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Background Complex wounds associated with the Nuss procedure are a resource intensive complication that may lead to significant morbidity with potential removal of the implanted device and abandonment of the repair. We report our management technique of this complication utilizing microdeformational wound therapy (MDWT) that is safe, is efficacious and allows for salvage of the repair. Operative technique We defined a complex wound as a wound that became suppurative and drained in the postoperative period and failed to resolve with a trial of conventional wound management and antibiotics. Upon recognition of a complex wound, we recommend an initial operative wound debridement. This allows wound cultures, wound assessment and precise initiation of MDWT. It is not uncommon to have exposed hardware in the wound early in the course of therapy. Metal allergy must be excluded. The patient is transitioned to oral antibiotics following resolution of the acute process. MDWT is performed until the wounds are completely epithelialized with no clinical signs of drainage or infection. The average length of MDWT in our patients was 39 days. Following complete wound healing the patients are maintained on antibiotics until implant removal. Conclusions The use of microdeformational wound therapy in complex wounds associated with the Nuss procedure is a safe and effective modality. The technique may reduce the likelihood of implant removal with potential recurrent pectus excavatum. Type of study Operative technique. Level of evidence Level IV, case series with no comparison group

Regulated negative pressure-assisted wound therapy (RNPT) is one of the most important wound treatment technologies developed and applied over the last two decades. To-date RNPT has been proven to be clinically effective in treating chronic wounds, however, the effects of different specific pressure delivery protocols on the progress and quality of tissue repair are not adequately understood yet. Here, we suggest a viscoelastic, three-dimensional finite element modeling framework of RNPT, with several realistic features such as a non-symmetrically configured multi-layered tissue structure. The effects of the RNPT system on the wound-bed were simulated by applying time varying pressure boundary conditions. Three commonly-used operation modes were simulated: continuous, non-continuous intermittent and dynamic, and each mode was applied at four different pressure levels. Outcome measures of strain and stress magnitudes and distributions were acquired from the dermis and subcutaneous fat. Taken together, the strain and stress data from the different simulated RNPT modes and intensities demonstrated that tissue loads which are actually applied in and around the wound, and at the different tissue components of the wound, can differ substantially from the pressure levels that are set in the device during therapy sessions. This is critical information for understanding the potential effects of RNPT, for setting the device prior to therapy and for designing the next generation of these systems.

While wound therapy remains a clinical challenge in current medical practice, much effort has focused on developing biological therapeutic approaches. This paper presents a comprehensive review of delivery systems for current biologicals for the treatment of chronic wounds and severe burns. The biologicals discussed here include proteins such as growth factors and gene modifying molecules, which may be delivered to wounds free, encapsulated, or released from living systems (cells, skin grafts or skin equivalents) or biomaterials. Advances in biomaterial science and technologies have enabled the synthesis of delivery systems such as scaffolds, hydrogels and nanoparticles, designed to not only allow spatially and temporally controlled release of biologicals, but to also emulate the natural extracellular matrix microenvironment. These technologies represent an attractive field for regenerative wound therapy, by offering more personalised and effective treatments.

Background Compromised wound healing in cranio-maxillo-facial surgery is a threat to the patient's rehabilitation. Therapy of chronic and/or infected wounds is time- and cost-consuming, burdensome and occasionally futile. Cold atmospheric plasma is a new approach that promises to overcome these limitations. The aim of this proof-of-concept study was to evaluate the clinical outcome of cold plasma irradiation in patients with impaired wound healing who are refractory to conservative wound therapy and/or revision surgery. Materials and methods We enrolled six patients (mean age: 63.5 years; SD 8.8 years; 1 female and 5 males) who experienced various cranio-maxillo-facial surgical procedures and suffered from wound healing disturbances. In addition to established wound care, all wounds were irradiated with cold atmospheric plasma. The primary outcome variable was the attainment of complete wound closure. Results In all patients, complete remission in terms of wound closure was observed within a mean time of 15.5 weeks (range: 4–38 weeks). No undesirable side effects were observed, and no inflammation or infection occurred after cold plasma initiation. Conclusion The use of cold atmospheric plasma might offer a reliable, conservative treatment option in complicated wound healing disturbances in cranio-maxillo-facial surgery.

Background: Negative pressure wound therapy is a ubiquitous wound management resource. The influence of NPWT on the bacterial bioburden of the subjacent wound remains unclear. We sought to examine the evidence. Datasources: MEDLINE, Embase, PubMed, the Cochrane Database of Systematic Reviews and the Cochrane Controlled Trials Register were searched for articles quantitatively evaluating bacterial load under NPWT. Results: Twenty-four studies met the inclusion criteria including 4 randomised controlled trials, 8 clinical series and 12 experimental studies. Twenty studies evaluated conventional NPWT while 4 evaluated Infiltration-based NPWT. While 8 studies using conventional NPWT failed to demonstrate an observable effect on bacterial load, 7 studies reported that NPWT was inherently bacteriostatic and 5 others reported species selectivity with suppression of non-fermentive Gram-negative bacilli (NFGNB), including pseudomonas spp. Simultaneously, there was some evidence of enhanced proliferation of Gram-positive cocci where the niche was cleared of NFGNB. Two of the 4 studies using infiltration-based NPWT also reported selectively impaired proliferation of pseudomonas spp. Conclusion: The assumption that NPWT suppresses bacterial proliferation is oversimplified. There is evidence that NPWT exhibits species selectivity, suppressing the proliferation of NFGNB. However, this may depopulate the niche for exploitation by Gram-positive cocci. This, in turn, has implications for the use of NPWT where highly virulent strains of Gram-positive cocci have been isolated, as well as the duration of NPWT therapy and frequency of dressing changes.

Large avulsed skin flaps of the lower extremity caused by degloving injuries eventually develop skin necrosis in most cases. The current treatment option involves excision of the degloved skin and reapplication as a full- or split-thickness skin graft. We considered that reattachment of avulsed skin flaps without excision would be theoretically beneficial, since some circulation may remain around the connected pedicle and thus facilitate graft take. Furthermore, securing the skin to the original anatomic position is much easier using retained landmarks. We treated a total of 12 patients (13 cases) with degloving injuries of the lower extremity. In all cases, the avulsed skin flap was defatted and sewn back to the original position, then negative-pressure wound therapy was applied over those grafts as a bolster for approximately 7 days. Most of the avulsed skin flap took excellently, particularly close to the connected pedicle. Nine cases did not need any additional surgical procedures. Four cases required secondary skin graft for a small area of open wound due to partial necrosis of the defatted skin, as well as the raw surface left by the primary skin defect in the initial operation. Primary reattachment of the avulsed skin flaps without excision is convenient and efficient to cover the open wound over the exposed fascia and periosteum in degloving injuries. This would potentially offer a better alternative to definitive wound closure.

Venous congestion remains to be a major factor in causing digit replantation failures. The established solutions are: use of medical leech, local application of heparin gauze, and continuous nail bed massage. However, each method has its drawbacks. In theory, subatmospheric pressure wound therapy promotes continuous bleeding from the venules of the applied area, resulting in the relief of congestion. We applied subatmospheric pressure wound therapy to two replanted fingers of which venous congestion was noted shortly after the operation. The therapy was applied to each patient for one week. Both replanted fingers survived. No complication was noted.

Advanced therapeutic dressings that take active part in wound healing to achieve rapid and complete healing of chronic wounds is of current research interest. There is a desire for novel strategies to achieve expeditious wound healing because of the enormous financial burden worldwide. This paper reviews the current state of wound healing and wound management products, with emphasis on the demand for more advanced forms of wound therapy and some of the current challenges and driving forces behind this demand. The paper reviews information mainly from peer-reviewed literature and other publicly available sources such as the US FDA. A major focus is the treatment of chronic wounds including amputations, diabetic and leg ulcers, pressure sores, and surgical and traumatic wounds (e.g., accidents and burns) where patient immunity is low and the risk of infections and complications are high. The main dressings include medicated moist dressings, tissue-engineered substitutes, biomaterials-based biological dressings, biological and naturally derived dressings, medicated sutures, and various combinations of the above classes. Finally, the review briefly discusses possible prospects of advanced wound healing including some of the emerging physical approaches such as hyperbaric oxygen, negative pressure wound therapy and laser wound healing, in routine clinical care.

BPC157 displays protective activity in various organs and tissues. This report presents preclinical toxicity studies with BPC157 in mice, rats, rabbits and dogs. The single-dose toxicity study did not show any test-related effects that could be attributed to the test article. In repeated-dose toxicity evaluations, BPC157 was well tolerated in dogs, with no abnormal changes between the BPC157-treated groups and the solvent control group, with the exception of a decrease in creatinine level at a dose of 2 mg/kg but not at lower doses. The animals recovered spontaneously after 2 weeks of withdrawal. This may be due to the pharmacological activity of BPC157. A local tolerance test showed that the irritation caused by BPC157 was mild. BPC157 also showed no genetic or embryo-fetal toxicity. In summary, BPC157 was well tolerated and did not cause any serious toxicity in mice, rats, rabbits and dogs. These preclinical safety data contribute to the initiation of an ongoing clinical study. Based on the stability and protective effect of BPC157, which has been widely reported, BPC157 may have a better application prospect than the widely used cytokine drugs in wound therapy.

Antibiotics in wound dressing materials are critical in wound therapy; however, their overuse has led to increased concerns. In the present study, gold nanoparticles (AuNPs) were used to amplify the antibacterial effect of the typical antibiotic, gentamicin sulfate (GM), to reduce its dosage during wound therapy. A facile method for the preparation of antibacterial wound dressing using woven silk fabrics (SF) was developed. By simple treatment of SF with HAuCl4 solution in a short process, AuNPs were loaded across the fabric (SF@Au) through in situ reduction of HAuCl4 by the sericin from silk; a subsequent simple process led to SF@Au conjugation with gentamicin sulfate (GM) to form a novel dressing fabric (SF@Au/GM). The results demonstrated that considerably enhanced antibacterial performance could be obtained even when minimal GM was applied with AuNPs, compared to the large GM quantities used without AuNPs. In addition, the fabric displayed good biocompatibility and serviceability as a wound dressing. Animal experiments revealed that SF@Au/GM performed better than the commercial wound dressing Aquacel Ag®, as faster growth of the cell appendages and epidermis inside wounds observed after therapy on day 15. These findings offer a potential option for reducing the risk of antibiotics overuse during wound therapy. Moreover, the study addresses the cleaner production of advanced biomedical textiles as the proposed preparation method was highly practical for cleaner mass production.

Study Objective Identify whether incisional (or prophylactic) negative-pressure wound therapy (iNPWT) is associated with reduced wound complications. Design Retrospective cohort study. Setting Quaternary referral academic center. Patients or Participants Included patients underwent an open abdominal procedure for a gynecologic indication with a gynecologic primary surgeon between July 1, 2015 and June 30, 2017. Type III or IV incisions were excluded. A total of 568 patients met inclusion criteria. Interventions iNPWT placed over a closed incision. Measurements and Main Results We compared our intervention group of patients who had 1+ additional risk factor and received iNPWT (Group A) to a group of patients managed by gynecologic surgeons who never use iNPWT (Group B) and to a cohort who did not receive iNPWT, but were managed by gynecologic surgeons who use iNPWT (Group C). The primary outcome was a composite of wound complications, including surgical site infections (SSIs), hematomas, seromas, or wound separations, within 30 days following surgery. Results were adjusted using inverse probability weighting. The unadjusted wound complication rates were 18.3%, 13.4% and 16.8%, in Groups A (N=71), B (N=283), and C (N=214), respectively, and were not significantly different. The adjusted rates were similar for overall wound complications but did show a lower SSI rate between Groups A and B (6.7% vs 8.2%) and groups A and C (5.0% vs 10.0%). A subgroup of patients with a BMI >40 kg/m2 and 1 additional risk factor showed similar SSI rates (10.5% vs 10.3%) between Groups A and C, and a lower rate in Group A when compared to Group C (10.5% vs 20.0%). However, SSI rate differences did not reach statistical significance due to low numbers. Conclusion There was no difference in overall wound complication rates among patients receiving iNPWT. Lower SSI rates were seen although statistical significance was not reached. iNPWT as an intervention may impact SSIs more than hematomas, seromas, and wound separations.

Diabetic foot ulcers (DFU) are common, complex, and often difficult to treat. We examined planned interim data of a prospective, randomized, double-blind multi-center study comparing the clinical efficacy of the TransCu O 2 ® device to standard moist wound therapy (MWT). The therapy, known as continuous diffusion of oxygen (CDO), delivers pure oxygen to the wound at low flow rates, preserves patient mobility, showed significant benefits in animal studies and received FDA clearance in August 2009. We summarize here the results of a per protocol interim analysis of complete wound closure at 12 weeks in a double blind 2-arm clinical trial of 84 subjects randomized 1:1 to Active CDO versus Sham, conducted when 50% of the planned number of subjects completed 12 weeks of therapy (Active 21, Sham 21). We also report treatment comparisons with regard to days to wound closure, study period, and after excluding subjects who experienced fast closure or a small wound ( 2 ) at screen. Complete wound closure at 12 weeks was not significantly associated with treatment per protocol [Active 11 (52.3%), Sham 8 (38.1%), RR 1.38 (95% CI 0.7, 2.7), p = 0.54]. Wound size at Enrollment did not vary significantly with treatment ( p = 0.3), days to closure was significantly less among patients who experienced closure in the Active ( N = 9) arm relative to those in the Sham arm ( N = 3) [mean difference 20 ± 7.9, 95% CI 2.4–37.5, p = 0.03], and complete wound closure at 12 weeks was significantly increased in the Active arm ( N = 9) relative to Sham ( N = 8) in the second half of the study [Active 77.8%, Sham 12.5%, p = 0.02]. With the numbers available to study in this interim analysis, the absolute performance in the Active arm appeared non-inferior to other reimbursable wound treatment devices.

Negative pressure wound therapy (NPWT) is a useful management tool in the treatment of traumatic wounds and high-risk incisions after surgery. Since its development nearly 2 decades ago, uses and indications of NPWT have expanded, allowing its use in a variety of clinical scenarios. In addition to providing a brief summary on its mechanism of action, this article provides a focused, algorithmic approach on the use of NPWT by reviewing the available data, the appropriate clinical scenarios and indications, and the specific strategies that can be used to maximize outcomes.

Distal limb wounds are frequent in horses after traumatic events. The use of platelet-rich plasma (PRP) represents a simple method of treating wounds in equines. A case of a chronic severely contaminated distal limb wound in an 8-month-old foal is presented. The patient was managed with the combination of standard wound therapy (debridement and bandages), surgery, and PRP obtained by a manual tube protocol. No complications were observed with the PRP treatment, and the foal was fully recovered 2 months later. The results from this case report indicate that PRP and its by-products (platelet-poor plasma) could be used as an adjunctive treatment in severe distal limb wounds in horses. A clinical controlled study should be performed to test this hypothesis.

Pressure ulcers continue to impact the lives of spinal cord injury patients severely. Pressure ulcers must be accurately staged according to National Pressure Ulcer Advisory recommendations before treatment design. The first priority in treatment of pressure ulcers is offloading. Intact skin ulcers may be treated with noncontact nonthermal low-frequency ultrasound. Superficial pressure ulcers may be treated with a combination of collagenase and foam dressings. Deeper pressure ulcers warrant negative-pressure wound therapy dressings along with biologic adjuncts to fill in wound depth. Discovery and treatment of osteomyelitis is a high priority when initially evaluating pressure ulcers. Surgical intervention must always be considered.

Worldwide, healthcare is facing enormous problems with the continuing rise of drug-resistant infectious diseases. In view of the scarcity of new antimicrobial agents and the withdrawal of many pharmaceutical houses from the fray, alternative approaches are required. One of these is photoantimicrobial chemotherapy, which is highly effective across the range of microbial pathogens and does not suffer from resistance. However, there is a lack of uptake of this approach by healthcare providers and the pharmaceutical industry alike. It is seldom recalled that, unlike anticancer photodynamic therapy, the development of photoantimicrobial agents has evolved from the antiseptic ‘dye therapy’ in common use until the widespread introduction of the penicillin class in the mid-1940s. Cationic biological dyes such as methylene blue, crystal violet and acriflavine were effective in local wound therapy and today provide a sound basis for light-activated antimicrobial therapeutics. It is proposed that such ‘safe’ dyes are introduced as locally administered photoantimicrobials, especially in order to conserve valuable conventional antibacterial drugs.

The great diversity of wounds and the broad range of available dressings complicate the selection of proper chronic wound treatment. Choosing the right treatment is the essential step in the healing process. In this review, we focus on chronic nonhealing ulcers, which are a critical problem in clinical practice, and current knowledge about persistent wound care. Here, we present the objectives of local treatment with description of several types of dressings and their ingredients, features, indications, and contraindications. These include hydrocolloid, alginate, hydrogel, and dextranomer dressings; polyurethane foam and membrane dressings; semipermeable polyurethane membrane dressings; and TenderWet (Hartmann, Rock Hill, SC) and flax dressings. There is also a brief section on the use of other alternative wound-healing accelerators, such as platelet-rich plasma and light-emitting diode therapy.

The evolution of wound care has seen much technological advancement over many decades. Most recently, negative-pressure therapy, by which a vacuum pressure is applied through a wound bed, has dramatically improved the surgical outcomes of complex wounds. Although initial studies focused on wounds to the abdomen, torso, and extremities, more publications are appearing that demonstrate the efficacy of negative-pressure wound therapy in the head and neck. This article reviews the history and evolution of negative-pressure therapy, highlights the current opinions on its mechanism of action, and summarizes its use in complex head and neck wounds.

Microdeformational Wound Therapy (MDWT) is a class of medical devices that have revolutionized the treatment of complex wounds over the last 20 years. These devices, are a subset of Negative Pressure Wound Therapy (NPWT), in which there is a highly porous interface material placed between the wound and a semi-occlussive dressing and connected to suction. The porous interface material acts to deform the wound on a micro scale promoting cellular proliferation. These devices appear to significantly improve the speed of healing in many wounds, facilitate granulation tissue formation and reduce the complexity of subsequent reconstructive operations. The mechanisms through which such effects are obtained are beginning to be better understood through basic research and clinical trials. Further work in this field is likely to yield devices that are designed to treat specific wound types.

Surgeons and scientists have been developing alternative methods of hand reconstruction that may play an adjunctive role to, or completely supplant, more traditional reconstructive modalities. This article provides an overview of these emerging techniques, with an emphasis on skin substitutes and negative-pressure wound therapy as they apply to the treatment of soft tissue defects of the hand. The indications, contraindications, and relative advantages and disadvantages of these techniques are discussed in detail.

In the emergency treatment of infected internal fixation after ankle fractures, the infection needs to be resolved quickly to protect the implants, bone, and tendons. Vacuum wound therapy (topical negative pressure therapy) has been used for more than 15 years to assist in closure and to accelerate healing of a wide range of wounds. In the present report, we describe the results of treatment of 7 angiopathic (dysvascular) patients who developed a deep wound infection after ankle osteosynthesis. Each patient was treated with initial surgical debridement, followed by vacuum wound therapy and meshed split-thickness skin graft transplantation. The mean inpatient length of vacuum wound therapy was 14.0 ± 4.31 days, and the mean total duration of vacuum treatment was 54.43 ± 7.74 days.

Negative-pressure wound therapy (NPWT) is used to promote wound healing by using suction to drain excess fluid from wounds. A systematic literature review was undertaken to assess the effectiveness, safety and cost-effectiveness of NPWT for the treatment of chronic wounds. Medline, Embase, CENTRAL, CINAHL and the Cochrane Wounds Group Specialised Trials Register were searched. A total of 9 randomized controlled trials (n = 568) comparing NPWT with conventional wound therapy and four economic evaluations identified through NHS EED database were included. Five trials showed significant differences in favour of NPWT in primary outcome measures; however, most studies had small sample sizes and low scientific validity. Complications and adverse effects of NPWT are scarce compared to those of conventional treatment. There is no conclusive scientific evidence on the effectiveness and cost- effectiveness of NPWT in the treatment of chronic wounds and therefore its widespread use is not justified.

Summary Negative-pressure wound therapy (NPWT) has revolutionised wound care. Yet, it is still not understood how hypobaric tissue pressure accelerates wound healing. There is very little reported on the relevant physics of any substance subjected to suction in this manner. The common assumption is that applying suction to a substance is likely to result in a reduction of pressure in that substance. Although more than 250 research articles have been published on NPWT, there are little data verifying whether suction increases or decreases the pressure of the substance it is applied to. Clarifying this basic question of physics is the first step in understanding the mechanism of action of these dressings. In this study, pressure changes were recorded in soft plasticene and processed meat, using an intracranial tissue pressure microsensor. Circumferential, non-circumferential and cavity NPWT dressings were applied, and pressure changes within the underlying substance were recorded at different suction pressures. Pressures were also measured at 1 cm, 2 cm and 3 cm from the NPWT placed in a cavity. In all three types of NPWT dressings, the underlying substance pressure was increased (hyperbaric) as suction pressure increased. Although there was a substantial pressure increase at 1 cm, the rise in pressure at the 2-cm and 3-cm intervals was minimal. Substance pressure beneath all types of NPWT dressing is hyperbaric in inanimate substances. Higher suction pressures generate greater substance pressures; however, the increased pressure rapidly dissipates as the distance from the dressing is increased. The findings of this study on inanimate objects suggest that we may need to review our current perception of the physics underlying NPWT dressings. Further research of this type on living tissues is warranted.

Small clinical studies suggest adjunctive use of acoustic pressure wound therapy (APWT) may enhance wound healing, even in challenging patients. This noncontact low-frequency, nonthermal ultrasound therapy for assisting with the debridement of necrotic tissue from challenging wounds is generally better tolerated by patients for whom treatment-related wound pain, anticoagulation, or medical instability precludes sharp, surgical, or mechanical debridement.To evaluate changes in amount of devitalized tissue, amount and type of wound drainage, and wound surface area after administration of APWT.Retrospective chart review of 48 consecutive patients treated with adjunctive APWT at a single center between January 2006 and October 2007.Paired comparisons of baseline versus posttreatment values for wound area, tissue characteristics, drainage, and pain were analyzed. Time, frequency, and duration of APWT and treatment-related adverse events were collected.APWT was administered a mean of 2.1 times per week for a mean of 4.1 minutes per session. Mean duration of therapy was 5.5 weeks. Median wound area was reduced by 92% from baseline to end of APWT (6.2 cm(2) to 0.2 cm(2),P.0001). The proportion of wounds with75% granulation tissue increased from 37% to 89% (P.0001). The proportion of wounds without fibrin slough or eschar increased from 31% to 75% (P.0001) and from 72% to 94% (P = .02), respectively.Retrospective design, lack of control group, small sample population.As an adjunct to conventional wound management, APWT appears to improve parameters associated with wound healing, including increased tissue granulation, decreased necrotic tissue, and decreased wound area.

There are fundamental differences between acute wounds that proceed to uncomplicated healing and those that become chronic wounds. Non-healing or chronic wounds can result from a combination of overlapping factors that prevent healing, including local tissue ischemia, repetitive trauma and ischemia/reperfusion injury, presence of tissue necrosis, impaired cellular and systemic host response to stress, and critical bacterial contamination. The bacterial burden in the wound contributes to a sustained inflammatory state, which inhibits normal progression to the proliferative phase of healing, thereby preventing restoration of tissue integrity. Appropriate wound bed preparation removes local barriers to healing and optimizes the tissue environment to achieve wound healing. It is an essential element of wound management that advances endogenous healing as well as the efficacy of topical and other wound therapy. This article will summarize a systematic approach to wound bed preparation using the "TIME" principle, and will highlight important advances in topical wound care.

Background: Vacuum-assisted closure wound therapy (vacuum therapy) has been used in our department since 1997 as a tool to bridge the period between debridement and definite surgical closure in full-thickness wounds. We performed a prospective randomised clinical trial to compare the efficacy of vacuum therapy to conventional moist gauze therapy in this stage of wound treatment. Methods: Treatment efficacy was assessed by semi-quantitative scoring of the wound conditions (signs of rubor, calor, exudate and fibrinous slough) and by wound surface area measurements. Tissue biopsies were performed to quantify the bacterial load. Besides this, the duration until 'ready for surgical therapy' and complications encountered during therapy and postoperatively were recorded. Results: Fifty-four patients were included (vacuum n = 29, conventional n = 25). With vacuum therapy, healthier wound conditions were observed. Furthermore, a tendency towards a shorter duration of therapy was found, which was most prominent in late-treated wounds. In addition, the wound surface area reduced significantly faster with vacuum therapy. Surprisingly, these results were obtained without a decrease in the number of bacteria colonising the wound. Complications were minor, except for one case of septicaemia and one case of increased tissue necrosis, which compelled us to stop vacuum therapy. For the treatment of full-thickness wounds, vacuum therapy has proven to be a valid wound healing modality.

Moist wound treatment improves healing at a possibly increased risk of bacterial infection and many local antiseptics impair healing. A moist treatment modality with efficient antimicrobial activity would be desirable.In this monocentric, randomized, observer blinded, phase III study, a new hydrosome polyvinyl-pyrrolidone (PVP)-iodine preparation in hydrogel containing iodine in a 3% concentration (Repithel) was investigated for its effect on epithelialization in patients receiving meshed skin grafts. Grafts of 167 patients (donor site defects, burn wounds, or chronic defects) were dressed either with Repithel (n=83) covered with a gauze (Jelonet), or Jelonet-gauze only (n=84) until healing.Grafts receiving Repithel healed significantly earlier (9.4 days versus 12.4 days; p0.0001) and faster than controls as measured by neo-epithelialization of mesh holes between days 7 and 11 (91.2+/-22.8% versus 82.3%+/-28.6, p0.0001). A subgroup analysis showed that the effects on grafted burn wounds (p=0.0042) and chronic defects (p0.0001) was more significant than on donor sites. Also a higher take rate of grafts (p=0.0053) and a reduced loss of grafts was observed with Repithel treatment (8 grafts versus 20 grafts) (p=0.0063, respectively). Smokers had improved graft take (p=0.0069) and higher rate of epithelialization (p=0.0040) compared to smokers of the control group.The results demonstrate significant clinical advantages of Repithel. This new local wound healing drug combines antisepsis and wound moisture efficiently resulting in significantly enhanced epithelialization, decreased transplant losses, and significantly improved healing especially in smokers.

In 2002 the European Tissue Repair Society (ETRS) held a focused meeting in Nice on the status of new technologies in tissue repair at the beginning of the 21st century. This paper was a contribution to that meeting. The Journal of Tissue Viability would like to thank the ETRS for their approval to reproduce this material from the ETRS Bulletin Volume 12, 2005

In 2002 the European Tissue Repair Society (ETRS) held a focused meeting in Nice on the status of new technologies in tissue repair at the beginning of the 21st century. This paper was a contribution to that meeting. The Journal of Tissue Viability would like to thank the ETRS for their approval to reproduce this material from the ETRS Bulletin Volume 12 2005

Objective: This study compared healing rates in stage III and IV pressure ulcers treated with noncontact normothermic wound therapy or moist dressings. Periwound temperature changes with noncontact normothermic wound therapy were evaluated. Design: This 8-week, prospective, randomized clinical trial evaluated linear rate of healing of the wound edge and periwound temperature changes during the 1-hour warming treatment and for 15 minutes after warming. Setting and subjects: Forty subjects referred from primary care providers, home care providers, acute care facilities, and long-term care facilities were enrolled in the study. Twenty-nine subjects completed the trial (14 received standard care, and 15 received noncontact normothermic wound therapy). Instruments: Ulcers were measured with acetate tracings, digital and Polaroid photography, and Pressure Sore Status Tool evaluations. The linear rate of healing was determined with use of computerized planimetry. Periwound temperatures were recorded with use of a Cole Parmer thermometer YSI 400 series. Methods: Subjects were evaluated weekly. Subjects randomly assigned to noncontact normothermic wound therapy received 3 treatments daily, during which the dressing was warmed to 38°C for 1 hour. Subjects in the standard care group were treated with dressings that were moisture retentive and provided absorption as needed. Results: The two groups were statistically similar with regard to baseline and wound characteristics. The linear rate of healing was significantly faster in the group treated with noncontact normothermic wound therapy (Mann-Whitney U test = 47, P = .01). On average, periwound temperatures increased 2.4°C at the end of warming (1 hour), a significant increase above baseline values ( P = .001). Conclusions: The healing rate was significantly increased with noncontact normothermic wound therapy treatment. Periwound temperature increased significantly after 1 hour of warming, achieving levels approximating normothermia. Healing effects associated with noncontact normothermic wound therapy may be related to several mechanisms, including improvements in perfusion, oxygen supply, and cellular activity in response to warming. (J WOCN 2001;28:244-52.)

Introduction Groin lymphatic fistulas are a troublesome finding after limb revascularization surgery. Its management represents a difficult task for the clinician. Report We report our experience in the treatment of such a condition with negative-pressure wound therapy (NPWT) in a 70-year-old man which benefited from extra-anatomic prosthetic axillofemoral bypass. After a week of treatment, the fistula dried up and closure was obtained with simple suture under local anaesthesia. Follow-up at 9 months showed stable coverage without any sign of leakage. Discussion This study depicts NPWT as an effective non-invasive treatment in the management of groin lymphocutaneous fistula.

This preliminary study investigates the use of a radiant-heat bandage, Warm-Up Active Wound Therapy, as a new approach to the treatment of patients with chronic venous ulcers. Thirteen patients were randomly assigned to either conventional therapy or Warm-Up Active Wound Therapy for inpatient treatment of chronic venous stasis ulcers. Our results indicated that Warm-Up Active Wound Therapy is more effective than conventional therapy in healing chronic venous ulcers, and patients reported a significant reduction in wound pain. Warm-Up Active Wound Therapy also was found to be a safe treatment modality with no adverse events occurring in any patient.

Current tissue-culture techniques enable keratinocytes from a small piece of skin to be grown into sheets of epithelium, or cultured keratinocyte grafts, that are suitable for treating wounds. Serial subculture enables rapid expansion of a cell population, such that grafts of a total area equivalent to that of the surface of an adult can be obtained from an initial skin biopsy of approximately 2 cm2 in under one month. In this article, the methods currently used for culturing keratinocytes, the search for a fully functional replacement for the dermal elements of skin, and the prospects for clinical development of these technologies in the near future are discussed.

The development of recombinant growth factors for the treatment of nonhealing or badly healing wounds has reached the clinical-trial phase. These first studies in humans are yielding valuable information on the physiological role of growth factors in different types of wounds, their mode of action and their stability under in vivo conditions. Data from these early trials in humans can be interpreted in the light of the continuing scientific progress being made in wound-healing research, and thus lead to an improvement in the design of future studies. Growth-factor-based therapeutics are expected to enter the marketplace in the middle of this decade, and to become a highly profitable sector of the health-care industry by the turn of the century.

This study employs a liquid-tight vinyl chamber for the topical fluid-phase treatment of experimental wounds in pigs. Continuous treatment with normal saline significantly reduced the early progression of tissue destruction in partial thickness burns. Uncovered burns formed a deep layer of necrosis (0.49 +/- 0.004 mm, mean +/- SD) although burn wounds covered with empty chambers demonstrated less necrosis (0.14 +/- 0.01 mm), fluid-treated wounds formed no eschar, and little tissue necrosis could be detected (less than 0.005 mm). Topical treatment with hypertonic dextran increased water flux across burn wounds by 0.24 ml/cm2/24 hr (mean, n = 95) over saline-treated wounds during the first 5 days after wounding. When partial thickness burn and excisional wounds were immersed in isotonic saline until healed, the daily efflux of water, protein, electrolytes, and glucose across the wound surface declined during healing to baseline values found in controls (saline-covered unwounded skin). The declining protein permeability was used as a reproducible, noninvasive, endogenous marker for the return of epithelial barrier function. Saline-treated excisional wounds healed within 8.6 +/- 0.6 days (mean +/- SD, n = 27) and burn wounds within 12.1 +/- 1.4 days (mean +/- SD, n = 15). Healing of fluid-treated wounds occurred without tissue maceration and showed less inflammation and less scar formation than healing of air exposed wounds (no attempt was made to compare rates of healing between air- and fluid-exposed wounds). We consider the fluid-filled chamber a potentially very useful diagnostic, monitoring, and delivery system for wound-healing research and for human wound therapy.

Negative pressure wound therapy (NPWT) is a commonly used modality to facilitate tissue granulation and thus hasten the healing process. While the modern vacuum systems are quite sophisticated, their historic origins can be traced to ancient times. This is a historic review of the precursors to the current negative pressure wound therapy.

Pitman-Moore, Inc., has reached a contractual agreement with the Carolon Company for exclusive worldwide marketing and distribution rights of CHAMP ~ products. Pitman-Moore officials say the new agreement will complement the company's present line of equine therapy products. "The Carolon agreement has created an excellent niche for us in the surgical market," says Ed Haddad, product manager for surgicals at Pitman-Moore, Inc. "We now offer a complete line of quality support and compression wound therapy products specific to equine sports medicine."