Month: September 2018

BOSTON, Sept. 26, 2018 /PRNewswire/ — Recently, research undertaken by the UK’s House of Commons library at the request of the UK’s Labour Party revealed that diabetic foot and toe amputations performed by the UK’s National Health Service (NHS) has risen by 26 percent. Between April 2010 and March 2013, minor amputations due to diabetes numbered 15,075. This has risen to 19,073 in the same 3-year period of 2014 – 2017. Though the Department of Health and Social Care acknowledge that the rate of minor amputations has increased, it is also important to note that they state that the number of major amputations (above the ankle) has decreased. Regardless, diabetic foot amputations are estimated to cost the NHS over £44 million just in the year 2016.

Patients typically arrive at the point of requiring a lower limb amputation due to tissue necrosis resulting from an infected diabetic foot ulcer (DFU). DFUs are hard to heal wounds that remain open for extended time. Thus, extra care is required in keeping the wound clean and in preventing infection. DFUs are formed in the first place due to ischemia and neuropathy, two side effects of poor blood glucose management.

Clearly, the best intervention is to prevent the formation of DFUs in the first place. This may begin in good management of blood glucose to prevent ischemia and neuropathy, though sensor technologies can also be used for the express purpose of preventing DFUs. Once the wound is formed, preventing and treating any wound infection is critical. However, there are many factors that healthcare providers have to contend with during the treatment of DFUs … read more

SalvePeds:  An early-stage pharmaceutical company offering the novel drug ND-336 as a topical therapy for the treatment of diabetic foot ulcers. SalvePeds’ goal is to provide an effective, safe and convenient therapeutic treatment for DFUs to improve the quality of life for patients and ultimately decrease the number of ulcer related amputations. (University of Notre Dame) … from Inside Indiana Business

     as First-Line Treatment of DFUs in the Wound Clinic

Diabetic foot ulcers (DFUs) are a major concern in the outpatient wound clinic due to the growing diabetes epidemic, the significant morbidity and mortality associated with DFUs, and the economic burden on the healthcare system. Despite a well-established standard of care for DFUs, which includes effective offloading as a cornerstone, there are gaps in practice with regard to clinical implementation of appropriate offloading. This article will provide a discussion of the evidence supporting the use of offloading as a standard of care for DFUs with a focus on total contact casting (TCC). In addition, we will discuss barriers to using TCC in clinical practice followed by an example of how one heavily trafficked wound clinic located in Texas has successfully implemented TCC and has experienced a positive impact on wound healing rates as well as clinic efficiency … read more

Support surfaces alone neither prevent nor heal pressure ulcers. They are to be used as part of a total program of prevention and treatment. When pressure ulcers deteriorate or fail to heal, the professional should consider replacing the existing support surface with one that will improve pressure redistribution and microclimate (heat and moisture control) for the individual. Changing the support surface is only one of several strategies to consider. The individual and his or her pressure ulcer should be re-evaluated. Preventive interventions and local wound care should also be intensified as needed. A significant increase in risk status may also prompt such re-evaluation of the individual and the support surface … read more

     in patients with soft tissue sarcoma with long-term follow-up

In a cohort of patients treated for soft tissue sarcoma (STS) with modern radiotherapy (RT) and surgical techniques, experts assessed the rates of acute and chronic wound complications and related factors. They identified all adult nonmetastatic patients treated for STS at a single institution between 2006 and 2015 with a minimum 1-year follow-up. In these patients, the rate of acute wound complications was 22.1%. In STS patients, numerous factors linked to acute and chronic wound complications, including the timing of RT, tumor site, and reconstruction use, were found. Results demonstrated the probable correlation between development of acute wound complications with a higher risk of chronic wound complications … read more

Corstrata, a provider of digital healthcare IT solutions and services for wound prevention and care management, announced today a partnership with Citus Health, a digital health solutions provider for the post-acute care industry, to power its next-generation virtual clinic. Corstrata will leverage Citus Health’s state-of-the-art patient and provider engagement platform to enable enhanced remote access to wound and ostomy care experts for wound and ostomy patients everywhere … Corstrata will utilize the Citus Health platform to serve its wound and ostomy customers, provider customers, and Diabetic Foot Ulcer Prevention members. Citus provides a versatile, leading-edge, patient and provider engagement architecture for enhanced care coordination and communication to improve clinical and financial outcomes. The Corstrata branded app powered by Citus Health will integrate key technologies, including wound image capture, video, patient engagement, and with the flexibility of the platform, streamline the capability to add third-party IoT data sources in the future … read more

BOSTON, Sept. 26, 2018 /PRNewswire/ — Recently, research undertaken by the UK’s House of Commons library at the request of the UK’s Labour Party revealed that diabetic foot and toe amputations performed by the UK’s National Health Service (NHS) has risen by 26 percent. Between April 2010 and March 2013, minor amputations due to diabetes numbered 15,075. This has risen to 19,073 in the same 3-year period of 2014 – 2017. Though the Department of Health and Social Care acknowledge that the rate of minor amputations has increased, it is also important to note that they state that the number of major amputations (above the ankle) has decreased. Regardless, diabetic foot amputations are estimated to cost the NHS over £44 million just in the year 2016 … read more

A new system that uses a multilayer patch made with a patient’s own leukocytes, platelets, and fibrin can speed the healing of diabetic foot ulcers, according to new findings … “The use of LeucoPatch is associated with significant enhancement of healing of hard-to-heal foot ulcers in people with diabetes,” Dr. Frances Game of Derby Teaching Hospitals NHS Foundation Trust in the UK and colleagues conclude in The Lancet Diabetes & Endocrinology online September 19 report … read more

Researchers have identified a new mechanism involving ginsenoside Rb1, which has the ability to stimulate keratinocyte migration and promote cutaneous wound healing. They report the results of a study showing that Rb1 enhances keratinocyte migration in an article published in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The researchers demonstrated that Rb1 significantly increases the production of sphingosine-1-phosphate (S1P), which is a signaling factor in keratinocytes known to stimulate wound repair through greater keratinocyte migration … read more

Comprehensive treatment of diabetic foot ulcers (DFUs) includes moist local or topical wound care, serial sharp debridement, treatment of infection, mechanical offloading, glycemic control, nutritional management, and overall chronic disease management. These facets of therapy are best addressed by an interdisciplinary approach.

If we understand the principles of healing, what can we do to prevent the pathologic process of DFUs? Instituting measures to prevent development of DFUs can decrease morbidity and mortality. There are several organizations with guidelines for prevention of DFU and subsequent complications including amputation, infection, and loss of independence. This article will review the highlights of some of the most recent guidelines for DFU prevention … read more

JACKSONVILLE, Fla.–(BUSINESS WIRE)–Healogics Inc., the nation’s largest provider of advanced wound care services, today announced they have joined the App Orchard to begin working on an integration to improve interoperability within their nationwide network of Wound Care Centers®. Currently, this integration is set to deploy in the fall of 2019.

This integration will allow discrete data flow between systems with a goal to reduce errors for hospital compliance and audits, eliminate redundant double entry work for Wound Care Centers and foster better partnerships with hospital systems. Additionally, these updates will allow for integration with Healogics applications, and Epic creating a more streamlined user experience.

“This integration is a major step forward for Healogics’ hospital partners that are looking to use Epic in their Wound Care Center,” said Ty Smith, Chief Information Officer at Healogics. “This level of integration will bring the best of Healogics applications into the Epic ecosystem and supports our Centers with the best technology available. We are looking forward to all the ways in which these updates will improve the patient experience and save time for clinicians and physicians, all while increasing the quality and consistency of patient care.” … read more

MiMedx Group (NASDAQ:MDXG) is up 6% premarket on light volume on the heels of the publication of a study evaluating its dehydrated human umbilical cord (dHUC) for the treatment of chronic diabetic foot ulcers in the International Wound Journal … In the intent-to-treat group, 70% of patients receiving weekly dHUC allograft achieved complete healing by week 12 compared to 48% of those receiving standard-of-care (SOC) treatment for 12 weeks (p=0.0089) … read more

     a structured review of published clinical trials

MEDLINE, PubMed, and related registries were searched through December 2017 to identify randomized, quasi-randomized or observational trials that evaluated the efficacy of lower extremity DNS on pain relief (primary outcome) or other secondary outcomes. Observational studies were included, given investigators’ reluctance to use sham surgery controls. Outcome effect size was estimated, and a weighted average was calculated.
Results: Eight of 23 studies evaluated pain relief, including a double-blind randomized controlled trial (with a sham surgery leg), an unblinded trial with a nonsurgical control leg, and 6 observational studies. All reported substantial pain relief post-DNS with average effect sizes between two and five. Unexpectedly, the double-blind trial showed improvement in the sham leg comparable to the DNS leg … read more

Having read a recent article on clean versus sterile dressing technique, commenting again on this issue seems highly appropriate. The conclusion of the paper essentially is that a clean technique for acute wound care does not affect the incidence of infection.¹ There is insufficient evidence in the literature relating to chronic wound care. I particularly appreciated the comment that nurses need to decide which approach to have by using critical thinking skills. I was reminded of a visit to a patient to utilize a fancy new dressing that I had never used before …  read more

NuVasive (NSDQ:NUVA) said today it launched three new products as part of its biologics portfolio, including its Traditional Bone Allograft, Amniotic Membrate DS and Propel DBM …The San Diego-based company’s Traditional Bone Allograft includes cancellous chips, demineralized cancellous chips, cortical cancellous chips and cancellous crushed, which the company claims the has osteoconductive properties intended to provide a scaffold for bone growth … The newly launched Amniotic Membrane DS is a dual-sided layer of human amniotic membrane intended to act as a biologic barrier to prevent adhesions and reduce scar tissue formation near adjacent muscle, nerve and fascia layer tissues … read more

With the plethora of wound dressings available, how can you choose the right dressing for your patients? Assessing the merits and drawbacks of current and emerging dressings, these authors share their experience with multi-layer dressings, wound cleansers, dressings that facilitate wound debridement and others … In our wound care practice, we diagnose and treat various etiologies of lower extremity wounds including diabetic foot ulcers, venous leg ulcers, pressure ulcers and other wounds. As there are hundreds of wound dressings and topical treatments available in the United States today … read more

Peripheral arterial disease (PAD) is a term used to describe atherosclerotic vessels in the periphery, mostly affecting the lower extremities. The blocked vessels impair blood and oxygen perfusion to the lower limbs and may lead to increased risk of ulceration, wounds and amputations. PAD is also associated with increased risk of coronary and cerebrovascular incidents. More than 50% of people living with PAD may not have any clinical symptoms, posing a challenge to diagnosis and management. This article will discuss the aetiology, presentation, risk factors, and management of PAD as related to the lower extremities … read more

     on each chronic wound patient

• Chronic wounds, such as diabetic foot ulcers, pressure ulcers and venous leg ulcers, take more than 8 months to heal for the average patient and some will be affected for decades1
• Despite advancements in wound care, patients report dressings are changed on average 5 times a week1
• This poses a huge burden on UK nurses and impacts the quality of life for nearly all (90%) of patients1

     The impact of a wound centre on a vascular surgery practice

The opening of an outpatient wound centre has been associated with a significant increase in peripheral vascular practice and a significant decrease in amputation rate. Venita Chandra and colleagues Alyssa M Flores, Matthew W Mell and Ronald L Dalman (Stanford University, Stanford, USA) believe that such centres result in synergistic systems that promote more aggressive and effective limb salvage strategies. Chandra presented the findings of a recent study analysing the clinical impact of a wound care centre on a vascular surgery practice, at the Society for Vascular Surgery’s Vascular Annual Meeting (VAM; 20–23 June, Boston, USA) … read more

MUNICH — Local injection of mesenchymal stem cells derived from autologous bone marrow shows promise in healing recalcitrant neuropathic diabetic foot ulcers, a novel study from Egypt shows.

Presenting the results at the European Association for the Study of Diabetes (EASD) 2016 Annual Meeting, Ahmed Albehairy, MD, from Mansoura University, Egypt, said: “In patients who received the mesenchymal stem cells, ulcer reduction was found to be significantly higher compared with patients on conventional treatment after both 6 weeks and 12 weeks of follow-up. This is despite the fact that initial ulcer size was larger in the stem-cell–treated group.”

After 6 weeks, median ulcer reductions were 49.9% and 7.67% (P = .001) in stem-cell–treated and control groups, respectively, and after 12 weeks, median ulcer reductions were 68.24% and 5.27% (P = .0001). Complete healing was achieved in one case in the mesenchymal stem cell–treated group.

“The healing mechanism may be due to the pure effect of injected mesenchymal stem cells … read more

May Solve Problems For Patients With Chronic Wounds

Bio-inks are becoming an increasingly common feature of next-generation medicine. These inks consist of living cells from donor tissues that may be suspended in bio-compatible solutions or polymers. The bio-inks are laid down or deposited using techniques much like medical-grade 3D printing … A recent project that incorporates bio-inks is intended to address deep skin wounds and the issues that affect their treatment and ultimate healing. The scientists behind it hope that their innovative solution can improve outcomes for these patients while overcoming the problems they face as a result of current medical practice … read more

     Subepidermal Moisture Measurements Versus Ultrasound and Visual Skin Assessments for Early Detection of Pressure Injury

Pressure ulcers (PUs) are detected by visual skin assessment (VSA). Evidence suggests ultrasound (US) and subepidermal moisture (SEM) scanner technology can measure tissue damage before it is visible … A pilot study was conducted to evaluate consistency between SEM and US examinations of suspected deep tissue injury (sDTI) … Using an observational, prospective cohort study design, patients >55 years of age were recruited. VSA, SEM, and US assessments were performed daily for a minimum of 3 and maximum of 10 consecutive days following enrollment. US results were considered indicative of sDTI if hypoechoic lesions were present. SEM readings were considered abnormal when ∆ ≥0.6 was noted for at least 2 consecutive days. Boolean analysis was utilized to systematically determine consistency between US and SEM where sDTI was the clinical judgment … read more

     the UK, Denmark, and Sweden: an observer-masked, randomised controlled trial

The LeucoPatch device uses bedside centrifugation without additional reagents to generate a disc comprising autologous leucocytes, platelets, and fibrin, which is applied to the surface of the wound. We aimed to test the effectiveness of LeucoPatch on the healing of hard-to-heal foot ulcers in people with diabetes … Methods … This was a multicentre, international, observer-masked, randomised controlled trial of people with diabetes and a hard-to-heal foot ulcer done in 32 specialist diabetic foot clinics in three countries (UK, Denmark, and Sweden). After a 4-week run-in period, those with a reduction in ulcer area of less than 50% were randomly allocated … read more

While 3M is 116 years old, the company continues to churn out new products like a young startup. Research and development remains the heartbeat of 3M with the company spending $1.9 billion or 6% of sales in 2017 on research and development to drive organic growth and new products … Top priorities for growth today include automotive electrification, advanced wound care, connected safety, data centers, structural adhesives, filtration, air quality and population health … read more

Brookfield-based professional training webinar provider OnCourse Learning is set to be acquired by German company Bertelsmann for a reported $500 million. The transaction is expected to close this fall, pending regulatory approval … OnCourse was sold by New York private equity firm CIP Capital, which acquired the company in 2014 from Cleveland private equity firm The Riverside Co. The transaction was described by Bertelsmann as “in the mid-nine-digit euro range.” Reuters pegged the deal at around $500 million … The company, which was founded in 2007, has grown steadily via acquisition. In January, it announced the acquisition of Lake Geneva-based Wound Care Education Institute Inc., … read more

3D–printed objects are no longer a novelty and are paving the way for incredible scientific innovation. For example, a large 3D–printed engine part was successfully tested and could be used in the next generation SLS rocket that will send humans to the moon and Mars, NASA reported … The road to recovery for any individual with deep skin wounds, which affect all three layers of the skin, can be as painful and traumatic as the incident itself … Researchers at the University of Toronto have developed a handheld 3D printer filled with “bio ink” — essentially an ink cartridge containing biological materials. The bio ink contains strips of biomaterial that include the proteins collagen and fibrin, which are used to promote wound healing … read more

• Wound care management in Indonesia: issues and challenges in diabetic foot ulceration
  There are 415 million people aged 20–79 years with diabetes worldwide, almost 153 million of them live in the Western Pacific region (Ogurtsova et al, 2017). The number of people with diabetes is predicted to rise to 642 million worldwide by 2040 (Ogurtsova et al, 2017). Indonesia has approximately 258 million citizens, making it the world’s fourth most populated country. It is one of 21 countries and territories in the International Diabetes Federation Western Pacific region. According to the International Diabetes Federation (2017), about 10.3 million Indonesians have diabetes
• Optimising quality of life for people with non-healing wounds
  Some wounds persist for months or years (Krasner et al, 2014). Non-healing wounds may be a result of host factors, such as inadequate vasculature, medications that interfere with the healing process, immunocompromised status or critically-ill status with non-modifiable risk factors (terminal disease, end-stage organ failure and other life-threatening health conditions). Among patients who are dying, receiving hospice or palliative care, non-healing or palliative wounds can be associated with complications
• Reconstruction of a soft tissue defect of the big toe by pedicled perforator flap
  Treatment of soft tissue defect on the distal of the big toe is challenging due to the lack of reliable options that can be used to create a local flap to cover the injured area. Following injury, soft tissue defects expose the structures, joints, tendons and bone. Even a small defect will become problematic if it is not managed appropriately
• Natrox® — Let the topical oxygen flow for healing complex wounds
  The presence of a wound increases the body’s requirement for oxygen by 20% for a patient with a clean wound and by 50% for an infected wound (Dernling, 2009). Oxygen is critical to many of the processes required in wound healing including the production of energy to fuel cell function and metabolism, angiogenesis, collagen synthesis and cross-linking

     AB-PA01 product targeting P.aeruginosa infections

AmpliPhi Biosciences Corporation, a clinical-stage biotechnology company focused on precisely targeted bacteriophage therapeutics for antibiotic-resistant infections, today announced that the company has received positive feedback, via written response, from the U.S. Food and Drug Administration (FDA) regarding its development plans for AB-PA01, without the need for a Type B Pre-IND meeting … “We are delighted with the FDA’s response to our development plans for AB-PA01, AmpliPhi’s bacteriophage product candidate targeting Pseudomonas aeruginosa infections, and the FDA’s concurrence on the proposed design of two randomized controlled clinical trials, in hospital-acquired and ventilator-associated pneumonia and P. aeruginosabacteremia,” said Paul C. Grint, M.D., CEO … read more

Beverly Hospital will be hosting its first Amputation Prevention Summit on Saturday, September 29, 2018 on the hospital campus at 309 West Beverly Boulevard, Montebello, California, drawing clinicians from the greater Los Angeles area.

This educational event will highlight the urgent nature of the diabetes epidemic— diabetes being among one of the top ten leading causes of death in California and the leading cause of non-traumatic lower extremity amputation. Guest speakers will share important data, current trends in limb salvage and best-practices in the battle against diabetes-related complications. They will also discuss ways healthcare professionals can improve their practices in order to reduce lower extremity amputations.

A person with diabetes has a risk of leg amputation that is 15-40 times greater than a person without diabetes. Within two to four years of unilateral limb loss, one-third of all patients lose the other leg. Only about 50% survive more than five years following a leg amputation. With the future incidence of diabetes projected to rise to 550 million people worldwide by the year 2030, limb salvage is becoming a viable alternative, often producing better outcomes than amputation … read more

     may be mediated through differential gene expression

Negative pressure wound therapy (NPWT) has been successfully used as a treatment for diabetic foot ulceration (DFU). Its mechanism of action on the molecular level, however, is not fully understood. We assessed the effect of NPWT on gene expression in patients with type 2 diabetes (T2DM) and DFU … The final cohort encompassed 21 patients treated with NPWT and 8 with standard therapy. The groups were similar in terms of age (69.0 versus 67.5 years) and duration of T2DM (14.5 versus 14.4 years). We identified four genes differentially expressed between the two study arms post-treatment, but not pre-treatment: GFRA2 (GDNF family receptor alpha-2), C1QBP (complement C1q binding protein), RAB35 (member of RAS oncogene family) and SYNJ1 (synaptic inositol 1,4,5-trisphosphate 5-phosphatase 1) … read more

One Call, the nation’s leading provider of workers’ compensation care management services, and Broadspire®, a subsidiary of Crawford & Company® and a leading global third-party administrator, today announced a partnership to develop a customized patient-centric wound resource program to improve wound healing of injured workers.

The primary goal of wound care is to provide optimal conditions for the natural reparative processes to take place on their own. One Call’s new wound resource program, in partnership with Broadspire, utilizes evidence-based protocols to proactively identify injured workers who either have a non-healing wound or may be at risk for developing wounds.

Wounds that have continued for more than 30 days are 36-69 percent less likely to heal. Chronic wounds affect 5.7 million people in the U.S. at an annual cost of $20 billion.^[1] Pressure ulcers are among the most common chronic wounds. According to the Agency for Healthcare Research and Quality (AHRQ), pressure ulcers account for more than 17,000 lawsuits annually and are the second most common claim after wrongful death. Sadly, about 60,000 patients die as a direct result of a pressure ulcer each year.

“Pressure ulcers and other chronic wounds have an enormously detrimental impact on function and overall healing,” said Dr. Marcos Iglesias, chief medical officer at Broadspire … read more

Launches October 1, 2018

COLUMBIA, Md., Sept. 17, 2018 (GLOBE NEWSWIRE) — Osiris Therapeutics, Inc.(NASDAQ: OSIR), a regenerative medicine company focused on developing and marketing products for wound care, orthopedics, and sports medicine, announces that GrafixPL PRIME™, a human placental membrane that can be stored at ambient temperatures, launches for sale on October 1, 2018.  The structural matrix, growth factors, and cell viability of GrafixPL PRIME is equivalent to those of Grafix^®, a cryopreserved placental membrane, but without the constraints of ultra-low temperature storage.

GrafixPL PRIME is processed using Prestige Lyotechnology^SM, which is Osiris’s preservation technique for ambient storage of living tissues.  GrafixPL PRIME is flexible and conforming and designed as a wound cover/barrier for application directly to hard-to-treat acute and chronic wounds, including but not limited to diabetic foot ulcers, venous leg ulcers and thermal burns.

Jason Keefer, Interim President and CEO said: “I am pleased to announce that our ambient temperature stable GrafixPL PRIME product will be available in all settings of care, in addition to our cryopreserved Grafix products … read more

Broadcast times available: 8:00 AM (UK), 11:00 AM (UK), 15:00 PM (UK)

Evidence has proven the positive effects of topical oxygen therapy on chronic, hard-to-heal wounds. It is becoming widely accepted that hard-to-heal wounds contain biofilm and that the presence of biofilm delays and/or prevents healing. This webcast will inform practitioners about the issue of biofilm and how it affects wound chronicity, as well as how topical oxygen therapy may help to kickstart stalled healing. The NATROX study has shown that topical oxygen therapy has a positive effect on biofilm in chronic wounds, and this webcast will provide practical guidance so this can be applied in practice to improve healing outcomes ….. read more

     Product Chosen to be a Part of Healogics New iSupply(SM) Program

NEWPORT NEWS, Va., Sept. 10, 2018 /PRNewswire/ — Solsys Medical, LLC (“Solsys”) (formerly known and doing business as Soluble Systems, LLC) (“Solsys Medical”), which markets TheraSkin®, a cellular and tissue-based product for regenerative wound healing, announced today that it has partnered with Healogics, the nations largest provider of advanced chronic wound care services, to be a part of the new Healogics iSupply program, offering TheraSkin to Healogics facilities. Through the partnership with Healogics, Solsys furthers its mission to improve quality outcomes while reducing the total cost of care.  TheraSkin is a living human split-thickness skin allograft that is cryopreserved to preserve living cells and growth factors while maintaining a mature native human dermal architecture.  The versatility in applications and sizes of TheraSkin reduces product waste and helps to drive operational efficiencies in the wound care center to better manage total cost of care and quality outcomes related to wound care.

“We are very excited to be working with Healogics and have TheraSkin included in its iSupply initiative,” stated Allan Staley, CEO of Solsys Medical. “The iSupply program enables Healogics’ hospital partners improved access to TheraSkin in order to improve wound healing outcomes at a lower cost.” … read more

Diabetic foot ulcers (DFUs) are arguably among the most difficult types of wounds to manage; the etiology of these wounds poses some of the greatest clinical challenges for healing, considering the multifaceted nature of diabetes mellitus (DM). Multiple patient-related factors must be addressed and controlled through faithful adherence to the prescribed plan of care, which is developed by both the patient and clinicians to ensure success … Treatment of DFUs requires multidisciplinary provider involvement (podiatry, vascular, infectious disease, internal medicine or family practice, endocrinology, cardiology, nephrology, and physical therapy). The standard of care for patients with DFUs includes medical management of chronic disease, including nutrition and glucose control, routine wound assessments with ulcer grading and risk stratification, topical wound management with attention to serial debridements and moist wound healing … read more

Classification of Diabetic Foot Ulcers

Historically, classification and subsequent treatment of DFUs do not adequately include management of concomitant ischemia of peripheral arterial disease (PAD). The Wagner Diabetic Foot Ulcer Grade Classification System, which has been in use since its inception in the 1970s, did not have the capacity to describe ischemic components of DFU. The University of Texas Diabetic Foot Ulcer Classification System, PEDIS (perfusion, extent, depth, infection, and sensation), WIfI Threatened Limb (Wound/Ischemia/Foot Infection), and SINBAD (Site, Ischemia, Neuropathy, Bacterial infection, And Depth) are classification systems that utilize degrees of ischemia as a contributing factor.

At present, subclassification of DFUs can be divided into three categories: neuropathic, ischemic, and neuroischemic. The most prevalent of the three is the neuroischemic DFU, which comprises approximately 50% of such ulcerations. Organization and reproducibility of the assessment process are crucial to success. Workups should include identification of intrinsic and extrinsic factors, both modifiable and non-modifiable. We will review appropriate assessments by using a typical history and physical examination format … read more

Scientists have revealed how proteins in menstrual blood can be used to stimulate skin repair, including wounds that otherwise recover poorly. Today, tens of billions of dollars are spent on chronic skin injuries, and increasing rates of diabetes are adding to this demand, so utilizing the womb’s incredible ability to repair itself quickly could be the way forward … “The lining of the uterus, the endometrium, is an amazing tissue which undergoes ‘self-destruction’ each month at menstruation, followed by repair and regeneration of the tissue in preparation for pregnancy. This occurs, on average, 450 times in each woman’s reproductive life,” said Dr Jemma Evans of Melbourne’s Hudson Institute of Medical Research in a statement … read more

Two analyses from the LEADER Trial show reduced risks of deaths and better outcomes in both heart health and diabetes-related foot ulcers and associated complications in patients with type 2 diabetes who are at increased risk for cardiovascular disease … GLP-1 Proves Effective in Lessening Risks of 2 Common Diabetes-Related Risks … Patients with type 2 diabetes who were at heightened risk of cardiovascular disease (CVD) and received liraglutide, a glucagon-like peptide-1 receptor agonist (GLP-1) saw a reduction in CVD events and cardiovascular death … read more

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     therapeutic targets and drug delivery systems

Wound healing process is an intricate sequence of well-orchestrated biochemical and cellular phenomena to restore the integrity of the skin and subcutaneous tissue. Several plant extracts and their phytoconstituents are known as a promising alternative for wound healing agents due to the presence of diverse active components, ease of access, and their limited side effects. The development of nanotechnological methods can help to improve the efficacy of different therapeutics as well as herbal-based products. Here, we present a review of the efficacy of the plant based-nanomaterials in the management of wounds and discuss the involved therapeutic targets. For this purpose, a profound search has been conducted on in vitro, in vivo, and/or clinical evidences evaluating the efficacy and pharmacological mechanisms of natural product-based nanostructures on different types of wounds … read more

     a reproducibility assessment study

To assess the reproducibility of using AutoCAD software to measure the area of venous leg ulcers (VLUs) … Data from patients with VLUs were collected between March and July 2015, using data collection forms and photographing the different ulcers. A researcher and five nurses collected the data. The wounds were measured using AutoCAD software. Data were analysed using intraclass correlation coefficient (ICC), concordance correlation coefficient (CCC) and Bland-Altman analysis … read more (login required)

To help improve the care of troops injured in combat, the United States military has been exploring the complex microbiology of combat wounds … The goal of the initiative “is to expand the understanding of the complex microbiology inherent within combat-related extremity wounds,” according to Katrin Mende, PhD … Biofilm formation in 376 Enterococcus wound isolates was found to be generally weak — 8.8% in the presence of human plasma and 1.9% in the absence of human plasma, Mende and colleagues reported … read more

Pressure injuries (bedsores) are common and reduce quality of life. They are also costly and difficult to treat. This health technology assessment evaluates the effectiveness, cost-effectiveness, budget impact, and lived experience of adding electrical stimulation to standard wound care for pressure injuries … We conducted a systematic search for studies published to December 7, 2016, limited to randomized and non–randomized controlled trials examining the effectiveness of electrical stimulation plus standard wound care versus standard wound care alone for patients with pressure injuries. We assessed the quality of evidence through Grading of Recommendations Assessment, Development, and Evaluation (GRADE). In addition, we conducted an economic literature review and a budget impact analysis to assess the cost-effectiveness and affordability of electrical stimulation for treatment of pressure ulcers in Ontario. Given uncertainties in clinical evidence and resource use, we did not conduct … read more

When discharging patients from acute care facilities, consider cognitive and functional status; the home environment; family or caregiver support; access to services, medications, and transportation; and follow-up care.
Depending on the patient’s situation, the three goals of wound care are healing, maintenance, and comfort.
After discharge from an acute-care facility, patient medication management, diet, and lifestyle can help support wound healing … read more

     argues prof of vascular surgery

Former Head of Vascular Surgery at Bradford’s Royal Infirmary Professor Peter Vowden gave the opening address at the 3rd International Skin Integrity and Tissue Viability Conference which explored advances in and the management of all aspects wound care.

IT is estimated that annually the NHS treats over two million wounds at a cost of £5.3 billion and with tougher financial constraints being announced every year, there needs to be ongoing research to ensure the lack of finances doesn’t affect the quality of wound care available.

This was the topic of the opening lecture at the 3rd International Skin Integrity and Tissue Viability Conference hosted by the University of Huddersfield’s Institute of Skin Integrity and Infection Prevention (ISIaIP), in conjunction with the Journal of Wound Care … read more

Closing a wound usually requires a needle going through your skin, or staples. Just imagine having to sit there watching staples sticking into your flesh, not a pretty sight, right? Well, researchers have found an easier way to get things done.

One of the primary reasons the ways as mentioned above to close wounds are not perfect is the fact that they do not completely seal the entrance area. OK then, maybe doctors should use sealants to get the job done, but you know what? None of the ones available today meet the requirements of being a useful surgical tool … read more

     Management of Diabetic Foot Ulcers

The best practice recommendation articles are special publications of Wound Care Canada. Together they form the Foundations of Best Practice for Skin and Wound Management, an online resource available for free download from the Wounds Canada website (woundscanada.ca). These 2017 updates build on the work of previous author teams and incorporate the latest research and expert opinion. We would like to thank everyone involved in the production of past and present versions of these articles for their hard work, diligence and rigour in researching, writing and producing these valuable resources … read more

There does not appear to be a clinically meaningful association between baseline or prospective hemoglobin A1c (A1C) and wound healing in patients with diabetic foot ulcers (DFUs), according to a study published online April 16 in Diabetes Care.

The researchers found that baseline A1C was not associated with wound healing in univariate or in fully adjusted models. In the participants with baseline A1C <7.5 percent (hazard ratio [HR], 2.07; 95 percent CI, 1.08 to 4.00), no association with wound healing was seen with the mean A1C change from baseline. A nadir A1C change of 0.09 to 2.4 (tertile 3) was positively associated with long-term wound healing versus those with a nadir A1C … read more

Angelini and APR Applied Pharma Research strengthen their partnership in wound care with the launch of Nexodyn in the USA.

The new Nexodyn AOS wound care solution, cleared for sale by the FDA, is now starting to be available in the USA, promoted and commercialized by the Italian pharmaceutical company Angelini, as a result of an exclusive partnership with the Swiss company APR Applied Pharma Research, the owner and developer of the proprietary, patented technology TEHCLO, for the production of acidic super-oxidizing solutions.

Nexodyn helps cleanse and moisten the wound environment by removing dirt, debris and foreign material by flushing across the wound. Nexodyn is intended for use, under the supervision of healthcare … read more

     when sutured into tissue

For the first time, researchers led by Tufts University engineers have integrated nano-scale sensors, electronics and microfluidics into threads – ranging from simple cotton to sophisticated synthetics – that can be sutured through multiple layers of tissue to gather diagnostic data wirelessly in real time, according to a paper published online July 18 in Microsystems & Nanoengineering. The research suggests that the thread-based diagnostic platform could be an effective substrate for a new generation of implantable diagnostic devices and smart wearable systems … read more

Wounds can cover diabetic foot ulcers, pressure injury, vascular ulcers or wounds, immunopathic wounds and traumatic wounds. Chronic, hard-to-heal wounds also have an adverse effect on health-related quality of life. Wounds are a global problem, with increasing incidence due in part to the increase in diabetes mellitus. In Asia, there are more than 4 billion people, and this is where diabetes and its complications, namely diabetic foot, are increasing at an alarming rate … read more

     Metal–Bisphosphonate Coordination Chemistry for Wound Healing

Biomaterial‐based regenerative approaches would allow for cost‐effective off‐the‐shelf solution for the treatment of wounds. Hyaluronan (HA)‐based hydrogel is one attractive biomaterial candidate because it is involved in natural healing processes, including inflammation, granulation, and reepithelialization. Herein, dynamic metal–ligand coordination bonds are used to fabricate moldable supramolecular HA hydrogels with self‐healing properties. To achieve reversible crosslinking of HA chains, the biopolymer is modified with pendant bisphosphonate (BP) ligands using carbodiimide coupling and chemoselective “click” reactions. Hydrogel is formed immediately after simple addition of silver (Ag⁺) ions to the solution of HA containing BP groups (HA‐BP). Compared with previous HA‐based wound healing hydrogels, the HA‐BP·Ag⁺ hydrogel is highly suitable … read more

More than 120 foot and toe amputations are carried out every week in England as a result of diabetes.

Shocking figures reveal the number of amputations linked to the disease have risen by over a quarter since 2013.

Type 2 diabetes’ prevalence has more than doubled over the past decade due to rising rates of obesity, inactivity and unhealthy eating.

The disease can lead to amputations if it causes nerve damage that lead to infected wounds that do not heal. These infections can then spread to a person’s bones and even result in gangrene … read more

Windsor skin care products provider Scapa Healthcare said Thursday it has agreed to acquire an England-based maker of wound care products.

Scapa said acquiring Systagenix, and its 335,000-square-foot manufacturing facility, will “significantly” add to the Windsor company’s wound care footprint. Financial terms were not disclosed for the deal expected to be completed in October …. read more

     to using offloading devices among people with diabetes

Foot ulcers are a diabetic complication associated with significant morbidity, mortality, and amputation risk. Offloading devices prevent and heal foot ulcers, but adherence to using these devices is low. The reasons for nonadherence are unclear, and study results are difficult to compare due to methodological heterogeneity. This paper explores aspects of investigating adherence to using offloading devices among people with diabetes and provides recommendations for future studies, focusing on study designs, definitions of adherence, measurement methods, and conceptual frameworks. Most studies use a cross-sectional observational study design, limiting the potential to establish the temporal sequence between predictors and adherence, rule out confounding factors, and establish causality. Studies defining adherence as the length of time the device is worn have often used self-report to measure adherence, which may be unreliable. Studies using activity monitors to … read more

     therapy in obese and diabetic patients

Surgical site infections are a significant complication that can prevent proper wound healing, require expensive treatment and may even lead to death in severe cases. Patients with higher body mass indices and with diabetes have an increased risk of developing incision infections.

With a $1.7 million, two-year grant from the Centers for Disease Control and Prevention, researchers in the University of Illinois at Chicago Epicenter for Prevention of Healthcare Associated Infections — one of six such centers funded by the CDC — will determine whether negative pressure wound therapy can help reduce the incidents of surgical site infections in obese and diabetic patients.

“Obese patients are more prone to develop surgical site infections because incisions tend to be larger and need to be deeper to allow surgeons to access the areas they need to work,” said Dr. Susan Bleasdale, associate professor of clinical medicine in the UIC College of Medicine and principal investigator on the grant … read more

A smartphone application called MyWoundDoctor can help people needing wound care get quick access and treatment from a certified healthcare provider.

Here’s a simple version of how it can work: You snap a picture of the wound, select where on your body it’s located, and share a few more details about your condition. Then 30 minutes to four hours later, you’ll receive a doctor’s assessment, treatment instructions, and personalized supplies mailed to your home in a few days.

“It’s sort of a self-serve model,” said Dan Heneghan, the CEO of MyWoundDoctor, LLC which is based in Wilmington.

MyWoundDoctor was founded in 2015 by Heneghan and Dr. Nick Sieveking, a board-certified plastic surgeon.

Heneghan said he was talking with Sieveking, who said his patients had been sending pictures of wounds to him through his smartphone … read more

Researchers trick wound cells in mice into becoming healing surface skin cells

Scientists have discovered a new way of treating skin wounds in mice by tricking the cells in the wound into becoming healing surface skin cells.

The findings raise the prospect of being able to develop simple, non-surgical treatments for human wounds in the future.

Large skin wounds and ulcers are painful and occasionally life-threatening. When the surface of the skin is ruptured, epithelial cells, which make up the outer layer of the skin, migrate towards the wound in an effort to seal up the injury. But this healing process becomes more difficult in larger wounds and is impaired in older people, making the need for simple, effective treatments all the greater … read more

Antibiotic resistance is one of the factors which causes delay in wound healing and a corresponding spike in medical and healthcare expenses.

The primary reason for the emergence of resistance is the inappropriate use of antimicrobials. To use antibiotics wisely, it is necessary to understand the principles of diagnosing wound infection, what organisms are likely to be responsible, and to what antimicrobial agents they respond.

This knowledge will help to ensure that antibiotics are used only when essential, and in a manner that does not cause more resistance to be generated … read more

13 Sep 2018
Broadcast times available: 8:30 AM (UK), 12:30 PM (UK), 16:30 PM (UK)
This Wounds International webcast focuses on the role of oxygen in wound healing and how topical oxygen therapy can improve oxygenation and, therefore, healing.

In the first presentation, Breda Cullen, Research and Development Director, UK, outlines the vital role that oxygen plays throughout the healing process and the impact that lack of oxygen (hypoxia) can have on the wound. Breda explores the factors that can cause compromised healing and how these can be addressed.

In the next presentation, Hanna Kaufman, Orthopaedic Surgeon, Israel, looks in depth at the clinical evidence and how this can be applied to practice. Hanna identifies the wounds that are suitable for topical oxygen therapy and shares tips for use in practice, drawing on clinical evidence and experience.

In the final presentation, Tjun Tang, Vascular Surgeon, Singapore, looks at the role of topical oxygen therapy in limb salvage.

read more

Background and Prevalence of Diabetic Foot Ulcers
Diabetes-related foot complications, including diabetic foot ulcers (DFUs), are leading causes of non-traumatic lower extremity amputation. Of the approximately 420 million adults in the United States with diabetes mellitus, one fourth will develop at least one DFU. DFUs are preceded by a compendium of risk factors, including the presence of neuropathy, external trauma, infection, effects of ischemia from concomitant peripheral arterial disease, malnutrition, and poor hygiene or self-care, among others. In 80% of patients, DFU is a precursor to some degree of lower extremity amputation. And, for these patients who have undergone amputation, their risk for further amputation becomes double that of a patient without diabetes. The mortality rate following a diagnosis of diabetic foot ulceration is 5% in the first year. The five-year mortality rate is 50% and rises to 70% after amputation. Once healed, 40% of DFUs will recur within 12 months, nearly 70% at three years, and nearly 75% at five years … read more

Sept. 6 (UPI) — Scientists have developed a technique to convert cells in open wounds into skin cells as an alternative to plastic surgery for treatment of large cutaneous ulcers.

The method involves reprogramming the cells into a stem-cell-like state for healing skin damage, including severe burns, bedsores or chronic diseases such as diabetes. The researchers at the Salk Institute also see this process as a way to counter the effects of aging and better understanding skin cancer.

Their findings were published Wednesday in the journal Nature.

“This knowledge might not only be useful for enhancing skin repair but could also serve to guide in vivo regenerative strategies in other human pathological situations, as well as during aging, in which tissue repair is impaired,” senior author Dr. Juan Carlos Izpisua Belmonte, a professor at he Salk Institute, said in a press release … read more

GLASGOW — Residents at Signature HealthCARE of Glasgow can avoid trips to a doctor’s office or to the hospital for treatment of some medical conditions thanks to telehealth technology through YourDoc2U.

With telehealth technology, health care providers can talk face-to-face with residents, as well as the staff at the nursing facility via computer screen that sits atop a cart enabling it to be moved from location to location as needed.

Psychiatric and wound care evaluations are the medical services available to the nursing facility residents through telehealth technology.

“If we identify a need with any of our elders, we call the primary physician and ask for a consult with telewound,” said Kim Poynter, director of nursing at Signature HealthCare of Glasgow. “It’s all online. They have nurse practitioners and physicians available. If it’s an emergency situation, like if we have an elder who is having a crisis and needs psych services, we either call in or get online and make an appointment. They are available 24/7.” read more

     during burn wound care and dressing changes

Little has been published regarding intravenous (IV) ketamine for burn wound care in adult patients. Ketamine may serve as a safe alternative to provide conscious sedation and limit opioid administration to patients. The purpose of this study was to characterize IV ketamine use during burn wound care and establish its potential role as a safe adjunct to opioid and benzodiazepine medications. This is a retrospective review of adult patients admitted to a regional burn center who received IV ketamine for burn wound care. Patient demographics, medications, and ketamine-related side effects including hypertension and dysphoric reactions were recorded. Cardiopulmonary complications were also tracked. Thirty-six patients met inclusion criteria; 50 total cases were performed. The median patient age was 37 [IQR 28 – 55] years with a median burn size of 9.5 [IQR 4.0 – 52] %TBSA. The median ketamine dose administered was 1.2 [IQR 0.8 – 2.1] mg/kg. IV midazolam was administered in almost all cases (98%) at a median dose of 3.0 [IQR 2.0 – 5.0] mg. Opioids were administered in 13 of 50 cases (26%) at a median morphine … read more

BRISBANE, Australia, Sept. 05, 2018 (GLOBE NEWSWIRE) — Factor Therapeutics Limited (ASX: FTT, the “Company”), an Australian biomedical company developing therapeutics for advanced wound care, is pleased to announce that the Company’s Phase 2 clinical trial VF00102, for the treatment of venous leg ulcers (VLU), is approaching the end of its treatment phase.

“Since finalising recruitment in July, the study has progressed to schedule and there are now only eight patients left to complete treatment. We expect the last patient to have their final treatment visit in the first week of October, a key milestone for the study as it then triggers a final round of data cleaning and quality checks before top-line results can be analysed in November,” said Dr Ros Wilson, CEO of Factor Therapeutics … read more

After reviewing evidence, a tool to evaluate benefit and risk has been developed showing when and when not to use an SGLT-2 inhibitor.

The management of type 2 diabetes has significantly diversified over recent years, producing a data-rich environment. SGLT2 inhibitors are a more recent agent that work by reabsorbing glucose in the kidney and cause an increase in glucose excretion in the urine. There have been misconceptions concerning the efficacy, safety and appropriate use of SGLT2 inhibitors in diabetes management. In order to address these concerns, the UK created The Improving Diabetes Steering Committee, consisting of diabetes specialists.

The Improving Diabetes Steering Committee used multiple trials to developed a quick reference guide that aims to clarify common areas in type 2 diabetes management, with a focus on SGLT2 inhibitors … read more

Cold atmospheric plasmas (CAPs) are investigated for several medical applications; major research effort is devoted to the promotion of wound healing in of chronic wounds. These wounds, typically associated with diabetes, are a major health concern due to their high occurrence in the population, long healing time, and associated high costs. Cell culture studies and clinical trials show promising results towards wound reduction or closure using relatively short plasma treatment times between 45 s and 2 min. Another growing application of CAPs is the inactivation of cancer cells. While short treatment times associated with wound healing seem to induce no permanent damage, cancer treatments are performed at significantly higher plasma exposure times.

Due to the complex nature of both wound healing and cancer, investigating the effect of plasma is challenging. One system that seems highly interesting in both wound healing and cancer is the epidermal growth factor receptor (EGFR) and one of its ligands, the epidermal growth factor (EGF). EGFR is known to be involved in several cancer types, because an overproduction or overstimulation of EGFR has a severe impact on the cell cycle by inducing proliferation … read more

So many times, we get questions about how to “skill” a resident. Is she skilled if she’s getting IVs? Is he skilled because he’s getting wound care? What about the resident whose trach is capped? Is she skilled? When the rehab patient reaches the almighty “plateau”, and isn’t getting better, is he still skilled?

We need to remember what the S-word means (no, not that one.) “Skilled” in our arena is defined by the services that we are delivering to the client, not by what the client is or isn’t doing … read more

     The impact of a wound centre on a vascular surgery practice

The opening of an outpatient wound centre has been associated with a significant increase in peripheral vascular practice and a significant decrease in amputation rate. Venita Chandra and colleagues Alyssa M Flores, Matthew W Mell and Ronald L Dalman (Stanford University, Stanford, USA) believe that such centres result in synergistic systems that promote more aggressive and effective limb salvage strategies. Chandra presented the findings of a recent study analysing the clinical impact of a wound care centre on a vascular surgery practice, at the Society for Vascular Surgery’s Vascular Annual Meeting (VAM; 20–23 June, Boston, USA).

According to Chandra, chronic wounds remain a growing problem, not only in the USA but worldwide—with many patients at risk of limb loss presenting as particularly challenging. This cohort requires complex and resource-intensive medical care, reported Chandra.

World experts and leaders in this specialty have developed and described programs to attempt to improve the care of these complex patients and decrease the risk of amputation … read more