03-01

241

Wound healing potential of formulated extract from hibiscus sabdariffa calyx.  

PubMed

Wound healing agents support the natural healing process, reduce trauma and likelihood of secondary infections and hasten wound closure. The wound healing activities of water in oil cream of the methanol extract of Hibiscus sabdariffa L. (Malvaceae) was evaluated in rats with superficial skin excision wounds. Antibacterial activities against Pseudomonas aeroginosa, Staphylococcus aureus and Echerichia coli were determined. The total flavonoid content, antioxidant properties and thin layer chromatographic fingerprints of the extract were also evaluated. The extract demonstrated antioxidant properties with a total flavonoid content of 12.30±0.09 mg/g. Six reproducible spots were obtained using methanol:water (95:5) as the mobile phase. The extract showed no antimicrobial activity on the selected microorganisms, which are known to infect and retard wound healing. Creams containing H. sabdariffa extract showed significant (P<0.05) and concentration dependent wound healing activities. There was also evidence of synergism with creams containing a combination of gentamicin and H. sabdariffa extract. This study, thus, provides evidence of the wound healing potentials of the formulated extract of the calyces of H. sabdariffa and synergism when co-formulated with gentamicin. PMID:23901160

Builders, P F; Kabele-Toge, B; Builders, M; Chindo, B A; Anwunobi, Patricia A; Isimi, Yetunde C

2013-01-01

242

Use of Urgotul SSD to reduce bacteria and promote healing in chronic wounds.  

PubMed

This product focus seeks to give an overview of the management of wound bioburden in relation to the use of antimicrobial dressings, according to recent guidelines and best practice statements. Identification of critical colonisation/localised infection and the role of biofilms is a key aspect of effective wound management. Silver antimicrobial dressings are efficient in reducing bacteria in wounds, but must be used appropriately to prevent overuse. Silver sulphadiazine has traditionally been used for the treatment of burns or Pseudomonas infection in leg ulceration, often in a cream formation. This article will be looking specifically at the effective use of Urgotul SSD in three critically colonised/non healing wounds. PMID:23682500

Downe, Annette

2013-03-01

243

Multispecies biofilm in an artificial wound bed--A novel model for in vitro assessment of solid antimicrobial dressings.  

PubMed

Wound infections represent a major problem, particularly in patients with chronic wounds. Bacteria in the wound exist mainly in the form of biofilms and are thus resistant to most antibiotics and antimicrobials. A simple and cost-effective in vitro model of chronic wound biofilms applied for testing treatments and solid devices, especially wound dressings, is presented in this work. The method is based on the well-established Lubbock chronic wound biofilm transferred onto an artificial agar wound bed. The biofilm formed by four bacterial species (Staphylococcus aureus, Enterococcus faecalis, Bacillus subtilis and Pseudomonas aeruginosa) was stable for up to 48h post-transplant. The applicability of the model was evaluated by testing two common iodine wound treatments. These observations indicate that this method enables assessing the effects of treatments on established resilient wound biofilms and is clinically highly relevant. PMID:24880129

Kucera, J; Sojka, M; Pavlik, V; Szuszkiewicz, K; Velebny, V; Klein, P

2014-08-01

244

Evaluation of a synthetic wound dressing capable of releasing silver sulfadiazine.  

PubMed

A silver sulfadiazine-impregnated poly-L-leucine wound dressing, AgSD-medicated wound dressing, was evaluated for antibacterial capacity against Pseudomonas aeruginosa and cytotoxicity to human fibroblasts and human epidermal keratinocytes. This wound dressing contained 0.4 mg AgSD/cm2. Antibacterial capacity was examined on experimentally infected wound surfaces (3.4 x 10(4) P. aeruginosa organisms/gm) on the dorsum of mice. The AgSD-medicated wound dressing showed effective bacterial control. Cytotoxicity was examined on a monolayer of cells formed in culture dishes. Cellular damage was reduced by the controlled release of AgSD from the hydrophobic poly-L-leucine sponge matrix of the AgSD-medicated wound dressing. Cytotoxicity of the AgSD-medicated wound dressing was much lower than that of 1% AgSD cream. PMID:1904876

Kuroyanagi, Y; Kim, E; Shioya, N

1991-01-01

245

n-Butyl cyanoacrylate adhesive for skin closure of abdominal wounds: preliminary results.  

PubMed Central

Tissue adhesives offer significant potential advantages over traditional methods of wound closure. A new n-butyl 2-cyanoacrylate adhesive formulation was utilised for the closure of abdominal wounds after general and laparoscopic gastrointestinal surgery. One hundred and two patients with 240 wounds were recruited. Wounds were classified as > 10 cm, n = 39; 5-9 cm, n = 27; and < 5 cm, n = 176. Complications included one small seroma and two partial superficial dehiscences. There were no incidences of wound infection. This preliminary study indicates that this tissue adhesive can safely and effectively be utilised for general abdominal wound closure. It should now be subjected to the rigorous of a randomised controlled trial to compare its performance against the more traditional methods of wound closure. PMID:9432925

Qureshi, A.; Drew, P. J.; Duthie, G. S.; Roberts, A. C.; Monson, J. R.

1997-01-01

246

Negative pressure wound therapy with instillation: the current state of the art.  

PubMed

Traditional negative pressure wound therapy (NPWT) has revolutionized the treatment of complex wounds for nearly 20 years. A decade ago, a modification of the original system added intermittent automated instillation of topical wound irrigation solutions to traditional negative pressure wound therapy. This combined therapy, termed negative pressure wound therapy with instillation (NPWTi), has been shown to be effective in the treatment of a variety of complex wounds. Negative pressure wound therapy with instillation has been shown to reduce bioburden and biofilms present in wounds helping heal clinically infected wounds. It has also been used with success to jump-start stalled wounds, in relieving wound pain and treating infected foreign bodies including infected orthopedic hardware and some types of exposed abdominal wall mesh. The system includes a foam dressing placed in the wound covered by a semi-occlusive drape. A tubing placed over a hole cut in the drape connects the foam dressing to a pump run by a computerized microprocessor that delivers negative pressure to the dressing and wound. A preset volume of instillation fluid is automatically delivered via the instillation tubing to the wound. The fluid is held in the foam to bathe the wound for a predetermined time period. Negative pressure is then re-started draining the irrigation fluid and any wound exudate into a collection canister. The entire sequence is automated and consists of three phases: (1) fluid instillation; (2) holding for a period of time in the wound, which is fully expanded since the negative pressure is off during this phase; and then (3) a cycle of continuous negative pressure. The entire sequence repeats itself automatically. Typically the dressing is changed three times a week. The variables involved in treating patients with negative pressure wound therapy with instillation included: the indicated wound types; the system settings; the choice of the irrigation solution and the duration of therapy. This article will serve as a reference to help the negative through treating patients with NPWTi from patient selection, system setting to the complication of therapy. PMID:24574014

Wolvos, Tom A

2014-03-01

247

Use of an Acellular Regenerative Tissue Matrix Over Chronic Wounds  

PubMed Central

Objectives: Bioengineered skin grafts, including acellular dermal matrices, may be effective in treating lower extremity and trunk wounds that are not responsive to traditional wound management. Acellular dermal wound matrix is derived from human acellular dermal wound matrix (HADWM) tissue and provides a scaffold that supports cellular repopulation and revascularization. The major structural components of the dermis are retained during processing, and a single application has been shown to help achieve wound closure. Methods: This patient case series examined the use of HADWM on lower extremity and trunk wounds in 11 patients (6 male and 5 female) with a mean age of 55 years (range: 31–83 years). Wounds were debrided 1 to 2 times, followed by placement of HADWM (range: 4–330 cm2) on wounds that varied from the dorsal surface of the foot, lower abdomen, and lower extremity to the Achilles flap. A nonadherent layer in conjunction with bacitracin was placed over HADWM. Negative pressure wound therapy (NPWT) was placed over the HADWM and initiated continuously at ?125 mm Hg for 1 to 2 weeks. After the application of NPWT, HADWM was covered with various gauze dressings using mineral oil. Results: All patients completed their treatment successfully, and follow-up ranged from 1 week to 6 months. One patient experienced an infection, which resulted in partial graft loss that required replacement with HADWM and NPWT. No additional complications occurred in the other patients. Conclusions: This patient case series demonstrated successful use of HADWM and NPWT, which further supports published studies documenting HADWM success in chronic wounds. PMID:24324850

Stacey, D. Heath

2013-01-01

248

Use of Platelet Rich Plasma Gel on Wound Healing: A Systematic Review and Meta-Analysis  

PubMed Central

Objective: Autologous platelet rich plasma is an advanced wound therapy used in hard-to-heal acute and chronic wounds. To better understand the use and clinical outcomes of the therapy, a systematic review of the published literature in cutaneous wounds was performed. Methods: Electronic and hand searches for randomized controlled trials and comparative group studies using platelet rich plasma therapy in cutaneous wounds and published over the last 10 years was conducted. Eligible studies compared the treatment to standard care or other interventions. All citations were screened and eligible studies were assessed for validity, quality, and bias using accepted scoring methods. The primary outcomes were effect of platelet rich plasma and control wound care on wound healing and related healing measurements. Secondary outcomes related to healing such as infection, pain, exudate, adverse events, and quality of life were also considered. The meta-analysis utilized appropriate statistical methods to determine the overall treatment effect on chronic and acute wound healing and infection. Results: The search terms resulted in 8577 citations and after removing duplicates and screening for protocol eligibility, a total of 24 papers were used. The meta-analysis of chronic wound studies revealed platelet rich plasma therapy is significantly favored for complete healing. The meta-analysis of acute wounds with primary closure studies demonstrated that presence of infection was reduced in platelet rich plasma treated wounds. Conclusions: This systematic review and meta-analysis of platelet rich plasma therapy in cutaneous wounds showed complete and partial wound healing was improved compared to control wound care. PMID:22028946

Carter, Marissa J.; Fylling, Carelyn P.; Parnell, Laura K. S.

2011-01-01

249

[Atypical maxillofacial shot wound].  

PubMed

Maxillofacial shot wounds belong to the relatively less frequent injuries. The soft tissues might be affected in particular, however the most of injuries are combined with infliction of hard tissues. Shot wounds by the bow or crossbow are very rare. They might result as a consequence of either accident or suicide. In the literature some cases of a suicidal experiments had been published, all of these cases were due to arrow from the crossbow. There was no injury being documented due to arrow from the bow. The authors present a case of maxillofacial injury done by shoot of arrow from the bow in the course of a child's play. PMID:21416697

Malachovský, I; Straka, L; Novomeský, F; Statelová, D; Janícková, M; Stilla, J; Urbanová, E

2011-01-01

250

Application of the Single Use Negative Pressure Wound Therapy Device (PICO) on a Heterogeneous Group of Surgical and Traumatic Wounds  

PubMed Central

Objectives: Traumatic wounds and surgery inherently have their complications. Localized infections, wound dehiscence, and excessive wound leakage can be devastating to the patient with a prolonged recovery, but it is also costly to the hospital with an increased length of stay, extra workload, and dressing changes. The single use PICO (Smith and Nephew Healthcare, Hull, United Kingdom) negative pressure wound therapy (NPWT) dressing has revolutionized our management of various acute, chronic, and high output wounds. It requires fewer dressing changes than conventional practice, is used in the outpatient setting, and is a necessary adjuvant therapy to hasten wound healing. Aims: To observe the efficacy of the PICO vacuum-assisted healing within a cost improvement programme. Settings: Plastic surgery department, Royal London Hospital. Materials and Methods: Twenty-one patients with a diversity of postoperative or posttraumatic wounds were considered suitable for PICO application and treated totally on an outpatient basis once the PICO dressing was applied. All wounds were then subjected to continued PICO dressings until healed. Results: All patients tolerated the PICO well with no dressing failure or failure to comply. The number of dressings per patient ranged from 1 to 7. The cost per patient of treatment ranged from £120 to £1578. Estimated cost of all PICO dressing for 21 patients including plastic surgery dressing clinic appointments = £13,345. Median length of treatment to healing (days) = 16; standard deviation = 9.5. Eight patients would have had an inpatient bed stay with conventional therapy, total 24 bed days saved at Bartshealth @£325 per day. Conclusions: The outpatient application of a disposable NPWT can benefit a wide range of clinical wounds that optimizes patient care, promotes rapid wound healing, and importantly helps manage costs. PMID:24917894

Payne, Caroline; Edwards, Daren

2014-01-01

251

Cell therapy for wound healing.  

PubMed

In covering wounds, efforts should include utilization of the safest and least invasive methods with goals of achieving optimal functional and cosmetic outcome. The recent development of advanced wound healing technology has triggered the use of cells to improve wound healing conditions. The purpose of this review is to provide information on clinically available cell-based treatment options for healing of acute and chronic wounds. Compared with a variety of conventional methods, such as skin grafts and local flaps, the cell therapy technique is simple, less time-consuming, and reduces the surgical burden for patients in the repair of acute wounds. Cell therapy has also been developed for chronic wound healing. By transplanting cells with an excellent wound healing capacity profile to chronic wounds, in which wound healing cannot be achieved successfully, attempts are made to convert the wound bed into the environment where maximum wound healing can be achieved. Fibroblasts, keratinocytes, adipose-derived stromal vascular fraction cells, bone marrow stem cells, and platelets have been used for wound healing in clinical practice. Some formulations are commercially available. To establish the cell therapy as a standard treatment, however, further research is needed. PMID:24616577

You, Hi-Jin; Han, Seung-Kyu

2014-03-01

252

[Useful wound management at home].  

PubMed

In wound care, close observation of the quantity and nature of exudate from a wound, and selection of appropriate dressing and/or medication are crucial. Care should be taken to prevent wounds with excessive exudate from becoming too moist. Furthermore, wound care at home must be easy, which is achievable through the use of readily available materials and medications. 1 ) A wound with little to moderate exudate should be treated using wrap therapy with perforated polyethylene sheets. This therapy can be used to treat pressure ulcers, wounds, wounds with slough, and burns. 2 ) An 18-gauge needle can be used to perforate wounds with little exudate, such as mild pressure ulcers or wounds with slough, and polyurethane film can then be applied. 3 ) Polyurethane film should be applied to blisters, pressure ulcers, or similar skin injuries with little exudate. 4 ) A hydrocolloid dressing should be used on wounds with light exudate. 5 ) An ointment containing steroids should be applied to critically colonized wounds. 6 ) Melolin dressings, Moiskin Pads, or a disposable diaper should be used to manage wounds with heavy exudate. PMID:25595088

Mizuhara, Akihiro; Taguchi, Akemi; Sato, Mikako; Shindo, Kazuko

2014-12-01

253

Optimizing Prevention of Healthcare-Acquired Infections After Cardiac Surgery (HAI)_2  

ClinicalTrials.gov

Cardiovascular Disease; Healthcare Associated Infectious Disease; Sternal Superficial Wound Infection; Deep Sternal Infection; Mediastinitis; Thoracotomy; Conduit Harvest or Cannulation Site; Sepsis; Pneumonia

2014-06-20

254

Healing Invisible Wounds  

ERIC Educational Resources Information Center

As many as 9 in 10 justice-involved youth are affected by traumatic childhood experiences. According to "Healing Invisible Wounds: Why Investing in Trauma-Informed Care for Children Makes Sense," between 75 and 93 percent of youth currently incarcerated in the justice system have had at least one traumatic experience, including sexual abuse, war,…

Adams, Erica J.

2010-01-01

255

Spiral wound extraction cartridge  

DOEpatents

A cartridge device for removing an analyte from a fluid comprises a hollow core, a sheet composite comprising a particulate-loaded porous membrane and optionally at least one reinforcing spacer sheet, the particulate being capable of binding the analyte, the sheet composite being formed into a spiral configuration about the core, wherein the sheet composite is wound around itself and wherein the windings of sheet composite are of sufficient tightness so that adjacent layers are essentially free of spaces therebetween, two end caps which are disposed over the core and the lateral ends of the spirally wound sheet composite, and means for securing the end caps to the core, the end caps also being secured to the lateral ends of the spirally wound sheet composite. A method for removing an analyte from a fluid comprises the steps of providing a spirally wound element of the invention and passing the fluid containing the analyte through the element essentially normal to a surface of the sheet composite so as to bind the analyte to the particulate of the particulate-loaded porous membrane, the method optionally including the step of eluting the bound analyte from the sheet composite. 4 figs.

Wisted, E.E.; Lundquist, S.H.

1999-04-27

256

Stress and Wound Healing  

Microsoft Academic Search

Over the past decade it has become clear that stress can significantly slow wound healing: stressors ranging in magnitude and duration impair healing in humans and animals. For example, in humans, the chronic stress of caregiving as well as the relatively brief stress of academic examinations impedes healing. Similarly, restraint stress slows healing in mice. The interactive effects of glucocorticoids

Lisa M. Christian; Jennifer E. Graham; David A. Padgett; Ronald Glaser; Janice K. Kiecolt-Glaser

2006-01-01

257

Hepatic wound repair  

Microsoft Academic Search

BACKGROUND: Human chronic liver diseases (CLDs) with different aetiologies rely on chronic activation of wound healing that represents the driving force for fibrogenesis progression (throughout defined patterns of fibrosis) to the end stage of cirrhosis and liver failure. ISSUES: Fibrogenesis progression has a major worldwide clinical impact due to the high number of patients affected by CLDs, increasing mortality rate,

Maurizio Parola; Massimo Pinzani

2009-01-01

258

[Modern wound dressings for the therapy of chronic wounds].  

PubMed

The incidence of chronic wounds is increasing in developed Western countries. There are many causes for chronic or non-healing wounds. A multidisciplinary diagnostic approach and attention to underlying disorders are essential. A modern, moist, and phase adapted wound therapy is also essential. Modern wound dressings include activated charcoal, alginates, hyaluronic acid, hydrofibers, hydrogels, hydrocolloids, impregnated gauze, collagen, moist methods, proteolytic enzymes, foams, semipermeable membranes and silver dressings. Because of the lack of comparative investigations the phase-adapted use of wound dressings is still empiric. Application of modern wound dressings may help to create an optimized wound milieu and accelerate healing. Treatment of the underlying causes is an absolute requirement for long-term complete healing. PMID:16317552

Dissemond, J

2006-10-01

259

Systematic review of the use of honey as a wound dressing  

Microsoft Academic Search

OBJECTIVE: To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. DATA SOURCES: Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. REVIEW METHODS:

Owen A Moore; Lesley A Smith; Fiona Campbell; Kate Seers; Henry J McQuay; R Andrew Moore

2001-01-01

260

Developing a Real Time Sensing System to Monitor Bacteria in Wound Dressings  

PubMed Central

Infection control is a key aspect of wound management strategies. Infection results in chemical imbalances and inflammation in the wound and may lead to prolonged healing times and degradation of the wound surface. Frequent changing of wound dressings may result in damage to healing tissues and an increased risk of infection. This paper presents the first results from a monitoring system that is being developed to detect presence and growth of bacteria in real time. It is based on impedance sensors that could be placed at the wound-dressing interface and potentially monitor bacterial growth in real time. As wounds can produce large volumes of exudate, the initial system reported here was developed to test for the presence of bacteria in suspension. Impedance was measured using disposable silver-silver chloride electrodes. The bacteria Staphylococcus aureus were chosen for the study as a species commonly isolated from wounds. The growth of bacteria was confirmed by plate counting methods and the impedance data were analysed for discernible differences in the impedance profiles to distinguish the absence and/or presence of bacteria. The main findings were that the impedance profiles obtained by silver-silver chloride sensors in bacterial suspensions could detect the presence of high cell densities. However, the presence of the silver-silver chloride electrodes tended to inhibit the growth of bacteria. These results indicate that there is potential to create a real time infection monitor for wounds based upon impedance sensing. PMID:25585709

Farrow, Malcolm J.; Hunter, Iain S.; Connolly, Patricia

2012-01-01

261

Wound Bed Preparation for Chronic Diabetic Foot Ulcers  

PubMed Central

The escalating incidence of diabetic mellitus has given rise to the increasing problems of chronic diabetic ulcers that confront the practice of medicine. Peripheral vascular disease, neuropathy, and infection contribute to the multifactorial pathogenesis of diabetic ulcers. Approaches to the management of diabetic ulcers should start with an assessment and optimization of the patient's general conditions, followed by considerations of the local and regional factors. This paper aims to address the management strategies for wound bed preparation in chronic diabetic foot ulcers and also emphasizes the importance of preventive measures and future directions. The “TIME” framework in wound bed preparation encompasses tissue management, inflammation and infection control, moisture balance, and epithelial (edge) advancement. Tissue management aims to remove the necrotic tissue burden via various methods of debridement. Infection and inflammation control restores bacterial balance with the reduction of bacterial biofilms. Achieving a moist wound healing environment without excessive wound moisture or dryness will result in moisture balance. Epithelial advancement is promoted via removing the physical and biochemical barriers for migration of epithelium from wound edges. These systematic and holistic approaches will potentiate the healing abilities of the chronic diabetic ulcers, including those that are recalcitrant. PMID:23476800

Mat Saad, Arman Zaharil; Khoo, Teng Lye; Halim, Ahmad Sukari

2013-01-01

262

Multimodal noninvasive monitoring of soft tissue wound healing.  

PubMed

Here we report results of non-invasive measurements of indirect markers of soft tissue healing of traumatic wounds in an observational swine study and describe the quantification of analog physiological signals. The primary purpose of the study was to measure bone healing of fractures with four different wound treatments. A second purpose was to quantify soft tissue wound healing by measuring the following indirect markers: (1) tissue oxygenation, (2) fluid content, and (3) blood flow, which were all measured by non-invasive modalities, measured with available devices. Tissue oxygenation was measured by near infrared spectroscopy; fluid content was measured by bipolar bio-impedance; and blood flow was measured by Doppler ultrasound. Immediately after comminuted femur fractures were produced in the right hind legs of thirty anesthetized female Yorkshire swine, one of four wound treatments was instilled into each wound. The four wound treatments were as follows: salmon fibrinogen/thrombin-n = 8; commercial bone filler matrix-n = 7; bovine collagen-n = 8; porcine fibrinogen/thrombin-n = 7. Fractures were stabilized with an external fixation device. Immediately following wound treatments, measurements were made of tissue oxygenation, fluid content and blood flow; these measurements were repeated weekly for 3 weeks after surgery. Analog signals of each modality were recorded on both the wounded (right) hind leg and the healthy (left) hind leg, for comparison purposes. Data were processed off-line. The mean values of 10-s periods were calculated for right-left leg comparison. ANOVA was applied for statistical analysis. Results of the bone healing studies are published separately (Rothwell et al. in J Spec Oper Med 13:7-18, 2013). For soft tissue wounds, healing did not differ significantly among the four wound treatments; however, regional oxygenation of wounds treated with salmon fibrinogen/thrombin showed slightly different time trends. Further studies are needed to establish standards for healthy wound healing and for detection of pathological alterations such as infection. Non-invasive measurement and quantification of indirect markers of soft tissue wound healing support the goals and principles of evidence-based medicine and show potential as easy to administer tools for clinicians and battlefield medical personnel to apply when procedures such as the PET scan are not available or affordable. The method we developed for storing analog physiological signals could be used for maintaining electronic health records, by incorporating vital signs such as ECG and EEG, etc. PMID:23832619

Bodo, Michael; Settle, Timothy; Royal, Joseph; Lombardini, Eric; Sawyer, Evelyn; Rothwell, Stephen W

2013-12-01

263

Nutritional support for wound healing.  

PubMed

Healing of wounds, whether from accidental injury or surgical intervention, involves the activity of an intricate network of blood cells, tissue types, cytokines, and growth factors. This results in increased cellular activity, which causes an intensified metabolic demand for nutrients. Nutritional deficiencies can impede wound healing, and several nutritional factors required for wound repair may improve healing time and wound outcome. Vitamin A is required for epithelial and bone formation, cellular differentiation, and immune function. Vitamin C is necessary for collagen formation, proper immune function, and as a tissue antioxidant. Vitamin E is the major lipid-soluble antioxidant in the skin; however, the effect of vitamin E on surgical wounds is inconclusive. Bromelain reduces edema, bruising, pain, and healing time following trauma and surgical procedures. Glucosamine appears to be the rate-limiting substrate for hyaluronic acid production in the wound. Adequate dietary protein is absolutely essential for proper wound healing, and tissue levels of the amino acids arginine and glutamine may influence wound repair and immune function. The botanical medicines Centella asiatica and Aloe vera have been used for decades, both topically and internally, to enhance wound repair, and scientific studies are now beginning to validate efficacy and explore mechanisms of action for these botanicals. To promote wound healing in the shortest time possible, with minimal pain, discomfort, and scarring to the patient, it is important to explore nutritional and botanical influences on wound outcome. PMID:14653765

MacKay, Douglas; Miller, Alan L

2003-11-01

264

Clinical experience with Leptospermum honey use for treatment of hard to heal neonatal wounds: case series.  

PubMed

Preterm, critically ill neonates represent a challenge in wound healing. Many factors predispose infants to skin injuries, including decreased epidermal-dermal cohesion, deficient stratum corneum, relatively alkaline pH of skin surface, impaired nutrition and presence of multiple devices on the skin. We present a case series describing the use of medical-grade honey-Leptospermum honey (Medihoney), for successful treatment of slowly healing neonatal wounds, specifically stage 3 pressure ulcer, dehiscent and infected sternal wound, and full-thickness wound from an extravasation injury. PMID:24476663

Boyar, V; Handa, D; Clemens, K; Shimborske, D

2014-02-01

265

Infection et pied diabétique  

Microsoft Academic Search

The large number of factors that influence the outcome of patients with diabetic foot infections calls for a multidisciplinary management of such patients. Infection is always the consequence of a preexisting foot wound whose chronicity is facilitated by the diabetic peripheral neuropathy, whereas peripheral vascular disease is a factor of poor outcome, especially regarding the risk for leg amputation. Primary

E. Senneville

2008-01-01

266

Studies on Wound Healing Activity of Heliotropium indicum Linn. Leaves on Rats  

PubMed Central

The petroleum ether, chloroform, methanol, and aqueous extracts of Heliotropium indicum Linn. (Family: Boraginaceae) were separately evaluated for their wound healing activity in rats using excision (normal and infected), incision, and dead space wound models. The effects of test samples on the rate of wound healing were assessed by the rate of wound closure, period of epithelialisation, wound breaking strength, weights of the granulation tissue, determination of hydroxyproline, super oxide dismutase (SOD), catalase, and histopathology of the granulation tissues. Nitrofurazone (0.2%?w/w) in simple ointment I. P. was used as reference standard for the activity comparison. The results revealed significant promotion of wound healing with both methanol and aqueous extracts with more promising activity with the methanol extract compared to other extracts under study. In the wound infection model (with S. aureus and P. aeruginosa), the methanol extract showed significant healing activity similar to the reference standard nitrofurazone. Significant increase in the granulation tissue weight, increased hydroxyproline content, and increased activity of SOD and catalase level with the animals treated with methanol extract in dead space wound model further augmented the wound healing potential of H. indicum. The present work substantiates its validity of the folklore use. PMID:22084720

Dash, G. K.; Murthy, P. N.

2011-01-01

267

Proteases and Delayed Wound Healing  

PubMed Central

Significance Proteases and their inhibitors contribute to the balance between extracellular matrix (ECM) degradation and deposition, creating an equilibrium that is essential for the timely and coordinated healing of cutaneous wounds. However, when this balance is disrupted, wounds are led into a state of chronicity characterized by abundant levels of proteases and decreased levels of protease inhibitors. Recent Advances Researchers have sought to investigate the roles of proteases within both acute and chronic wounds and how the manipulation of protease activity may aid healing. Indeed, numerous wound dressings have been developed that target such proteases in an attempt to promote wound healing. Critical Issues The normal tissue response to injury involves a complex interaction between cells and cellular mediators. In particular, the inflammatory response is augmented in chronic wounds which are characterized by elevated levels of proinflammatory cytokines and proteases. While controlling levels of inflammation and protease expression is a critical part of normal wound healing, elevated and prolonged expression of proteases produced during the inflammatory phase of healing can lead to excessive ECM degradation associated with impaired healing. Future Directions It seems plausible that future research should aim to investigate the ways in which proteases may be targeted as an alternative therapeutic approach to wound management and to assess the benefits and draw-backs of utilizing wound fluids to assess wound progression in terms of proteolytic activity. PMID:24688830

McCarty, Sara M.; Percival, Steven L.

2013-01-01

268

Wounding, wound healing and staining of mature pear fruit  

Microsoft Academic Search

Incidence of wounding in commercially-harvested `d'Anjou' and `Bosc' pear fruit, healing of wounds to decrease decay caused by Botrytis cinerea, Mucor piriformis, Penicillium expansum, and Penicillium solitum at ?1°C, 20°C, and 28°C, and formation of compounds potentially involved in resistance were determined. Use of a blue food coloring to make wounds on fruit more visible on packinghouse lines was evaluated.

Robert A Spotts; Peter G Sanderson; Cheryl L Lennox; David Sugar; Louis A Cervantes

1998-01-01

269

Wound Healing Activity of Rubus sanctus Schreber (Rosaceae): Preclinical Study in Animal Models  

PubMed Central

Young shoots of Rubus species have been used for healing of wounds, infected insect bites and pimples in folk medicine for ages. In order to evaluate the wound healing activity of Rubus sanctus, four different extracts were prepared from the whole aerial parts of the plant by using n-hexane, chloroform, ethyl acetate and methanol, respectively. Incision wound healing model by using tensiometer on rats and excision model on mice were employed to assess the activity. Remarkable wound healing activity was observed with the ointment formulation of the methanol extract at 1% concentration on the mentioned models. The results of histopathological examination also supported the outcome of both incision and excision wound models. The wound healing effect was comparatively evaluated with a reference ointment Madecassol. The experimental data confirmed the ethnobotanical usage of R. sanctus. PMID:19755505

Süntar, Ipek; Koca, Ufuk; Kele?, Hikmet; Akkol, Esra Küpeli

2011-01-01

270

Shedding Light on a New Treatment for Diabetic Wound Healing: A Review on Phototherapy  

PubMed Central

Impaired wound healing is a common complication associated with diabetes with complex pathophysiological underlying mechanisms and often necessitates amputation. With the advancement in laser technology, irradiation of these wounds with low-intensity laser irradiation (LILI) or phototherapy, has shown a vast improvement in wound healing. At the correct laser parameters, LILI has shown to increase migration, viability, and proliferation of diabetic cells in vitro; there is a stimulatory effect on the mitochondria with a resulting increase in adenosine triphosphate (ATP). In addition, LILI also has an anti-inflammatory and protective effect on these cells. In light of the ever present threat of diabetic foot ulcers, infection, and amputation, new improved therapies and the fortification of wound healing research deserves better prioritization. In this review we look at the complications associated with diabetic wound healing and the effect of laser irradiation both in vitro and in vivo in diabetic wound healing. PMID:24511283

Houreld, Nicolette N.

2014-01-01

271

[Pathophysiology of wound healing and current treatment strategies in a urological context].  

PubMed

Acute wound healing is a dynamic, interactive process culminating in the closure of a tissue defect. Chronic wounds result when the healing cascade is impaired. Proteases destroy important growth factors and matrix proteins, inflammation is prolonged, and the normal healing process does not take place within the expected time span. Owing to demographic changes the investigation of age-related pathologies, including treatment-resistant wounds, has become increasingly important. The TIME concept (tissue, infection, moisture imbalance, edge of wound) assesses essential elements in the healing process that can be addressed in the treatment of chronic wounds. Moist wound treatment is standard therapy. Definitive research trials on the level of success that can be achieved with different dressings are still needed. New types of treatment should be selected with due consideration for clinical variables, the patient's quality of life and independence, and cost effectiveness. PMID:18004538

Wicke, C; Schilling, D; Feyerabend, S; Königsrainer, A; Stenzl, A

2007-12-01

272

Hospitalized Patients and Fungal Infections  

MedlinePLUS

... or liquids. This can make it easier for fungi to enter your body and increase your chances ... infection such as candidemia. 1 , 2 Disease-causing fungi can enter your body through cuts, wounds, and ...

273

Formylpeptide Receptors Mediate Rapid Neutrophil Mobilization to Accelerate Wound Healing  

PubMed Central

Wound healing is a multi-phased pathophysiological process requiring chemoattractant receptor-dependent accumulation of myeloid cells in the lesion. Two G protein-coupled formylpeptide receptors Fpr1 and Fpr2 mediate rapid neutrophil infiltration in the liver of Listeria-infected mice by sensing pathogen-derived chemotactic ligands. These receptors also recognize host-derived chemotactic peptides in inflammation and injury. Here we report the capacity of Fprs to promote the healing of sterile skin wound in mice by initiating neutrophil infiltration. We found that in normal miceneutrophils rapidly infiltrated the dermis in the wound before the production of neutrophil-specific chemokines by the injured tissue. In contrast, rapid neutrophil infiltration was markedly reduced with delayed wound closure in mice deficient in both Fprs. In addition, we detected Fpr ligand activity that chemoattracted neutrophils into the wound tissue. Our study thus demonstrates that Fprs are critical for normal healing of the sterile skin wound by mediating the first wave of neutrophil infiltration. PMID:24603667

Liu, Mingyong; Chen, Keqiang; Yoshimura, Teizo; Liu, Ying; Gong, Wanghua; Le, Yingying; Gao, Ji-Liang; Zhao, Jianhua; Wang, Ji Ming; Wang, Aimin

2014-01-01

274

Formylpeptide receptors mediate rapid neutrophil mobilization to accelerate wound healing.  

PubMed

Wound healing is a multi-phased pathophysiological process requiring chemoattractant receptor-dependent accumulation of myeloid cells in the lesion. Two G protein-coupled formylpeptide receptors Fpr1 and Fpr2 mediate rapid neutrophil infiltration in the liver of Listeria-infected mice by sensing pathogen-derived chemotactic ligands. These receptors also recognize host-derived chemotactic peptides in inflammation and injury. Here we report the capacity of Fprs to promote the healing of sterile skin wound in mice by initiating neutrophil infiltration. We found that in normal miceneutrophils rapidly infiltrated the dermis in the wound before the production of neutrophil-specific chemokines by the injured tissue. In contrast, rapid neutrophil infiltration was markedly reduced with delayed wound closure in mice deficient in both Fprs. In addition, we detected Fpr ligand activity that chemoattracted neutrophils into the wound tissue. Our study thus demonstrates that Fprs are critical for normal healing of the sterile skin wound by mediating the first wave of neutrophil infiltration. PMID:24603667

Liu, Mingyong; Chen, Keqiang; Yoshimura, Teizo; Liu, Ying; Gong, Wanghua; Le, Yingying; Gao, Ji-Liang; Zhao, Jianhua; Wang, Ji Ming; Wang, Aimin

2014-01-01

275

Electric Current Wound Healing David Cukjati  

E-print Network

one or more phases of wound healing. When conservative methods of wound care cannot facilitate wound31 Electric Current Wound Healing David Cukjati Laboratory of Biocybernetics, Faculty of Electrical, Slovenia The authors review the existing physical modalities for treatment of chronic wounds and show

Ljubljana, University of

276

Electrospun nanofibers as dressings for chronic wound care: advances, challenges, and future prospects.  

PubMed

Chronic non-healing wounds show delayed and incomplete healing processes and in turn expose patients to a high risk of infection. Treatment currently focuses on dressings that prevent microbial infiltration and keep a balanced moisture and gas exchange environment. Antibacterial delivery from dressings has existed for some time, with responsive systems now aiming to trigger release only if infection occurs. Simultaneously, approaches that stimulate cell proliferation in the wound and encourage healing have been developed. Interestingly, few dressings appear capable of simultaneously impairing or treating infection and encouraging cell proliferation/wound healing. Electrospinning is a simple, cost-effective, and reproducible process that can utilize both synthetic and natural polymers to address these specific wound challenges. Electrospun meshes provide high-surface area, micro-porosity, and the ability to load drugs or other biomolecules into the fibers. Electrospun materials have been used as scaffolds for tissue engineering for a number of years, but there is surprisingly little literature on the interactions of fibers with bacteria and co-cultures of cells and bacteria. This Review examines the literature and data available on electrospun wound dressings and the research that is required to develop smart multifunctional wound dressings capable of treating infection and healing chronic wounds. PMID:24678050

Abrigo, Martina; McArthur, Sally L; Kingshott, Peter

2014-06-01

277

Next Science Wound Gel Technology, a Novel Agent That Inhibits Biofilm Development by Gram-Positive and Gram-Negative Wound Pathogens  

PubMed Central

Loss of the skin barrier facilitates the colonization of underlying tissues with various bacteria, where they form biofilms that protect them from antibiotics and host responses. Such wounds then become chronically infected. Topical antimicrobials are a major component of chronic wound therapy, yet currently available topical antimicrobials vary in their effectiveness on biofilm-forming pathogens. In this study, we evaluated the efficacy of Next Science wound gel technology (NxtSc), a novel topical agent designed to kill planktonic bacteria, penetrate biofilms, and kill the bacteria within. In vitro quantitative analysis, using strains isolated from wounds, showed that NxtSc inhibited biofilm development by Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae by inhibiting bacterial growth. The gel formulation NxtSc-G5, when applied to biofilms preformed by these pathogens, reduced the numbers of bacteria present by 7 to 8 log10 CFU/disc or CFU/g. In vivo, NxtSc-G5 prevented biofilm formation for 72 h when applied at the time of wounding and infection and eliminated biofilm infection when applied 24 h after wounding and infection. Storage of NxtSc-G5 at room temperature for 9 months did not diminish its efficacy. These results establish that NxtSc is efficacious in vitro and in vivo in preventing infection and biofilm development by different wound pathogens when applied immediately and in eliminating biofilm infection already established by these pathogens. This novel antimicrobial agent, which is nontoxic and has a usefully long shelf life, shows promise as an effective agent for the prevention and treatment of biofilm-related infections. PMID:24637684

Miller, Kyle G.; Tran, Phat L.; Haley, Cecily L.; Kruzek, Cassandra; Colmer-Hamood, Jane A.; Myntti, Matt

2014-01-01

278

Murine model of wound healing.  

PubMed

Wound healing and repair are the most complex biological processes that occur in human life. After injury, multiple biological pathways become activated. Impaired wound healing, which occurs in diabetic patients for example, can lead to severe unfavorable outcomes such as amputation. There is, therefore, an increasing impetus to develop novel agents that promote wound repair. The testing of these has been limited to large animal models such as swine, which are often impractical. Mice represent the ideal preclinical model, as they are economical and amenable to genetic manipulation, which allows for mechanistic investigation. However, wound healing in a mouse is fundamentally different to that of humans as it primarily occurs via contraction. Our murine model overcomes this by incorporating a splint around the wound. By splinting the wound, the repair process is then dependent on epithelialization, cellular proliferation and angiogenesis, which closely mirror the biological processes of human wound healing. Whilst requiring consistency and care, this murine model does not involve complicated surgical techniques and allows for the robust testing of promising agents that may, for example, promote angiogenesis or inhibit inflammation. Furthermore, each mouse acts as its own control as two wounds are prepared, enabling the application of both the test compound and the vehicle control on the same animal. In conclusion, we demonstrate a practical, easy-to-learn, and robust model of wound healing, which is comparable to that of humans. PMID:23748713

Dunn, Louise; Prosser, Hamish C G; Tan, Joanne T M; Vanags, Laura Z; Ng, Martin K C; Bursill, Christina A

2013-01-01

279

Novel bilayer wound dressing composed of silicone rubber with particular micropores enhanced wound re-epithelialization and contraction.  

PubMed

Wound dressing is critical important for cutaneous wound healing. However, the application of current products is limited due to poor mechanical property, unsuitable water vapor transmission rate (WVTR), poor anti-infective property or poor biocompatibility, etc. In the present study, a microporous silicone rubber membrane bilayer (SRM-B) composed of two layers with different pore sizes was prepared. The physical properties, the influences of pore structure on the bacterial penetration, the cell adhesion and proliferation were studied. Lastly, the effects of the SRM-B on the healing of a mouse full-thickness wound were examined. The data showed that the small pore upper layer of SRM-B could effectively prevent the bacterial invasion, as well as properly keep the water vapor transmission rate; the large pore lower layer of SRM-B could promote the cell adhesion and proliferation. The in vivo results showed that SRM-B could significantly enhance wound re-epithelialization and contraction, which accelerated the wound healing. Our data suggested that the SRM-B, with different particular pore sizes, could serve as a kind of promising wound dressing. PMID:25498800

Xu, Rui; Luo, Gaoxing; Xia, Hesheng; He, Weifeng; Zhao, Jian; Liu, Bo; Tan, Jianglin; Zhou, Junyi; Liu, Daisong; Wang, Yuzhen; Yao, Zhihui; Zhan, Rixing; Yang, Sisi; Wu, Jun

2015-02-01

280

Wounded Nucleons, Wounded Quarks, and Relativistic Ion Collisions  

E-print Network

A concept of wounded nucleons and/or wounded quarks plays an important role in parametrizing and to some extent explaining many a feature of the relativistic ion collisions. This will be illustrated in a historical perspective, up to and including the latest developpments.

Helena Bialkowska

2006-09-06

281

Wound tube heat exchanger  

DOEpatents

What is disclosed is a wound tube heat exchanger in which a plurality of tubes having flattened areas are held contiguous adjacent flattened areas of tubes by a plurality of windings to give a double walled heat exchanger. The plurality of windings serve as a plurality of effective force vectors holding the conduits contiguous heat conducting walls of another conduit and result in highly efficient heat transfer. The resulting heat exchange bundle is economical and can be coiled into the desired shape. Also disclosed are specific embodiments such as the one in which the tubes are expanded against their windings after being coiled to insure highly efficient heat transfer.

Ecker, Amir L. (Duncanville, TX)

1983-01-01

282

Wound Warning Signs  

MedlinePLUS

... Campaigns Read Patient Stories Health News About Emergencies Childhood / Student Emergencies Diseases & Infections Disaster Preparedness Elderly Safety Holiday & Seasonal Injury Prevention Travel & Motor Vehicle Safety En Español ER ...

283

[Infection and diabetic foot].  

PubMed

The large number of factors that influence the outcome of patients with diabetic foot infections calls for a multidisciplinary management of such patients. Infection is always the consequence of a preexisting foot wound whose chronicity is facilitated by the diabetic peripheral neuropathy, whereas peripheral vascular disease is a factor of poor outcome, especially regarding the risk for leg amputation. Primary and secondary prevention of IPD depends both on the efficacy of wound off-loading. Antibiotic treatment should only be considered for clinically infected foot wounds for which diagnostic criteria have recently been proposed by international consensus. The choice of the antibiotic regimen should take into account the risk for selecting bacterial resistance, and as a consequence, agents with a narrow spectrum of activity should be preferred. Respect of the measures for preventing the spread of bacterial resistance in diabetic foot centers is particularly important. PMID:18822250

Senneville, E

2008-09-01

284

miRNA in Diabetic Wound Healing  

Cancer.gov

Impairment of dermal wound healing is a debilitating complication commonly encountered during diabetes mellitus. Dysregulated inflammatory and angiogenesis phases are key players in the impairment of diabetic wound healing. Emerging studies indicate that miRNAs play a key role in regulating several hubs that orchestrate the wound inflammation and angiogenesis processes. Our laboratory first reported dysfunction in wound macrophage efferocytosis function leading to impaired resolution of wound inflammation in diabetic wounds.

285

Nanofiber Microenvironment and Diabetic Wound Healing  

Cancer.gov

Diabetic nonhealing wounds represent a major public health problem. Diabetic wounds are characterized by altered wound microenvironment, unbalanced proteolytic activity, prolonged inflammation, and insufficient neovascularization. The efficacy of conventional therapies is unsatisfactory and often results in recurrence of wounds at characteristically predisposed sites, as a direct consequence of poor wound repair. Skin substitutes based on novel biocomposite materials represent the most promising bioengineering technology today and may offer an exciting new treatment strategy in management of chronic wounds.

286

Comparison of Efficacy of 1% Silver Sulfadiazine and ActicoatTM for Treatment of Partial-Thickness Burn Wounds  

Microsoft Academic Search

Background: Acticoat?(Smith & Nephew, Hull, UK) is a silver-coated dressing reported to reduce infection and exhibit antimicrobial activity in wounds. Objective: The purpose of the present study was to compare the efficacy of acticoatand 1% silver sulfadiazine (1% AgSD) for treatment of partial thickness burn wounds. Material and Method: The authors reviewed 50 patients who had partial thickness burn wounds

Pornprom Muangman

287

Use of incisional negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery: clinical evidence and consensus recommendations.  

PubMed

Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors' own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery. PMID:25280449

Dohmen, Pascal M; Markou, Thanasie; Ingemansson, Richard; Rotering, Heinrich; Hartman, Jean M; van Valen, Richard; Brunott, Maaike; Segers, Patrique

2014-01-01

288

Skin Substitutes and Wound Healing  

Microsoft Academic Search

Medical science has vastly improved on the means and methods available for the treatment of wounds in the clinic. The production and use of various types of skin substitutes has led to dramatic improvements in the odds of survival for severely burned patients, but they have also shown promise for many other applications, including cases involving chronic wounds that are

F. A. Auger; D. Lacroix; L. Germain

2009-01-01

289

Chemokines in cutaneous wound healing  

Microsoft Academic Search

Healing of wounds is one of the most complex biological events after birth as a result of the interplay of different tissue structures and a large number of resident and infiltrating cell types. The latter are mainly constituted by leukocyte sub- sets (neutrophils, macrophages, mast cells, and lymphocytes), which sequentially infiltrate the wound site and serve as immunological effector cells

Reinhard Gillitzer; Matthias Goebeler

2001-01-01

290

Difficult wounds: an update.  

PubMed

The purpose of this collective review is to describe revolutionary advances in the treatment of Gardner's syndrome (GS), pseudofolliculitis barbae, nasal septal perforation, factitious wounds, and hidradenitis suppurativa (HS). Gardner's syndrome or familial polyposis has various manifestations that appear to be controlled by a single genetic locus. Apart from the large bowel adenomas, which are always present, a common extracolonic symptom of Gardner's syndrome is the occurrence of epidermal cysts. These cysts can be seen before the intestinal polyps are evident. Because epidermal cysts in patients with Gardner's syndrome are always benign, we excise these cysts using incisions that are commonly used for rhytidectomy. Pseudofolliculitis barbae, a pseudofolliculitis caused by ingrown hairs, effects 85% of blacks who shave their beards. When this disease is allowed to progress to keloid formation, we use a surgical approach that includes excision of the keloidal scar, meticulous debridement of all residual ingrown hairs in the underlying wound, and coverage of the defect with a split-thickness skin graft. More recently, laser therapy has revolutionized the treatment of pseudofolliculitis barbae and has enabled a cure for the first time for those plagued with this disorder and for whom a beardless face is acceptable. Nasal septal perforation is a well recognized complication of septal surgery. Other iatrogenic causes of perforation include cryosurgery, electrocoagulation for epitaxis, nasotracheal intubation, or nose packing. In recent years drugs such as cocaine account for an increasing number of perforations. It has only been with the use of an external approach for the repair of the nasal septal defect that surgical closure has become easier and more reliable. The external approach allows for greater surgical closure and enables the surgeon to use both hands with the aid of binocular vision to mobilize and suture local mucosal advancement flaps and the intraseptal connective tissue grafts. More recently, surgeons have repaired large septal perforations with a radial forearm free flap. Because of its availability and deep emotional significance, the skin is a common site for self-destructive behavior with the development of factitious skin wounds. When suspected, psychiatric care must proceed immediately. Second, the ulcer can then be healed by appropriate techniques and wound repair. It is important to emphasize that the treating physician must first confront the patient, and then a psychiatrist should provide appropriate psychotherapy. Hidradenitis suppurativa is an inflammatory disease of the skin and subcutaneous tissue that occurs in apocrine-gland-bearing areas distributed in the axilla, mammary nipple areola, mons pubis, groin, scrotum, perineum, perianal region, and umbilicus. The condition has an insidious onset. The susceptibility of women's axillary skin to hidradenitis suppurativa may be related, in part, to the practice of axillary removal of hair with a safety razor. Consequently, the use of safety razors must be avoided and replaced with the use of an electric razor. The method of treatment will vary with the stage of the disease. Treatment of the chronic stage of axillary hidradenitis suppurativa is primarily surgical. More recently, carbon dioxide laser treatment, with healing by secondary intention, is proving to be a rapid, efficient, and economic treatment of this difficult wound. PMID:16022640

Edlich, Richard F; Winters, Kathryne L; Britt, L D; Long, William B; Gubler, K Dean; Drake, David B

2005-01-01

291

Vasculogenic Cytokines in Wound Healing  

PubMed Central

Chronic wounds represent a growing healthcare burden that particularly afflicts aged, diabetic, vasculopathic, and obese patients. Studies have shown that nonhealing wounds are characterized by dysregulated cytokine networks that impair blood vessel formation. Two distinct forms of neovascularization have been described: vasculogenesis (driven by bone-marrow-derived circulating endothelial progenitor cells) and angiogenesis (local endothelial cell sprouting from existing vasculature). Researchers have traditionally focused on angiogenesis but defects in vasculogenesis are increasingly recognized to impact diseases including wound healing. A more comprehensive understanding of vasculogenic cytokine networks may facilitate the development of novel strategies to treat recalcitrant wounds. Further, the clinical success of endothelial progenitor cell-based therapies will depend not only on the delivery of the cells themselves but also on the appropriate cytokine milieu to promote tissue regeneration. This paper will highlight major cytokines involved in vasculogenesis within the context of cutaneous wound healing. PMID:23555076

Crawford, Jeffrey D.

2013-01-01

292

Anaerobic Infections in Children with Neurological Impairments.  

ERIC Educational Resources Information Center

Children with neurological impairments are prone to develop serious infection with anaerobic bacteria. The most common anaerobic infections are decubitus ulcers; gastrostomy site wound infections; pulmonary infections (aspiration pneumonia, lung abscesses, and tracheitis); and chronic suppurative otitis media. The unique microbiology of each of…

Brook, Itzhak

1995-01-01

293

Wounding in the plant tissue: the defense of a dangerous passage  

PubMed Central

Plants are continuously exposed to agents such as herbivores and environmental mechanical stresses that cause wounding and open the way to the invasion by microbial pathogens. Wounding provides nutrients to pathogens and facilitates their entry into the tissue and subsequent infection. Plants have evolved constitutive and induced defense mechanisms to properly respond to wounding and prevent infection. The constitutive defenses are represented by physical barriers, i.e., the presence of cuticle or lignin, or by metabolites that act as toxins or deterrents for herbivores. Plants are also able to sense the injured tissue as an altered self and induce responses similar to those activated by pathogen infection. Endogenous molecules released from wounded tissue may act as Damage-Associated Molecular Patterns (DAMPs) that activate the plant innate immunity. Wound-induced responses are both rapid, such as the oxidative burst and the expression of defense-related genes, and late, such as the callose deposition, the accumulation of proteinase inhibitors and of hydrolytic enzymes (i.e., chitinases and gluganases). Typical examples of DAMPs involved in the response to wounding are the peptide systemin, and the oligogalacturonides, which are oligosaccharides released from the pectic component of the cell wall. Responses to wounding take place both at the site of damage (local response) and systemically (systemic response) and are mediated by hormones such as jasmonic acid, ethylene, salicylic acid, and abscisic acid. PMID:25278948

Savatin, Daniel V.; Gramegna, Giovanna; Modesti, Vanessa; Cervone, Felice

2014-01-01

294

Wound Repair By Laser Welding  

NASA Astrophysics Data System (ADS)

In this study, we have developed a concept of wound closure by laser welding and studied the wound healing process. In the first set of experiments, six-millimeter long, full-thickness incisions were made in the skin on the back of hairless mice. Control wounds were closed with interrupted 5-0 prolene suture. The experimental wounds were approximated and closed by laser welding using a Nd:YAG (1.06 ?m) laser. Selected wounds were excised for histopathology, transmission electron microscopy, tensile strength determination and assay of type I collagen specific messenger-RNA. The laser welded wounds demonstrated rapid healing with good cosmetic results. The tensile strength was identical both for laser welded and sutured wounds at 7, 16, and 21 days. A significant increase of type I collagen specific mRNA was noted in both specimens at 4, 10 and 16 days, but a higher level was recorded in the sutured specimens at day 16 (2652 vs. 911 U/pg total RNA). We further initiated a comparative study to identify the laser which would be most suitable for skin welding. For this purpose argon, Nd:YAG (1.06 ?m and 1.32 ?m) and CO2 lasers were used to weld skin. Wound healing, tensile strength and collagen analyses were performed. The results indicated that both argon and Nd:YAG (1.32 ?m) lasers achieved the most effective closure. These results suggest that laser welding provides an efficient method for closing skin wounds. The laser welding has clear advantages over conventional suturing techniques, being sterile, non-tactile, not requiring introduction of foreign materials into the wound, and providing improved cosmetic results.

Abergel, R. Patrick; Lyons, Richard F.; Glassberg, Edward; Saperia, David; White, Rodney A.; Lask, Gary; Dwyer, Richard M.; Uitto, Jouni

1986-08-01

295

Preparation of SMART wound dressings based on colloidal microgels and textile fibres  

NASA Astrophysics Data System (ADS)

Wound dressings and other types of wound healing technologies are experiencing fast-paced development and rapid growth. As the population ages, demand will continue to rise for advanced dressings used to treat chronic wounds, such as pressure ulcers, venous stasis ulcers, and diabetic ulcers. Moist wound dressings, which facilitate natural wound healing in a cost-effective manner, will be increasingly important. In commercially available hydrogel / gauze wound dressings the gel swells to adsorb wound excreta and provide an efficient non adhesive particle barrier. An alternative to hydrogels are microgels. Essentially discrete colloidal gel particles, as a result of their very high surface area to volume ratio compared to bulk gels, they have a much faster response to external stimuli such as temperature or pH. In response to either an increase or decrease in solvent quality these porous networks shrink and swell reversibly. When swollen the interstitial regions within the polymer matrix are available for further chemistry; such as the incorporation of small molecules. The reversible shrinking and swelling as a function of external stimuli provides a novel drug release system. As the environmental conditions of a wound change over its lifetime, tending to increase in pH if there is an infection combining these discrete polymeric particles with a substrate such as cotton, results in a smart wound dressing.

Cornelius, Victoria J.; Majcen, Natasa; Snowden, Martin J.; Mitchell, John C.; Voncina, Bojana

2007-01-01

296

Combination of negative pressure wound therapy with open bone grafting for bone and soft tissue defects.  

PubMed

The aim of this study was to investigate the efficiency of negative pressure wound therapy (NPWT) combined with open bone graft (OBG; NPWT-OBG) for the treatment of bone and soft tissue defects with polluted wounds in an animal model. All rabbits with bone and soft tissue defects and polluted wounds were randomly divided into two groups, the experimental group (NPWT with bone graft) and the control group (OBG). The efficacy of the treatment was assessed by the wound conditions and healing time. Bacterial bioburdens and bony calluses were evaluated by bacteria counting and X-rays, respectively. Furthermore, granulation tissue samples from the wounds on days 0, 3, 7 and 14 of healing were evaluated for blood vessels and vascular endothelial growth factor (VEGF) levels. Wounds in the experimental group tended to have a shorter healing time, healthier wound conditions, lower bacterial bioburden, improvement of the bony calluses and an increased blood supply compared with those in the control group. With NPWT, wound infection was effectively controlled. For wounds with osseous and soft tissue defects, NPWT combined with bone grafting was demonstrated to be more effective than an OBG. PMID:23784004

Deng, Kai; Yu, Ai-Xi; Xia, Cheng-Yan; Li, Zong-Huan; Wang, Wei-Yang

2013-08-01

297

Assessment of the effectiveness of silver-coated dressing, chlorhexidine acetate (0.5%), citric acid (3%), and silver sulfadiazine (1%) for topical antibacterial effects against the multi-drug resistant Pseudomonas aeruginosa infecting full-skin thickness burn wounds on rats.  

PubMed

The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 10(8) CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp. PMID:24229034

Yabanoglu, Hakan; Basaran, Ozgur; Aydogan, Cem; Azap, Ozlem Kurt; Karakayali, Feza; Moray, Gokhan

2013-01-01

298

Assessment of the Effectiveness of Silver-Coated Dressing, Chlorhexidine Acetate (0.5%), Citric Acid (3%), and Silver Sulfadiazine (1%) for Topical Antibacterial Effects Against the Multi-Drug Resistant Pseudomonas Aeruginosa Infecting Full-Skin Thickness Burn Wounds on Rats  

PubMed Central

The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 108 CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp. PMID:24229034

Yabanoglu, Hakan; Basaran, Ozgur; Aydogan, Cem; Azap, Ozlem Kurt; Karakayali, Feza; Moray, Gokhan

2013-01-01

299

Wound-healing potential of the root extract of Albizzia lebbeck.  

PubMed

The present investigation is an attempt to scientifically validate the traditional use of the roots of the plant Albizzia lebbeck in Ayurvedic system of medicine for curing wounds. The study included phytochemical standardization of the ethanol root extract of A. lebbeck, which was further subjected to oral acute toxicity study. Wound-healing activity of the ethanol root extract was evaluated using incision and excision wound models. Biochemical parameters such as hydroxyproline, hexuronic acid, hexosamine, and antioxidant enzymes like superoxide dismutase, reduced glutathione and free radical parameters including lipid peroxidation and nitric oxide were evaluated on the 10th post-wounding day following dead space method. For confirmation of activity, histopathology of the wounds and granulation tissues from excision and dead space wound model were performed. The study also included assessment of antibacterial activity of ethanol root extract against strains implicated in wound infection. The ethanol root extract was found to be highly rich in flavonoids, saponins, phenols, and tannins, while the amount of rutin was found to be 4.66 % w/w. It significantly increased the wound breaking strength showing a ceiling effect at 500 mg/kg p. o. The ethanol root extract at 500 mg/kg p. o. depicted an optimum wound contraction on the 18th day, while complete wound contraction was observed at the 22nd post wound day. It also demonstrated a significant increase in dry tissue weight, total protein, hydroxyproline, hexosamine, hexuronic acid, superoxide dismutase, and reduced glutathione levels, whereas a decrease in the levels of lipid peroxidation and nitric oxide was also observed with a potential antibacterial activity. Histopathological studies revealed a normal epithelization and fibrosis which was evidenced through an increase in collagen density. Thus, the study scientifically validated the wound-healing activity of the ethanol root extract along with a potential antibacterial property which may be attributed to the enhanced collagen synthesis and a potential antioxidant activity. PMID:23677526

Joshi, Apurva; Sengar, Nidhi; Prasad, Satyendra K; Goel, Raj Kumar; Singh, Akanksha; Hemalatha, Siva

2013-06-01

300

The efficacy of absorbable polysaccharide haemostats in wound healing.  

PubMed

Wound healing represents an ancient problem for humans, and various materials and methods have been tried for wound dressing. A dressing should protect against infection and shorten healing; moreover, it should not cause tissue damage and should be nonallergenic, cost effective and easy to apply. These are characteristics that may be found in herbal extracts. An absorbable polysaccharide haemostat (APH) is a plant-based haemostatic agent. We aimed to evaluate the effect of APH on wound healing. A total of 24 Wistar rats were divided into three groups, each consisting of eight rats. We generated triangular tissue defects on the dorsal regions of the rats. The wound size of each rat was drawn on acetate paper on the 3rd, 7th and 14th days and dressed with APH, saline and wheat meal. Wound healing rates were calculated using planimetric software. Scar tissue excision was performed on the 14th day and histopathological examination was carried out. The mean wound contraction rate was statistically higher in the APH group than in the wheat meal and saline groups on the 14th day (P??0.05). However, the intensities of fibroblasts (P?wound healing. In addition to its blood-stopping effect, APH may be useful for tissue defects, which arise after trauma or surgical procedures. PMID:25158986

Sonmez, Ertan; Turkdogan, Kenan A; Civelek, Cemil; Dur, Ali; Gulen, Bedia; Karayel, Eda; Gucin, Zuhal; Sogut, Ozgur

2015-01-01

301

Wound healing in plants  

PubMed Central

Copper amine oxidases (CuAO) and flavin-containing amine oxidases (PAO) are hydrogen peroxide (H2O2)-producing enzymes responsible for the oxidative de-amination of polyamines. Currently, a key role has been ascribed to apoplastic amine oxidases in plants, i.e., to behave as H2O2-delivering systems in the cell wall during cell growth and differentiation as well as in the context of host-pathogen interactions. Indeed, H2O2 is the co-substrate for the peroxidase-driven reactions during cell-wall maturation and a key signalling molecule in defence mechanisms. We recently demonstrated the involvement of an apoplastic PAO in the wound-healing process of the Zea mays mesocotyl. Experimental evidence indicated a similar role for an apoplastic PAO in Nicotiana tabacum. In this addendum we suggest that a CuAO activity is also involved in this healing event. PMID:19704660

Tisi, Alessandra; Angelini, Riccardo

2008-01-01

302

Water-filtered infrared-A (wIRA) in acute and chronic wounds  

PubMed Central

Water-filtered infrared-A (wIRA), as a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface, can improve the healing of acute and chronic wounds both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA increases tissue temperature (+2.7°C at a tissue depth of 2 cm), tissue oxygen partial pressure (+32% at a tissue depth of 2 cm) and tissue perfusion. These three factors are decisive for a sufficient supply of tissue with energy and oxygen and consequently also for wound healing and infection defense. wIRA can considerably alleviate pain (without any exception during 230 irradiations) with substantially less need for analgesics (52–69% less in the groups with wIRA compared to the control groups). It also diminishes exudation and inflammation and can show positive immunomodulatory effects. The overall evaluation of the effect of irradiation as well as the wound healing and the cosmetic result (assessed on visual analogue scales) were markedly better in the group with wIRA compared to the control group. wIRA can advance wound healing (median reduction of wound size of 90% in severely burned children already after 9 days in the group with wIRA compared to 13 days in the control group; on average 18 versus 42 days until complete wound closure in chronic venous stasis ulcers) or improve an impaired wound healing (reaching wound closure and normalization of the thermographic image in otherwise recalcitrant chronic venous stasis ulcers) both in acute and in chronic wounds including infected wounds. After major abdominal surgery there was a trend in favor of the wIRA group to a lower rate of total wound infections (7% versus 15%) including late infections following discharge from hospital (0% versus 8%) and a trend towards a shorter postoperative hospital stay (9 versus 11 days). Even the normal wound healing process can be improved. The mentioned effects have been proven in six prospective studies, with most of the effects having an evidence level of Ia/Ib. wIRA represents a valuable therapy option and can generally be recommended for use in the treatment of acute as well as of chronic wounds. PMID:20204090

Hoffmann, Gerd

2009-01-01

303

Comparison of Surface Swab and Quantitative Biopsy Cultures Dependent on Isolated Microorganisms from Burn Wounds  

PubMed Central

Objective: Infections are one of the most important and potentially serious complications of burn wounds. Quantitative biopsy cultures are useful for showing that a burn wound infection is not present, but these cultures are not useful for showing that an infection is present. Swab cultures are used to diagnosis surface colonization and may not accurately reflect the organism(s) causing the wound infection. Materials and Methods: To perform a comparison of surface swab and biopsy cultures for isolated microorganisms from burn wounds, 160 biopsy/surface swab pairs were collected from 160 patients. Results: Seventy-seven patients (48.1%) showed positive micro-organism cultures from the burn wounds; 19.3 percent had both positive surface cultures and significant bacterial counts from the biopsy cultures, whereas 28.8 percent of the patients had only positive surface cultures. There was moderate agreement (41%) between the results of surface swab and quantitative biopsy cultures used to diagnose burn wound infections. Pseudomonas aeruginosa (45.5%) was the most predominantly isolated bacteria from the wounds, and there was good concordance between the results of the surface swab and quantitative biopsy culture samples (78%). Coagulase-negative Staphylococci (CNS) and Escherichia coli strains were only isolated from the surface swab samples because they are colonizing bacteria. The univariate analysis revealed that there were significant associations between the results of the positive biopsy cultures and the total surface body area, open flame burns, prolonged hospitalization and female gender (p<0.05). Conclusion: Surface swab and quantitative biopsy cultures have a high rate of concordance in predicting P. aeruginosa invasion and the colonization of E. coli and CNS strains in burn wounds.

Vural, Mete Koray; Altoparlak, Ulku; Celebi, Demet; Akcay, Mufide Nuran

2013-01-01

304

Prevent Bite Wounds  

MedlinePLUS

... animal bites is the child’s risk of contracting rabies. Rabies is a very serious viral infection that affects ... fever, swallowing difficulties, convulsions, and eventually, death. Fortunately, rabies in humans is rare today (most domesticated animals ...

305

Roles of apoplastic peroxidases in plant response to wounding.  

PubMed

Apoplastic class III peroxidases (EC 1.11.1.7) play key roles in the response of plants to pathogen infection and abiotic stresses, including wounding. Wounding is a common stress for plants that can be caused by insect or animal grazing or trampling, or result from agricultural practices. Typically, mechanical damage to a plant immediately induces a rapid release and activation of apoplastic peroxidases, and an oxidative burst of reactive oxygen species (ROS), followed by the upregulation of peroxidase genes. We discuss how plants control the expression of peroxidases genes upon wounding, and also the sparse information on peroxidase-mediated signal transduction pathways. Evidence reviewed here suggests that in many plants production of the ROS that comprise the initial oxidative burst results from a complex interplay of peroxidases with other apoplastic enzymes. Later responses following wounding include various forms of tissue healing, for example through peroxidase-dependent suberinization, or cell death. Limited data suggest that ROS-mediated death signalling during the wound response may involve the peroxidase network, together with other redox molecules. In conclusion, the ability of peroxidases to both generate and scavenge ROS plays a key role in the involvement of these enigmatic enzymes in plant stress tolerance. PMID:25027646

Minibayeva, Farida; Beckett, Richard Peter; Kranner, Ilse

2014-07-12

306

Longitudinal shift in diabetic wound microbiota correlates with prolonged skin defense response  

PubMed Central

Diabetics frequently suffer from chronic, nonhealing wounds. Although bacterial colonization and/or infection are generally acknowledged to negatively impact wound healing, the precise relationship between the microbial community and impaired wound healing remains unclear. Because the host cutaneous defense response is proposed to play a key role in modulating microbial colonization, we longitudinally examined the diabetic wound microbiome in tandem with host tissue gene expression. By sequencing 16S ribosomal RNA genes, we show that a longitudinal selective shift in wound microbiota coincides with impaired healing in diabetic mice (Leprdb/db; db/db). We demonstrate a parallel shift in longitudinal gene expression that occurs in a cluster of genes related to the immune response. Further, we establish a correlation between relative abundance of Staphylococcus spp. and the expression of cutaneous defense response genes. Our data demonstrate that integrating two types of global datasets lends a better understanding to the dynamics governing host–microbe interactions. PMID:20668241

Grice, Elizabeth A.; Snitkin, Evan S.; Yockey, Laura J.; Bermudez, Dustin M.; Liechty, Kenneth W.; Segre, Julia A.; Mullikin, Jim; Blakesley, Robert; Young, Alice; Chu, Grace; Ramsahoye, Colleen; Lovett, Sean; Han, Joel; Legaspi, Richelle; Fuksenko, Tatyana; Reddix-Dugue, Natalie; Sison, Christina; Gregory, Michael; Montemayor, Casandra; Gestole, Marie; Hargrove, April; Johnson, Taccara; Myrick, Jerlil; Riebow, Nancy; Schmidt, Brian; Novotny, Betsy; Gupti, Jyoti; Benjamin, Betty; Brooks, Shelise; Coleman, Holly; Ho, Shi-ling; Schandler, Karen; Smith, Lauren; Stantripop, Mal; Maduro, Quino; Bouffard, Gerry; Dekhtyar, Mila; Guan, Xiaobin; Masiello, Cathy; Maskeri, Baishali; McDowell, Jenny; Park, Morgan; Jacques Thomas, Pamela

2010-01-01

307

Current Aspects in the Pathophysiology and Treatment of Chronic Wounds in Diabetes Mellitus  

PubMed Central

Impaired wound healing is a frequent and very severe problem in patients with diabetes mellitus, yet little is known about the underlying pathomechanisms. In this paper we review the biology of wound healing with particular attention to the pathophysiology of chronic wounds in diabetic patients. The standard treatment of diabetic ulcers includes measures to optimize glycemic control as well as extensive debridement, infection elimination by antibiotic therapy based on wound pathogen cultures, the use of moisture dressings, and offloading high pressure from the wound bed. In this paper we discuss novel adjuvant therapies with particular reference to the use of autologous skin transplants for the treatment of diabetic foot ulcers which do not respond to standard care. PMID:23653894

Tsourdi, Elena; Barthel, Andreas; Rietzsch, Hannes; Reichel, Andreas; Bornstein, Stefan R.

2013-01-01

308

EGF containing gelatin-based wound dressings  

Microsoft Academic Search

In case of bulk loss of tissue or non-healing wounds such as burns, trauma, diabetic, decubitus and venous stasis ulcers, a proper wound dressing is needed to cover the wound area, protect the damaged tissue, and if possible to activate the cell proliferation and stimulate the healing process. In this study, synthesis of a novel polymeric bilayer wound dressing containing

Kezban Ulubayram; A. Nur Cakar; Petek Korkusuz; Cemile Ertan; Nesrin Hasirci

2001-01-01

309

Transdermal CO2 Application in Chronic Wounds  

Microsoft Academic Search

Chronic wounds are a challenge to treatment. In this retrospective study, the effect of transdermal CO2 application on wound healing in chronic ulcers was investigated and compared to the effect of CO2 on acute surgical wounds.Eightysix patients (52 females and 34 males) with chronic wounds of different origin except arterial occlusive disease were included. In addition, 17 patients (5 females,

U. Wollina; Birgit Heinig; Christine Uhlemann

2004-01-01

310

Estimating Caloric Needs to Promote Wound Healing  

Microsoft Academic Search

Q: How can I estimate the number of calories a patient with a wound requires each day? A: Patients with wounds have elevated caloric needs. If caloric needs are not met, the patient may lose weight and wound heal- ing may be impaired. Accurately calculating the caloric needs of a patient with a wound is important for ensuring that his

Nancy Collins

2002-01-01

311

The phenotype of murine wound macrophages  

Microsoft Academic Search

The phenotype of wound macrophages has not been studied by direct examination of these cells, yet macro- phages recruited to sites of injury are described as al- ternatively activated macrophages, requiring IL-4 or IL-13 for phenotypic expression. This study character- ized wound macrophage phenotype in the PVA sponge wound model in mice. Eighty-five percent of wound macrophages isolated 1 day

Jean M. Daley; Samielle K. Brancato; Alan A. Thomay; Jonathan S. Reichner; Jorge E. Albina

2009-01-01

312

Use of Negative Pressure Wound Therapy for Abdominal Wounds: A Review of Recent Literature  

Microsoft Academic Search

Introduction: Negative Pressure Wound Therapy (NPWT) is used extensively in the acute and chronic wound care arena of health care. It has become a standard of care for many types of wounds from non-healing diabetic foot ulcers and burns to traumatic and surgical wounds. Recently attention has been paid to using this system for the treatment of catastrophic abdominal wounds.

Evan T. Excell

2008-01-01

313

Burn-wound healing effect of gelatin/polyurethane nanofiber scaffold containing silver-sulfadiazine.  

PubMed

Despite the fact that advances of burn treatment have led to reduction in the morbidity caused by burns, burn infection is still a serious problem. In this study, we designed blended synthetic and natural polymers nanofiber scaffolds using polyurethane (PU) and gelatin, which were prepared by an electrospinning method. Silver-sulfadiazine (SSD) was co-mixed to the blended polymer solution for being incorporated into the nanofibers after the electrospinning, followed by examination of burn-wound healing effect. The nanofiber scaffolds containing SSD should not only serve as a substrate for skin regeneration, but may also deliver suitable drugs, within a controlled manner during healing. The SSD release was able to prevent the growth of a wide array of bacteria and accelerate the wound healing by preventing infection. Therefore it could accelerate the burn-wound closure rate. We confirmed that PU/gelatin nanofiber scaffolds containing SSD lead to enhanced regeneration of burn-wounds. PMID:23621008

Heo, Dong Nyoung; Yang, Dae Hyeok; Lee, Jung Bok; Bae, Min Soo; Kim, Jung Ho; Moon, Seong Hwan; Chun, Heoung Jae; Kim, Chun Ho; Lim, Ho-Nam; Kwon, Il Keun

2013-03-01

314

Recent accomplishments in wound healing.  

PubMed

The challenge to balance limited resources with infinite demand has encouraged an evolution in the way health care services are managed and operated. Chronic wound management is complex and prolonged, and places a considerable financial burden on health services. A typical driver of cost includes the necessity to change dressings on a regular basis. Over the last few decades, several scientific and biological advances have furthered the development of wound care products and facilitated wound management. This article investigates some of the major advancements that have occurred within the wound-care arena during the last 5 years and how these advancements are being translated to provide better delivery of clinical care to patients. PMID:24618286

Mudge, Elizabeth J

2015-02-01

315

Nitric Oxide Regulates Wound Healing  

Microsoft Academic Search

Nitric oxide (NO) synthesis occurs during wound healing, but its role has not been defined. To study the effect of NO on wound repair,S-methyl isothiouronium (MITU, a competitive inhibitor of NO synthase) was administered at a dose of 10, 50, and 100 mg\\/kg body weight\\/day, using intraperitoneally implanted miniosmotic pumps. Groups of 10 male Balb\\/C mice underwent a dorsal skin

Michael R. Schäffer; Udaya Tantry; Steven S. Gross; Hannah L. Wasserkrug; Adrian Barbul

1996-01-01

316

The effects of silver dressings on chronic and burns wound healing.  

PubMed

Silver (Ag) has been thought to improve wound healing and reduce instances of associated infections for many years. There are centuries-old records of silver being used in wound treatment, but the past two decades in particular have seen an increasing clinical application of silver-impregnated wound dressings and as such, have seen the number of research articles similarly increase. The majority of these articles focus on the positives and potential negatives (e.g. the toxicity of silver as a heavy metal) of using silver-impregnated dressings in the clinical management of wounds. This article examines the potential advantages and disadvantages of using silver in the management of chronic and burn wounds, and provides a physiological understanding of the body's response to silver absorption. The author also attempts to critically appraise the opposing literature related to the clinical relevance of microbial kill-time and the volume of silver contained in dressings, while investigating the efficacy of silver-impregnated dressings in the management of burns and chronic wounds. In order to collect literature relevant to this review, the author searched CINAHL, Medline, BMJ, Medscape, Journal of Advanced Nursing, the Electronic Medicines Compendium (EMC), and the Cochrane Library, using the terms silver, silver sulfadiazine, impregnated, wound, burn, dressing, review, quantative, efficacy, in vitro, in vivo, nanocrystalline, toxicity, infection, microbial kill-time, and comparison. PMID:20852480

Elliott, Chris

317

Historical survey of wound healing.  

PubMed

The response of living tissues to injury forms the foundation of all surgical practices. Indeed, from the historical point of view, tissue injury or Vrana or wound and its sequelae have participated in cure of most of the general medical problems from the days of Susruta till date. The earlier medical literatures extensively considered wound care as based on instinctive remedies but on the other hand, the present concepts cogitate healing of wound based on visual observations. Basic perception of wound healing only in its interpretation, which has varied from civilization to civilization. There are various methods for treating of wounds and have since been passed over by ancient humans to today's modern surgeons. Therefore, it is very essential to know the historical aspects of Vrana and its Ropana since the beginning of the tear of medicine as compare to wound and it's healing from the modern point of view. On the basis of above said facts an attempt has been made to explore the historical background of and healing in present paper. PMID:15981379

Mehra, Raakhee

2002-01-01

318

Ultrasound detection of foreign body and gas contamination of a penetrating wound.  

PubMed

We report a case in which ultrasonography (US) examination was used in the Emergency Department to reveal and diagnose gas contamination of a penetrating wound. Air microbubbles are extremely small and their typical distribution and movement are like those of "sparkling-wine microbubbles". US assessment of spontaneous disappearance of the air bubbles can distinguish a harmless traumatic nature of the wound from a life-threatening gas-producing bacterial infection. PMID:23397000

Testa, A; Giannuzzi, R; Zirio, G; La Greca, A; Silveri, N Gentiloni

2009-03-01

319

Ultrasound detection of foreign body and gas contamination of a penetrating wound  

PubMed Central

We report a case in which ultrasonography (US) examination was used in the Emergency Department to reveal and diagnose gas contamination of a penetrating wound. Air microbubbles are extremely small and their typical distribution and movement are like those of “sparkling-wine microbubbles”. US assessment of spontaneous disappearance of the air bubbles can distinguish a harmless traumatic nature of the wound from a life-threatening gas-producing bacterial infection. PMID:23397000

Testa, A.; Giannuzzi, R.; Zirio, G.; La Greca, A.; Silveri, N. Gentiloni

2009-01-01

320

Early soft tissue coverage and negative pressure wound therapy optimises patient outcomes in lower limb trauma  

Microsoft Academic Search

BackgroundThe timing of soft tissue reconstruction for severe open lower limb trauma is critical to its successful outcome, particularly in the setting of exposed metalware and pre-existing wound infection. The use of negative pressure wound therapy (NPWT) may allow a delay in soft tissue coverage without adverse effects. This study evaluated the impact of delayed free-flap reconstruction, prolonged metalware exposure,

David Shi Hao Liu; Foti Sofiadellis; Mark Ashton; Kirstie MacGill; Angela Webb

321

Gauze-based negative pressure wound therapy: a valid method to manage pyoderma gangrenosum.  

PubMed

Pyoderma gangrenosum (PG) is an uncommon ulcerative, non-infective chronic inflammatory skin disorder of unknown aetiology. Systemic therapies are necessary to control the associated medical diseases, and, due to the inflammatory nature of PG, topical or systemic immunosuppressant agents are effective, but wound healing is usually slow. Negative wound pressure therapy (NPWT) has become an important tool for the management of complex skin ulcers, and usage in PG has been recently described in the literature: we present four cases of classic PG in which NPWT in association with systemic therapy achieved wound healing and a drastic pain reduction. PMID:22891652

Fraccalvieri, Marco; Fierro, Maria Teresa; Salomone, Marco; Fava, Paolo; Zingarelli, Enrico M; Cavaliere, Giovanni; Bernengo, Maria G; Bruschi, Stefano

2014-04-01

322

Advanced Wound Therapies in the Management of Severe Military Lower Limb Trauma: A New Perspective  

PubMed Central

Objective: The purpose of this article is to describe the treatment of injuries resulting from land mine explosions using a holistic approach that includes gauze-based negative pressure wound therapy (NPWT) and encompasses wound bed preparation, exudate management, and infection control. Method: In the treatment of 3 traumatic injuries, each requiring limb amputation, we describe the application of NPWT using the Chariker-Jeter system, which uses a single layer of saline-moistened antimicrobial gauze laid directly onto the wound bed. A silicone drain is placed on the gauze and then more gauze is placed over the drain to fill the wound. This is then covered with a clear semipermeable film, cut so that there is a 2- to 3-cm border around the wound allowing it to be sealed onto healthy skin. Results: In each of the cases described, we were able to achieve wound closure prior to successful skin grafting, and the patients have recovered well despite the severity of their injuries. Conclusion: We discuss the potential advantages of the Chariker-Jeter system over polyurethane foam as a method of delivering NPWT in highly extensive and irregular-shaped wounds created by land mine explosions while stressing the importance of thorough and effective wound bed preparation. PMID:19696875

Jeffery, Lt Col S. L. A.

2009-01-01

323

PLGA nanoparticles loaded with host defense peptide LL37 promote wound healing.  

PubMed

Wound treatment remains one of the most prevalent and economically burdensome healthcare issues in the world. Poly (lactic-co-glycolic acid) (PLGA) supplies lactate that accelerates neovascularization and promotes wound healing. LL37 is an endogenous human host defense peptide that modulates wound healing and angiogenesis and fights infection. Hence, we hypothesized that the administration of LL37 encapsulated in PLGA nanoparticles (PLGA-LL37 NP) promotes wound closure due to the sustained release of both LL37 and lactate. In full thickness excisional wounds, the treatment with PLGA-LL37 NP significantly accelerated wound healing compared to PLGA or LL37 administration alone. PLGA-LL37 NP-treated wounds displayed advanced granulation tissue formation by significant higher collagen deposition, re-epithelialized and neovascularized composition. PLGA-LL37 NP improved angiogenesis, significantly up-regulated IL-6 and VEGFa expression, and modulated the inflammatory wound response. In vitro, PLGA-LL37 NP induced enhanced cell migration but had no effect on the metabolism and proliferation of keratinocytes. It displayed antimicrobial activity on Escherichia coli. In conclusion, we developed a biodegradable drug delivery system that accelerated healing processes due to the combined effects of lactate and LL37 released from the nanoparticles. PMID:25173841

Chereddy, Kiran Kumar; Her, Charles-Henry; Comune, Michela; Moia, Claudia; Lopes, Alessandra; Porporato, Paolo E; Vanacker, Julie; Lam, Martin C; Steinstraesser, Lars; Sonveaux, Pierre; Zhu, Huijun; Ferreira, Lino S; Vandermeulen, Gaëlle; Préat, Véronique

2014-11-28

324

A prospective pilot study to evaluate wound outcomes and levels of serum C-reactive protein and interleukin-6 in the wound fluid of patients with trauma-related chronic wounds.  

PubMed

If surgical closure of chronic wounds is an option, choosing an appropriate time to definitely close these wounds remains a challenge. Although the underlying mechanisms of nonhealing are not completely understood, serum C-reactive protein (CRP) and interleukin-6 (IL-6) in wound fluid have been found to be markers of the systemic and local inflammation state of chronic wounds. The purpose of this prospective, descriptive pilot study was to evaluate the effect of debridement, systemic antibiotics, and negative pressure wound therapy (NPWT) on the outcomes of trauma-related chronic wounds and changes in local inflammation responses, measured using CRP and IL-6 levels as indicators of cytokine regulation. Between June 2012 and May 2013, 20 consecutive patients (14 men, six women, mean age 40 [range 17-56] years) with various trauma-related, nonhealing chronic wounds were enrolled in the study after failing to heal for an average of 8.5 (range 6-16) weeks using a protocol of regular debridement and gauze dressings. Before the start of the study, wounds were cultured, and laboratory values for white blood cell count (WBC), neutrophils, and levels of serum CRP and IL-6 in the wound fluid obtained. Wounds were surgically debrided and NPWT (continuous at 125 mm Hg) applied. All patients were prescribed systemic antibiotics, and mean time interval between NPWT dressing changes was 5 (range 3-7) days. During an average mean NPWT treatment time of 13 (range 5-20) days, CRP and IL-6 concentrations decreased from 66.4 mg/L to 10.4 mg/L and 44.1 pg/mL to 8.6 pg/mL, respectively (P <0.001). The presence/absence of bacteria, WBC, and neutrophil counts did not change. No complications were noted, and all wounds were successfully closed using various surgical procedures. In this study, clinical wound improvement and a significant decrease in wound fluid CRP and IL-6 levels were observed. Studies with a larger sample size and a more robust study design may help elucidate the relationship between inflammatory molecules, infection, and healing outcomes. PMID:24905355

Liu, Tao; Yang, Fan; Li, Zhanfei; Yi, Chengla; Bai, Xiangjun

2014-06-01

325

Elevation of thromboxane in pressure wounds.  

PubMed

Arachidonic acid metabolites have been implicated as mediators of progressive dermal ischemia. Decubitus ulcer formation results from chronic mechanical pressure on the skin which results in a diminished blood supply to the skin and underlying tissues. To evaluate the role of thromboxanes in pressure wounds, we measured TxB2, a stable metabolite of TxA2, in spontaneously occurring pressure wounds on Greyhound dogs. In pressure wounds in which the skin was showing early signs of pressure necrosis but was still intact, elevated TxB2 concentrations were found in healthy appearing tissues immediately adjacent to the pressure wounds, in the inner edge of the wounds, and in the center of the wounds. Significantly greater TxB2 concentrations (P less than 0.05) were found in the center of the intact wounds versus the TxB2 concentrations in the inner edge of the wounds or in healthy appearing tissues adjacent to the wounds. In pressure wounds in which the center of the wound had ulcerated or had an eschar, elevated TxB2 concentrations were found in tissues in the inner edge of the wounds and in healthy appearing tissues immediately adjacent to the pressure wounds. These results demonstrate the occurrence of elevated thromboxane concentrations in and around spontaneously occurring pressure wounds. PMID:2762367

Vaughn, D M; Swaim, S F; Milton, J L

1989-07-01

326

Systemic wound care: a meta-review of cochrane systematic reviews.  

PubMed

Wound care is a classic example of a surgical realm with a great variation in care. The diversity in wounds and wound treatments, the limited amount of convincing evidence, and the diverging opinions among doctors and nurses involved in wound care contribute to this undesirable variation in care. For chronic wounds, such as arterial or venous ulcers, pressure sores, and diabetic foot ulcers, but also for acute wounds after surgery or trauma, international and national guidelines provide recommendations on diagnostic procedures and treatment options, but rely mostly on expert opinion. We present the available evidence from Cochrane systematic reviews for the systemic treatment (i.e., not prevention) of patients with wounds, as opposed to topical wound treatments. This evidence shows: - Venous ulcers: High-compression therapy is the classic and evidence-based treatment for treating venous ulcers. Oral pentoxifylline promotes ulcer healing with and without compression therapy. Oral zinc is not effective to heal venous ulcers. - Acute wounds: Recombinant human growth hormone accelerates healing of large burn wounds and donor sites, while high-carbohydrate feeding might reduce the risk of pneumonia. Linezolid is more effective than vancomycin for treating skin and soft tissue infections. Hyperbaric oxygen may help heal crush wounds and skin grafts. Therapeutic touch does not heal acute wounds. - Pressure sores: Air-fluidized and some low-tech devices appear effective for treating existing pressure ulcers. Oral zinc, protein, or vitamin C supplements seem ineffective. Also, evidence is lacking on the effectiveness of repositioning regimes as a treatment option. - Diabetic ulcers: Hyperbaric oxygen therapy and pressure-relieving devices may improve healing rates. - Arterial ulcers: Prostanoids and spinal cord stimulation may be effective in healing ischemic ulcers. Thus, fortunately, some high-level evidence exists for various local and systemic interventions in wound care. Caregivers should be aware of, and apply, the strongest evidence available. Only when all stakeholders (patients, physicians, wound care nurses, but also manufacturers and buyers) implement this available evidence will optimum quality of care for patients with wounds be ensured. PMID:24700218

Ubbink, Dirk T; Santema, Trientje B; Stoekenbroek, Robert M

2014-03-01

327

Clinical update: gunshot wound ballistics.  

PubMed

Although firearm related injury and mortality actually may be declining, gunshot trauma remains a significant cause of morbidity and socioeconomic cost with 115,000 missile injuries annually and as many as 40,000 deaths. Wounds typically are classified as low-velocity (< 2000 feet/second) or high-velocity (> 2000 feet/second). However, these terms can be misleading. More important is the efficiency of energy transfer, which is dependent on the projectile's physical characteristics including deformation and fragmentation, kinetic energy, stability, entrance profile, path traveled through the body, and the biologic characteristics of the tissues. Therefore, the decision whether to explore the wound should not be based solely on the involvement of a high-velocity or low-velocity weapon. The majority of low-velocity gunshot wounds can be treated safely nonoperatively with local wound care and outpatient treatment. Treatment of associated fractures generally is dictated by the bony injuries, which have similar personalities to closed fractures. Because contamination is not always apparent, routine antibiotic prophylaxis still is recommended. The soft tissues assume a more crucial role in high-velocity and shotgun fractures, whereas high-energy injuries and grossly contaminated wounds mandate irrigation, appropriate debridement, and the use of open fracture protocols. However, a patient with a high-velocity wound with limited soft tissue disruption, no significant functional deficits, no evidence of bullet fragmentation, and minimal bony involvement can be a candidate for simple wound care. When exploration is indicated, decompression and excision of necrotic tissue is the rule with color, consistency, contractility, and capacity to bleed providing valuable information regarding muscle viability. PMID:12616039

Bartlett, Craig S

2003-03-01

328

Effect of negative pressure wound therapy on wound healing.  

PubMed

The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is small and much more can be learned about the mechanisms of action. In the future, hopefully we will have the data to assist clinicians in selecting optimal parameters for specific wounds including interface material, waveform of suction application, and the amount of suction to be applied. Further investigation into specific interface coatings and instillation therapy are also needed. We believe that advances in mechanobiology, the science of wound healing, the understanding of biofilms, and advances in cell therapy will lead to better care for our patients. PMID:24935079

Huang, Chenyu; Leavitt, Tripp; Bayer, Lauren R; Orgill, Dennis P

2014-07-01

329

Acceleration Of Wound Healing Ny Photodynamic Therapy  

DOEpatents

Disclosed is a method for accelerating wound healing in a mammal. The method includes identifying an unhealed wound site or partially-healed wound site in a mammal; administering a photosensitizer to the mammal; waiting for a time period wherein the photosensitizer reaches an effective tissue concentration at the wound site; and photoactivating the photosensitizer at the wound site. The dose of photodynamic therapy is selected to stimulate the production of one or more growth factor by cells at the wound site, without causing tissue destruction.

Hasan, Tayyaba (Arlington, MA); Hamblin, Michael R. (Revere, MA); Trauner, Kenneth (Sacramento, CA)

2000-08-22

330

[Water-filtered infrared-A (wIRA) promotes wound healing].  

PubMed

Water-filtered infrared-A (wIRA) is a special form of heat radiation with high tissue penetration and low thermal load to the skin surface which promotes the healing of acute and chronic wounds both by thermal and thermic as well as by non-thermal and non-thermic effects. Water-filtered infrared-A increases tissue temperature (+ 2.7 °C at a tissue depth of 2 cm), tissue oxygen partial pressure (+ 32 % at a tissue depth of 2 cm) and tissue perfusion. These three factors are decisive for a sufficient supply of tissue with energy and oxygen and consequently also for wound healing and infection defense. Water-filtered infrared-A promotes normal as well as disturbed wound healing by diminishing inflammation and exudation, by promotion of infection defense and regeneration, and by alleviation of pain. These effects have been proven in a total of seven prospective studies (of these six randomized controlled studies) with most of the effects having an evidence level of Ia or Ib. The additional cases of complicated courses of wound healing presented in this article illustrate the proven effects of wIRA. Not only in the 6 presented cases wIRA turned the complicated courses of wound healing for the better and facilitated the healing of the wounds after varying total times of irradiation (in the 6 cases 51-550 h) and after variable times of wound care and mostly after transplantation of split skin grafts. In complicated courses of wound healing wIRA does not replace consultation and, when indicated, treatment by an experienced plastic surgeon and by a surgeon specialized in septic surgery. With these limitations wIRA can be recommended as a valuable complement for the treatment of acute as well as of chronic wounds. PMID:25385134

Winkel, R; Hoffmann, G; Hoffmann, R

2014-11-01

331

Multifunctional activities of KSLW synthetic antimicrobial decapeptide: Implications for wound healing  

NASA Astrophysics Data System (ADS)

Wound healing is a complex process leading to the maintenance of skin integrity. Stress is known to increase susceptibility to bacterial infection, alter proinflammatory cytokine expression, and delay wound closure. Recently, antimicrobial peptides have generated interest due to their prokaryotic selectivity, decreased microbial resistance and multifunctional roles in wound healing, including fibroblast stimulation, keratinocyte migration and leukocyte migration. The objective of this dissertation project was to evaluate the effect of a synthetic antimicrobial decapeptide (KSLW) on bacterial clearance inflammation, and wound closure during stress-impaired healing. SKH-1 mice were randomly assigned to either control or restraint-stressed (RST) groups. Punch biopsy wounds (3.5 mm in diameter) were created bilaterally on the dorsal skin. Wounds were injected with 50 microL of empty carriers or KSLW prepared in Pluronic-F68, phospholipid micelles, or saline. Bacterial assays of harvested wounds were conducted on BHI agar. Wound closure was determined by photoplanimetry. Cytokine and growth factor mRNA expression was assessed with real-time RT-PCR. Human neutrophil migration assays and checkerboard analyses were performed using Transweli plates, and counting on hemacytometer. Oxidative burst activity was measured by spectrophotometric analysis of 2,7-dichlorofluorescein oxidation. KSLW-treatment resulted in significant reductions in bacterial load among RST mice, with no difference from control after 24h. The effect was sustained 5 days post-wounding, in RST mice treated with KSLW-F68. Temporal analysis of gene induction revealed reversals of stress-induced altered expression of growth factors, proinflammatory cytokines, and chemokines essential for favorable wound healing, at various time points. KSLW-treatment in RST mice demonstrated faster wound closure throughout the stress period. KSLW, at micromolar concentrations, demonstrated a significant effect on neutrophil migration and oxidative burst. These data suggest KSLW enhances bacterial clearance and promotes proinflammatory activity during early wound healing in stressed mice. Peptide delivery in Pluronic-F68 demonstrated increased substantivity, with faster wound closure, compared to other delivery systems. In addition to its antimicrobial activity, KSLW was shown to enhance neutrophil chemotaxis and sustain cell viability by inhibition of oxidative burst responses. Taken together, the cationic peptide may be implicated in the management of infection in different systems demonstrating impaired healing, including diabetes, age, hormone-imbalance, and bum models.

Williams, Richard Leroy

332

Skin Wound Healing and Scarring: Fetal Wounds and Regenerative Restitution  

PubMed Central

The adverse physiological and psychological effects of scars formation after healing of wounds are broad and a major medical problem for patients. In utero, fetal wounds heal in a regenerative manner, though the mechanisms are unknown. Differences in fetal scarless regeneration and adult repair can provide key insight into reduction of scarring therapy. Understanding the cellular and extracellular matrix alterations in excessive adult scarring in comparison to fetal scarless healing may have important implications. Herein, we propose that matrix can be controlled via cellular therapy to resemble a fetal-like matrix that will result in reduced scarring. PMID:24203921

Yates, Cecelia C.; Hebda, Patricia; Wells, Alan

2014-01-01

333

Wound Dressings and Comparative Effectiveness Data.  

PubMed

Significance: Injury to the skin provides a unique challenge, as wound healing is a complex and intricate process. Acute wounds have the potential to move from the acute wound to chronic wounds, requiring the physician to have a thorough understanding of outside interventions to bring these wounds back into the healing cascade. Recent Advances: The development of new and effective interventions in wound care remains an area of intense research. Negative pressure wound therapy has undoubtedly changed wound care from this point forward and has proven beneficial for a variety of wounds. Hydroconductive dressings are another category that is emerging with studies underway. Other modalities such as hyperbaric oxygen, growth factors, biologic dressings, skin substitutes, and regenerative materials have also proven efficacious in advancing the wound-healing process through a variety of mechanisms. Critical Issues: There is an overwhelming amount of wound dressings available in the market. This implies the lack of full understanding of wound care and management. The point of using advanced dressings is to improve upon specific wound characteristics to bring it as close to "ideal" as possible. It is only after properly assessing the wound characteristics and obtaining knowledge about available products that the "ideal" dressing may be chosen. Future Directions: The future of wound healing at this point remains unknown. Few high-quality, randomized controlled trials evaluating wound dressings exist and do not clearly demonstrate superiority of many materials or categories. Comparative effectiveness research can be used as a tool to evaluate topical therapy for wound care moving into the future. Until further data emerge, education on the available products and logical clinical thought must prevail. PMID:25126472

Sood, Aditya; Granick, Mark S; Tomaselli, Nancy L

2014-08-01

334

Wound Dressings and Comparative Effectiveness Data  

PubMed Central

Significance: Injury to the skin provides a unique challenge, as wound healing is a complex and intricate process. Acute wounds have the potential to move from the acute wound to chronic wounds, requiring the physician to have a thorough understanding of outside interventions to bring these wounds back into the healing cascade. Recent Advances: The development of new and effective interventions in wound care remains an area of intense research. Negative pressure wound therapy has undoubtedly changed wound care from this point forward and has proven beneficial for a variety of wounds. Hydroconductive dressings are another category that is emerging with studies underway. Other modalities such as hyperbaric oxygen, growth factors, biologic dressings, skin substitutes, and regenerative materials have also proven efficacious in advancing the wound-healing process through a variety of mechanisms. Critical Issues: There is an overwhelming amount of wound dressings available in the market. This implies the lack of full understanding of wound care and management. The point of using advanced dressings is to improve upon specific wound characteristics to bring it as close to “ideal” as possible. It is only after properly assessing the wound characteristics and obtaining knowledge about available products that the “ideal” dressing may be chosen. Future Directions: The future of wound healing at this point remains unknown. Few high-quality, randomized controlled trials evaluating wound dressings exist and do not clearly demonstrate superiority of many materials or categories. Comparative effectiveness research can be used as a tool to evaluate topical therapy for wound care moving into the future. Until further data emerge, education on the available products and logical clinical thought must prevail. PMID:25126472

Sood, Aditya; Granick, Mark S.; Tomaselli, Nancy L.

2014-01-01

335

Graphite filament wound pressure vessels  

NASA Technical Reports Server (NTRS)

Filament wound NOL rings, 4-inch and 8-inch diameter closed-end vessels involving three epoxy resin systems and three graphite fibers were tested to develop property data and fabrication technology for filament wound graphite/epoxy pressure vessels. Vessels were subjected to single-cycle burst tests at room temperature. Manufacturing parameters were established for tooling, winding, and curing that resulted in the development of a pressure/vessel performance factor (pressure x volume/weight) or more than 900,000 in. for an oblate spheroid specimen.

Feldman, A.; Damico, J. J.

1972-01-01

336

Wound contraction and macro-deformation during negative pressure therapy of sternotomy wounds  

Microsoft Academic Search

BACKGROUND: Negative pressure wound therapy (NPWT) is believed to initiate granulation tissue formation via macro-deformation of the wound edge. However, only few studies have been performed to evaluate this hypothesis. The present study was performed to investigate the effects of NPWT on wound contraction and wound edge tissue deformation. METHODS: Six pigs underwent median sternotomy followed by magnetic resonance imaging

Christian Torbrand; Martin Ugander; Henrik Engblom; Håkan Arheden; Richard Ingemansson; Malin Malmsjö

2010-01-01

337

Successful treatment of surgical abdominal wounds complicated by multiple bowel fistulas with a combination of total parenteral nutrition, hyaluronan-iodine complex and delayed surgery: results of a monocentric experience  

Microsoft Academic Search

Background: Abdominal catastrophe, suture leakage and wound dehiscence are seri- ous complications of surgical procedures. Wound infection is a frequent complication and the mor- tality is high due to long and difficult treatment procedures. Treatment is often difficult as a result of fistula formation, presence of necrotic and infected tissue, and complex surgical management. Long-term nutritional support is necessary between

L. SOBOTKA; J. MANAK; P. VYROUBAL; R. MOTTL; V. BLAHA; M. SLEMROVA; M. CHOBOLA

338

Modern Collagen Wound Dressings: Function and Purpose  

PubMed Central

Collagen, which is produced by fibroblasts, is the most abundant protein in the human body. A natural structural protein, collagen is involved in all 3 phases of the wound-healing cascade. It stimulates cellular migration and contributes to new tissue development. Because of their chemotactic properties on wound fibroblasts, collagen dressings encourage the deposition and organization of newly formed collagen, creating an environment that fosters healing. Collagen-based biomaterials stimulate and recruit specific cells, such as macrophages and fibroblasts, along the healing cascade to enhance and influence wound healing. These biomaterials can provide moisture or absorption, depending on the delivery system. Collagen dressings are easy to apply and remove and are conformable. Collagen dressings are usually formulated with bovine, avian, or porcine collagen. Oxidized regenerated cellulose, a plant-based material, has been combined with collagen to produce a dressing capable of binding to and protecting growth factors by binding and inactivating matrix metalloproteinases in the wound environment. The increased understanding of the biochemical processes involved in chronic wound healing allows the design of wound care products aimed at correcting imbalances in the wound microenvironment. Traditional advanced wound care products tend to address the wound’s macroenvironment, including moist wound environment control, fluid management, and controlled transpiration of wound fluids. The newer class of biomaterials and wound-healing agents, such as collagen and growth factors, targets specific defects in the chronic wound environment. In vitro laboratory data point to the possibility that these agents benefit the wound healing process at a biochemical level. Considerable evidence has indicated that collagen-based dressings may be capable of stimulating healing by manipulating wound biochemistry. PMID:24527149

Fleck, Cynthia Ann; Simman, Richard

2011-01-01

339

A Global Perspective on Wound Care  

PubMed Central

The development of an interprofessional team approach to the care of acute and chronic wounds is a worldwide challenge. This global unmet need has recently been recognized by the World Health Organization (WHO) and addressed by the Association for the Advancement of Wound Care (AAWC) Global Volunteers program. This article provides an overview of the escalating international wound problem. Current programs established to deal with wounds in resource-poor countries are presented as well as information on volunteering. PMID:25126476

Serena, Thomas E.

2014-01-01

340

Dressings and Products in Pediatric Wound Care  

PubMed Central

Significance: The increasing complexity of medical and surgical care provided to pediatric patients has resulted in a population at significant risk for complications such as pressure ulcers, nonhealing surgical wounds, and moisture-associated skin damage. Wound care practices for neonatal and pediatric patients, including the choice of specific dressings or other wound care products, are currently based on a combination of provider experience and preference and a small number of published clinical guidelines based on expert opinion; rigorous evidence-based clinical guidelines for wound management in these populations is lacking. Recent Advances: Advances in the understanding of the pathophysiology of wound healing have contributed to an ever-increasing number of specialized wound care products, most of which are predominantly marketed to adult patients and that have not been evaluated for safety and efficacy in the neonatal and pediatric populations. This review aims to discuss the available data on the use of both more traditional wound care products and newer wound care technologies in these populations, including medical-grade honey, nanocrystalline silver, and soft silicone-based adhesive technology. Critical Issues: Evidence-based wound care practices and demonstration of the safety, efficacy, and appropriate utilization of available wound care dressings and products in the neonatal and pediatric populations should be established to address specific concerns regarding wound management in these populations. Future Directions: The creation and implementation of evidence-based guidelines for the treatment of common wounds in the neonatal and pediatric populations is essential. In addition to an evaluation of currently marketed wound care dressings and products used in the adult population, newer wound care technologies should also be evaluated for use in neonates and children. In addition, further investigation of the specific pathophysiology of wound healing in neonates and children is indicated to promote the development of wound care dressings and products with specific applications in these populations. PMID:24761363

King, Alice; Stellar, Judith J.; Blevins, Anne; Shah, Kara Noelle

2014-01-01

341

Comparison of healing time of the 2nd degree burn wounds with two dressing methods of fundermol herbal ointment and 1% silver sulfadiazine cream  

PubMed Central

BACKGROUND: Burn wounds are one of the health problems in modern societies that are associated with irreparable harms and many side problems for patients and their families. Infection due to burn wounds is the main cause of death in such patients. One of the methods to prevent infection of burn wounds is topical antibiotic ointments. This study aimed to investigate and identify effective ointments to treat burn wounds. For this purpose, the effects of two types of ointment, fundermol and 1% silver sulfadiazine cream on second degree burn wounds were compared. METHODS: This was a clinical trial study conducted in 2008. Using convenient and continuous sampling method, 50 patients referred to Imam Mousa Kazem Burn Injury Clinic in Isfahan, Iran with 2nd degree burn wounds in 1% to 10% surface area were enrolled. The patients were randomly divided into two groups of treatment with fundermol and sulfadiazine and the dressing was changed once a day. The healing time for burn wounds in each patient was recorded in a checklist and data were analyzed by independent t-test via SPSS software. RESULTS: The healing time of burn wounds in the group treated with fundermol was shorter than that in the group treated with sulfadiazine (p < 0.001). CONCLUSIONS: The present study showed that fundermol ointment accelerates burn wound healing. Therefore, fundermol can be introduced as a good replacement for current treatments of burn wounds. PMID:21589770

Daryabeigi, Reza; Heidari, Mohammad; Hosseini, Sayed Abbas; Omranifar, Mahmoud

2010-01-01

342

Autofluorescence imaging device for real-time detection and tracking of pathogenic bacteria in a mouse skin wound model: preclinical feasibility studies  

NASA Astrophysics Data System (ADS)

Bacterial infection significantly impedes wound healing. Clinical diagnosis of wound infections is subjective and suboptimal, in part because bacteria are invisible to the naked eye during clinical examination. Moreover, bacterial infection can be present in asymptomatic patients, leading to missed opportunities for diagnosis and treatment. We developed a prototype handheld autofluorescence (AF) imaging device (Portable Real-time Optical Detection, Identification and Guidance for Intervention-PRODIGI) to noninvasively visualize and measure bacterial load in wounds in real time. We conducted preclinical pilot studies in an established nude mouse skin wound model inoculated with bioluminescent Staphylococcus aureus bacteria. We tested the feasibility of longitudinal AF imaging for in vivo visualization of bacterial load in skin wounds, validated by bioluminescence imaging. We showed that bacteria (S. aureus), occult to standard examination, can be visualized in wounds using PRODIGI. We also detected quantitative changes in wound bacterial load over time based on the antibiotic treatment and the correlation of bacterial AF intensity with bacterial load. AF imaging of wounds offers a safe, noninvasive method for visualizing the presence, location, and extent of bacteria as well as measuring relative changes in bacterial load in wounds in real time.

Wu, Yichao Charlie; Kulbatski, Iris; Medeiros, Philip J.; Maeda, Azusa; Bu, Jiachuan; Xu, Lizhen; Chen, Yonghong; DaCosta, Ralph S.

2014-08-01

343

Topical application of Katupila (Securinega leucopyrus) in Dushta Vrana (chronic wound) showing excellent healing effect: A case study  

PubMed Central

Securinega leucopyrus (Willd.) Muell. is known as Humari in India, Katupila in Sri Lanka and Spinous fluggea in English. It is a desert climatic plant used topically in paste form for healing of chronic and non-healing wounds. Application of Katupila Kalka (paste) is used commonly in the management of acute as well as chronic wounds in Sri Lanka as a folklore medicine. The aim of this study is to evaluate the role of herbal paste of Katupila in the treatment of Dushta Vrana (chronic wound). It is a single observational innovative case study. A female aged 40 years presented with a non-healing infected wound on her right buttock with a history of 2 months. On examination, there was a rounded wound having black color necrosed tissue and slough with foul smelling, measuring about 3 inch × 3 inch × 1 inch in diameter caused by pyogenic local infection. The routine laboratory investigations were within normal limit except hemoglobin and the swab culture test of the wound bed was reported infection of Staphylococcus aureus. This case study showed effective wound healing by topical application of Katupila paste and sesame oil. PMID:25558163

Ajmeer, Ahamed Shahan; Dudhamal, Tukaram S.; Gupta, Sanjay Kumar; Mahanta, Vyasadeva

2014-01-01

344

Modern wound care - practical aspects of non-interventional topical treatment of patients with chronic wounds.  

PubMed

The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and débridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds. PMID:24813380

Dissemond, Joachim; Augustin, Matthias; Eming, Sabine A; Goerge, Tobias; Horn, Thomas; Karrer, Sigrid; Schumann, Hauke; Stücker, Markus

2014-07-01

345

Cutaneous wound healing: Current concepts and advances in wound care  

PubMed Central

A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise. PMID:25593414

Klein, Kenneth C; Guha, Somes Chandra

2014-01-01

346

Cutaneous wound healing: Current concepts and advances in wound care.  

PubMed

A non-healing wound is defined as showing no measurable signs of healing for at least 30 consecutive treatments with standard wound care.[1] It is a snapshot of a patient's total health as well as the ongoing battle between noxious factors and the restoration of optimal macro and micro circulation, oxygenation and nutrition. In practice, standard therapies for non-healing cutaneous wounds include application of appropriate dressings, periodic debridement and eliminating causative factors.[2] The vast majority of wounds would heal by such approach with variable degrees of residual morbidity, disability and even mortality. Globally, beyond the above therapies, newer tools of healing are selectively accessible to caregivers, for various logistical or financial reasons. Our review will focus on the use of hyperbaric oxygen therapy (HBOT), as used at our institution (CAMC), and some other modalities that are relatively accessible to patients. HBOT is a relatively safe and technologically simpler way to deliver care worldwide. However, the expense for including HBOT as standard of care for recognized indications per UHMS(Undersea and Hyperbaric Medical Society) may vary widely from country to country and payment system.[3] In the USA, CMS (Centers for Medicare and Medicaid Services) approved indications for HBOT vary from that of the UHMS for logistical reasons.[1] We shall also briefly look into other newer therapies per current clinical usage and general acceptance by the medical community. Admittedly, there would be other novel tools with variable success in wound healing worldwide, but it would be difficult to include all in this treatise. PMID:25593414

Klein, Kenneth C; Guha, Somes Chandra

2014-01-01

347

TU Delft researchers have invented a wound  

E-print Network

to localise and characterise invisible wounds during an operation. To cut health care costs, reduce the lengthTU Delft researchers have invented a wound characterisation method that improves the accuracy and efficiency of wound diagnostics. A portable device using this method is capable of defining all important

Langendoen, Koen

348

Swellability of Silver (I) Antimicrobial Wound Dressings  

Technology Transfer Automated Retrieval System (TEKTRAN)

An important characteristic of moist wound dressings is their ability to swell and absorb exudates from the wound, while maintaining a moist atmosphere at the wound site. At the Southern Regional Research Center, we have developed antimicrobial silver- CM-cotton print cloth from CM-Printcloth with l...

349

Functionalized silk biomaterials for wound healing.  

PubMed

Silk protein-biomaterial wound dressings with epidermal growth factor (EGF) and silver sulfadiazine were studied with a cutaneous excisional mouse wound model. Three different material designs and two different drug incorporation techniques were studied to compare wound healing responses. Material formats included silk films, lamellar porous silk films and electrospun silk nanofibers, each studied with the silk matrix alone and with drug loading or drug coatings on the silk matrices. Changes in wound size and histological assessments of wound tissues showed that the functionalized silk biomaterial wound dressings increased wound healing rate, including reepithelialization, dermis proliferation, collagen synthesis and reduced scar formation, when compared to air-permeable Tegaderm tape (3M) (- control) and a commercial wound dressing, Tegaderm Hydrocolloid dressing (3M) (+ control). All silk biomaterials were effective for wound healing, while the lamellar porous films and electrospun nanofibers and the incorporation of EGF/silver sulfadiazine, via drug loading or coating, provided the most rapid wound healing responses. This systematic approach to evaluating functionalized silk biomaterial wound dressings demonstrates a useful strategy to select formulations for further study towards new treatment options for chronic wounds. PMID:23184644

Gil, Eun Seok; Panilaitis, Bruce; Bellas, Evangelia; Kaplan, David L

2013-01-01

350

A New Wound Healing Agent–Sphingosylphosphorylcholine  

Microsoft Academic Search

Sphingosylphosphorylcholine (lysosphingomyelin or SPC) is an effective and broad spectrum cell growth promoting agent and a candidate for evaluation on wound healing. The effect of SPC on full-thickness excision and incision wounds in genetically healing impaired diabetic (db\\/db) mice was evaluated by measurement of wound area, skin strength, and tissue histology. The effect on cell proliferation was measured in vivo

Liying Sun; Lan Xu; Fleetwood A. Henry; Sarah Spiegel; Thor B. Nielsen

1996-01-01

351

Honey in wound care: antibacterial properties  

PubMed Central

Honey is an ancient wound treatment that was re-introduced into modern medical practice in Australasia and Europe following the development of regulated wound care products. Its therapeutic properties are attributed to its antimicrobial activity and its ability to stimulate rapid wound healing. This review will briefly describe the evidence that demonstrates its antimicrobial activity in vitro and in vivo. PMID:20204083

Cooper, Rose

2007-01-01

352

Epithelial stem cells, wound healing and cancer  

Microsoft Academic Search

It is well established that tissue repair depends on stem cells and that chronic wounds predispose to tumour formation. However, the association between stem cells, wound healing and cancer is poorly understood. Lineage tracing has now shown how stem cells are mobilized to repair skin wounds and how they contribute to skin tumour development. The signalling pathways, including WNT and

Esther N. Arwert; Esther Hoste; Fiona M. Watt

2012-01-01

353

Ageing and its influence on wound healing  

Microsoft Academic Search

Given the constantly rising percentage of older people in the population and the huge cost of treating wounds in this patient group, the importance of examining the relationship between ageing and wound healing cannot be underestimated. This article will examine current thinking in this area. Despite early reports of delays in wound healing associated with age and changes in cutaneous

Demetrius A Minimas

354

Solutions to intraoperative wound classification miscoding in a subset of american college of surgeons national surgical quality improvement program patients.  

PubMed

Intraoperative wound classification is a predictor of postoperative infection. Therefore, accurately assigning the correct classification to a surgical wound is of particular importance. Our institution participates in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), a national outcomes database that collects wound classification for all qualifying operative procedures, and we noted discrepancies when comparing ACS NSQIP wound classification coding with perioperative coding in our electronic medical record. We tested the effectiveness of an intervention that included staff educational sessions, informational posters, and postoperative debriefings on improving the accuracy of documented intraoperative wound classification. The ?(2) test was used to compare proportions of wound classification miscodings before and after educational sessions and debriefings commenced. Baseline data revealed misclassification of wounds occurred 21 per cent (30 of 141) of the time in predominately colorectal procedures performed by two surgeons from April through August 2012. Errors decreased to 9 per cent (13 of 147) from August to December 2012, after our intervention of education sessions with operating room staff and the surgeons incorporating a statement confirming the wound classification at the end of the case debriefing. The ?(2) statistic was 8.7589. The P value was significant at 0.003. Ensuring concordance of classification between the surgeon and nurse during a postprocedure debriefing as well as education of perioperative nursing staff through posters and seminars significantly improved the accuracy of intraoperative wound classification coding. PMID:25642884

Turrentine, Florence E; Giballa, Sarah B; Shah, Puja M; Jones, David R; Hedrick, Traci L; Friel, Charles M

2015-02-01

355

Long-term follow-up of negative pressure wound therapy with instillation: a limb salvage procedure?  

PubMed

Negative pressure wound therapy (NPWT) is a treatment to reduce oedema, stimulate granulation tissue formation, remove wound exudate and diminish wound area, thus preparing it for secondary healing, skin grafting or coverage with flaps. The association of instillation to NPWT (NPWTi) is a new method for treating severe wounds, in particular, limb lesions at high risk for amputation. This therapy helps to deliver instillation fluid automatically into the contaminated wound, before application of negative pressure. These steps, repeated cyclically, help to remove infectious material, leading to a better moist environment, a necessary condition for wound healing. We report our experience of treating three patients with complex wounds and associated noble structure exposition conservatively with NPWTi and flap coverage. In a long-term follow-up (5?years), we were able to achieve a stable surgery reconstruction on preserved limbs, without evidence of chronic infection and other sequelae or complications. Despite the fact that our experience is limited , as it is based on only a few cases, it suggests how NPWTi could be considered useful in a conservative approach to the treatment of acute complex wounds of the lower extremities. In these patients with high risk of amputation, a long-term follow-up becomes fundamental in order to evaluate wound bed status after NPTWi. PMID:25234266

Bollero, Daniele; Degano, Kiran; Gangemi, Ezio N; Aloj, Domenico; Malvasio, Valeria; Stella, Maurizio

2014-09-19

356

Diabetic lower extremity wounds: the rationale for growth factors-based infiltration treatment.  

PubMed

Repair machinery and local infection control failure contribute to wound chronicity and lower extremity amputation in diabetic patients. In these wounds, inflammation is a proximal condition which disrupts wound matrix turnover and the local redox balance. Contemporary therapeutic interventions are relatively broad including drugs, devices and surgical procedures. However, clinical efficacy remains modest and recurrences are frequent. Recombinant growth factors advent was followed by their premature and empiric introduction in the clinical practice. Its topical administration is still challenged by local kinetic and pharmacodynamic limitations related to the hostile microenvironment of chronic wounds. The rationale of infiltrating epidermal growth factor (EGF) down inside complex diabetic wounds as an alternative treatment modality is described here. The concept emerged from two experimental evidences: (a) locally infiltrated EGF prevented trophic ulcers and limb necrosis upon denervation, (b) acute, controlled experimental wounds' exudate exhibited proteolytic activity. Depositing EGF in deep cells' responsive strata allows for two main pharmacological actions indispensable for chronic wounds healing: cyto-protection and proliferation of fibroblasts and endothelial cells, thus inducing progressive granulation. Ten years of clinical experience have validated laboratory and theoretical concepts, while most importantly have improved quality-of-life to thousands of diabetic patients. PMID:21910827

Berlanga-Acosta, Jorge

2011-12-01

357

Preparation and Evaluation of Transdermal Plasters Containing Norfloxacin: A Novel Treatment for Burn Wound Healing  

PubMed Central

Objective: In an attempt for better treatment of bacterial infections and burn wounds, plaster formulations containing different concentrations of norfloxacin were prepared using polymers like polyvinylpyrrolidone and polyvinyl alcohol and evaluated for physicochemical parameters, in vitro drug release, antimicrobial activity, and burn wound healing properties. The prepared formulations were compared with silver sulfadiazine cream 1%, USP. Methods: Plaster formulations containing different concentrations of norfloxacin were prepared by solvent casting method using combination of polymers like polyvinylpyrrolidone and polyvinyl alcohol. These plasters were characterized for drug content, thickness, percentage elongation, tensile strength, in vitro drug release properties, and antimicrobial activity against various strains of aerobic and anaerobic microorganisms. The wound healing property was evaluated by histopathological examination and by measuring the wound contraction. Results: The in vitro release and in vitro skin permeation followed the first-order kinetics followed by diffusion as dominant release mechanism. In spite of the significant antimicrobial and wound healing effects produced by plasters, the observed values were less than the values obtained with silver sulfadiazine 1% cream (P < .05). Various histopathological changes observed during the study period (days 1, 4, 8, and 12) also supported the wound healing process. Conclusion: Based on the observed in vitro performances along with antimicrobial and wound healing effects, the 5% norfloxacin transdermal plasters could be employed as an alternative to commercial silver sulfadiazine 1% cream. PMID:20596234

Dua, Kamal; Ramana, M. V.; Sara, U. V. S.; Agrawal, D. K.; Pabreja, Kavita; Chakravarthi, Srikumar

2010-01-01

358

Recent Developments in Topical Wound Therapy: Impact of Antimicrobiological Changes and Rebalancing the Wound Milieu  

PubMed Central

Wound therapy improves every year by developing new wound treatment options or by advancing already existing wound materials, for example, adding self-releasing analgesic drugs or growth factors to wound dressings, or by binding and inactivating excessive proteases. Also new dressing materials based on silk fibers and enhanced methods to reduce bacterial burden, for example, cold argon plasma, might help to fasten wound healing. PMID:24829919

Erfurt-Berge, Cornelia; Renner, Regina

2014-01-01

359

[Corneal perforated wounds treatment by "thermal contact": report of 25 cases].  

PubMed

Authors present a particular treatment of perforated corneal wounds. Patients presenting traumatic perforated corneal wound with iris hernia infected or not, have been treated by a weekly hernia's outside cauterization. Wound dressing, rifamycin eye drop until cicatrization, antibiotic and anti-inflammatory per os, are daily instituted for 10 days. Patients follow up runs from 5 months to 4 years. We have obtained in all cases ocular bulb conservation but one case of phthisis bulb. Visual acuity increase between 2/10 and 7/10 after eyes with peripheral perforated wounds cicatrization. Second eye is normal in all cases. This technique can be used to avoid mutilation surgery in our region when prosthesis is difficult to get. PMID:15770809

Banla, M; Balo, K P; Soboslay, P; Meda, D N; Ouro Djeri, S

2003-01-01

360

Eradication of multidrug-resistant A. baumannii in burn wounds by antiseptic pulsed electric field  

PubMed Central

Emerging bacterial resistance to multiple drugs is an increasing problem in burn wound management. New non-pharmacologic interventions are needed for burn wound disinfection. Here we report on a novel physical method for disinfection: antiseptic pulsed electric field (PEF) applied externally to the infected burns. In a mice model, we show that PEF can reduce the load of multidrug resistant Acinetobacter baumannii present in a full thickness burn wound by more than four orders of magnitude, as detected by bioluminescence imaging. Furthermore, using a finite element numerical model, we demonstrate that PEF provides non-thermal, homogeneous, full thickness treatment for the burn wound, thus, overcoming the limitation of treatment depth for many topical antimicrobials. These modeling tools and our in vivo results will be extremely useful for further translation of the PEF technology to the clinical setting, as they provide the essential elements for planning of electrode design and treatment protocol. PMID:25089285

Golberg, Alexander; Broelsch, G. Felix; Vecchio, Daniela; Khan, Saiqa; Hamblin, Michael R.; Austen, William G.; Sheridan, Robert L.; Yarmush, Martin L.

2014-01-01

361

THE LINEAR EXCISIONAL WOUND: AN IMPROVED MODEL FOR HUMAN EX-VIVO WOUND EPITHELIALIZATION STUDIES  

PubMed Central

Background/Purpose Wound healing is a complex process that involves multiple intercellular and intracellular processes and extracellular interactions. Explanted human skin has been used as a model for the re-epithelialization phase of human wound healing. The currently used standard technique employs a circular punch biopsy tool to make the initial wound. Despite its wide use, the geometry of round wounds makes them difficult to measure reliably. Methods Our group has designed a linear wounding tool, and compared the variability in ex vivo human linear and circular wounds. Results An F test for differences in variances demonstrated that the linear wounds provided a population of wound size measurements that was fifty percent less variable than that obtained from a group of matched circular wounds. This reduction in variability would provide substantial advantages for the linear wound technique over the circular wound punch technique, by reducing the sample sizes required for comparative studies of factors that alter healing. Conclusion This linear wounding tool thus provides method for wounding that is standardized, provides minimal error in wound gap measurements, and is easily reproducible. We demonstrate its utility in an ex vivo model for the controlled investigation of human skin wounds. PMID:21605167

Rizzo, Amilcar Ezequiel; Beckett, Laurel A.; Baier, Brian S.; Isseroff, R. Rivkah

2013-01-01

362

Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?: A prospective study.  

PubMed

We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/?l. PMID:24293603

Howard, N E; Phaff, M; Aird, J; Wicks, L; Rollinson, P

2013-12-01

363

Evaluation of vacuum-assisted closure in patients with wound complications following tumour surgery.  

PubMed

Covering the reconstructed area with a healthy soft-tissue envelope is a major challenge after limb-sparing surgery in patients with malignant bone and soft-tissue tumours. Negative pressure wound therapy (NPWT) of open wounds hastens healing and minimises the requirement for complex reconstructive soft-tissue surgery. The aim of this study was to investigate the effectiveness and safety of NPWT in bone and soft-tissue malignant tumour patients with postoperative wound complications. Between January 2006 and November 2009, at a single institution, 13 patients with malignant bone and soft-tissue tumours who had undergone wide resection were retrospectively analysed. NPWT was performed in all patients to temporarily close the soft-tissue defects. After obtaining the culture negativity and normal infection markers, definitive soft-tissue reconstruction was performed to close the wound with primary suturisation in two patients, split thickness grafts in four patients, full thickness grafts in two patients, rotational flaps in three patients and free flaps in two patients. Mean duration of hospitalisation was 20 (range 8-48) days and mean follow-up period was 57·3 (range 50-74) months. There was no tumour recurrence or skip metastasis in the follow-up period. In addition, there was no periprosthetic infection or complication associated with NPWT. In conclusion, NPWT therapy seems to be a safe and effective option in the management of local wound problems and secondary surgical site infections after musculoskeletal tumour surgery. PMID:24976480

Mermerkaya, Ugur; Bekmez, Senol; Alkan, Erkan; Ayvaz, Mehmet; Tokgozoglu, Mazhar

2014-06-26

364

Cross-linked silver-impregnated skin for burn wound management.  

PubMed

Biological skin is effective in restoring the missing water vapor barrier and promoting healing in burn wounds. Its effectiveness in wound management has been limited, however, by its inherently limited antibacterial properties and the fact that it is sometimes rejected before healing is complete, even reversing previous beneficial effects. Limited availability and storage difficulties have posed further problems. Impregnation of biological skin with silver ions has been proven to provide a potent bactericidal effect directly at the wound surface. We hypothesized that aldehyde cross-linking of silver-impregnated skin would mask the histocompatibility sites from the recipient's immune system. This has been demonstrated previously with aldehyde cross-linking of allografts and xenografts, prolonging retention sufficiently to permit complete wound healing. Commercially available skin was treated with an aldehyde compound and impregnated with silver. Initial studies of this cross-linked skin for treatment of burn wounds showed average retention to be between 117 and 161 days, far exceeding that of any untreated skin. It was subsequently found that the aldehyde cross-linking permitted impregnation with higher concentrations of silver than had previously been possible--2,600 to 2,830 ppm as compared to an average of 1,020 to 1,350 ppm in previously available silver-impregnated skin. This results in a more potent, immediate antibacterial effect at the wound surface and an extended period of time-release antibacterial action before the silver is exhausted. The antibacterial properties of this aldehyde cross-linked silver-impregnated skin are effective in decontaminating even grossly infected wounds and in protecting against contamination of clean wounds from adjacent infected areas or external sources.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3192604

Ersek, R A; Denton, D R

1988-01-01

365

Physics of Wound Healing I: Energy Considerations  

E-print Network

Wound healing is a complex process with many components and interrelated processes on a microscopic level. This paper addresses a macroscopic view on wound healing based on an energy conservation argument coupled with a general scaling of the metabolic rate with body mass M as M^{\\gamma} where 0 wound healing rate peaks at a value determined by {\\gamma} alone, suggesting a concept of wound acceleration to monitor the status of a wound. 2) We find that the time-scale for wound healing is a factor 1/(1 -{\\gamma}) longer than the average internal timescale for producing new material filling the wound cavity in corresondence with that it usually takes weeks rather than days to heal a wound. 3) The model gives a prediction for the maximum wound mass which can be generated in terms of measurable quantities related to wound status. We compare our model predictions to experimental results for a range of different wound conditions (healthy, lean, diabetic and obses...

Apell, S Peter; Papazoglou, Elisabeth S; Pizziconi, Vincent

2012-01-01

366

Mechanisms of systemic wound response in Drosophila.  

PubMed

In response to cellular and tissue losses caused by physical or chemical injuries, organisms must activate multiple wound repair systems at the cellular, tissue, and organismal levels. The systemic wound response (SWR) that occurs via interorgan communication between local wound sites and remote organs ensures that the host is protected efficiently in response to a local wound. The local wound response around the wound site is fairly well documented, but the molecular mechanisms that allow the host to launch SWR are poorly understood. Recent studies on the Drosophila adult model system have shown that the local wound response is not restricted to the wound site because it plays an essential role in generating signals transmitted to remote organs that subsequently achieve SWR. By exploiting the genetic methods available for investigating Drosophila, we are just beginning to understand the complex interorgan networks that operate during SWRs. This review discusses the basic processes involved with classical integumental wound responses and tissue regeneration, such as epithelial cell movement, hemocyte recruitment, apoptosis, melanization, and generation of reactive oxygen species, as well as the recently described intestinal epithelial cell renewal program that occurs in response to gut cell damages. Furthermore, we discuss how these local wound responses integrate with organ-to-organ communication to launch SWR. Genetic analysis of SWRs using the Drosophila model system will provide a unique opportunity to dissect the molecular mechanisms that control wound-induced organ-to-organ communication. PMID:24512709

Lee, Won-Jae; Miura, Masayuki

2014-01-01

367

Topical treatments in equine wound management.  

PubMed

Wound repair is a complex series of coordinated events regulated by a delicately orchestrated cascade of cytokines and growth factors that restore the structural integrity of damaged tissue. Manipulation of the growth factor profile or wound environment through topical application of therapeutic agents could positively influence the rate and quality of wound repair. Transforming growth factor-beta,platelet-rich plasma, activated macrophage supernatant, and growth hormone are sources of mediators that may facilitate wound healing. Solcoseryl, ketanserin, tripeptide- and tetrapeptide-copper complexes, maltodextrin, live yeast cell derivative, corticosteroids,aloe vera, acemannan, phenytoin, honey, sugar, and maggots may modify the wound environment and promote repair. The process of wound healing is complex, however, and it is currently unknown whether any one agent can ameliorate all issues of repair or cover all vulnerabilities of impaired wound healing. PMID:15691601

Dart, Andrew J; Dowling, Brad A; Smith, Christine L

2005-04-01

368

Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions - when, where and how to use: what does the evidence show?  

PubMed

Infections of contaminated or colonised acute or chronic wounds remain a grave risk for patients even today. Despite modern surgical debridement concepts and antibiotics, a great need exists for new therapies in wound management. Since the late 1990s, advantageous effects of negative pressure wound therapy (NPWT) have been combined with local antiseptic wound cleansing in the development of NPWT with instillation (NPWTi). This article summarises the current scientific knowledge on this topic. MEDLINE literature searches were performed on the subject of negative pressure wound and instillation therapy covering publications from the years 1990 to 2013 (36 peer-reviewed citations) and regarding randomised controlled trials (RCTs) covering wound care with bone involvement (27 publications) or soft-tissue wounds without bone participation (11 publications) from 2005 to 2012. The use of NPWTi in the therapy of infected wounds appears to be not yet widespread, and literature is poor and inhomogeneous. However, some reports indicate an outstanding benefit of NPWTi for patients, using antiseptics such as polyhexanide (concentration 0·005-0·04%) and acetic acid (concentration 0·25-1%) in acute and chronic infected wounds and povidone-iodine (10% solution) as prophylaxis in contaminated wounds with potential viral infection. Soaking times are recommended to be 20?minutes each, using cycle frequencies of four to eight cycles per day. Additionally, the prophylactic use of NPWTi with these substances can be recommended in contaminated wounds that cannot be closed primarily with surgical means. Although first recommendations may be given currently, there is a great need for RCTs and multicentre studies to define evidence-based guidelines for an easier approach to reach the decision on how to use NPWTi. PMID:24251842

Back, David A; Scheuermann-Poley, Catharina; Willy, Christian

2013-12-01

369

Simplified Negative Pressure Wound Therapy in Pediatric Hand Wounds  

Microsoft Academic Search

Negative pressure wound therapy (NPWT) is commonly used as a bolster for skin grafts. The technique offers the benefit of\\u000a negative pressure as well as reduced dressing changes. Skin grafting of the hand provides a unique challenge, and currently,\\u000a the only commercially available NPWT hand dressings are adult-sized, precluding their use in small children. We present our\\u000a custom NPWT “mitten”

Rahul Kasukurthi; Gregory H. Borschel

2010-01-01

370

Keratinocyte Growth Factor2 Accelerates Wound Healing in Incisional Wounds  

Microsoft Academic Search

Background.Keratinocyte growth factor-2 (KGF-2) also described as fibroblast growth factor-10 (FGF-10) is a newly identified member of the fibroblast growth factor family. KGF-2 is 96% identical to the recently identified rat FGF-10 and specifically stimulates growth of normal human epidermal keratinocytes. The present study was undertaken to examine the effects of topically applied KGF-2 in an incisional wound healing model.

Pablo A. Jimenez; Mark A. Rampy

1999-01-01

371

Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children  

PubMed Central

Significance: The costs and morbidity of pediatric traumatic wounds are not well known. The literature lacks a comprehensive review of the volume, management, and outcomes of children sustaining soft tissue injury. We briefly review the existing literature for traumatic wounds such as open fractures and burns. Such injuries require dedicated wound care and we propose a novel approach for more efficient and more effective delivery of dedicated pediatric wound care. Recent Advances: New pediatric literature is emerging regarding the long-term effects of wound care pain in traumatic injuries—especially burns. A variety of wound dressings and alternative management techniques exist and are geared toward reducing wound care pain. Our institution utilizes a unique model to provide adequate sedation and pain control through a dedicated pediatric wound care unit. We believe that this model reduces the cost of wound care by decreasing emergency department and operating room visits as well as hospital length of stay. Critical Issues: First, medical costs related to pediatric traumatic wound care are not insignificant. The need for adequate pain control and sedation in children with complex wounds is traditionally managed with operating room intervention. Afterward, added costs can be from a hospital stay for ongoing acute wound management. Second, morbidities of complex traumatic wounds are shown to be related to the acute wound care received. Future Directions: Further guidelines are needed to determine the most effective and efficient care of complex traumatic soft tissue injuries in the pediatric population. PMID:24761364

Bernabe, Kathryn Q.; Desmarais, Thomas J.; Keller, Martin S.

2014-01-01

372

A Dressing Solution for Burn Wounds: Antibacterial and Low-Adherent Wound Dressings  

NASA Astrophysics Data System (ADS)

Considering the infection and second trauma caused by dressing changes, development of antibacterial and low-adherent wound dressings is urgently needed. Silver ion is a widely used antimicrobial agent, but its cytotoxicity remains a problem. In this study, low-adherent PAM (polyacrylamide) hydrogel incorporated with less toxic AgNP (silver nanoparticle), was immobilized onto PET (poly(ethylene terephthalate)) substrates by an IPN (interpenetrating polymer network) method. The modified PET is effectively antibacterial and the surface is significantly less adherent than untreated PET. However, silver-resistant bacteria become a potential problem. Thus, ionic 5,5-dimethylhydantoin (DMH) analogues containing either a quaternary ammonium moiety or a phosphonate functional group were designed and synthesized. The DMH analogues were converted to antibacterial N-chloramine counterparts through chlorination to serve as potential alternatives to AgNP. The N-chloramine with a structural cation exhibited distinctly enhanced antibacterial functions both in solution and after immobilization on fabrics.

Pu, Tianyun

373

Pulsed electric fields for burn wound disinfection in a murine model.  

PubMed

Emerging bacterial resistance renders many antibiotics ineffective, making alternative strategies of wound disinfection important. Here the authors report on a new, physical burn wound disinfection method: pulsed electric fields (PEFs). High voltage, short PEFs create nonthermal, permanent damage to cell membranes, possibly by irreversible electroporation. In medicine, PEF technology has recently been used for nonthermal ablation of solid tumors. The authors have expanded the spectrum of PEF applications in medicine to burn wound disinfection. A third-degree burn was induced on the dorsal skin of C57BL/6 mice. Immediately after the injury, the burn wound was infected with Acinetobacter baumannii expressing the luxCDABE operon. Thirty minutes after infection, the infected areas were treated with 80 pulses delivered at 500 V/mm, 70 ?s, 1 Hz. The authors used bioluminescence to quantify bacteria on skin. Three animals were used for each experimental condition. PEFs were effective in the disinfection of infected burned murine skin. The bacterial load reduction correlated with the number of delivered pulses. Forty pulses of 500 V/mm led to a 2.04 ± 0.29 Log10 reduction in bacterial load; 80 pulses led to the immediate 5.53 ± 0.30 Log10 reduction. Three hours after PEF, the bacterial reduction of the skin treated with 500 V/mm, 80 pulses was 4.91 ± 0.71 Log10. The authors introduce a new method of wound disinfection using high voltage, short PEFs. They believe that PEF technology may represent an important alternative to antibiotics in addressing bacterial contamination of wounds, particularly those contaminated with multidrug-resistant bacteria. PMID:25167374

Golberg, Alexander; Broelsch, G Felix; Vecchio, Daniela; Khan, Saiqa; Hamblin, Michael R; Austen, William G; Sheridan, Robert L; Yarmush, Martin L

2015-01-01

374

[Use of new materials in the treatment of chronic post-traumatic wounds].  

PubMed

Postoperative infection and the presence of osteosynthetic material in human body pose a major problem for patients and operators. Previously, it was considered that osteosynthetic material must be removed, and only then the expected full infection recovery could occur. However, removal of osteosynthetic material in unhealed fractures complicates bone fracture healing, as well as infection recovery. Nowadays, it is indicated to place an external bone fixator and in case of soft tissue recovery access to reosteosynthesis. The negative pressure wound therapy has brought new opportunities for treatment of this type of infections without the need of osteosynthetic material removal. Direct and indirect effects of negative pressure wound therapy create optimal healing conditions. Local use of new materials, transforming powder (Altrazeal) and topical hemoglobin spray (Granulox), provide and improve physiological conditions for appropriate and safe healing. PMID:25326994

Marinovi?, Marin; Spanjol, Josip; Fumi?, Nera; Bakota, Bore; Pin, Maja; Cukelj, Fabijan

2014-10-01

375

Thyroid Hormone and Wound Healing  

PubMed Central

Although thyroid hormone is one of the most potent stimulators of growth and metabolic rate, the potential to use thyroid hormone to treat cutaneous pathology has never been subject to rigorous investigation. A number of investigators have demonstrated intriguing therapeutic potential for topical thyroid hormone. Topical T3 has accelerated wound healing and hair growth in rodents. Topical T4 has been used to treat xerosis in humans. It is clear that the use of thyroid hormone to treat cutaneous pathology may be of large consequence and merits further study. This is a review of the literature regarding thyroid hormone action on skin along with skin manifestations of thyroid disease. The paper is intended to provide a context for recent findings of direct thyroid hormone action on cutaneous cells in vitro and in vivo which may portend the use of thyroid hormone to promote wound healing. PMID:23577275

Safer, Joshua D.

2013-01-01

376

The Wound-Healing Process  

Microsoft Academic Search

Diabetes is on the rise in the United States and the rest of the world, and its complications are even more evident in the\\u000a aging population. Among the most severe complications of diabetes are impaired circulation and wound healing. The former condition,\\u000a together with peripheral neuropathy, contributes to an insensate, poorly vascularized lower extremity that is prone to the\\u000a development

Jeffrey M. Davidson; Luisa DiPietro

377

On the application of a photo plasma dynamic method for pussy wounds treatment  

Microsoft Academic Search

We offer a new photo plasma dynamic method and ELECTRON -PULSAR complex of apparatuses for the implementation of the method. The method and the complex of the apparatuses ensure the treatment for pussy wounds by means of a gaseous mixture effecting on the infection nidus. The gaseous mixture includes the following highly- active components such as O*, O2* 1O2, O',

V. V. Pedder; D. V. Belik; G. Z. Rot; I. V. Sourgutskova; Y. V. Shkuro; A. V. Pedder; I. A. Shnyptev

2008-01-01

378

The effect of multifunctional polymer-based gels on wound healing in full thickness bacteria-contaminated mouse models  

PubMed Central

We determined whether a two part space-conforming polyethyleneglycol/dopa polymer-based gel promoted healing of contaminated wounds in mice. This silver-catalysed gel was previously developed to be broadly microbiocidal in vitro while being biocompatible with human wound cell functioning. Full-thickness wounds were created on the backs of mice. The wounds were inoculated with 104 CFU of each of four common skin wound contaminants, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumanii and Clostridium perfringens. The wounds were then treated with our multifunctional polymer-based gel, the commercially-available NewSkin product, or left to heal untreated. The untreated wounds were overtly infected, and presented detectable bacterial loads over the entire 21 day healing period, while the gel and NewSkin groups presented significantly smaller rises in bacterial levels and were cleared of detectable colonies by the third week, with the gel group clearing the bacteria earlier. While all three groups healed their wounds, the polymer-based gel treated group demonstrated signficantly earlier re-epithelialization and dermal maturation (P < 0.05). This was reflected in a quick regain of tensile strength. This accelerated dermal maturation and regain in strength was noted in mice treated with the polymer-based gel when compared to wound treated with the commercially-available Aquacel-Ag dressing (P < 0.05). What distinguishes the polymer-based gel from these other products is that is incorporated within the healing wound. These preclinical studies show that the anti-microbial polymer gel not only supports but also accelerates healing of bacterially contaminated wounds. PMID:17561250

Yates, Cecelia Christina; Whaley, Diana; Babu, Ranjith; Zhang, Jianying; Krishna, Priya; Beckman, Eric; Pasculle, A. William; Wells, Alan

2007-01-01

379

Infection control in cardiac surgery.  

PubMed

This report relates the results of a multifaceted, 4 year program directed toward reduction of infection in patients undergoing cardiac operations and extracorporeal circulation in a large teaching hospital. Retrospective analysis of all superficial and deep wound infections and prosthetic valve infections for the period of 1966 to 1970 and a prospective study of the period of 1970 to 1974 were made. The multifaceted program begun in 1970 consisted of (1) renovation of a cardiac operating room with incorporation of a high flow, vertical unidirectional ventilation system, (2) change in the gown and draping material for improvement of barriers to bacteriologic shedding, (3) frequent steam sterilization of prosthetic valves, (4) routine use of an antistaphylococcal agent in patients receiving valve replacement, and (5) an unannounced bacteriologic monitoring program of the cardiac operating room personnel. Studies of airborne particulates and bacteria and adequacy of skin preparation and hair removal also were conducted. The studies showed that (1) a high-flow HEPA filtered vertical ventilation system and altered operating room clothing reduced the concentration of airborne particles and the concentration of bacteria at the wound by a factor of 10 compared to conventional operating rooms, (2) the incidence of markedly contaminated scrubbed and unscrubbed hands decreased, (3) shedders and carriers were identified, and (4) current patient skin preparation and hair removal practices were satisfactory. The results of the program were a reduction of the deep wound infection rate from 2.9 to 0.6 percent (p less than 0.01) and a concomitant total wound infection decrease from 6.6 to 3.3 percent. Prosthetic valve infection rates decreased fourfold, from 5.6 to 1.4 percent. It is concluded that careful attention to possible endogenous sources of infection from the patient and a multifaceted program directed to exogenous sources of infection can lower infection rates in cardiac surgical patients. PMID:1246694

Clark, R E; Amos, W C; Higgins, V; Bemberg, K F; Weldon, C S

1976-01-01

380

C. elegans epidermal wounding induces a mitochondrial ROS burst that promotes wound repair.  

PubMed

Reactive oxygen species (ROS) such as hydrogen peroxide are generated at wound sites and act as long-range signals in wound healing. The roles of other ROS in wound repair are little explored. Here, we reveal a cytoprotective role for mitochondrial ROS (mtROS) in Caenorhabditis elegans skin wound healing. We show that skin wounding causes local production of mtROS superoxide at the wound site. Inhibition of mtROS levels by mitochondrial superoxide-specific antioxidants blocks actin-based wound closure, whereas elevation of mtROS promotes wound closure and enhances survival of mutant animals defective in wound healing. mtROS act downstream of wound-triggered Ca(2+) influx. We find that the mitochondrial calcium uniporter MCU-1 is essential for rapid mitochondrial Ca(2+) uptake and mtROS production after wounding. mtROS can promote wound closure by local inhibition of Rho GTPase activity via a redox-sensitive motif. These findings delineate a pathway acting via mtROS that promotes cytoskeletal responses in wound healing. PMID:25313960

Xu, Suhong; Chisholm, Andrew D

2014-10-13

381

From model to molecules: the development and experimental manipulation of an in vivo contaminated extremity war wound.  

PubMed

Wound infection is a key determinant of outcome in survivors of armed conflict. One factor having potential for promoting healing, decreasing bacterial burden and influencing prognosis is the dressing that covers the ballistic-injured extremity. Although antiseptic and silver dressings are applied to acute wounds, evidence to support their use is scarce with no controlled studies reported of antimicrobial wound dressings in extremity trauma. Given the recent burden of ballistic extremity injury, the requirement to investigate the role of antimicrobial dressings in contaminated wounds is transparent. This paper details a programme of work undertaken at the Defence Science and Technology Laboratory of developing and trialling a recovery model to investigate the early management of contaminated war wounds. A New Zealand White rabbit flexor carpi ulnaris muscle belly, isolated and then injured by a drop rig mechanism, was contaminated with Staphylococcus aureus to provide a reproducible contaminated muscle wound. This model was developed to support a series of randomised controlled trials to determine the impact of antimicrobial dressings on decreasing the bacterial burden of combat related extremity wounds. The results of the initial trial indicated that over a 48-h period, dressings augmented with antiseptic or silver offer no advantage over saline-soaked gauze in reducing the bacterial burden of a contaminated soft tissue injury. The model has subsequently been used to investigate the efficacy of dressings over a 7-day study period and impact of antibiotics and to evaluate biofilm formation and wound cytokines. PMID:24599972

Eardley, Will G P; Guthrie, H C

2014-06-01

382

Evaluation of Antimicrobial and Wound Healing Potentials of Ethanol Extract of Wedelia biflora Linn D.C. Leaves.  

PubMed

To rationalize scientifically the traditional claim on use of Wedelia biflora (Linn.) D. C. for the treatment of wounds and infections, the present study was designed to evaluate the antimicrobial and wound healing activity of ethanol extract of leaves of W. biflora. In in vitro assays the test extract was subjected to antimicrobial activity by agar well-diffusion method and minimum inhibitory concentration method in different microbial strains. Wound healing activity of the test extract was studied by excision wound model and incision wound model in Wistar albino rats. In excision wound model, 97.90% wound healing was recorded in 10% w/w extract treated group on 16(th) days of postsurgery, whereas only 58.50% was observed in control group. In incision model, higher breaking strength, high hydroxyl proline content and histopathological study in extract treated groups revealed higher collagen redeposition than the control group. The agar well-diffusion evaluation and minimum inhibitory concentration established antimicrobial efficacy of ethanol extracts of W. biflora. These observations established the traditional claim and therapeutic activity of W. biflora and it could be a potent wound healing candidate for use in future. PMID:24019563

Biswas, D; Yoganandam, G P; Dey, A; Deb, L

2013-03-01

383

Comparative Analysis of Single-Species and Polybacterial Wound Biofilms Using a Quantitative, In Vivo, Rabbit Ear Model  

PubMed Central

Introduction The recent literature suggests that chronic wound biofilms often consist of multiple bacterial species. However, without appropriate in vivo, polybacterial biofilm models, our understanding of these complex infections remains limited. We evaluate and compare the effect of single- and mixed-species biofilm infections on host wound healing dynamics using a quantitative, in vivo, rabbit ear model. Methods Six-mm dermal punch wounds in New Zealand rabbit ears were inoculated with Staphylococcus aureus strain UAMS-1, Pseudomonas aeruginosa strain PAO1, or both, totaling 10?6 colony-forming units/wound. Bacterial proliferation and maintenance in vivo were done using procedures from our previously published model. Wounds were harvested for histological measurement of wound healing, viable bacterial counts using selective media, or inflammatory cytokine (IL-1?, TNF-?) expression via quantitative reverse-transcription PCR. Biofilm structure was studied using scanning electron microscopy (SEM). For comparison, biofilm deficient mutant UAMS-929 replaced strain UAMS-1 in some mixed-species infections. Results Bacterial counts verified the presence of both strains UAMS-1 and PAO1 in polybacterial wounds. Over time, strain PAO1 became predominant (p<0.001). SEM showed colocalization of both species within an extracellular matrix at multiple time-points. Compared to each monospecies infection, polybacterial biofilms impaired all wound healing parameters (p<0.01), and increased expression of IL-1? and TNF-? (p<0.05). In contrast, mixed-species infections using biofilm-deficient mutant UAMS-929 instead of wild-type strain UAMS-1 showed less wound impairment (p<0.01) with decreased host cytokine expression (p<0.01), despite a bacterial burden and distribution comparable to that of mixed-wild-type wounds. Conclusions This study reveals that mixed-species biofilms have a greater impact on wound healing dynamics than their monospecies counterparts. The increased virulence of polybacterial biofilm appears dependent on the combined pathogenicity of each species, verified using a mutant strain. These data suggest that individual bacterial species can interact synergistically within a single biofilm structure. PMID:22905182

Seth, Akhil K.; Geringer, Matthew R.; Hong, Seok J.; Leung, Kai P.; Galiano, Robert D.; Mustoe, Thomas A.

2012-01-01

384

Chronic nicotine inhibits inflammation and promotes influenza infection  

Microsoft Academic Search

Epidemiological data suggest an association between smoking, respiratory infections, and impaired wound healing. Inflammation is critical in the body’s defense against pathogens and in the wound-healing process. Although nicotine is used to treat some inflammatory conditions, the mechanism of this action is largely unknown. To determine how nicotine affects inflammation, rats and mice were exposed to nicotine via miniosmotic pumps,

Seddigheh Razani-Boroujerdi; Shashi P. Singh; Cindy Knall; Fletcher F. Hahn; Juan Carlos Peña-Philippides; Roma Kalra; Raymond J. Langley; Mohan L. Sopori

2004-01-01

385

A study on the ability of quaternary ammonium groups attached to a polyurethane foam wound dressing, to inhibit bacterial attachment and biofilm formation.  

PubMed

Bacterial infection of acute and chronic wounds impedes wound healing significantly. Part of this impediment is the ability of bacterial pathogens to grow in wound dressings. In this study, we examined the effectiveness of a polyurethane foam wound dressings coated with poly diallyl-dimethylammonium chloride (pDADMAC-PU) to inhibit the growth and biofilm development by three main wound pathogens: Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii, within the wound dressing. pDADMAC-PU inhibited the growth of all three pathogens. Time-kill curves were conducted both with and without serum to determine the killing kinetic of pDADMAC-PU. pDADMAC-PU killed S. aureus, A. baumannii, and P. aeruginosa. The effect of pDADMAC-PU on biofilm development was analyzed quantitatively and qualitatively. Quantitative analysis, (CFU) assay, revealed that pDADMAC-PU dressing produced more than 8 log reduction in biofilm formation by each pathogen. Visualization of the biofilms by either confocal laser scanning microscopy or scanning electron microscopy confirmed these findings. In addition, it was found that the pDADMAC-PU treated foam totally inhibited migration of bacteria through the foam for all three bacterial strains. These results suggest that pDADMAC-PU is an effective wound dressing that inhibits the growth of wound pathogens both within the wound and in the wound dressing. PMID:25469865

Tran, Phat L; Hamood, Abdul N; de Souza, Anselm; Schultz, Gregory; Liesenfeld, Bernd; Mehta, Dilip; Reid, Ted W

2014-12-01

386

Next-Generation Sequencing: A Review of Technologies and Tools for Wound Microbiome Research  

PubMed Central

Significance: The colonization of wounds by specific microbes or communities of microbes may delay healing and/or lead to infection-related complication. Studies of wound-associated microbial communities (microbiomes) to date have primarily relied upon culture-based methods, which are known to have extreme biases and are not reliable for the characterization of microbiomes. Biofilms are very resistant to culture and are therefore especially difficult to study with techniques that remain standard in clinical settings. Recent Advances: Culture-independent approaches employing next-generation DNA sequencing have provided researchers and clinicians a window into wound-associated microbiomes that could not be achieved before and has begun to transform our view of wound-associated biodiversity. Within the past decade, many platforms have arisen for performing this type of sequencing, with various types of applications for microbiome research being possible on each. Critical Issues: Wound care incorporating knowledge of microbiomes gained from next-generation sequencing could guide clinical management and treatments. The purpose of this review is to outline the current platforms, their applications, and the steps necessary to undertake microbiome studies using next-generation sequencing. Future Directions: As DNA sequencing technology progresses, platforms will continue to produce longer reads and more reads per run at lower costs. A major future challenge is to implement these technologies in clinical settings for more precise and rapid identification of wound bioburden.

Hodkinson, Brendan P.; Grice, Elizabeth A.

2015-01-01

387

Corals Use Similar Immune Cells and Wound-Healing Processes as Those of Higher Organisms  

PubMed Central

Sessile animals, like corals, frequently suffer physical injury from a variety of sources, thus wound-healing mechanisms that restore tissue integrity and prevent infection are vitally important for defence. Despite the ecological importance of reef-building corals, little is known about the cells and processes involved in wound healing in this group or in phylogenetically basal metazoans in general. A histological investigation into wound healing of the scleractinian coral Porites cylindrica at 0 h, 6 h, 24 h and 48 h after injury revealed differences in cellular components between injured and healthy tissues. Cell counts of the obligate endosymbiont, Symbiodinium, and melanin volume fraction analysis revealed rapid declines in both Symbiodinium abundance and tissue cross-sectional area occupied by melanin-containing granular cells after injury. Four phases of wound healing were identified, which are similar to phases described for both vertebrates and invertebrates. The four phases included (i) plug formation via the degranulation of melanin-containing granular cells; (ii) immune cell infiltration (inflammation); (iii) granular tissue formation (proliferation); and (iv) maturation. This study provides detailed documentation of the processes involved in scleractinian wound healing for the first time and further elucidates the roles of previously-described immune cells, such as fibroblasts. These results demonstrate the conservation of wound healing processes from anthozoans to humans. PMID:21887359

Palmer, Caroline V.; Traylor-Knowles, Nikki G.; Willis, Bette L.; Bythell, John C.

2011-01-01

388

Wound Care Nursing: Professional Issues and Opportunities  

PubMed Central

As the field of wound care advances and seeks validity as a distinctive healthcare specialty, it becomes imperative to define practice competencies for all related professionals in the arena. As such, the myriad nurses practicing wound care in settings across the continuum should be understood for their unique contribution to the wound care team. Furthermore, the hierarchy of wound care nursing with varying levels of licensure, certification, and scope of practice can be clarified to delineate leadership and reimbursement issues to meet current health care challenges. A review of the role of nursing in wound care from a historical and evolutionary perspective helps to characterize the trend towards advanced practice nursing in the wound care specialty. PMID:24527304

Corbett, Lisa Q.

2012-01-01

389

A reliable method of determining wound healing rate  

E-print Network

healing. When conservative methods of wound care cannot facilitate wound healing, the wound is consideredA reliable method of determining wound healing rate D. Cukjati S. RebersÏek D. MiklavcÏicÏ Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia AbstractÐSeveral wound healing rate

Ljubljana, University of

390

The Cost and Efficacy of Two Wound Treatments  

Microsoft Academic Search

Using the physiology of moist wound healing as the framework, this nonexperimental, retrospective chart review compared the rate of wound healing and cost of wound care associated with wet-to-dry normal saline gauze dressings to the rate of wound healing and cost of wound care associated with amorphous hydrogel dressings for patients with infrainguinal arterial disease and diabetes. These patients were

Virginia A. Capasso; Barbara Hazard Munro

2003-01-01

391

Wound healing potential of Tephrosia purpurea (Linn.) Pers. in rats  

Microsoft Academic Search

Tephrosia purpurea is a well-known herb for its hepatoprotective, anticancer, antiulcer, antibacterial and in healing bleeding piles, etc. The present study was aimed for wound healing potential of ethanolic extract of Tephrosia purpurea (aerial part) in the form of simple ointment using three types of wound models in rats as incision wound, excision wound and dead space wound. The results

Santram Lodhi; Rajesh Singh Pawar; Alok Pal Jain; A. K. Singhai

2006-01-01

392

Cellular and Genetic Analysis of Wound Healing in Drosophila Larvae  

E-print Network

Cellular and Genetic Analysis of Wound Healing in Drosophila Larvae Michael J. Galko*, Mark A postembryonic wound healing, we characterized epidermal wound healing in Drosophila larvae. Following puncture wound healing responses. Conversely, mutations that block scab formation, and a scabless wounding

Krasnow, Mark A.

393

Prognostic factors, prediction of chronic wound healing and electrical stimulation  

E-print Network

Prognostic factors, prediction of chronic wound healing and electrical stimulation David Cukjati 1 healing rate and to propose a system for wound healing rate prediction. Predicting the wound healing rate follow-ups of wound healing process, which alone were found to accurately predict the wound healing rate

Robnik-Sikonja, Marko

394

Ultrashort peptide nanofibrous hydrogels for the acceleration of healing of burn wounds.  

PubMed

There is an unmet clinical need for wound dressings to treat partial thickness burns that damage the epidermis and dermis. An ideal dressing needs to prevent infection, maintain skin hydration to facilitate debridement of the necrotic tissue, and provide cues to enhance tissue regeneration. We developed a class of 'smart' peptide hydrogels, which fulfill these criteria. Our ultrashort aliphatic peptides have an innate tendency to self-assemble into helical fibers, forming biomimetic hydrogel scaffolds which are non-immunogenic and non-cytotoxic. These nanofibrous hydrogels accelerated wound closure in a rat model for partial thickness burns. Two peptide hydrogel candidates demonstrate earlier onset and completion of autolytic debridement, compared to Mepitel(®), a silicone-coated polyamide net used as standard-of-care. They also promote epithelial and dermal regeneration in the absence of exogenous growth factors, achieving 86.2% and 92.9% wound closure respectively, after 14 days. In comparison, only 62.8% of the burnt area is healed for wounds dressed with Mepitel(®). Since the rate of wound closure is inversely correlated with hypertrophic scar formation and infection risks, our peptide hydrogel technology fills a niche neglected by current treatment options. The regenerative properties can be further enhanced by incorporation of bioactive moieties such as growth factors and cytokines. PMID:24636214

Loo, Yihua; Wong, Yong-Chiat; Cai, Elijah Z; Ang, Chuan-Han; Raju, Ashvin; Lakshmanan, Anupama; Koh, Alvin G; Zhou, Hui J; Lim, Thiam-Chye; Moochhala, Shabbir M; Hauser, Charlotte A E

2014-06-01

395

Pythium aphanidermatum Infection following Combat Trauma?  

PubMed Central

Pythium aphanidermatum is a fungus-like plant pathogen which has never been reported as a cause of human infection. We report a case of P. aphanidermatum invasive wound infection in a 21-year-old male injured during combat operations in Afghanistan. PMID:21813724

Calvano, Tatjana P.; Blatz, Peter J.; Vento, Todd J.; Wickes, Brian L.; Sutton, Deanna A.; Thompson, Elizabeth H.; White, Christopher E.; Renz, Evan M.; Hospenthal, Duane R.

2011-01-01

396

Treatment of thoracic wounds with adapted vacuum therapy.  

PubMed

This is a report of seven cases of infected thoracic wounds treated with an adapted low-cost vacuum therapy in the Thoracic Surgery Unit of Santa Marcelina Hospital. The vacuum system used was designed and adapted to our hospital due to financial limitations on the acquisition of commercial kits. The vacuum-assisted closure kit used in this study consisted of chlorhexidine sponges (which are usually used for antisepsis of the surgical team), a 16F nasogastric tube, and two sterile adhesive films (OPSITE) for surgical field reinforcement. The mean duration of vacuum therapy was 13.4 days (range, 10-20 days), with an average of three dressing changes (range, 1-5). After treatment with vacuum-assisted closure, three wounds (3/7) were closed with simple primary sutures, one of the lesions (1/7) was closed by muscle flap rotation, and three wounds (3/7) healed by second intention. This adapted vacuum therapy was safe and easy to apply in our institution, including its use in patients with thoracostomies. PMID:24026077

de Abreu, Igor Renato L B; Pontes, Edgard P O; Tamagno, Mauro F L; Sardenberg, Rodrigo Afonso; Younes, Riad Naim; Abrão, Fernando Conrado

2014-01-01

397

Using Light to Treat Mucositis and Help Wounds Heal  

NASA Technical Reports Server (NTRS)

A continuing program of research and development is focusing on the use of controlled illumination by light-emitting diodes (LEDs) to treat mucositis and to accelerate healing of wounds. The basic idea is to illuminate the affected area of a patient with light of an intensity, duration, and wavelength (or combination of wavelengths) chosen to produce a therapeutic effect while generating only a minimal amount of heat. This method of treatment was originally intended for treating the mucositis that is a common complication of chemotherapy and radiation therapy for cancer. It is now also under consideration as a means to accelerate the healing of wounds and possibly also to treat exposure to chemical and radioactive warfare agents. Radiation therapy and many chemotherapeutic drugs often damage the mucosal linings of the mouth and gastrointestinal tract, leading to mouth ulcers (oral mucositis), nausea, and diarrhea. Hyperbaric-oxygen therapy is currently the standard of care for ischemic, hypoxic, infected, and otherwise slowlyhealing problem wounds, including those of oral mucositis. Hyperbaric-oxygen therapy increases such cellular activities as collagen production and angiogenesis, leading to an increased rate of healing. Biostimulation by use of laser light has also been found to be effective in treating mucositis. For hyperbaricoxygen treatment, a patient must remain inside a hyperbaric chamber for an extended time. Laser treatment is limited by laser-wavelength capabilities and by narrowness of laser beams, and usually entails the generation of significant amounts of heat.

Ignatius, Robert W.; Martin, Todd S.; Kirk, Charles

2008-01-01

398

Multifunctional medicated lyophilised wafer dressing for effective chronic wound healing.  

PubMed

Wafers combining weight ratios of Polyox with carrageenan (75/25) or sodium alginate (50/50) containing streptomycin and diclofenac were prepared to improve chronic wound healing. Gels were freeze-dried using a lyophilisation cycle incorporating an annealing step. Wafers were characterised for morphology, mechanical and in vitro functional (swelling, adhesion, drug release in the presence of simulated wound fluid) characteristics. Both blank (BLK) and drug-loaded (DL) wafers were soft, flexible, elegant in appearance and non-brittle in nature. Annealing helped to improve porous nature of wafers but was affected by the addition of drugs. Mechanical characterisation demonstrated that the wafers were strong enough to withstand normal stresses but also flexible to prevent damage to newly formed skin tissue. Differences in swelling, adhesion and drug release characteristics could be attributed to differences in pore size and sodium sulphate formed because of the salt forms of the two drugs. BLK wafers showed relatively higher swelling and adhesion than DL wafers with the latter showing controlled release of streptomycin and diclofenac. The optimised dressing has the potential to reduce bacterial infection and can also help to reduce swelling and pain associated with injury due to the anti-inflammatory action of diclofenac and help to achieve more rapid wound healing. PMID:24700434

Pawar, Harshavardhan V; Boateng, Joshua S; Ayensu, Isaac; Tetteh, John

2014-06-01

399

Determining risk factors for surgical wound dehiscence: a literature review.  

PubMed

Postoperative wound healing plays a significant role in facilitating a patient's recovery and rehabilitation. Surgical wound dehiscence (SWD) impacts on mortality and morbidity rates and significantly contributes to prolonged hospital stays and associated psychosocial stressors on individuals and their families. A narrative review of SWD was undertaken on English-only studies between 1945 and 2012 using three electronic databases Ovid CINHAL, Ovid Medline and Pubmed. The aim of this review was to identify predisposing factors for SWD and assessment tools to assist in the identification of at-risk patients. Key findings from the included 15 papers out of a search of 1045 revealed the most common risk factors associated with SWD including obesity and wound infection, particularly in the case of abdominal surgery. There is limited reporting of variables associated with SWD across other surgical domains and a lack of risk assessment tools. Furthermore, there was a lack of clarity in the definition of SWD in the literature. This review provides an overview of the available research and provides a basis for more rigorous analysis of factors that contribute to SWD. PMID:23692188

Sandy-Hodgetts, Kylie; Carville, Keryln; Leslie, Gavin D

2013-05-21

400

[Postoperative infection with Mycobacterium chelonae].  

PubMed

A 70-year-old patient developed Mycobacterium chelonae infection at a donor vein graft site following cardiac bypass surgery. The infection presented as fibrinous, necrotic ulcerations in the scar area. Mycobacterium chelonae and mycobacterium fortuitum are atypical mycobacteria and have been described previously causing infections after injections or surgical procedures. Infection of donor vein graft site is a rare complication after cardiac surgery. As mycobacterium chelonae cannot be cultivated on normal culture media, delayed wound healing might be disinterpretated as a primary wound healing disorder. Treatment of atypical myobacteriosis includes antibiotics, local heat therapy and surgical excision. Clarithromycin is the antibiotic of choice. We obtained complete healing after two months of Clarithromycin treatment, combined with heat therapy. PMID:9036143

Engelhardt, E; Feldmann, R; Skaria, A; Salomon, D

1996-11-01