Search

Treatment of infected wounds remains a major challenge for clinicians. Antimicrobial stewardship is an important pillar in wound treatment and, as the role of bacteria in wound repair is not well understood, new treatment options and products are constantly being developed to tackle local infection and biofilm. This case report describes a case of antibiotic-resistant Burkholderia cepacia skin infection and subsequent leg ulceration in an 86-year-old man during the COVID pandemic in Italy, which was successfully treated in a conservative way using 1% acetic acid and silver oxysalts in conjunction with compression bandage. [ABSTRACT FROM AUTHOR]

Patients with a stoma are at risk of developing peristomal skin complications (PSCs) that can negatively impact their quality of life. This study aims to identify potential risk factors for dermatitis, pruritis/xerosis, infections, and ulcerations among patients with a stoma and evaluate preventive measures. This cross-sectional study involved data regarding 232 Italian patients with a stoma. A questionnaire was used to collect patient characteristics, comorbidities, and stoma management data. The most frequent PSCs observed were dermatitis and pruritis/xerosis in approximately 60% of patients. Psoriasis was strongly correlated with dermatitis, while being overweight or obese increased the risk of pruritis/xerosis. Class 2 obesity and atopic dermatitis were associated with an increased risk of infections. Being underweight, completely nonautonomous, and having inflammatory bowel disease were associated with a higher risk of ulcerations, while radiotherapy was a strong risk factor for ulceration. Preventive measures such as using hydrocolloid barriers, TNT gauze cleansing, and low pH detergent were effective in preventing dermatitis. Appropriate stoma care and maintenance, including the use of protective film and careful monitoring of weight and comorbidities, are crucial in minimizing the risk of complications associated with a stoma. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of Vac VeraFlo for the treatment of an iatrogenic upper limb ulcer, in minimizing the risk of infection, accelerating healing times and improving quality of life. Method: Combined home and outpatient care for the management of a full thickness lesion of the left forearm, in a patient with Hodgkin's lymphoma. Case Presentation: 57-year-old male, July 2020 diagnosed with hodgkin's lymphoma, underwent three cycles of chemotherapy with ABVD (Adriamycin, Bleomycin, Vinblastine, Dacarbazine); January 2021 chemotherapy extravasation. June 2021 presents extensive full-thickness eschar on the left forearm, which, although serious, does not deteriorate its constitution, but aggravates its quality of life. Phase 1: Debridement; Phase 2: NPWT with instillation; Phase 3: Skin graft. Results / Discussion: Excellent wound bed preparation to receive a dermo-epidermal graft. Conclusion: Hospital-territory continuity increases patient compliance allowing for a reduction in treatment times which translates into better outcomes. [ABSTRACT FROM AUTHOR]

Aim: To present a case management of a rare, large Marjolin's ulcer in a far from ideal setting on 68 year old gentleman who was advised, but refused, to undergo above knee amputation Method: Excision as wide and as feasible as possible. Adjuvant topical 5FU postoperatively combined with standard wound care. After wound bed preparation, a split thickness skin grafting was done. An improvised very low cost NPWT was used on the excision site. Wound was opened five days later. Results / Discussion: Basal Margin, as anticipated, was positive for tumor. Wound bed preparation with the method described was very successful and a repeat biopsy was deemed unnecessary prior to skin grafting Skin graft take was more than 90%. Patient was followed up frequently post op until skin graft was fully stable. Two-year follow-up showed no recurrence of any ulcer and patient is able to live normally. Conclusion: Where the only next option is a major amputation, a less radical excision of large Marjolin's ulcer combined with adjuvant topical 5FU and appropriate wound management may prove successful. It is a rare malignancy with no established treatment protocol and trying scientifically logical methods may save both life and limb. [ABSTRACT FROM AUTHOR]

Aim: The patients' ability to understand health issues is closely related to the clarity and simplicity of the communication. Communication with the patient and their education are essential elements of the assistance process. The active partecipation of both patient and caregiver in this process is very important for the successful and positive outcome of the treatment. The relationship with the patient and their education are foundamental in the context of wound care, in implementing treatments focused on bringing a wound to heal. The objective of this work is to simplify communication by reducing the use of medical terms to a minimum and relying on visual representations to explain the processes involved in tissue regeneration. Method: This work is aimed at supporting the educational activities led by wound care specialists, based upon the principles of Health Literacy, Self-Care and Patient Empowerment. Results / Discussion: Leg-w was born like a step-by-step, time-lapse representation of the wound bed preparation who explains to the patient the key characteristics to monitor during the wound healing process, in a way that avoids any visual shock. Conclusion: Today's patient population is increasing and the demographic is shifting towards more IT-literate individuals, who are comfortable accessing technological resources. This new approach enables and facilitates a treatment process centered around simple, clear and scientifically accurate communication. This educational tool, in addition to being simple and effective, is also looking to be modern in its approach. [ABSTRACT FROM AUTHOR]

Aim: In dermatology, artificial skin lesions are not uncommon. Good wound care is essential to avoid complications especially in cases of severe findings. To improve care, it is important to better understand the patients, their behaviors, and characteristics of artificial wounds. Method: The electronic patient records of 178 patients with artificial skin lesions were analyzed. The observation period was from Jan. 1st, 2011, to July 21st, 2022, and included outpatient, day-care, and inpatient cases. We considered cases with ICD-10 codes for organic hallucinosis, borderline, and dermatitis artefacta. Results / Discussion: Mean age of the patients was 48 years, 71% were female, and 72% had dermatitis artefacta as a diagnosis code. In 25% the diagnosis was suspected and in 57% it was confirmed. 33 patients were hospitalized with an average duration of 6.4 days. The skin lesions had existed for an average of 6 months prior to presentation to our clinic and in many cases had been previously treated by physicians of other specialties. Artificial wounds were predominantly located in easily accessible sites of the body, such as the trunk, arms, and face. About 25% of the artificial skin lesions appeared as wounds and in about 20% a histological examination was present, which often showed neutrophilic infiltrate. Conclusion: Facitcious wounds present a challenge in differential diagnosis and can sometimes mimic other atypical wounds. Focus on patient history, distribution of lesions, histopathological findings and interdisciplinary collaboration with psychiatrists and other specialists can help in the diagnosis of facitious wounds. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to investigate the effect of Cord Lining Mesenchymal Stem Cells (CL-MSCs) in accelerating the healing of diabetic wounds. Method: We utilised twenty-five db/db mice and created two excisional wounds (10 mm x 10 mm) onto the dorsal aspect of each mouse. In addition, we used six hyperglycemic-induced pigs, and created six full thickness dermal wound (5 cm x 5 cm) onto the dorsal aspect of each pig. All animals were randomly divided into three arms; with CL-MSCs delivered through either (i) topical route, or (ii) intraperitoneal (IP) route, while sham media were administered for (iii) control group. Results / Discussion: Treated animals in both mice and pig models showed significant wound healing advancement when compared with the control counterpart, and the superiority is seen as early as POD 7 for mice (p < 0.001); while topical treated pigs demonstrated advancement from POD 14 (p=0.019) and IP treated pigs showed significant advancement from POD 21 (p=0.006). It is shown that CL-MSCs formed collagen fibres that are larger in diameter in both topical treated pigs (p<0.001) and IP treated pigs (p=0.006). Further, the anti-inflammatory marker IL-10 and IL-1ra were intensified at crucial time points (POD 7, POD 14, POD 21, POD 28), which corresponded with a lower intensity level of proinflammatory TNF-α in treated animals. Conclusion: CL-MSCs accelerated wound healing in both diabetic (db/db) mice and hyperglycemic pigs. It also enhanced tissue structure to be architecturally more stable with collagen fibres that are larger in diameter. The ability to modulate inflammatory cells and regulate the immune responses might be key contributors to this process. [ABSTRACT FROM AUTHOR]

Aim: Highlighting the diagnostic complexity of skin ulcers. Method: We present a 31-year-old female patient who came to the ulcer unit of "Andreas Syggros" Hospital suffering from a festering necrotic ulcer that appeared a year earlier. She provided a previous punch biopsy result which was compatible with pyoderma gangrenosum. In accordance with the diagnosis, she was already treated with steroids, colchicine, and multiple antibiotics due to positive cultures for E. coli and Pseudomonas aeruginosa. These treatments had little or no response. Due to the atypical clinical presentation of a persistent ulcer and the later appearance of systemic symptoms, we proceeded to do a surgical wedge biopsy and an immunohistochemistry examination. Results / Discussion: The new biopsy was compatible with a diagnosis of T-cell non-Hodgkin lymphoma (ALK+ large cell lymphoma). Conclusion: In some cases, a punch biopsy may lead to a misdiagnosis, so it is useful to perform a surgical wedge biopsy. Physicians should therefore be alert when a skin lesion persists, because it may indicate the presence of a serious underlying systemic disease. [ABSTRACT FROM AUTHOR]

Aim: Acinetobacter baumannii is a leading nosocomial pathogen worldwide and a significant threat in skin ulcer. The therapeutic options are limited due to high rates of antibiotic resistance and virulence factors. This study investigates the clinical impact of A. baumannii isolates in patients with chronic leg ulcers. Method: Antibiotic resistance, a comprehensive bioinformatic analysis, and the biofilm-forming ability of 18 A. baumannii isolates were examined. Results: Most of the isolates were resistant to fluoroquinolones (66.7%), aminoglycosides (55.5%), and carbapenems (44.4%). In addition, many genes encoding for virulence factors, (adeF, bfmS, bfmR, and bau) and iron uptake, were highly prevalent in A. baumannii isolates. Moreover, genes responsible for fimbriae production (csu), early adhesion (ompA), and biofilm formation (pgaB, pgaC, pgaD, ageG, adeH, and bap) were reported in more than 89% of the strains. Sequence type (ST) 2 was the most prevalent (44.4%). It was associated with high rates of antimicrobial resistance, low biomass production, and poor adhesion than other STs and A. baumannii ATCC 19606. The median MIC90 values for these isolates were 0.5 μg/mL (0.25-32 μg/mL) for colistin and 1.0 μg/ mL (0.125--4 μg/mL) for cefiderocol. In contrast, the minimal biofilm eradication concentration (MBEC90) for cefiderocol and colistin was 2 μg/mL (0.25-64 μg/mL) and 2 μg/mL (0.25-128), respectively. Conclusion: This study provides significant information about the genetic determinants and virulence factors of A. baumannii isolates to optimize antibiotic prescribing and stewardship programs and to improve the treatment of these infections among patients with chronic leg ulcers. [ABSTRACT FROM AUTHOR]

Aim: Skin ulcers, especially digital ulcers, are a frequent complication of systemic sclerosis, affecting about 50 percent of patients. They are often resistant to treatment, cause pain, and decrease patients' quality of life. The use of platelet-rich plasma (PRP) for the treatment of difficult-to-heal ulcers is already present in the literature, for diabetic, pressure, and vascular ulcers and for those undergoing a systemic sclerosis, albeit with a low level of evidence. The rationale behind the use of PRP is that since it is a platelet concentrate, it is characterized by a high presence of growth factors and molecules involved in the wound healing process. Methods: We report 10 scleroderma skin ulcers that have been present for at least 6 weeks and are resistant to conventional treatments, such as prostanoids, phosphodiesterase 5 inhibitors, calcium channel blockers, antiplatelets, and advanced dressings. The ulcers were treated with homologous PRP, harvested by apheresis, gelled by thrombin and calcium gluconate, and applied at the ulcer site. The treatment was administered 1 time per week until the wound healed, for up to 8 weeks. Results: We report a reduction in ulcer area of 78% after an average of 4,7 applications. In addition, all patients reported marked improvement in pain symptoms. Conclusions: Homologous PRP is a good therapeutic option for scleroderma skin ulcers. [ABSTRACT FROM AUTHOR]

Extensive skin defect represents a real problem and major challenge in plastic and reconstructive surgery. On one hand, skin grafts offer a practical method to deal with skin defects despite their unsuitability for several complicated wounds. On the other hand, negative pressure wound therapy (NPWT), applied before skin grafting, promotes granulation tissue growth. The aim of the study is to evaluate the improvement in wound healing given by the merger of these two different approaches. We treated 23 patients for large wounds of multiple factors. Of these, 15 were treated with the application of V.A.C.® Therapy (KCI Medical S.r.l., Milan, Italy), in combination with skin grafts after a prior unsuccessful treatment of 4 weeks with mesh skin grafts and dressings. Another 8 were treated with only mesh skin graft. Pain reduction and wound area reduction were found statistically significant (p<0.0009, p<0.0001). Infection was resolved in almost all patients. According to our study, the use of the negative pressure wound therapy over mesh skin grafts is significantly effective especially in wounds resistant to conventional therapies, thereby improving the rate of skin graft take. [ABSTRACT FROM AUTHOR]

Objective. To retrospectively analyse the features of calcinosis in a cohort of SSc patients. Methods. Charts of SSc patients attending the Ulcer Unit of the Rheumatology Department, University of Florence and presenting a clinical suspicion of calcinosis were considered in the study. Data on clinical history, including recent skin changes, and clinical examination of all areas with suspected calcinosis, radiological imaging of the calcinotic area, demographics and SSc-related organ involvement and pain measured by a visual analogue scale were recorded. Results. In 52 of 112 SSc patients, a total of 316 calcinoses were recorded and were divided into visible and palpable {154 [47.4%], clustered according to their macroscopic features as mousse [49 (31.8%)] and stone [105 (68.2%)]} and non-visible but palpable {162 [52.6%]: net [5 (3%)], plate [22 (13.8%)] and stone [135 (83.2%)]}. The X-ray-based classification of all calcinoses, both visible and non-visible, was as follows: stone, 289 (91.4%); net, 12 (3.8%) and plate, 15 (4.8%). Skin ulcers complicated 154 of 316 calcinoses (48.7%). Mousse calcinosis was associated with pulmonary arterial hypertension, the stone subset was suggestive of pulmonary involvement and justified further investigation and the net subset was the slowest to heal. Conclusion. Our data indicate that calcinosis may be classified in SSc as mousse, stone, net and plate according to its clinical and X-ray features. This classification awaits validation for a possible use in clinical practice and to support early treatment and prevention of complications. [ABSTRACT FROM AUTHOR]