Category: Articles

Nutrition can aid in healing diabetic foot ulcers

In this issue, Susan Weiner, MS, RDN, CDE, CDN, talks with nutrition and wound care expert Nancy Collins, PhD, RDN, LD, NWCC, FAND, about the role of nutrition in prevention and treatment of diabetic foot ulcers. Nutrition is a critical component of healing diabetic foot ulcers, particularly as it relates to immune function, malnutrition, glycemic control, and weight loss and weight maintenance. Diabetes educators should include nutrition assessment and intervention as key components of the overall diabetes treatment plan to help patients with diabetic foot ulcers maximize their nutritional status and promote wound healing.


Nutrition is not often the first thing clinicians think of when dealing with diabetic foot ulcers. How important is it, and exactly what role does nutrition play?


Collins: Nutrition does indeed play an important role in the prevention and treatment of diabetic foot ulcers. A poor diet can result in altered immune function, malnutrition and poor glycemic control, all of which are risk factors for poor healing. Malnutrition and nutrient deficiencies can impair collagen synthesis, prolong inflammation, decrease phagocytosis causing dysfunction of B and T cells, and decrease the mechanical strength of the skin. Once a patient has a wound, achieving and maintaining a healthy body weight can help maximize wound healing because obesity can negatively affect glycemic control. Often just losing extra weight can help with glucose control and, in turn, wound healing. Of course, weight loss proves very challenging for most patients. This is where referral to a registered dietitian nutritionist with expertise in diabetes can help … read more

Under the Off-Load: A Pilot Case Series to Identify Ideal Dressings

     to use under Total Contact Casts (TCC)


Introduction: It is well stated in the literature that Total Contact Casting (TCC) is a standard of care for off-loading of neuropathic ulcers of the plantar surface. Another standard of care is to provide a moist wound healing environment. Evidence to support appropriate wound dressings under TCC is currently unavailable despite recognition that the wound environment and thus the amount of drainage changes as the wound progresses towards healing. This pilot case series of three patients with plantar based diabetic neuropathic ulcers uses two dressings, a five layer silicone foam with absorbent polymer and moisture retentive backing dressing (SF)* for low to moderate drainage and a non-adherent super-absorbent (SAP)† polymer dressing for moderate to high exudate levels.


Clinical Problem: May TCC kits include a generic, open-cell, polyurethane foam dressing (OCF). These dressings do not absorb or retain fluid in a moderate to high exudate environment which can lead to maceration and non-healing. Furthermore, due to the high moisture vapor transmission rate of OCF, wounds with low exudate may experience desiccation and result in the development of slough and biofilm … read more

Nearly 50% Reduction in Diabetic Foot Ulcers With Stem Cells

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% (= .001) in stem-cell–treated and control groups, respectively, and after 12 weeks, median ulcer reductions were 68.24% and 5.27% (= .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, which is due to the ability of these cells to simulate angiogenesis in the wound bed, decrease excessive inflammation, and suppress scarring,” explained Dr Albehairy … read more

Molecular study of wound healing after using biosynthesized

     BNC/Fe3O4 nanocomposites assisted with a bioinformatics


Magnetic nanoparticles were biosynthesized by using Aloe vera extract in new isolated bacterial nanocellulose (BNC) RM1. The nanocomposites were characterized using X-ray diffraction, Fourier transform infrared, and field emission scanning electron microscopy. Moreover, swelling property and metal ions release profile of the nanocomposites were investigated. The ability of nanocomposites to promote wound healing of human dermal fibroblast cells in vitro was examined. Bioinformatics databases were used to identify genes with important healing effect. Key genes which interfered with healing were studied by quantitative real time PCR.


Results: Spherical magnetic nanoparticles (15–30 nm) were formed and immobilized within the structure of BNC. The BNC/Fe3O4 was nontoxic (IC50>500 μg/mL) with excellent wound healing efficiency after 48 hours. The nanocomposites showed good antibacterial activity ranging from 6±0.2 to 13.40±0.10 mm against Staphylococcus aureusStaphylococcus epidermidis and Pseudomonas aeruginosa. The effective genes for the wound healing process were TGF-B1MMP2MMP9Wnt4CTNNB1hsa-miR-29b, and hsa-miR-29c with time dependent manner. BNC/Fe3O4 has an effect on microRNA by reducing its expression and therefore causing an increase in the gene expression of other genes, which consequently resulted in wound healing … read more

VTT is developing 3-D-printing materials for wound care

     and decorative elements


Cellulose nanofibrils have properties that can improve the characteristics of bio-based 3D-printing pastes. VTT Technical Research Centre of Finland is developing a 3D wound care product for monitoring wound condition in hospital care. However, the first commercial nanocellulose applications will be seen in indoor decoration elements, textiles and the production of mock-ups.


3D printing has proven to be an efficient manufacturing method for complex, customised and light structures. In addition to thermoplastics, 3D printing materials include metals, ceramics and foodstuffs. The range of biomaterials in 3D paste printing is still fairly limited, since pastes pose unique challenges: their structure must not collapse during printing and the objects manufactured must remain sufficiently strong, rigid or flexible after drying. In 3D biomaterial filaments, however, commercial products already exist … read more

Human Adipose-Derived Stem Cell Conditioned Media and Exosomes Containing

MALAT1 Promote Human Dermal Fibroblast Migration and Ischemic Wound Healing


Objective: Chronically ill patients heal recalcitrant ulcerative wounds more slowly. Human adipose-derived stem cells (hADSCs) play an important role in tissue regeneration and exosomes secreted by hADSC contribute to their paracrine signaling. In addition to cytokines, lipids and growth factors, hADSC secrete mRNA, miRNA, and long noncoding (lnc) RNA into exosomes. In this study we examined the role of lncRNA MALAT1 (metastasis-associated lung adenocarcinoma transcript 1), an abundant lncRNA in exosomes from conditioned media (CM), on cell migration and ischemic wound healing.

Approach: CM and isolated exosomes from hADSC were applied to human dermal fibroblast (HDF) in scratch assays and electric cell-substrate impedance sensing (ECIS) assays. CM was also applied to a rat model of ischemic wound healing and wound closure was followed.

Results: CM stimulated cell migration of HDFs in vitro by 48%. CM stimulated the closure of ischemic wounds in a rat model 50% faster than unconditioned media. The depletion of MALAT1 in adipose-derived stem cell (ADSC) CM significantly reduced cell migration. Since MALAT1 is secreted into exosomes, a purified population of exosomes was applied to HDF where they enhanced cell migration in a similar manner to FGF-2 or basic fibroblast growth factor (bFGF) in ECIS wound healing assays. The uptake of exosomes by HDF was shown using dynasore, an inhibitor that blocks clathrin- and caveolin-dependent endocytosis. Depletion of MALAT1 in hADSC with antisense oligonucleotides resulted in exosomes without MALAT1. These exosomes had an effect similar to the unconditioned, control media in ECIS assays …. read more (fee)

Using technology to reduce waste and improve surgical care

Every day, millions of patients undergo procedures in ambulatory surgery centers (ASCs), and a very small percentage of them have complications during and after the procedure. Fortunately, new technologies promise to address problems that have challenged patients and their surgical teams.New analytical tools using artificial intelligence and machine learning, coupled with data streams from patients, can be used to better understand patient risk sand develop treatment strategies to reduce complications and improve outcomes.These new tools promise to reduce waste (defined as care that does not add to the patient’s health).For example, a patient who develops a wound infection post-operatively that requires re-operation and hospital admission may benefit from those interventions, but if the patient had gotten treatment earlier for the wound infection,hospitalization and re-operation could have been avoided altogether. Waste is common in our healthcare system today, but things are already starting to change.


How can new technologies reduce waste and improve outcomes for patients treated in ASCs? These tools can help predict risk of complications, better manage surgical procedures, and post-operative recovery.Physicians and teams managing surgical patients face several difficult issues: when is it safe to take my patient to surgery? What are the identifiable risks of surgery for this patient and what can be done to minimize those risks? How can the surgery be made as safe as possible? What does this patient need to heal successfully after surgery and what can be done to minimize surgical complications that require treatment? Better answers to these questions lead to better outcomes for patients and reduce wasteful expenditures … read more

Microcurrent as an adjunct therapy to accelerate chronic wound healing

     and reduce patient pain


The primary aim is to assess the efficacy of microcurrent, a form of electrical stimulation, as an adjunct therapy in accelerating healing in chronic wounds by reducing wound size and pain level. The secondary aim is to assess the qualitative changes in these parameters: inflammatory symptoms, vasodilation, sleep quality, gait and frequency of bowel movement … read more

Prevention of Plantar Ulcers in People With Diabetic Peripheral Neuropathy

Using Pressure-Sensing Shoe Insoles


The SurroSense Rx system is a set of pressure-sensing shoe insoles that connect wirelessly to a proprietary smartwatch and is intended for people with diabetes who have mild to moderate sensory loss associated with diabetic peripheral neuropathy, or nerve damage. By providing real-time alerts about plantar pressure distributions, or the area of pressure between the foot and the surface supporting it, users of the SurroSense Rx system can alter their activities in order to relieve unsafe pressures. The SurroSense Rx system is used in addition to current standard-of-care treatment for the prevention of plantar ulcers in diabetic patients. There is currently no available evidence that using the SurroSense Rx system prevents plantar ulcers. However, there are ongoing clinical trials that may identify patient populations that will benefit from its use.


Over time, high blood sugar in people living with diabetes causes damage to the peripheral nerves — the nerves that serve the arms, hands, legs, and feet. This damage, called diabetic peripheral neuropathy, includes symptoms such as painful tingling or burning sensations in the hands and feet, and the loss of protective sensations such as feeling pain or temperature changes. When pain sensation is lost, there is an increased risk of developing open sores caused by prolonged pressure or other injuries … read more

Surgical wound dehiscence: Improving prevention and outcomes

Surgical wound dehiscence (SWD) is almost certainly under-reported, not least because of variation in the interpretation of what constitutes SWD. As a result, patients with SWD may not receive optimal treatment and may experience additional surgical site complications, increased mortality, prolonged hospital stays and readmission. Following a meeting in July 2017, an international panel of clinical experts developed a consensus document to raise awareness of SWD, to aid identification of patients at increased risk and to provide practical guidance in prevention and management. This document has the endorsement of the World Union of Wound Healing Societies (WUWHS) and ultimately aims to improve outcomes for patients … read more

Chronic Wound Management

     Optimizing the Wound Healing Environment


Chronic wounds are any types of wounds that have failed to heal in 90 days. Identifying the cause of a chronic wound is most important in the healing process. We as clinicians must help bolster advanced wound care by sharing advances in education in evidence-based treatment, prevention, and wound assessment.


A wound must go through hemostasis, inflammation, proliferation, and remodeling, along with various cellular contributions. The scaffolding of the extracellular matrix is what provides the elasticity and tensile strength to the skin structure. Various proteins such as collagen, fibronectins, elastins, and laminins make up this vital matrix to aid and complete the process of wound closure. We see extracellular matrix damage mostly in our geriatric population … read more

Nutrition in patients with chronic non-healing ulcers

     a paradigm shift in wound care


Chronic ulcers continue to pose a significant clinical and economic burden for both patients and wound care practitioners. Despite good standard of care (SOC), many wounds fail to heal. Wound healing requires a complex cascade of physiologic and immunologic processes as well as proper nutrition. An adequate balance of macro- and micronutrients is important to support the cellular activities that are necessary for repairing and remodeling of tissue. Despite being well documented in a number of clinical studies there continues to be a gap in recognizing nutritional deficits as well as appropriate clinical interventions in patients with chronic wounds. Effective management of malnutrition in patients with chronic wounds requires collaboration among multiple clinical disciplines. A holistic nutritional management approach may yield both clinical and economic benefits … read more

TissueTech, Inc. Awarded Patent for Compositions of

Morselized Umbilical Cord and Amniotic Membrane


MIAMI–(BUSINESS WIRE)–TissueTech Inc., the pioneer in the development and clinical application of regenerative amniotic tissue-based products, announced that it has been awarded patent 9,808,491 by the U.S. Patent Trademark Office. The patent applies to the use of a gel composition comprising morselized placental amniotic membrane and/or morselized umbilical cord. as a method for treating an ocular wound or repairing damaged ocular tissue.


“TissueTech has been the leader in the development and clinical application of amniotic membrane transplantation for the treatment of a variety of patient conditions in ophthalmology, chronic wound care, orthopedics and sports medicine,” said Amy Tseng, Chief Executive Officer of TissueTech. “We are excited that this patent represents our continued innovation and is another step forward in excelling our technological advances in the industry.”

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The Whole Patient Approach

Addressing Common Comorbidities That Affect Wound Healing


When developing the plan of care for the patient with a chronic wound, it is imperative first to look at the “whole” patient and not just the “hole” in the patient.1 As we do, we are able to review any medical conditions or disease states that may affect wound repair and healing. Millions of Americans are affected by chronic wounds each year. These wounds include causes such as diabetic foot ulcers, venous leg ulcers, arterial insufficiency, and pressure ulcers. Common comorbid conditions that can affect healing include diabetes, venous insufficiency, peripheral arterial disease, cardiopulmonary and oxygen transport conditions, immune deficiencies, and dementia.2 This discussion is focused on these conditions and factors that contribute to chronic wounds and their management … read more

Connected sensors for the prevention of chronic ulcers

As advancements in connectivity and miniaturization of electronics are made, smart sensors are beginning to find traction within the wound care pathway. IDTechEx has published a report titled Advanced Wound Care Technologies 2018 – 2028 and have previously reported on why disruption is needed in wound care in the next 10 years. Here, we explore a few connected devices that can contribute to the prevention of chronic wounds of pressure ulcers (PUs) and diabetic foot ulcers (DFUs).


Sensors for the Prevention of Pressure Ulcers MedicusTek have created the Sensable Care system which relies on a connected sensor pad or sensor mattress for detection of patient positioning to prevent pressure ulcer formation. By tracking patient position over time, the Sensable Care system can determine which areas of the patient are being exposed to prolonged pressure and notify caregivers accordingly for repositioning. The system resets if the patient successfully repositions themselves, thus decreasing the burden on caregivers where possible. Moreover, caregivers can receive immediate feedback as to whether their repositioning efforts were adequate in reliving the excessive pressure.

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New engineering method could overcome barriers in diabetes cell therapy

Pancreatic cell transplants have the potential to be a permanent treatment for Type 1 diabetes. Problem is, the cells have trouble forming the blood vessel networks they need to thrive and provide insulin to patients. So scientists in the U.S. and Japan devised a new tissue engineering method to tackle this blood-supply problem in pancreatic cell transplantation. Using the method, they created pancreatic islets that cured severe Type 1 diabetes when they were transplanted into mice.


Human pancreatic islets tend to lose their blood vessels while being prepped for transplant, and attempts to combat this—including creating new islets from stem cells—have been largely unsuccessful, the researchers, from Cincinnati Children’s Hospital and Yokohama City University (YCU), wrote in their study. So to speed up vascularization in transplanted tissues, the researchers, led by Takanori Takebe of Cincinnati Children’s and Hideki Taniguchi of YCU, created a technique called self-condensation cell culture … read more

Australian diabetes-related foot disease strategy 2018-2022

The first step towards ending avoidable amputations within a generation


Diabetic Foot Australia September 2017


On any given day in Australia, the national burden of diabetes-related foot disease (DFD) is
• 300,000 people are at-risk of developing DFD
• 50,000 people are living with DFD
• 12,500 people are living with a diabetes-related amputation
• 1,000 people are in hospital because of DFD
• 12 people will undergo a diabetes-related amputation
• 4 people will die because of DFD
• $4 million will be spent managing DFD
To reduce this large national burden, the following three priorities should be addressed for people
with, or at-risk of, DFD:
A. Access to affordable and effective care
B. Provision of safe quality care
C. Research and development to improve patient outcomes

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Double-Blinded Clinical Trials

A Gift from the Devil’s Grandmother


By Thomas E. Serena MD, FACS, FACHM, FAPWCA

Editor’s note:This blog post is part of the WoundSource Trending Topics series, bringing you insight into the latest clinical issues and advancement in wound management, with contributions by the WoundSource Editorial Advisory Board.


I do not know the origin of the phrase “…a gift from the devil’s grandmother.” I first read it in Einstein’s letters to Schrödinger. Einstein employed the phrase to describe his fear of failing to find a unified theory of relativity and quantum physics. The problem appeared unsolvable.


A similar gift in the field of clinical trial research in wound healing appeared on my doorstep recently. I started my research career conducting double-blinded pharmaceutical trials. After a string of failures, I convinced myself that advanced therapy in chronic wounds was doomed; however, cellular and/or tissue-based products (CTPs) entered the market with encouraging results, brightening my spirits. To date, our cooperative group of investigators has published more than a dozen trials demonstrating the efficacy of CTPs in the treatment of diabetic and venous ulcers … read more

IDTechEx Research Report Explores Connected Sensors

for the Prevention of Chronic Ulcers


As advancements in connectivity and miniaturization of electronics are made, smart sensors are beginning to find traction within the wound care pathway. IDTechEx Research has published a report titled Advanced Wound Care Technologies 2018–2028 and have previously reported on why disruption is needed in wound care in the next 10 years. Here, IDTechEx explores a few connected devices that can contribute to the prevention of chronic wounds of pressure ulcers (PUs) and diabetic foot ulcers (DFUs).


Sensors for the Prevention of Pressure Ulcers

MedicusTek have created the Sensable Care system which relies on a connected sensor pad or sensor mattress for detection of patient positioning to prevent pressure ulcer formation. By tracking patient position over time, the Sensable Care system can determine which areas of the patient are being exposed to prolonged pressure and notify caregivers accordingly for repositioning. The system resets if the patient successfully repositions themselves, thus decreasing the burden on caregivers where possible. Moreover, caregivers can receive immediate feedback as to whether their repositioning efforts were adequate in reliving the excessive pressure … read more

The Risky Business of Wound Research, Algorithms and Systems

by Margaret Heale RN, MSc, CWOCN


The research lecturer’s name was Terry, and he had my respect and attention. Many of the students were dreading the research modules but were cheered by the prospect of Terry taking us through it.


Terry included this little gem in his introduction to research. A group of researchers came up with a hypothesis that spiders had ears in their legs. How could they prove this, they wondered. They procured some arachnids of exactly the same type and took great pains to match them for all important parameters. They checked carefully the hearing of each. Placing them in turn in a quiet, stable tray, each time they yelled “Run!” every spider would take off at speed at the sound. The next step was to remove the spiders’ ears, so the legs of each spider were removed. Now when the researchers yelled “Run!” the spiders did not hear and did not move at all. So there you have it, clear undeniable proof, spiders have ears in their legs. It is very easy to see the flaw in this rather cruel piece of research, but sadly it is not always that easy … read more

Total Contact Cast Offloading Real Treatment For All Plantar Based Wounds


Patient is a 49 year old male with a history of Charcot Marie Tooth Disease (CMT) who presented with a a plantar ulcer of the Left Foot. CMT is an inherited neuropathy which directly damage nerves fibers resulting in both sensory and motor neuropathy causing significant foot deformities. His medical history included an unknown type of reconstructive surgery to the left foot in 2007 for his CMT. The presenting plantar ulcer had been there for 7 months and treated continuously by a local podiatrist with Iodine dressings only. The patient had never been prescribed any offloading devices and presented wearing canvas sneakers. Our Initial treatment consisted of aggressive debridement of the ulcer to 100% bleeding surfaces including all skin margins. Hemostasis was achieved rapidly using Scion CLO-SURPLUS PADTM Chitosan Hemostatic dressing. M-Med’s Mobility Series Total Contact Cast Kit was used to allow for modification for his unusual foot configuration. He underwent total contact casting weekly with complete healing in 5 weeks. The multi-component TTC system allowed for modifications by adding, subtracting or modifying components for the desired fit needed at that time. He was placed in a custom molded shoe with inserts and has had no recurrence to date … read more

The Healing Trajectory: The Process of Wound Healing

There are four stages of wound healing. This systematic process moves in a linear direction. The four stages of wound healing are: hemostasis, inflammation, proliferation, and maturation. It is imperative to remember that wound healing is not linear. It is possible for a patient to move forward or backward through the wound healing phases due to intrinsic and extrinsic forces … read more



Current challenges and opportunities in wound care

3 CNOs weigh in


Wound care costs the U.S. healthcare system an estimated $50 billion annually. The large fiscal burden suggests wound care may be an overlooked target for quality improvement and cost reduction initiatives, according to Jacksonville, Fla.-based Healogics, the nation’s largest provider of advanced wound care services.


More than 30 million diabetics and 28.4 million individuals with heart disease reside in the U.S. Both morbidities represent public health epidemics and carry a heightened risk for chronic wound development. Approximately 6.7 million Americans are afflicted with chronic, non-healing wounds. This figure does not account for wounds attributable to conditions such as necrotizing fasciitis and surgical wounds related to the operating room. The Healogics team asserts that these numbers suggest America is experiencing a chronic wound epidemic.


On April 11, at Becker’s Hospital Review 9th Annual Meeting in Chicago, Arti Masturzo, MD, executive vice president of clinical innovation with Healogics, led a group of hospital leaders in a discussion on current challenges and opportunities related to wound care … read more

The Benefits of Effective Wound Debridement

by The WoundSource Editors

Overview of Debridement in Wound Care

Debridement is essential to promote healing and prevent infection. There are five main types of debridement methods. BEAMS is the common mnemonic to remember all types: biological, enzymatic, autolytic, mechanical, and surgical. In recent years, new types of debridement technology have been introduced, such as fluid jet technology, ultrasound debridement therapy, hydrosurgery, and monofilament polyester fiber pad debridement.


Combining debridement methods has been found to be an advantage in managing complex wounds and different pathological tissues since 2006. One common method of combining debridement techniques is using enzymatic debridement first to liquefy the tissue and then following with sharp debridement. Combining debridement methods in this way can ensure that you are removing as much dead tissue from the wound as possible and helping to promote wound healing.


Chen and Wang studied chronic pressure ulcers that were described as dry, hard, black, crusting eschar … read more

Ally Medical, Preston Wound Care merge under Acentus

TAMPA, Fla. – Principles from Tampa, Fla.-based Ally Medical Services and McKinney, Texas-based Preston Mobility Plus, dba Preston Wound Care, have merged. They’re now wholly owned subsidiaries of Acentus, also based in Tampa. Ally Medical is one of Florida’s larges providers of incontinence and medical nutritional supplies to children with special healthcare needs, and urological catheters to the neurogenic bladder patient population. Preston Wound Care is one of Texas’ largest wound care providers to patients living at home with diabetic ulcers and chronic wounds … read more

Staphylococcus aureus Toxins and Diabetic Foot Ulcers

Role in Pathogenesis and Interest in Diagnosis


Infection of foot ulcers is a common, often severe and costly complication in diabetes. Diabetic foot infections (DFI) are mainly polymicrobial, and Staphylococcus aureus is the most frequent pathogen isolated. The numerous virulence factors and toxins produced by S. aureus during an infection are well characterized. However, some particular features could be observed in DFI. The aim of this review is to describe the role of S. aureus in DFI and the implication of its toxins in the establishment of the infection. Studies on this issue have helped to distinguish two S. aureus populations in DFI: toxinogenic S. aureus strains (harboring exfoliatin-, EDIN-, PVL- or TSST-encoding genes) and non-toxinogenic strains. Toxinogenic strains are often present in infections with a more severe grade and systemic impact, whereas non-toxinogenic strains seem to remain localized in deep structures and bone involving diabetic foot osteomyelitis. Testing the virulence profile of bacteria seems to be a promising way to predict the behavior of S. aureus in the chronic wounds … read more

Hydrogel Dressings an emerging area for wound care


By Liji Thomas, MD


An emerging area for wound care is hydrogel dressings as they increase success and speed of wound healing due to the ability to maintain optimum wound healing environment superseding conventional dressings.


Hydrogel dressings consist of 90% water suspended in a gel made of insoluble hydrophilic polymers that swell up on contact with water, which are typically synthetic molecule polymers such as polyvinylpyrrolidine and polymethacrylate combined with alginate dressings, that control fluid exchange on wound-bandage interface with sodium and/or other molecules in wound discharge being exchanged for hydrogel compounds.


Hydrogel provides moisture to enable painless debridement of infected and necrotic tissues, promoting granulation while encouraging complete healing. Hydrogel dressings have high water content which makes them not completely absorbent and appropriate only for wounds with light to moderate exudation. Skin maceration and/or multiplication of microbes can result from water accumulation which can lead to foul smelling infected wounds. The cooling hydrogels can alleviate some pain, which flatten out the wound surface contours and prevent dead space from getting infected, while providing support for surface healing.


Hydrogel sheets are polymeric cross linked molecules capable of absorbing some water helping to prevent wounds with light exudation from becoming to wet with semipermeable polymer film backings. Evaporation is regulated with the backing and keeps wounds from drying out. Sheets can be cut to shape and size, and may be used as secondary or primary dressings … read more


National Alliance of Wound Care and Ostomy® Board of Directors Elect New President


Moore will lead the Board of Directors of the largest wound care credentialing organization in the United States


For Immediate Release:
May 7, 2018, St. Joseph, MI—National Alliance of Wound Care and Ostomy (NAWCO®) Board of Directors announced today, it has elected Ms. Ottamissiah (Missy) Moore, RN, WCC, DWC, GC, CSD-LTC, President of the Board.


“As a long-standing member of our Board of Directors, Missy’s forwardthinking contributions have helped articulate our vision. We welcome her leadership as President to elevate our mission further,” said Cindy Broadus, Executive Director NAWCO.


Moore is a past president of the National Federation of Licensed Practical Nurses and a Lifetime member of the National Black Nurses Association. She served on the board for the District of Columbia State Board of Nursing and other appointed committee positions including:


  • National Council of State Boards of Nursing, PN NCLEX Item Selection Committee
  • Commission of Graduates of Foreign Nursing Schools, LPN Standards Committee
  • National League for Nursing Licensed Practical Nurse Ad Hoc Committee.


“I am thrilled and honored to be elected President of the NAWCO Board of Directors. I am committed to elevate our support for this amazing group of certified healthcare clinicians,” said Moore.


Missy is employed as Community Liaison at Right at Home Of DC, located in Washington D.C. and Wound Education Consultant for Quality In-services and Training.


About NAWCO NAWCO is a non-profit credentialing board, dedicated to the advancement and promotion of excellence in wound care and ostomy management. NAWCO is the largest and fastest growing credentialing organization in the field of wound care and ostomy management for Nurses, Nurse Practitioners, Physical Therapists, Physical Therapy Assistants, Occupational Therapists, Occupational Therapy Assistants, Registered Dietitians/Registered Dietitian Nutritionists, Physician Assistants, and Physicians. For more information about NAWCO certifications, visit

Finesse Medical expands to create 200 jobs in Longford

Longford-based manufacturing company Finesse Medical, which was acquired by New York-listed Avery Dennison in a multimillion-euro deal last May, is to create 200 jobs locally over the next four years.


The news was announced as its parent said it planned to expand its medical product manufacturing operations at the Longford facility.


Avery Dennison said on Thursday that construction on a 6,000sq m facility expansion that will include a new clean room, integrated converting and manufacturing capabilities, will begin in September.


Set up in 2004, Finesse makes products for wound care and skin treatment, including skin barrier films and protection creams, and silicone and polyurethane foam wound dressings. It manufactures on behalf of a number of customers and posted revenues of about €15 million over the past year … read more



Hemoglobin A1c Levels Not Tied to Wound Outcomes

HealthDay News — 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.


Betiel K. Fesseha, MD, from Johns Hopkins University in Baltimore, and colleagues retrospectively evaluated the association between A1C and wound outcomes in 270 patients with 584 DFUs over a study period of 4.7 years… read more



Factors associated with amputation among patients

with diabetic foot ulcers in a Saudi population




A prospective study was conducted at the Armed Forces Hospital, Dhahran, Saudi Arabia, between January 2015 and December 2016 to identify the risk factors associated with amputation among diabetic foot ulcers DFUs patients.


In total, 82 patients were recruited. Fifty-five of the patients were males (67.07%), the mean (SD) age of the participants was 60 (± 11.4) years, the mean duration of diabetes was 8.5 (± 3.7) years, and the mean haemoglobin A1c was 4.8 (± 2.8)%. In Univariate analysis, older age and high white blood cell count (WBC) were factors associated with amputation (OR = 1.1, 95% CI = 1–1.1, P = 0.012; and OR = 383, 95% CI = 7.9–18,665, P = 0.003, respectively). On the other hand, an ischaemic ulcer was half as likely as a neuropathic ulcer to lead to amputation (OR = 0.5, 95% CI = 0.3–0.9, P = 0.036), and a higher Wagner’s grade was found to be protective against amputation OR = 14.5, 95% CI = 4.3–49.4, P < 0.001. In conclusion, the current study showed that although a number of factors have been described to complicate diabetic ulcers by different researchers, none of those factors were identified in our study apart from older age and high WBC.


Diabetes mellitus is a common endocrinopathy known for its various complications, including diabetic foot ulcers (DFUs) which often result in amputated limbs [1]. The prevalence of foot ulcers among patients with diabetes mellitus ranges from 4 to 10%, and its lifetime incidence may reach up to 25% [2]. Conservative management of DFU may be affected by proper offloading of the wounds, correct daily foot hygiene, and impaired distal vascular flow. Treatment of a DFU is difficult; it frequently gets infected, and it is therefore a very common cause of hospitalization [3]. Diabetes mellitus increases the risk of lower extremity amputations (LEAs) by up to 56% over 5 years, and … read more

HMP’s EMS World Expo Recognized as one of the Top 25

Fastest-Growing Trade Shows in Attendance by Trade Show News Network


HMP, a leading healthcare education and events company, today announced that its EMS World Expo has been recognized as one of the “Top 25 Fastest-Growing Shows in Attendance” by Trade Show News Network (TSNN). The list represents trade shows held between 2015-2017 and is ranked by overall attendance growth over that period. Winners will be honored during the 2018 TSNN Awards, taking place August 10-12 in Louisville, Kentucky.


Owned and produced by HMP, EMS World Expo is the largest EMS-dedicated event in the world and annually attracts thousands of emergency medical technicians and paramedics. With more than 250 educational sessions, EMS World Expo sets the standard in EMS education, offering the latest information, tools, technologies, and trends in prehospital care.


“Being recognized by Trade Show News Network as one of the fastest-growing trade shows in the U.S. is a great honor,” said Joshua D. Hartman, MBA, NRP, vice president, public safety division, HMP. “The growth reflects our commitment to providing quality education in prehospital care to EMS professionals in the U.S., and around the world.”


In 2017, more than 5,700 attendees from 50 countries participated in EMS World Expo. In addition to a trade show floor spanning 70,900 sq. ft., the 2017 exposition featured more than 360 exhibitors showcasing innovative products, services, and technologies to improve patient care, enhance provider safety, and increase operational efficiencies.


The 2018 EMS World Expo will take place October 29-November 2, in Nashville, Tennessee. For more information, visit


About EMS World Expo
As the largest EMS-dedicated event in the world, EMS World Expo, hosted in partnership with the National Association of Emergency Medical Technicians (NAEMT), annually attracts more than 5,700 EMS professionals. EMS World Expo sets the standard in EMS education, offering the training professionals need to do their jobs today, with the progressive curriculum and technology that provides the solutions for tomorrow.


About HMP
HMP is the force behind Healthcare Made Practical—and is a multichannel leader in healthcare events and education, with a mission to improve patient care. The company produces accredited medical education events and clinically relevant, evidence-based content for the global healthcare community across a range of therapeutic areas. Its brands include Consultant, the monthly, award-winning journal relied upon by primary care providers; Psych Congress, the largest independent mental health meeting in the U.S.; and the Symposium on Advanced Wound Care (SAWC), the largest wound care meeting in the world. For more information, visit

Original post in PRWeb

Wound Documentation Standards to Help Avoid Legal Issues

Medical providers, and especially wound care providers, seem to always be under the looming shadow of lawsuits and legal issues. I have written about this before, but it continues to be an issue as I receive requests for legal reviews repeatedly. I have read many charts for legal reviews, and it actually is very straightforward to avoid or mitigate any legal problems.


Important Steps to Take When Documenting a Wound

1. If you have a wound protocol, follow it or document why you didn’t. For example, if your protocol says a bed or chair bound patient on admission is high risk, then treat them as high risk, or document why you didn’t.

2. If you use an assessment tool such as Braden Scale or Norton Scale, be sure you know how to use it properly, and use it per protocol.

3. Document all calls to a physician and the response.

4. If there is a physician order, follow it and document that you adhered to the order.

  • For example, if an order says to notify physician if there is blood in the urine and you see blood in the Foley catheter, notify the physician and document that you did notify them and what the response was.

5. If you notice a change in your patient, report it to the proper person. For example: the patient has stopped eating normally, or the patient is acting differently. In an elderly patient this could be the first sign of infection … read more

AmpliPhi Biosciences Will Utilize NIAID Preclinical Services to Advance

Development of Its Targeted Therapeutic Candidate for the Treatment of Resistant Staphylococcus Aureus


SAN DIEGO–(BUSINESS WIRE)–AmpliPhi Biosciences Corporation (NYSE American: APHB), a clinical-stage biotechnology company focused on precisely targeted bacteriophage therapeutics for antibiotic-resistant infections, today announced that it will utilize the Therapeutic Development Services funded by the National Institute of Allergy and Infectious Disease (NIAID), part of the National Institutes of Health (NIH), to conduct further preclinical studies of AB-SA01. The Therapeutic Development Services program funds the provision of preclinical services for selected companies and researchers in order to advance development of promising interventional agents.


“We are pleased and encouraged by the support from the NIAID and its commitment to studying the role of bacteriophage in combating infectious diseases,” said Paul C. Grint, M.D., CEO of AmpliPhi Biosciences. “This service will help support the development of bacteriophages as a much needed treatment for antibiotic-resistant infections.”


AB-SA01 is a 3-phage investigational therapeutic being developed for treatment of serious and drug-resistant Staphylococcus aureus (S. aureus) infections. In preclinical studies, AB-SA01 demonstrated broad activity against more than 96% of global S. aureus clinical isolates, including multidrug-resistant forms. AB-SA01 has completed two Phase 1 studies and has also been administered to patients under compassionate use guidelines in the U.S. and Australia for treatment of serious and life-threatening S. aureus infections … read more

Recombinant human epidermal growth factor (EGF) to enhance healing for diabetic foot ulcers

This paper studies the healing effect of recombinant human epidermal growth factor (EGF) on chronic diabetic foot ulcers. A total of 89 patients (65 male and 24 female) aged from 36 to 82 years (average of 54) enrolled for the prospective, open-label trial, crossover study. Predetermined criteria were used for diagnosis and classification of ulcer. The average duration of ulcer was 6 months (range from 3 to 27 months) prior to study. Upon study, the ulcers were debrided and treated with hydrocolloid or composite dressing depending on the condition of the wound. If treatment effect was minimal using advanced dressing for 3 weeks, patients were crossed over to twice-a-day treatment with 0.005% EGF and advanced dressing. Among the patients, 21 patients showed improvement using hydrocolloid or composite dressing alone and 68 patients were crossed over to treatment with EGF and advanced dressing. In the EGF-treated patients, complete healing was noted in 52 patients within an average of 46 days (range from 2 to 14 weeks). Recurrence was not noted during the 6-month observation. But 5 patients showed new lesions different from the prior site. Sixteen patients required further interventions. This paper suggests that topical treatment with EGF combined with advanced dressing may have positive effects in promoting healing of chronic diabetic foot wounds.

original article from PubMed

Heberprot-P: a novel product for treating advanced diabetic foot ulcer

Diabetic foot ulcer is a principal diabetic complication. It has been shown that diabetic patients have decreased growth factor concentrations in their tissues, particularly epidermal growth factor. Growth factor shortage impairs wound healing, which leads to chronic nonhealing wounds and sometimes eventual amputation. Ischemic diabetic foot ulcer is the most difficult to treat and confers the highest amputation risk. Injecting epidermal growth factor deep into the wound bottom and contours encourages a more effective pharmacodynamic response in terms of granulation tissue growth and wound closure. Epidermal growth factor injected into the ulcer matrix may also result in association with extracellular matrix proteins, thus enhancing cell proliferation and migration. Heberprot-P is an innovative Cuban product containing recombinant human epidermal growth factor for peri- and intra-lesional infiltration; evidence reveals it accelerates healing of deep and complex ulcers, both ischemic and neuropathic, and reduces diabetes-related amputations. Clinical trials of Heberprot-P in patients with diabetic foot ulcers have shown that repeated local infiltration of this product can enhance healing of chronic wounds safely and efficaciously. As a result, Heberprot-P was registered in Cuba in 2006, and in 2007 was included in the National Basic Medications List and approved for marketing. It has been registered in 15 other countries, enabling treatment of more than 100,000 patients. Heberprot-P is a unique therapy for the most complicated and recalcitrant chronic wounds usually associated with high amputation risk. Local injection in complex diabetic wounds has demonstrated a favorable risk-benefit ratio by speeding healing, reducing recurrences and attenuating amputation risk. Further testing and deployment worldwide of Heberprot-P would provide an opportunity to assess the product’s potential to address an important unmet medical need.

Article from PubMed

Approval for commercialization of Heberprot-P® in Mexico

Havana, Cuba, May 4, 2018 – Heberprot-P® has been approved for commercialization in México. The Center for Genetic Engineering and Biotechnology (CIGB) is excited to announce regulatory approval of this innovative medicine indicated for advanced diabetic foot ulcer (DFU), which is expected to save thousands of people from lower limb amputation. The official approval date of Heberprot-P® was April 30th, 2018. Heberprot-P® stimulates granulation, accelerates DFU re-epithelization, and reduces healing time, surgical debridement, amputation risk, and recurrences. The intralesional infiltration of Heberprot-P® may be applied in combination with Good Wound Care (GWC), revascularization, and antibiotics. This medicine is an effective solution for an unmet medical need, a first in class product, unique worldwide, for DFU treatment. It is the only therapeutic choice available for advanced and complex DFU, reluctant to healing (grades 3, 4, and 5, according to Wagner’s classification).


Clinical experience derived from the intervention with Heberprot-P® in daily medical practice in Cuba was analyzed in 2013 in a study that reviewed the evolution of more than 2 000 patients as well as the pharmacovigilance of 1 788 patients, showing a 75% probability of granulation response, 61% healing rate, 71% amputation risk reduction, Bayes’ favorable factor (5.40), and complete granulation in 76% of ulcers in 5 weeks (Adv. Pharmacoepidem. 2013, 2 (2): 1000128; BMC Pharm. & Toxicol, 2013, 14: 44). The International Working Group of Diabetic Foot (IWGDF) evaluated results of the clinical trial performed with Heberprot-P® in Cuba and reported in 2009 as promising, highlighting the results obtained in only 2 weeks of treatment (Diabetes Metab Res Rev 2012; 28 (Suppl 1): 119-141).


In a later systematic review, clinical trials comparing the use of growth factors with GWC (Cochrane Database of Systematic Reviews 2015, Issue 10, Art. No. CD008548), the IWGDF’s evaluation was reported on all major issues and requirements of Heberprot-P® clinical trials in Cuba. Similar criteria were expressed by the IWGDF in the guidelines on DFU healing (IWGDF Guidance, 2015: 10). A fourth study reported similar observations on the intralesional EGF infiltration method: “… a highly significant difference between groups in the prevalence of granulation tissue after just 2 weeks” (Diabetes Metab Res Rev 2016; 32 (Suppl 1): 154- 168).


Results of clinical studies performed in Cuba, Russia, Turkey, Vietnam, Argentina, Mexico, and Ukraine were enough to demonstrate safety and efficacy profile of Heberprot-P®. This medicine has been used in more than 290 000 patients with diabetic foot ulcer (DFU) in Russia, Belarus, Georgia, Ukraine, Turkey, Algeria, China, Panama, Argentina, Cuba, Dominican Republic, Venezuela, Ecuador, Libya, Uruguay, Paraguay, Colombia, Guatemala, Philippines, Vietnam, Nicaragua, Saudi Arabia, Indonesia, Seychelles, Saint Lucia, Saint Vicente, Sri Lanka, Jordan, and Kuwait.


A national survey of health and nutrition in Mexico reported that prevalence of diabetes is 9.4% of total population, which sums up more than 11 million people, 9.1% of adult diabetic suffers DFU, and amputation is indicated to 5.5% of adult diabetics (National Survey of Health and Nutrition, INEGI 2016). According to recent reports, lower limb amputation is the unique alternative for 45% of diabetics with advanced DFU in Mexico (Diabet. Foot. Ankle. 2017 Sep 6, 8 (1): 1367210). In a previous study, similar results were reported: 42% patients with advanced DFU required major amputation (Wound Repair & Regen. 24 (5): 923-927).
Written by Jose A. Buxado, MSc., Assistant Researcher, CIGB.


The Center for Genetic Engineering and Biotechnology of Havana is an institution devoted to research, development, manufacturing, and commercialization of products and technology derived from life science.


Alyane Vazquez González, BA., Communication & Media, e-mail: Ave 31 e/ 158 y 190, Playa, P.O. Box 6162, Habana 10600, Cuba.


This release was published on openPR.

Diabetes UK commits £2.6 million to new research

  • New funding will be split between 14 new research projects and five new PhD grants
  • New research includes projects investigating whether medieval remedies can be used to treat foot ulcers, and if sleep disturbances can predict Type 2 diabetes

Diabetes UK has committed to invest £2.6 million in 19 brand new projects which aim to make life-changing improvements in diabetes care, and reduce people’s risk of Type 2 diabetes.


The funding will be given to projects looking into Type 1, Type 2 and gestational diabetes. In one of these projects, Dr Freya Harrison, from the University of Warwick, will be using medieval remedies to find new sources of antibiotics. She has already discovered a combination that can kill antibiotic-resistant bacteria in the lab. Dr Harrison will study this remedy further to investigate how it works and if it could be used to treat infected foot ulcers in the future.


There are more than 20 leg, foot and toe amputations each day due to diabetes, four out of five of which could be prevented. This research hopes to reduce the number of diabetes-related amputations and cases of sepsis, by treating foot ulcer infections more effectively.


Dr Martin Rutter, from the University of Manchester, has also been awarded Diabetes UK funding to find out if sleep problems can help predict who might be at risk of Type 2 diabetes. He will also look at whether sleep patterns in people with Type 2 diabetes can affect their blood glucose control, and their risk of serious diabetes-related complications, such as amputation, heart disease and blindness … read more

High School Senior Awarded Scholarship for Creating an Orthotic

that detects and prevents diabetic foot ulcers.


Western Albemarle high school senior Meg Richey is awarded a scholarship at the 18th annual Emily Couric Leadership Forum at the Omni Charlottesville Hotel on Wednesday. Richey, who will attend Stanford University, was awarded a scholarship of $30,000 for her work creating an orthotic that detects and prevents diabetic foot ulcers.

Meg Richey was this year’s main award winner, and she received a $30,000 scholarship.


A senior at Western Albemarle High School who plans to study computer science at Stanford University, Richey has a provisional patent for a medical device and is the youngest person to study at the University of Virginia’s Biomedical Engineering Design Lab.


Her device, named after her childhood bus driver, Mike Morris, was envisioned after Morris died after developing a diabetic foot ulcer.


“He was the first and last person we saw during the day,” Richey said. “It was so important, especially in middle school, to feel like someone genuinely cared.”


The Morris Orthotic is a custom foot insole with sensors that detect changes in pressure at the bottom of a diabetic patient’s foot. Possibly the first custom-fit orthotic with sensor technology, it might alert a patient to life-threatening conditions that are hard to detect … read more

Effectiveness of using a new polyurethane foam multi-layerdressing

in the sacral area to prevent the onset of pressure ulcerin the elderly with hip fractures: A pragmatic randomisedcontrolled trial


Hip fractures in the elderly are a serious problem for the health service due to the highrate of complications. One of these complications is pressure ulcers that, according to the literature, occur in 8.8% to 55% of patients and mainly arise in the sacral area.The present randomised controlled trial tests whether applying a new innovativemulti-layer polyurethane foam dressing (ALLEVYN LIFE™), reduces the onset ofpressure ulcers in the sacral area. From March to December 2016, 359 fragility hipfracture patients were randomly divided into 2 groups: 182 in the control group and177 in the experimental group. Pressure ulcers occurred overall in 36 patients (10%):8 patients (4.5%) in the experimental group compared to 28 (15.4%) in the controlgroup:P= 0.001, relative risk 0.29 (95% CI 0.14-0.61) with NNT of 9 (95% CI 6-21). In the experimental group the onset of pressure ulcers occurred on average onthe 6th day compared to the 4th day in the control group (HR 4.4). Using polyure-thane foam is effective at reducing the rate of pressure ulcers in the sacrum in elderlypatients with hip fracture. The adhesiveness of this device also enables costs to be kept down … read more

Protecting Periwound Skin in Chronic Wounds

The periwound is as important as the wound. As clinicians, we should carefully assess the wound bed, but we need to remember also to assess the periwound and surrounding skin. The periwound should be considered the 4cm of surrounding skin extending from the wound bed. Chronic wounds may manifest any of the following characteristics, depending on wound type: erythema, induration, epibole, ecchymosis, hyperkeratosis, and changes in shape.

Five-Step Periwound Assessment

  1. Temperature
  2. Location
  3. Shape
  4. Color
  5. Wound depth

The temperature of the periwound can be a good indicator of whether active infection is present or to determine whether there is normal blood flow. The back of the hand is most accurate … read more

Healogics, Inc. Names Allan Woodward

MBA as New Chief Financial Officer


JACKSONVILLE, Fla.–(BUSINESS WIRE)–Healogics, the nation’s largest provider of advanced chronic wound care services, today announced that it has appointed Allan Woodward to serve as Chief Financial Officer. In this role, Woodward will be responsible for the planning and oversight of the financial strategy for the company, the ongoing development of appropriate control systems and all reporting measures. Woodward will report directly to the Chief Executive Officer, David Bassin.


“Allan’s extensive experience in financial leadership roles, combined with his knowledge of the healthcare industry makes him an invaluable asset to our team. We are thrilled to welcome him as our new CFO,” said Bassin.


Over the course of his career, Allan has held several financial leadership roles in healthcare-based organizations. His most recent experience includes his service at eviCore Healthcare as the Senior Vice President of Finance and Strategy over the post-acute care and consumer engagement programs. He was responsible for all financial activities of the business unit, including the creation of financial structures for all product expansions and the development of alternative provider reimbursement initiatives.


Woodward earned his MBA from the University of Missouri and his Bachelor of Science from Middle Tennessee State University … read more

An evaluation of an ultrasonic debridement system

in patients with diabetic foot ulcers: a case series


Ferdinando CampitielloMD , Manfredi ManconeMD , Angela Della CorteMD , Raffaella GuernieroMD , Silvestro Canonico


This study evaluated the use of ultrasonic debridement in patients with diabetic foot ulcers (DFU).


In this prospective, single-arm, open-label study, all patients with DFUs underwent wound debridement by ultrasonic debridement system (SonicOne OR Ultrasonic debridement system). Wherever possible, the edges were approximated by means of stitches. In other cases, the surgical breach healed by secondary intention, or a partial thickness skin graft (with or without Integra Dermal Regeneration Template or Integra Flowable Wound Matrix) was applied, and subsequently healed by primary intention … read more

Sucrose octasulfate wound dressing may speed healing in diabetic foot ulcers

Patients with a noninfected neuroischemic diabetic foot ulcer were more likely to achieve wound closure within 20 weeks when randomly assigned a sucrose octasulfate dressing vs. those assigned a standard wound dressing, according to findings published in The Lancet Diabetes & Endocrinology.


“Delayed wound healing in neuroischemic diabetic foot ulcers has been related to excess matrix metalloprotease concentrations; these proteins destroy components of the extracellular matrix and damage growth factors and their receptors that are essential for healing,” Michael Edmonds, MD, of the Diabetic Foot Clinic at King’s College Hospital in London, and colleagues wrote. “Sulfated oligosaccharides are known to have many biological activities; in particular, the potassium salt of sucrose octasulfate has been shown to inhibit matrix metalloproteases and to interact with growth factors and restore their biological functions because it has high charge density.”


Edmonds and colleagues analyzed data from 240 patients with diabetes and a noninfected neuroischemic diabetic foot ulcer of grade IC or IIC, with a wound  … read more

To evaluate the efficacy of an acellular Flowable matrix

in comparison with a wet dressing for the treatment of patients with diabetic foot ulcers: a randomized clinical trial


The authors aimed to evaluate the efficacy of an advanced wound matrix (Integra Flowable Wound Matrix, Integra LifeScience Corp, Plainsboro, NJ, USA) for treating wounds with irregular geometries versus a wet dressing in patients with diabetic foot ulcers. Sixty patients with diabetic foot ulcers (Grades 3 Wagner) were included in this randomized clinical trial. The study was conducted in the General Surgery Unit and Geriatric of the Second University of Naples, Italy, in the last 12 months. Forty-six cases of diabetic foot ulcers were equally and randomly divided into control and test groups. The first group treated with Integra Flowable Wound Matrix, while the control group with a wet dressing. Both groups were evaluated once a week for 6 weeks to value the degree of epithelialization and granulation tissue of the wound. The complete healing rate in the whole study population was 69.56% (Integra Flowable Wound Matrix group, 86.95%, control group, 52.17%; p = 0.001). Amputation and rehospitalization … read more

New hope for treating diabetic wounds that just won’t heal

Mice bred without TSP2 protein heal faster, suggesting a new target for better treatments


One of the most frustrating and debilitating complications of diabetes is the development of wounds on the foot or lower leg. Once they form, they can persist for months, leading to painful and dangerous infections.


New research uncovers the role of a particular protein in maintaining these wounds and suggests that reversing its effects could help aid wound healing in patients with diabetes.


“We discovered that a specific protein, thrombospondin-2 (TSP2), is elevated in wounds of patients with diabetes as well as in animal models of diabetes,” said Britta Kunkemoeller, a doctoral student at Yale University who conducted the study. “To determine whether TSP2 contributes to delayed wound healing, we genetically removed TSP2 from a mouse model of diabetes and observed improved wound healing. Our study shows that TSP2 could be a target for a specific therapy for diabetic wounds.” … read more

Lower Extremity Amputation and Reamputation Predictors

Temple University School of Podiatric Medicine Journal Review Club
Editor’s note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article Title: Predictors of Lower Extremity Amputation and Reamputation Associated With the Diabetic Foot
Authors: Erdinc Acar MD, Burkay Kutluhan Kacıram, MS
Journal name and issueThe Journal of Foot & Ankle Surgery 56 (2017) 1218–1222
Reviewed by: Anthony Samaan, Class of 2018, Temple University School of Podiatric Medicine


A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.


The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included …  read more

HbA1c, wound healing unrelated in diabetic foot ulcers

Among patients with long-term diabetic foot ulcers, neither baseline HbA1c nor change in HbA1c was associated with wound healing time, according to findings from a clinic-based observational study.


“Although we know that chronic hyperglycemia leads to neuropathy and peripheral vascular disease, which are the proximal risk factors for diabetic foot ulcers, we did not see a clear association between HbA1c levels and wound healing in patients who have developed foot ulcers,” Nestoras Mathioudakis, MD, MHS, assistant professor of medicine and clinical director, division of endocrinology, diabetes and metabolism at Johns Hopkins University School of Medicine, told Endocrine Today. “It is likely that the damage induced by chronic hyperglycemia reaches a point where it cannot be reversed in a relatively short time frame to improve wound healing.”

read more

Amniotic membrane can be a valid source for wound healing


Amniotic membrane (AM) can promote proper epithelialization with suppression of excessive fibrosis by creating a supportive milieu for regeneration of chronic ulcer bed.


The objective of this study is to investigate whether AM scaffold can modulate the healing of a wound by promoting tissue reconstruction rather than promoting scar tissue formation.

Subjects and methods

AM was obtained and prepared and then applied to patients with chronic leg ulcers who were randomly divided into two different groups. Group I (control group) included eleven patients in whom ulcers were treated with conventional wound dressings that were changed daily for 8 weeks. Group II (study group) included 14 patients in whom the AM was placed in contact with the ulcer and held in place with a secondary dressing, which was changed daily. Follow-up was done to detect healing rate and detection of ulcer size, assessment of pain, and to take ulcer images (days 0, 7, 14, 21, 30, 45, and 60).


In group I, all ulcers showed no reduction in their size, and ulcer floor remained the same. Healthy granulations were present in two ulcers (18.2%) and absent in nine ulcers (81.8%). There was no improvement of pain level in the eleven ulcers. In group II, complete healing of 14 ulcers occurred in 14–60 days with a mean of 33.3±14.7; healing rate range was 0.064–2.22 and the mean 0.896±0.646 cm2/day. Healthy granulations were present in 13 ulcers (92.9%) and absent in one ulcer (7.1%). Three ulcers (21.4%) were of mild severity (grade 1 ulcers) while eleven ulcers (78.6%) were of moderate severity (grade 2 ulcers). The healing rate was faster in ulcers of mild severity (1.7±0.438 cm2/day) in comparison to ulcers of moderate severity (0.673±0.498 cm2/day). Eleven cases (78.6%) showed improvement in their pain level on a scale from 0 to 10.


AM graft can be of value in wound healing. Further studies are needed to confirm these findings.

Keywords: amniotic membrane, ulcer, placenta, cesarean section


Amniotic membrane (AM) is an attractive method of grafting for wounds as it has unique properties, including anti-inflammatory effects, bacteriostatic, wound protection, decreased scarring, and pain reduction properties, as well as epithelialization initialization capacities. Furthermore, AM is widely available and less costly than other bioengineered skin substitutes. Human AM was used for 2,308 ophthalmologic reconstructions in Germany 2008. Its special success in ophthalmology may be due to the immune privileged properties of the AM.


The anti-inflammatory property of AM seems to be a result of production of anti-inflammatory proteins and reduction of expression of transforming growth factor B and pro-inflammatory cytokines, such as interleukin. Also, AM produces B defensins, elastase inhibitors, elastin, and lactoferrin that contribute to its anti-inflammatory and antimicrobial effects. The reduction in scarring after application of AM to wounds might be due to the anti-inflammatory effects, acceleration of epithelialization, and inhibition of fibrosis. Accelerated reepithelialization was also demonstrated by Maral et al after covering split thickness skin graft with AM in rats. Loeffelbein et al demonstrated accelerated formation of basement membrane in wounds treated with AM that might be due to the release of growth factors. One of the most important properties of AM as a skin substitute is pain relieving which may be due to diminished inflammation, better hydration of wound bed, and protection of exposed nerve endings. AM expresses few antigens, which accounts for its good tolerability and the absence of rejection reactions. AM expresses many neurotrophic and angiogenic factors: endothelin-2 and -3, vascular endothelial growth factor, vascular endothelial growth factor-B, Tie-2 angiopoietin receptor, ephrin-A2, ephrin receptors A2, B1, B3, B4, B5, neuropilin-2, nerve growth factor receptor, and semaphorin-F19 as well as erythropoietin and its receptor that contribute to healing of wounds. Some studies demonstrated the effectiveness of AM graft for healing of wounds. Mermet et al put an AM graft for 15 chronic leg ulcers and healing occurred in all patients. Pesteil et al used cryopreserved AM in eight patients with resistant vascular ulcers. Tolerance to the graft was excellent with healing of six out of eight patients with significant improved pain. Alsina-Gibert and Pedregosa-Fauste used AM for four refractory ulcers with a mean 81.93% reduction of ulcer size after 16 weeks. Litwiniuk et al suggested the potential role of matrix metalloproteinase inhibitors present in radiation-sterilized amnion dressing in healing of 23 out of 25 patients with chronic venous ulcers. Sheikh et al used dehydrated amnion to provoke healing of chronic wounds in four patients and healed wounds did not recur on long-term follow-up. A similar study was done by Zelen et al who used dehydrated AM in diabetic foot ulcers with complete healing of 37 out of 40 ulcers. With respect to the low cost, wide availability, and easy preparation, AM can be an ideal graft for chronic refractory ulcers.

Subjects and methods

Study design

This was an experimental, comparative, and randomized clinical trial.

Description of patients and collection of data

This study was performed to test a technique for the treatment of chronic nonhealing wounds using AM to express its effect on the rate of healing of such nonhealing ulcers. Patients were recruited from the outpatient clinics or the inpatient wards of the Department of General Surgery, Faculty of Medicine, Cairo University and Department of Vascular Surgery, Faculty of Medicine, Assiut University from June 2012 to June 2015. Each patient signed an informed consent after accepting to be enrolled in the study. Ethical aspects whether substantial or procedural have been implicated in this study and approval was obtained from the Faculty of Medicine, Ethical Committee of Cairo University (30-9-2012).


Patients were then randomly divided into two different groups. Group I (the control group) included eleven patients with eleven chronic leg ulcers in whom ulcers were treated with conventional wound dressings that were changed daily for 8 weeks. Group II (the study group) included 14 patients with 14 chronic leg ulcers. The AM was placed in contact with the ulcer and held in place with a secondary dressing, which was changed daily. Inclusion criteria were presence of leg ulcers for more than 3 months with no improvement despite standard treatment and age between 26 and 43 years. Exclusion criteria were ulcers with ongoing active infection and presence of diabetes. Full history taking and clinical assessment were done with special reference to previous treatment and surgery, diagnosed diabetes and/or hypertension, causes, types, and duration of ulcers present.


The follow-up during treatment period includes assessment of ulcer healing and pain. Ulcer healing was assessed using the percentage of the healed wound area and healing rate. Using ImageJ program (Rasband, W.S., ImageJ, US National Institutes of Health, Bethesda, Maryland, USA), the wound areas were analyzed and a percentage of the healed wound area was calculated, in respect to the original wound area and the final wound area after 2 weeks and at the end of 2 months according to the formula:


Percentage of healed wound area=Original wound areaFinal wound areaOriginal wound area×100
The healing rate was then determined, in respect to the original wound area, and the final wound area reached according to the formula:
Healing rate=Original wound area-Final wound areaTime cons uumed to reach final wound area

The wound area is calculated by the formula for determining the area of an ellipse ((length × width) × π/4). Results of measured ulcer area size were used for follow-up, and ulcers were categorized with respect to surface area, exudate, and type of wound tissue. A comparison of total measurements over time provided an indicator of improvement or deterioration in ulcer healing. Pain was assessed using a visual analog scale, where 0 represented no pain and 10 represented the worst pain. Each patient has a special file in which all the data were present. Then, merging of data of all patients was done before statistical analysis.

AM isolation, preservation, grafting, and follow-up of patients

Human AM was prepared from placentae obtained from scheduled delivery by cesarean section following a noncomplicated pregnancy. Exclusion criteria were symptoms of infection in the newborn, delivery before 34 weeks gestation, and membrane rupture more than 12 hours before delivery. The donors gave written informed consent for the donation and use of the AM. One placenta can provide four to five AM tissue fragments 5 cm in diameter.


Preparation was performed in a classified (class D) room with a microbiological safety workstation (class A). The placenta was washed with physiological saline and left in contact with an antibiotic solution in its collection container until preparation within 2 hours of the cesarean delivery. The entire membrane structure was immersed in a sterile packing container. The AM is mixed with antibiotics and antifungal in the container. The AM was then cut into different sizes and AM tissue fragments were obtained (Figure 1). For cryopreservation of AM, a cryoprotective agent was added (Roswell Park Memorial Institute medium [RPMI] and glycerol), and then stored in a temperature of −80°C with each piece of the AM stored in a separate container. Three AM samples are collected for bacteriological examination. The placenta rinse fluid (8–10 mL) was used to inoculate two vials of aerobic and anaerobic organisms for bacteriological testing. The placenta was also prepared for a pathological evaluation. On the day of the cesarean section, test tubes containing blood from the mother were collected for the following serology tests: HIV-1 and -2, Ag p24, HCV, HTLV; syphilis: VDRL-TPHA; and HBV: HBs antigen-HBc antibody. Final validation of the AM was performed after a repeat serology test by testing again the donor woman after 120 days. Before use, the AM can be transported to hospital and stored on dry ice up to 24 hours and conserved up to 2 hours in normal saline at room temperature after thawing before utilization.

An external file that holds a picture, illustration, etc. Object name is ijwh-8-225Fig1.jpg

Figure 1

Preparation of amniotic membrane pieces.

The preparation of the ulcers includes cleaning and mechanical debridement with a scalpel. The membrane preservation solution was removed by washing with physiological saline and the membrane was applied directly onto the ulcer bed (Figure 2). The graft was then covered with vaseline dressing (Figure 3). Patients were confined to bed for 2 hours and then allowed to do moderate activity for the next 5 days.

An external file that holds a picture, illustration, etc. Object name is ijwh-8-225Fig2.jpg

Figure 2

Amniotic membrane application over two leg ulcers.

Notes: Two leg ulcers in one patient (A); application of amniotic membrane over the leg ulcers (B and C); image of the patient after amniotic membrane grafting (D).

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Figure 3

Vaseline dressing is added over amniotic membrane and then covered with dressing.


Notes: Application of vaseline dressing (A and B); application of gauze dressing after vaseline (C); gauze wrapping at the end (D).


Follow-up was done to detect healing rate and detection of ulcer size, assessment of pain, and to take ulcer images (days 0, 7, 14, 21, 30, 45, and 60). Statistical analyses of all data were performed with SPSS software version 15.0 for Windows (SPSS Inc, Chicago, IL, USA). A two-sided value of P<0.05 was considered statistically significant for all analyses. Continuous variables are presented as mean ± standard deviation (SD).


Demographic data of the sample

All patients were males between 26 and 43 years. In group I, there were a total of eleven leg ulcers. Age ranged from 26 to 43 years with a mean value 34.45±7.03. Nine ulcers (81.8%) were venous ulcers, while two ulcers (18.2%) were traumatic ulcers. In group II, there were a total number of 14 leg ulcers. Age ranged from 26 to 43 years with a mean value 32.86±6.94. Twelve ulcers (85.7%) were venous ulcers, while two ulcers (14.3%) were traumatic ulcers. All patients of groups I and II were nondiabetics, with no history of smoking, hypertension, or any other medical condition.

Results of the study

Only conventional treatment was performed for the control group. Chronicity of leg ulcers varied from 24 to 60 months. The ulcer area at the beginning of the study was 4.8±0.65 cm2 (mean ± SD). Mean percentage of healing rate was 0%, and all ulcers in this group showed no reduction in their size (Tables 1and ​and 2), and ulcer floor remained the same. Healthy granulations were present in two ulcers (18.2%) and absent in nine ulcers (81.8%). There is no improvement of pain level in the eleven ulcers (Table 3).

Table 1

Chronicity of leg ulcers, reduction in ulcer size with treatment, and healing rate

Parameters of healing Group I Group II
Chronicity of leg ulcer (range) 24–60 months 24–84 months
Chronicity of leg ulcer (mean + SD) 45.82+14.01 months 50.57+16.43 months
Reduction of ulcer size with treatment 0% 100% reduction in size
Reduction of ulcer size with treatment (mean + SD) 0.0+0.0 100.0+0.0
Healing rate cm2/day (range) 0.0–0.0 0.064–2.22
Healing rate cm2/day (mean + SD) 0.0+0.0 0.896±0.646

Abbreviation: SD, standard deviation.

Table 2

Percentage of healed ulcers

Ulcer healing Group I Group II
No healing 11 100% 0 0%
Complete healing 0 0% 14 100%
Incomplete healing 0 0% 0 0%

Notes: Group I included patients without amniotic membrane application; while Group II included patients with amniotic membrane application.

Table 3

Pain level improved or remained the same from day 0 till the end of study

Pain level Group I Group II
No pain 0 0.0% 3 21.4%
Improved 0 0.0% 11 78.6%
The same 11 100% 0 0.0%

In the study group, the AM was directly applied on leg ulcers. This group included 14 leg ulcers. Chronicity of leg ulcers varied from 24 to 84 months. The ulcer area at the start of the study was 5.1±0.48 cm2 (mean ± SD). Results obtained from the study group showed complete healing of 14 ulcers in 14–60 days with a mean of 33.3±14.7; healing rate range was 0.064–2.22 and mean 0.896±0.646 cm2/day with a 100% reduction in ulcer size. Ulcer floor improved in all ulcers. Healthy granulations were present in 13 ulcers (92.9%) and absent in one ulcer (7.1%). Three ulcers (21.4%) were of mild severity (grade 1 ulcers) while eleven ulcers (78.6%) were of moderate severity (grade 2 ulcers). The healing rate was faster in ulcers of mild severity (1.7±0.438 cm2/day) in comparison to ulcers of moderate severity (0.673±0.498 cm2/day). Eleven cases (78.6%) showed improvement in their pain level on a scale from 1 to 10. Three patients had no pain (Tables 1​1–3; Figure 4). AM graft was taken in four cases (28.6%), while AM was not taken in ten cases (71.4%) in the days following the graft application. In these ten cases, the ulcers also showed complete healing on follow-up. Reduction in ulcer size shows significant difference between group I (control group) in comparison to group II (P=0.001) in which we used AM alone.

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Figure 4

Healing of two leg ulcers after amniotic membrane application.

Notes: Two leg ulcers in one patient (A); application of amniotic membrane on the two ulcers (B); reduction in size of both ulcers (C); complete healing of the upper ulcer and 70% reduction in the size of the lower one on follow up (D).


Chronic leg ulcers are defined as a defect in the skin, below the level of the knee and above the foot, persisting for 6 weeks or more. A previous study found that ~60%–80% of chronic leg ulcers had a venous component, 10%–30% was associated with arterial insufficiency, and other factors included diabetes mellitus and rheumatoid disease. Arterial and venous insufficiency combined in 10%–20% of cases.


Chronic leg ulcers often heal poorly if there is no revascularization. Different lines of treatment are based on optimized local wound care: cleansing, debridement and dressings, compression therapy, and skin grafting. AM graft can be used as placental tissues contain a large quantity of growth factors. Furthermore, AM downregulates transforming growth factor (TGF)-β and its receptor expression by fibroblasts and in doing so it reduces the risk of fibrosis. Therefore, an AM scaffold can modulate the healing of a wound by promoting tissue reconstruction rather than promoting scar tissue formation.


AM is a natural scaffold, which is the supporting matrix upon which cells and tissues grow, and so it is considered an important component of tissue repair with multiple clinical applications. In addition, the AM has other biological properties important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, and low immunogenicity as previously discussed. AM may thus be regarded as a bio-therapeutic product composed of a single layer of epithelial cells that lie on a basement membrane and of a nonvascular collagenous stroma. These three components give AM its beneficial properties, including antiadhesive effects, bacteriostatic properties, wound protection, pain reduction, and epithelialization effects.


The AM epithelial cells reside on the inner layer of the AM, while amniotic mesenchymal stromal cells form the outer layer.


Results obtained from our study group showed complete healing of 14 ulcers in 14–60 days with a mean of 33.3±14.7; healing rate range was 0.064–2.22 and mean 0.896±0.646 cm2/day with a 100% reduction in ulcer size. Ulcer floor improved in all ulcers. Healthy granulations were present in 13 ulcers (92.9%) and absent in one ulcer (7.1%). Three ulcers (21.4%) were of mild severity (grade 1 ulcers) while eleven ulcers (78.6%) were of moderate severity (grade 2 ulcers). Eleven cases (78.6%) showed improvement in their pain level on a scale from 1 to 10. AM graft was taken in four cases (28.6%), while AM was not taken in ten cases (71.4%).


The current study results were supported by the results of Mermet et al in a prospective pilot study, in which they evaluated the safety, feasibility, and the effects on healing of AM graft in 15 patients with chronic venous leg ulcers. The percentage of granulation tissue increased significantly (from 17% on day 0 to 69% on day 14, P<0.0001), along with a significant decrease of fibrinous slough (from 36% at day 0 to 16% at day 14, P<0.001). There was significant reduction in ulcer size and pain level as well. Also, Alsina-Gibert and Pedregosa-Fauste performed AM transplantation for four refractory vascular ulcers. Complete wound reepithelialization was achieved for one ulcer by week 8; in the other three cases, there was a 50% reduction in size compared to baseline. At week 16, the mean reduction in wound size for the four ulcers was 81.93%. The corresponding reduction in pain intensity was 86.6%. No adverse effects were observed.


To our knowledge, this is the first study to prove the possible efficacy of AM in treating nonvascular (traumatic) refractory wounds (two cases in this study) in addition to efficacy in treating vascular refractory ulcers (12 cases in this study) that was shown by previous similar studies. The limitation of this study is the small number that needs further studies to support it.


AM graft can be an ideal choice instead of tissue-engineered skin equivalents to be used in wound healing. In addition to being an excellent scaffold, it has unique biological properties that are important for tissue repair, including anti-inflammatory, antimicrobial, antifibrosis, antiscarring, as well as a reasonable cost and low immunogenicity. Furthermore, presence of its own progenitor cells help in tissue repair.

Recommendations and implications to practice

Further studies should be done to support this study results. Comparing AM with alternative allogeneic or autologous skin substitutes in a randomized study will be worthwhile to determine the best therapeutic option and establish the potential of using AM in the treatment of leg ulcers. Routine preparation and preservation of AM will be of great value in tissue repair programs and implementation of biotherapy especially in developing countries due to its efficacy and low cost.



The authors report no conflicts of interest in this work.


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Articles from International Journal of Women’s Health are provided courtesy of Dove Press


Extracellular Matrix Device Designed to Reinforce Soft Tissue in a Range of Implantable Settings


Columbia, MD—(April 11, 2018) – ACell, Inc. today announced the introduction of Gentrix Incisional, a new implantable device comprised of the company’s proprietary MatriStem UBM™ technology, designed to reinforce soft tissue in surgical site incisions.


Gentrix Incisional is an extracellular matrix that facilitates the remodeling of site-appropriate, functional tissue where scarring would be expected. The device provides a scaffold for cellular infiltration and neovascularization, and can be used to reinforce primary closure of soft tissue in a variety of surgical settings.


“Gentrix Incisional is ideal for surgical cases where there are concerns about the integrity of the soft tissue repair,” said Thomas W. Gilbert, Ph.D., Chief Science Officer. “It is targeted for patients and procedures where additional reinforcement of primary closure is desired.”


“We are excited to offer an additional tool to surgeons and their patients with the introduction of Gentrix Incisional,” said Patrick A. McBrayer, President and CEO. “This addition to our family of MatriStem UBM devices represents our continued commitment to providing innovative and effective solutions in the area of surgical soft tissue reinforcement.”


About ACell, Inc.

ACell, Inc. is a leading regenerative medicine company focused on the development, manufacturing, and commercialization of medical devices for wound management and surgical soft tissue repair. ACell is committed to becoming and remaining an innovative leader in regenerative medical technology, offering superior healing options for doctors and patients. ACell is a privately held company and operates manufacturing facilities in Columbia, MD and Lafayette, IN.


Angela Ortado

Download a PDF of this article

Surgical wound dehiscence: Improving prevention and outcomes

Surgical wound dehiscence (SWD) is almost certainly under-reported, not least because of variation in the interpretation of what constitutes SWD. As a result, patients with SWD may not receive optimal treatment and may experience additional surgical site complications, increased mortality, prolonged hospital stays and readmission. Following a meeting in July 2017, an international panel of clinical experts developed a consensus document to raise awareness of SWD, to aid identification of patients at increased risk and to provide practical guidance in prevention and management. This document has the endorsement of the World Union of Wound Healing Societies (WUWHS) and ultimately aims to improve outcomes for patients … read more

In Pressure Injury Prevention and Treatment,

Is It All About Protein?


by Nancy Munoz, DCN, MHA, RDN, FAND


The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury as localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can manifest as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure, occasionally in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and the condition of the soft tissue.1


Pathophysiologic and intrinsic factors at the core of pressure injury development include nutrition. Maintaining adequate nutrition is considered a best practice for both the prevention and treatment of pressure injuries … read more

Fresh hypothermically stored amniotic allograft in …

the treatment of chronic nonhealing ulcers: a prospective case series


Introduction Millions suffer from diffcult to heal ulcers worldwide. The incidence of chronic ulcers is increasing rapidly, fueled by an aging population, rising incidence in obesity, diabetes, and venous insuffciency. Diabetic foot ulcers (DFUs), VLUs, and nonhealing postsurgical wounds are among the most frequently encountered ulcers in wound care practice. In the United States, over 4.3 million diabetic patients will develop a DFU in their lifetime, and ~2.5 million individuals suffer from VLUs. DFUs add 1–4 $9–$13 billion to the direct yearly cost associated with diabetes itself. The annual 5 cost of VLUs is $2.5–$3.5 billion. Nonhealing surgical wounds are also commonly 6 seen in wound care clinics. Surgical wounds pose an increased risk for infection and contribute to the growing economic burden of wound care management.


In recent years, several clinical trials have been conducted to investigate products derived from human amniotic membranes (HAMs) as adjunctive therapies to accelerate of different layers – the epithelium, basement membrane, and stroma – and these layers further consist of three contiguous but distinct layers – the inner compact layer, the middle fbroblast layer, and the outermost spongy layer. The HAM has been shown to have anti-infammatory, antifbrotic, antiangiogenic as well as antimicrobial properties. Research has confrmed that growth factors present in amniotic membranes can induce angiogenesis and human dermal fbroblast proliferation as well as recruit multiple stem cells relevant to wound repair and regeneration. 9,10


A fresh hypothermically stored amniotic allograft (HSAM) may improve healing rates by preserving growth factors and living cells, including stem cells, as well as retaining the membrane’s native structure. HSAM is aseptically processed and stored in a proprietary hypothermic storage solution using the Allofresh™ (Organogenesis, Canton, MA, sisting of topical antimicrobials. His comorbidities consisted USA) process. 13


A case study was conducted to evaluate an HSAM (Organogenesis) in the treatment of chronic wounds. Information was collected on patient demographics, wound type, wound location, age of wound, comorbidities, previous treatments, and current treatments. All patients were informed of study procedures and consented to have their case details and any accompanying photographs published. Digital planimetry (ARANZ Medical, Christchurch, New Zealand) was used ateach visit to record the wound surface area. Previous and current treatments were recorded. Two of the patients presented with VLU and one had a postsurgical wound.


The VLU patients had previously received compression, and one patient had also received negative pressure wound therapy. The one with a surgical wound had received a variety of previous therapies, including topical silver, Hydrofera Blue, and topical antibiotics. The age of the wounds for the VLUs were 2–3 weeks, while the surgical wound was 5 months. Comorbidities for the VLUs consisted of venous insuffciency, diabetes, arthritis, osteomyelitis to ulcer location, hypertension, and lymphedema. Comorbidities for the surgical wound patient consisted of arthritis and hypertension. The new treatment regimen consisted of HSAM covered with a knotted cellulose acetate fabric dressing (Adaptic ; Acelity, San Antonio, TX, USA) and appropriate standard of care, including offoading, multilayer compression, and of care, including offoading, multilayer compression, and surgical debridement.


Case 1

A 62-year-old patient presented to the wound clinic with a postop foot wound (nondiabetic), right foot dorsum. The duration of the wound was 5 months, with previous treatments consisting of topical antimicrobials. His comorbidities consisted of arthritis and hypertension. On day 0, the wound area size measured 3.3 cm , with 50% granulation, 10% fbrin, 40% slough, and a moderate amount of light red/pink serosanguineous drainage. Moderate edema was present. A 2.5 cm × 2.5 cm HSAM was applied and fxed in place using Steri-Strips™ (McKesson Medical-Surgical, Londonderry, NH, USA). On day 21, the wound area reduced to 2.9 cm2, a 12.12% reduction. There was an increase in the percentage of granulation tissue as well. By day 42, the wound area size had reduced by 81.82% with 100% granulation, and healed on day 71 (Figure 1).

Figure 1 Case 1 surgical wound.
Note: (A) Day 0, 3.3 cm2 ; (B) day 71, 0 cm2.

Case 2 
A 57-year-old patient presented with a left lower extremity VLU on the medial malleolus. The wound had been present for 8 weeks. The treatment thus far consisted of compression and topical antimicrobials. His past medical history included chronic venous insuffciency, peripheral vascular disease, deep vein thrombosis, and hyperlipidemia. On day 0, the wound area measured 0.3 cm . HSAM (2.5 cm x 2.5 cm) was applied and held in place with Steri-Strips™ ( McKesson Medical-Surgical) and compression wrap. On day 7, the wound was completed closed with no drainage (Figure 2).

Figure 2 Case 2 venous leg ulcer.
Note: (A) Day 0, 0.3 cm2; (B) day 7, 0 cm2.

Case 3
A 70-year-old patient presented with a VLU on the medial right lower extremity. The wound had been present for 2 weeks. The medical history obtained from this patient revealed hypertension, lymphedema, type II diabetes, and chronic venous insuffciency. At the time of HSAM (2.5 cm × 2.5 cm) application, the wound area measured 1.0 cm . By day 7, the wound area was reduced to 0.4 cm , and by day 14, it achieved complete closure (Figure 3).

Figure 3 Case 3 venous leg ulcer.
Note: (A) Day 0, 1.0 cm2; (B) day 14, 0 cm2

Prompt treatment of chronic ulcers is essential in preventing complications, reducing the cost of care, and lessening the economic burden on the health care system. In clinical studies, amniotic membranes have been shown to be effective in promoting healing in chronic wounds. Prior products consisted of dehydrated products. We postulated that fresh amniotic membrane would demonstrate even greater effect. Prior to embarking on large expensive clinical trials, we tried the fresh amniotic product on a few selected patients. Results from this study suggested that HSAM may be an effective treatment option for management of VLUs and other non-healing wounds. HSAM offers a new treatment alternative to promote healing in chronic wounds. This membrane contains numerous growth factors and cytokines. These growth factors are found to be released over an extended period and result in increased cellular migration, proliferation, and remodeling. Moreover, HSAM may reduce the long-term costs associated with the care of chronic ulcers by increasing the healing rate and lowering the risk of infection and complications This pilot case series was subsequently used to inform larger DFU and VLU trials that are ongoing at the time of this writing.


Original Article – Dovepress


Caring for the Diabetic Foot in Long-Term Care Facilities


By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary


As a Director of Nursing (DON) in a long-term care facility, do you know where the awareness level of diabetes and its complications is for your staff? Do they realize diabetes doesn’t stop? It is 24/7, 365 days a year. Knowing this reality of diabetes and understanding the disease process may assist with preventing serious health problems such as heart disease, stroke, blindness, kidney disease, and nerve damage that can lead to amputation.


Education is key. We cannot talk about this enough. Assuming someone knows or that common sense will tell people how to take care of these residents is a huge mistake. I don’t believe in common sense; I believe in common knowledge, but it is only common once it is taught. So, teach about diabetes and the care of residents with diabetes often.


Knowing the Risk of Diabetic Foot Ulcers and Diabetic Peripheral Neuropathy
In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes. The percentage of Americans age 65 and older remains high, at 25.2%, or 12.0 million seniors (diagnosed and undiagnosed).1Diabetic foot ulcer (DFU) is the number one risk factor contributing to non-traumatic foot amputations in persons with diabetes. Limb amputations are preceded by DFUs 58% of the time. The primary risk factor for the DFU is loss of protective sensations or diabetic peripheral neuropathy (DPN) … read more

Toward Eliminating Diabetic Foot Amputation In The Next Generation

David G. Armstrong, professor of surgery at the Keck School of Medicine of USC

Humanity crossed a line in 2009: For the first time in history, more people in the last decade died from non-communicable disease than from all the plagues in the world combined. We’ve entered what science pundit Steve Jones has, in a rather macabre but perceptive manner, dubbed the Age of Decay.


First was the Age of Disaster — 95 percent of human history — when people died from starvation, accidents, violence and cold temperatures. Around 12,000 years ago, we learned to “circle the wagons,” if you will, as a species. As we became agrarian, we moved closer together to store food. A natural byproduct of this was the Age of Disease, when plagues decimated populations. We’re now in the Age of Decay, when the big killers are non-communicable diseases — cancer, cardiovascular disease and diabetes. Pulmonary disease is fourth.


The longer that I have labored in my line of work, the more I realize it is the height of hubris as a clinician to think that I can “fix” anyone. Rather, I think the best thing I can do is help folks move through the world a little bit better. Our goal in this age as clinicians, scientists, policymakers, is to think not about fixing everything but rather to delay decay.


We all rightly take cancer and heart attacks seriously. Diabetes, however, has not risen to that level. If one were an evil deity and wanted to sock it to humanity, one wouldn’t pick something like cancer or a heart attack. Those are often far too dramatic. One would rather choose diabetes: It is silent, sinister and it happens in the background. No one sees it coming. How, then, does diabetes cause amputations?

read more

Diagnosing A Pruritic Skin Lesion In

    A Patient With Diabetes And Edema


A 56-year-old man presented to our institution with the chief complaint of a scaly, pruritic lesion on the lateral aspect of his left lower leg. He would notice some mild bleeding when scratching the area. He denied having any other lesions on his body and there was no previous treatment.


The patient’s past medical history included type 2 diabetes with Charcot arthropathy and neuropathy, hypertension, atrial fibrillation, and deep venous thrombosis. His past surgical history was remarkable for cardiac ablation. The patient is married and does not use tobacco products. He admitted to rare consumption of alcohol.


The patient’s physical exam revealed a man who appeared healthy. The pedal pulses were palpable with capillary refill in less than two seconds to the digits. Mild edema and varicosities were present at the ankle region bilaterally. The neurologic exam with the 10-gram Semmes-Weinstein monofilament showed decreased sensation to the dorsal and plantar aspects of both feet … read more

Ultrasonic debridement system in patients with diabetic foot ulcers

     A case series

This study evaluated the use of ultrasonic debridement in patients with diabetic foot ulcers (DFU).


In this prospective, single-arm, open-label study, all patients with DFUs underwent wound debridement by ultrasonic debridement system (SonicOne OR Ultrasonic debridement system). Wherever possible, the edges were approximated by means of stitches. In other cases, the surgical breach healed by secondary intention, or a partial thickness skin graft (with or without Integra Dermal Regeneration Template or Integra Flowable Wound Matrix) was applied, and subsequently healed by primary intention … read more

Silver dressings improve diabetic wound healing without reducing bioburden

Introduction. Silver dressings are widely used in the treatment of chronic wounds to reduce bacterial bioburden. However, little is known about the mechanism of silver ions on the healing process. In this study, a mouse model of wound healing was used to examine the effect of silver dressings in normal and diabetic wounds.


Two 5-mm full-thickness wounds were created on the dorsal skin of diabetic BKS.Cg- m+/+Leprdb/J mice (experimental group) and wild type C57BL/6 mice (control group), and treated with either a silver or gauze dressing. Measurement of wound areas by digital planimetry demonstrated faster healing in the silver-treated wounds of both diabetic and control mice.


Quantitative bacterial cultures showed a reduction of bioburden in silver-treated wounds in wild type mice. Unexpectedly, there was no decrease in bioburden in the silver-treated diabetic wounds compared to the control diabetic wounds, despite improved healing in the silver-treated diabetic wounds. Staphylococcus xylosus, a known biofilm producer, was the only bacteria identified in all the wounds. In vitro studies showed S. xylosus produced biofilms faster in higher glucose environments; this may explain the increased bioburden in the wounds in diabetic mice compared to wild type mice.


The results demonstrate improved healing and reduced bioburden in normal wounds with silver dressings. In contrast, silver dressings improved healing in diabetic wounds despite no effect on bioburden, suggesting silver may have beneficial effects in addition to its antimicrobial properties.

Original article from The National Library of Medicine (NLM) 

The Neuropathic Diabetic Foot Ulcer Microbiome Is Associated With Clinical Factors


Nonhealing diabetic foot ulcers (DFUs) are a common and costly complication of diabetes. Microbial burden, or “bioburden,” is believed to underlie delayed healing, although little is known of those clinical factors that may influence microbial load, diversity, and/or pathogenicity. We profiled the microbiomes of neuropathic nonischemic DFUs without clinical evidence of infection in 52 individuals using high-throughput sequencing of the bacterial 16S ribosomal RNA gene. Comparatively, wound cultures, the standard diagnostic in the clinic, vastly underrepresent microbial load, microbial diversity, and the presence of potential pathogens. DFU microbiomes were heterogeneous, even in our tightly restricted study population, but partitioned into three clusters distinguished primarily by dominant bacteria and diversity. Ulcer depth was associated with ulcer cluster, positively correlated with abundance of anaerobic bacteria, and negatively correlated with abundance of Staphylococcus. Ulcer duration was positively correlated with bacterial diversity, species richness, and relative abundance of Proteobacteria, but was negatively correlated with relative abundance of Staphylococcus. Finally, poor glycemic control was associated with ulcer cluster, with poorest median glycemic control concentrating to Staphylococcus-rich and Streptococcus-rich ulcer clusters. Analyses of microbial community membership and structure may provide the most useful metrics in prospective studies to delineate problematic bioburden from benign colonization that can then be used to drive clinical treatment … read more

Biofilm infections between Scylla and Charybdis

Interplay of host antimicrobial peptides and antibiotics


Purpose: The aim of this study is to improve the anti-biofilm activity of antibiotics. We hypothesized that the antimicrobial peptide (AMP) complex of the host’s immune system can be used for this purpose and examined the assumption on model biofilms.


Methods: FLIP7, the AMP complex of the blowfly Calliphora vicina containing a combination of defensins, cecropins, diptericins and proline-rich peptides was isolated from the hemolymph of bacteria-challenged maggots. The complex interaction with antibiotics of various classes was studied in biofilm and planktonic cultures of Staphylococcus aureusEscherichia coliPseudomonas aeruginosaKlebsiella pneumoniae and Acinetobacter baumannii by the checkerboard method using trimethyl tetrazolium chloride cell viability and crystal violet biofilm eradication assays supplemented with microscopic analysis.


Results: We found that FLIP7 demonstrated: high synergy (fractional inhibitory concentration index <0.25) with meropenem, amikacin, kanamycin, ampicillin, vancomycin and cefotaxime; synergy with clindamycin, erythromycin and chloramphenicol; additive interaction with oxacillin, tetracycline, ciprofloxacin and gentamicin; and no interaction with polymyxin B. The interaction in planktonic cell models was significantly weaker than in biofilms of the same strains. The analysis of the dose–effect curves pointed to persister cells as a likely target of FLIP7 synergistic effect. The biofilm eradication assay showed that the effect also caused total destruction of S. aureus and E. coli biofilm materials. The effect allowed reducing the effective anti-biofilm concentration of the antibiotic to a level well below the one clinically achievable (2–3 orders of magnitude in the case of meropenem, ampicillin, cefotaxime and oxacillin).

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Complications in Chronic Wound Healing and

Associated Interventions


Overview of Chronic Wounds
Chronic non-healing wounds affect millions of patients each year and contribute significantly to their morbidity and mortality. These wounds have a substantial impact because of their economic burden and the significant effect on the reduction in quality of life, as well as the increased risk of death for those patients affected by them. A 2014 study of Medicare data showed that chronic non-healing wounds and associated complications affect nearly 15% or 8.2 million Medicare beneficiaries. The study also estimated the cost to treat these wounds at between $28.1 billion and $31.7 billion annually. The highest costs were associated with infected or reopened surgical wounds, and outpatient care had the highest site-of-service costs. In addition to being older, most of these patients have obesity and diabetes. Underlying causes often include diabetic foot ulcers, venous leg ulcers, arterial insufficiency, and pressure ulcers. The list of complications contributing not only to chronicity but also to further deterioration is quite lengthy.


Specific Wound Healing Complications and Interventions
The prevalence of chronic wounds and their complications has not been well documented in the literature. However underappreciated they may be, the complications associated with chronic wounds increase the cost—both financial and personal—to the individuals with these wounds.Although not an all-inclusive list, some of the more common complications include infection, tissue necrosis and gangrene, periwound dermatitis, periwound edema, osteomyelitis, hematomas, and dehiscence. Our purpose is to discuss the presentation of each and potential interventions … read more

Initiative Launches Web Portal for Medical Students

Free resources provide education on chronic wound management


In an effort to further prepare medical professionals about the proper management and treatment of patients with wounds, HMP, a leading healthcare event and education company, today announced the launch of a new web portal designed exclusively for medical students as part of its Why Wound Care? (WWC) initiative.


Created in 2015, the Why Wound Care? initiative informs medical and nursing students, recent graduates, and faculty about rewarding careers in wound care while offering educational resources to supplement current academic curricula where wound care education may be limited.


With the development of the new portal, medical students and faculty now have access to the following complimentary, evidence-based wound care resources:


-Sixteen video modules covering the fundamentals of wound care, including
Burns, Surgical Wound Closure, Wound Epidemiology, Pressure Injuries, Diabetic Foot Ulcers … read more


Roles of alternative activation of macrophages phenotypes in normal wound healing

Normal wound healing process is characterized by highly organized controlled overlapping phases including haemostasis, inflammation, proliferation, and remodeling; through which acute wounds come to a complete healing with predictable time frame (Schreml et al, 2010). These phases are orchestrated by the interaction of different cell types and biochemical components to regulate and accomplish the different wound healing process such as coagulation, chemotaxis, phagocytosis, synthesis of extracellular matrix components, angiogenesis, epithelial migration, and remodeling components (Velnar et al, 2009). Components of the main cellular wound healing process include macrophages, keratinocytes, endothelial cells, fibroblast, neutrophils, and lymphocytes. These components are recruited, stimulated and activated according to their role in the healing process by which specific generic cytokines, growth factors, chemokines, and respective receptors are created to achieve physiological wound healing of skin wounds (Schreml et al, 2010) … read more

Meeting Report: ‘Raising the Bar’- creating a better tomorrow

This article is based on the proceedings of the one-day ‘Raising the Bar’ conference in Singapore held by Wounds International and supported by an educational grant from Urgo International on October 15, 2017. The day provided more than 100 clinicians from around Asia with an exceptional opportunity to gain insights and best practice recommendations from a faculty of local and regional wound care specialists, supported by visions from global practitioners … read more

The Effect of Foot Exercises on Wound Healing

in Type 2 Diabetic Patients With a Foot Ulcer: A Randomized Control Study


PURPOSE: The purpose of this study was to investigate the effect of foot exercises on wound healing in type 2 diabetic patients with a diabetic foot ulcer.


DESIGN: Prospective, randomized controlled study.


SUBJECT AND SETTINGS: Sixty-five patients from an outpatient clinic with grade 1 or 2 ulcers (Wagner classification) who met study criteria agreed to participate; 60 patients completed the study and were included in the final analysis. Subjects were followed up between February 2014 and June 2015.


METHODS: Subjects were recruited by the researchers in the clinics where they received treatment. Subjects were randomly allocated to either the control or intervention group. Data were collected using investigator-developed forms: patient information form and the diabetic foot exercises log …. read more

Bacteria can pass on memory to descendants, researchers discover

Led by scientists at UCLA, an international team of researchers has discovered that bacteria have a “memory” that passes sensory knowledge from one generation of cells to the next, all without a central nervous system or any neurons.


“This is a huge surprise to us and to the field,” said Gerard Wong, a professor of bioengineering and of chemistry and biochemistry, member of the California NanoSystems Institute at UCLA and one of the study’s senior authors.


These findings are a major step toward understanding hard-to-treat infections caused by bacterial biofilms in people with cystic fibrosis.


The team studied a strain of bacteria called Pseudomonas aeruginosa that forms biofilms in the airways of people with cystic fibrosis and causes persistent infections that can be lethal. Bacterial biofilms can also form on surgical implants, like an artificial hip; when they do, they can cause the implant to fail. Bacterial biofilms are composed of genetically identical bacteria cells that can colonize nearly any surface and form communities in which single cells organize and cooperate … read more



Watch How Engineering Students Step Up with Imager for Diabetics

Patients with diabetes must guard against nerve damage disorders that can numb feeling in their extremities. Engineering students developed a device to help patients with diabetes easily monitor their feet for cuts or other injuries.

Engineering students developed a device to help patients with diabetes easily monitor their feet for cuts or other injuries.


A simple device developed by Rice University students can help this population detect early signs of foot ulceration that, left untreated, could endanger their health and lead to amputation.The inspection device is likened to a foot stand one might see in a shoe store but with the addition of a clear plastic top, cameras, lights, a mirror and electronics that allow people to easily examine their feet.


The initial design attached a camera on a gooseneck to the end of a telescoping stick that patients could manipulate to manually inspect their feet … read more


Digital wound care provider nabs $11.6M in funding

A Toronto startup, looking to revolutionize wound care, just got a big boost in its expansion efforts.

Swift Medical recently announced that it has earned $11.6 million in funding, which will help to fuel its goal of being used across North America. The smartphone-based care aid helps clinicians to measure wounds, without touching the resident or using extra accessories. Already, it’s been adopted in more than 1,000 long-term care and other types of facilities.

“This growth funding enables us to expand our reach and bring Swift’s solution to every bedside in every hospital and care facility,” Carlo Perez, co-founder and CEO of Swift Medical, said in a press release. “There are more patients worldwide suffering from chronic wounds than from lung cancer, breast cancer, colon cancer and leukemia combined. By augmenting the abilities of clinicians and facility administrators to deliver the best possible wound care management, we’re helping them heal over 10,000 patients a month. And we’re just getting started.”

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The use of Prontosan® in combination with Askina® Calgitrol®

An independent case series

Many patients with chronic wounds will develop infection (Landis et al, 2007; Sibbald et al, 2011). Worldwide consensus on the specific use of silver antimicrobials recommends that silver dressings should be used initially for a ‘two-week challenge’ (Wounds International, 2012). Sixteen different individual case studies were carried out to evaluate the efficacy of a biofilm remover/cleanser in gel form, Prontosan® (B Braun), together with the use of an ionic releasing silver alginate, Askina® Calgitrol® Paste (B Braun) or Askina® Calgitrol® Thin (B Braun), when used on infected wounds. This study was completed in an advanced wound management centre in Pretoria, South Africa, during 2016.  Selection criteria included wounds showing clinical signs of infection with delayed healing for more than 2 weeks. The study results showed that 50% of the wounds’ clinical signs of infection resolved within the 2-week antimicrobial challenge and by week 3, 81% of all clinical signs resolved. Ninety-three per cent of the wounds had improved wound progress and healing .. read more



Reduction of 50% in Diabetic Foot Ulcers With Stem Cells

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, which is due to the ability of these cells to simulate angiogenesis in the wound bed, decrease excessive inflammation, and suppress scarring,” explained Dr Albehairy … read more

Clinical Challenges in Diagnosing Infected Wounds

Given the impact of infection on delayed wound healing, determining the presence of colonization and infection is imperative to achieving healed outcomes. Chronic wounds are always contaminated, and timely implementation of management and treatment interventions is a key component of the plan of care.


Diagnosis of infection can be a very challenging task to say the least, and it is further complicated by the presence of biofilms for which no diagnostic tool is currently available. If not addressed in a timely manner, these local infections can become systemic, leading to sepsis, multiple organ failure, and death. The first steps are a complete and thorough history and a physical examination of the whole patient, not just the patient’s wound, while taking into account both primary and secondary findings to understand the host response.


Having a thorough understanding of the principles of chronic wound care and of the current diagnostic modalities available is essential to the improvement of clinical outcomes and cost reduction related to the complication of wound infection. Our focus is on the challenges to diagnosing wound infection, including accurately determining risk factors, differentiating colonization from infection, and understanding the gold standard for diagnosing wound infection … read more

Wound Care in Crisis

Wound Care’s Newest Buzzword and Slogan


Every so often, in my readings of newspapers, articles, and while pleasure reading, or during conversations with friends and colleagues, I come across a word that smacks me right in the kisser. I was listening to a news commentary and this new buzzword nonchalantly emanated from the speaker’s lips. It took me but a second before I realized what an insidiously powerful little devil it was. The speaker droned on about the current political scenario, the state of medical care, and then, in Judge Wapner-like reckoning described his presumed foes points as “counterintuitive.” This unusual word “counterintuitive” has a definition that is both painfully simple and thought-provokingly powerful. Intuition is simply the perception of something using common sense. Adding “counter” to it moves it into the realm of mystery and suspense. Counter intuitive, something that is unlikely to be found correct when assessed and evaluated.


The problem is that the meaning of counterintuitive is usually in the eyes of the beholder or the “be-dabbler” in the case of wound care. There are far too many things done in an incorrect, non-evidence-based, un-best-practice-based manner in the profession that I love so dearly. The problem is that identifying something as counterintuitive means that you have to have some semblance of intuition regarding the issue or in other words, half an idea of what you are talking about. The real issue, however, is that the care you provide needs to be self-scrutinized, self-evaluated, and dare I say it, reviewed by your peers and those you work intimately with who will provide you an honest, unbiased opinion regardless of whether you like it or not.


I received a call from a patient in a long-term care facility to resume care for him. Once at home and doing well, he had fallen into the black hole of the local medical center and then was unceremoniously dumped into a long term care facility. The astute wound care NP running their wound “lack of care” program wrote a War and Peace worthy history and physical and then documented his venous insufficiency, venous insufficiency ulcers, mild secondary lymphedema and his obesity with debility … read more


Smart socks aim to catch diabetic foot problems early

SAN FRANCISCO (KGO) — For the millions of Americans living with diabetes, a new tech product offers early warning against the threat of losing a foot or a leg to the disease.


“I have very little sensation on the bottom of my feet,” explained Marc Fairman, who’s type 1 diabetic. Fairman will never take his feet for granted again. In 2012, he developed a foot ulcer that got out of control.


“I sought several opinions — surgeons and podiatrists — and several told me i would probably lose my foot,” he said. For 30 million Americans with diabetes, UCSF surgery professor Michael Conte said it’s a very real danger.


read more

Berlin doctor lauded for leg amputation research

BERLIN – A local doctor has received international honors for a scientific paper about a new scoring system he helped create to evaluate the risks of leg amputations.


Dr. Eric Newgent, medical director of sleep medicine at ThedaCare Medical Center-Berlin, wrote the article for The Journal of Wound Care with Dr. Michael Miller, a general surgeon and full-time wound care specialist in Indiana, according to ThedaCare … read more


A comprehensive scoring system to evaluate patient-centered risk factors regarding lower extremity amputation


Assessment and management of foot ulcers

for people with diabetes.


Major Recommendations

The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the “Major Recommendations” field.


Practice Recommendations




Recommendation 1.0


Obtain a comprehensive health history and perform physical examination of affected limb(s).

(Level of Evidence = Ib–IV)


Recommendation 1.1


Identify the location and classification of foot ulcer(s) and measure length, width, and depth of woundbed.

read more


Temperature-reading ‘smartmat’ catches diabetic foot ulcers early

Podimetrics, a startup created during an MIT “hackathon” in 2011, focuses on catching foot ulcers—a complication of diabetes that can lead to amputation—early. The company unveiled data showing its remote-monitoring technology caught a majority of foot ulcers well before they appeared.


A number of factors contribute to the development of diabetic foot ulcers, including nerve damage, which stops patients from feeling small injuries in their foot. A healthy person might change his or her movement or adjust a shoe, but a person with diabetes-related nerve damage will not notice the pain. Repetitive injury over time can lead to an ulcer, and early detection can help prevent an ulcer from forming or getting worse … read more


Feasibility and Efficacy of a Smart Mat Technology to Predict Development of Diabetic Plantar Ulcers

Podimetrics website



Wound care education in the developing world

The increasing burden of wound care is a major challenge for healthcare systems worldwide (Sen et al, 2009). In developing countries, there is insufficient capacity to meet patient requirements. Inadequate wound care is not, however, without consequences. In many developing countries, treatable injuries and wounds are the leading cause of death and disability in the under 60s.


Extent of the wound care burden In 2013, over 10% of the world’s population lived in extreme poverty on less than $1.90 per day (World Bank Group, 2016). A minimum of US$44 per capita is required per year to provide basic life-saving health services, however 26 World Health Organization (WHO) states spend less than this, with Eritrea spending the least at US$12 per person (WHO, 2014). Moreover, it is estimated that up to half the world’s population lacks access to basic wound care (Meara et al, 2015), although there is scant literature concerning its epidemiology and natural history, cost-effectiveness or the delivery of services … read more

Case series: ALLEVYN LIFE Non-Bordered foam dressing for

managing moderate to heavily exuding wounds


Exudate is vital for moist wound healing; however, overproduction of exudate is detrimental to the wound healing trajectory. Under compression, the capacity of some dressings to absorb exudate can fall by more than 40% and leaks are common, requiring more frequent dressing changes (Körber et al, 2008). Non-bordered foam dressings present a flexible class of dressings that can be used under compression and for cushioning, can conform to awkward positions on the body and can be cut to shape for unusually shaped wounds. This series of six case studies describes the use of ALLEVYN LIFE Non-Bordered foam dressing (Smith & Nephew) in the management of moderate to heavily exuding diabetic foot, venous and pressure ulcers. ALLEVYN LIFE Non-Bordered foam dressing is designed to lock in exudate and minimise the risk of skin damage … read more

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Prevention of hospital-acquired foot pressure injuries

Assessment and consideration of foot risk factors is essential for proactive prevention of hospital-acquired foot pressure injuries


The research outlined in this article aimed to see if high-risk feet were also identified as ‘at risk of ulceration’ by the Braden Score. One-hundred-and-thirty-two patients had foot risk stratified by a podiatrist and their admission Braden pressure injury (PI) risk level was compared. Only 36% were decreed to be at the same level of risk by both methods. The lack of agreement was demonstrated by a very low Kappa score. The Braden score underestimated PI risk to feet for 52% of the study population. Therefore, the authors concluded that less reliance on the Braden score is needed for the implementation of prevention to reduce rates hospital-acquired foot PIs … read more

Multidrug-Resistant Organisms in Wound Management

Among the greatest triumphs of modern medicine were the identification and naming of the Penicillium mold by Alexander Fleming in 1928, and its ability to inhibit bacteria growth on culture medium. Penicillin was then developed by the team of Heatley, Chain, and Florey in England during the Second World War.1 This miracle brought about the ability to cure previously untreatable diseases and devastating infections that had high morbidity and mortality rates. Along with the great efficacy of penicillin was the added benefit of very few side effects. This area of research brought about the era of antibiotic production, which began in the 1950s.


Mechanisms of Antibiotic Resistance and Implications for Health Care
Antibiotics target one or multiple modes of cellular communication which allow microorganisms to proliferate. These include cell wall, membrane transport, RNA function, DNA synthesis, protein function, or enzyme activity.2 Interrupting cellular communication and thus proliferation has made antibiotics very effective against a broad range of microoganisms. In looking at the history of multidrug-resistant organisms (MDROs) we must remember that there are two sides to every coin, and with the positive side of clinical efficacy against microoganisms there is also a downside. To ensure their survival, it has become necessary for microorganisms to evolve and genetically mutate. These processes have caused the organisms of today to be much different from the organisms of yesterday, much more virulent, and more multidrug resistant … read more

NPUAP Pressure Injury Stages

The National Pressure Ulcer Advisory Panel redefined the definition of a pressure injuries during the NPUAP 2016 Staging Consensus Conference that was held April 8-9, 2016 in Rosemont (Chicago), IL.


The updated staging definitions were presented at a meeting of over 400 professionals. Using a consensus format, Dr. Mikel Gray from the University of Virginia adeptly guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process. During the meeting, the participants also validated the new terminology using photographs.


The updated staging system includes the following definitions:

Pressure Injury:
A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue … read more

How Activity Benefits the Healing Patient

Maintaining an active lifestyle is critical to good health; this is especially true for patients recovering from wounds or extended hospital stays. Robust activity can improve mental health, reduce the risk of infection, and accelerate wound healing.1 Staying active can be challenging for patients with wounds, however, and it is critical that health care professionals take steps to enable their patients to stay as active as possible.


The Healing Benefits of Activity

Aside from the long-term benefits to heart health, mental health, and longevity, exercise provides many direct and indirect benefits to patients healing from wounds. Physical activity can promote rapid wound healing, reduce oxidative damage, and promote a healthy lifestyle. This can improve patient outcomes and reduce the costs of treatment.

Exercise Benefits Mental Health –
 There is ample evidence that exercise promotes good mental health, reduces the effects of depression, and causes people to report a greater level of happiness. These effects are especially important for those who have had an extended stay in a hospital or who are in a long-term care facility because these populations may be at greater risk of developing mental health problems.

Exercise Reduces Inflammation – 
Inflammation is one of the major causes of delayed healing. Research shows that wounds with low levels of inflammation heal much more quickly and completely. Exercise and other physical activity have been shown to reduce the level of inflammatory markers in the blood, thus helping to reduce the level of inflammation and promote rapid healing. Reduced inflammation may also provide palliative benefits by decreasing pain and discomfort in wounds … read more

Multi-resistant Infections: A Global Concern

A presentation by Associate Professor Geoff Sussman on antimicrobial resistence.


Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others … read more (pdf)

Efficacy of an imaging device at identifying the presence of bacteria in …

… wounds at a plastic surgery outpatients clinic


Current standard diagnostic practice of bacterial infections by visual inspection under white light is subjective, and microbiological sampling is suboptimal due to high false negative rates and the lengthy time needed for culture results to arrive. The MolecuLight i:X Imaging Device attempts to combat the issues faced in standard practice by providing a non-contact, real-time method of visualising bacteria within wounds. Our aim was to test this imaging device in a series of patients … read more

Risks and Diagnosis of Diabetic Foot Infections

Wound care clinicians deal with foot infections all the time, but when the patient is also diabetic, an infection can progress rapidly to a critical state. In fact, it is estimated that around 56% of diabetic foot ulcers become infected, and an infected foot wound precedes about two-thirds of amputations.  Being able to treat diabetic foot infections promptly – before they progress too far – helps prevent amputations, which is why your role is so crucial to a patient’s well-being.

What are the risk factors?

If you are treating a diabetic patient with a foot infection, there are a number of risk factors to consider. These include:

  • 30-day-old wounds
  • Wounds that go down to the bone
  • Recurrent foot infections
  • Peripheral vascular disease
  • An etiology from trauma

In particular, be on high alert with your diabetic patients for what they call an occult (hidden) infection … read more

Wound Care Education Institute and Vizient Work Together …

BROOKFIELD, Wis.March 21, 2018 /PRNewswire/ — Wound Care Education Institute (WCEI) and Vizient , the largest member-driven healthcare performance company in the United States, have partnered to reduce preventable hospital-acquired conditions and readmissions within the Vizient Hospital Improvement Innovation Network (HIIN) membership. As part of this campaign, Vizient is determined to achieve a 20-percent decrease in overall patient harm and a 12-percent reduction in 30-day hospital readmissions by 2019.


To support these goals, 50 clinicians from Vizient’s HIIN membership will attend WCEI’s Skin and Wound Management course during the week of April 23. The HIIN clinicians will be chosen from around the United States and meet in Irving, Texas, to complete the training.


“The Skin and Wound Management course is designed with patient-centered quality healthcare in mind,”

read more


Physical Training and Activity in People With Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (ie, walking and stair climbing). Although many beneficial effects of exercise for people with diabetes have been well established, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered to be a contraindication for walking or any weight-bearing exercise because of concerns about injuring a person’s insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people who have DPN but do not have severe foot deformity. Emerging research has revealed positive adaptations in response to overload stress in these people, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This perspective article reviews the evidence for peripheral neuroplasticity in animal models and early clinical trials, as well as adaptations of the integumentary system and the musculoskeletal system in response to overload stress. These positive adaptations are proposed to promote improved function in people with DPN and to foster the paradigm shift to including weight-bearing exercise for people with DPN. This perspective article also provides specific assessment and treatment recommendations for this important, high-risk group … read more

Amit Jain’s Triple Assessment of Foot in Diabetes

A rapid screening tool

Diabetic foot is on the increase with prevalence rates of diabetes growing around the world. In spite of this, it is frequently a neglected entity in many countries. Screening of the diabetic foot serves to identify any underlying problem and helps one to immediately institute preventive and therapeutic measures. There are few screening tools currently used for diabetic foot. Amit Jain’s Triple Assessment of Diabetic Foot is a new, fast and easy screening tool from the Indian subcontinent that addresses the classic triad of the diabetic foot (neuropathy, ischemia, and infection) both specifically and effectively … read more

The management of diabetic foot

A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine.


Major Recommendations
Definitions of the strength of the recommendations (Grade 1 or 2) and quality of the evidence (Level A–C) are provided at the end of the “Major Recommendations” field.


Prevention of Diabetic Foot Ulcers (DFUs)

1. The committee recommends that patients with diabetes undergo annual interval foot inspections by physicians (MD, DO, DPM) or advanced practice providers with training in foot care (Grade 1C).

2. The committee recommends that foot examination include testing for peripheral neuropathy using the Semmes-Weinstein test (Grade 1B).

3. The committee recommends education of the patients and their families about preventive foot care (Grade 1C).

4a. The committee suggests against the routine use of specialized therapeutic footwear in average-risk diabetic patients (Grade 2C).

4b. The committee recommends using custom therapeutic footwear in high-risk diabetic patients, including those with significant neuropathy, foot deformities, or previous amputation (Grade 1B).

5. The committee suggests adequate glycemic control (hemoglobin A1c <7% with strategies to minimize hypoglycemia) to reduce the incidence of DFUs and infections, with subsequent risk of amputation (Grade 2B).

6. The committee recommends against prophylactic arterial revascularization to prevent DFU (Grade 1C).

Off-Loading DFUs

1. In patients with plantar DFU, the committee recommends offloading with a total contact cast (TCC) or irremovable fixed ankle walking boot (Grade 1B).

2. In patients with DFU requiring frequent dressing changes, the committee suggests off-loading using a removable cast walker as an alternative to TCC and irremovable fixed ankle walking boot (Grade 2C). The committee suggests against using postoperative shoes or standard or customary footwear for off-loading plantar DFUs (Grade 2C).

3. In patients with nonplantar wounds, the committee recommends using any modality that relieves pressure at the site of the ulcer, such as a surgical sandal or heel relief shoe (Grade 1C).

read more

Researchers Examine Link Between Wound Healing and Time of Day

In addition to where a wound is located and how it developed, researchers now also believe that the time of day you get your wound may have something to do with how it heals and the type of wound care you receive as well.


Daytime and nighttime wounds
According to a team of British scientists, wounds (including burn wounds and cuts) healed almost 60 percent sooner if the injury originally occurred during the daytime as opposed to during the night, as reported by CNN.


The researchers from the Medical Research Council Laboratory of Molecular Biology in Cambridge, England, looked at the treatment records of more than 110 burn patients from facilities in Wales and England. The findings were published in Science Translational Magazine.


The scientists found that patients whose burn wounds occurred between 8 p.m. and 8 a.m.took more time to heal than those that happened between 8 a.m. and 8 p.m. More specifically, wounds that happened at night healed in approximately 28 days, compared to wounds incurred in the day, which healed in approximately 17 days … read more

Clinical Challenges in Diagnosing Infected Wounds

Given the impact of infection on delayed wound healing, determining the presence of colonization and infection is imperative to achieving healed outcomes. Chronic wounds are always contaminated, and timely implementation of management and treatment interventions is a key component of the plan of care.


Diagnosis of infection can be a very challenging task to say the least, and it is further complicated by the presence of biofilms for which no diagnostic tool is currently available. If not addressed in a timely manner, these local infections can become systemic, leading to sepsis, multiple organ failure, and death. The first steps are a complete and thorough history and a physical examination of the whole patient, not just the patient’s wound, while taking into account both primary and secondary findings to understand the host response.


Having a thorough understanding of the principles of chronic wound care and … read more

Managing inflammation by means of polymeric membrane dressings …

… in pressure ulcer prevention


Inflammation is the immediate normal response of the immune system to localised microscopic cell damage that precedes macroscopic tissue damage. Inflammation is triggered by secretion of chemokines that attract immune system cells to the sites of cell damage and facilitate their extravasation through increase in capillary permeability. The increased permeability of capillary walls in the inflammatory state consequently causes fluid leakage from the vasculature and, hence, oedema and associated pain. Polymeric membrane dressings (PolyMem®, Ferris Mfg. Corp.) are multifunctional dressings that focus and control the inflammation and oedema, and reduce pain. The literature reviewed in this article suggests that by having these effects on the inflammatory response, especially in fragile patients, the PolyMem dressing technology may facilitate repair of micro-damage in cell groups, which counteracts the evolution of damage to a macroscopic (tissue) level. Reducing the spread of inflammation and oedema in tissues appears to be a unique feature of PolyMem dressings, which supports repair of cell-scale damage under intact skin and tilts the delicate balance between the counteracting damage build-up and tissue repair mechanisms, thus promoting reversibility and self-healing … read more

Development of a generic wound care assessment minimum data set

At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment.


The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS … read more

Evaluation of the WIfI classification system in older patients with diabetes

There are numerous factors that have an impact on diabetic foot ulcer (DFU) healing, among them critical limb ischaemia (CLI) — a term that was not intended to include patients with diabetic foot wounds and neuropathy. The Society for Vascular Surgery, therefore, created a new classification system for threatened lower extremities in which the severity of ulceration and severity of limb ischaemia are both graded. They also added a grade or classification scheme for infection.


The need to reconsider how the threatened limb is classified is clear. Ischaemia, while of fundamental importance, is but one component among a triad of major factors that place a limb at risk for amputation. The proposed Society for Vascular Surgery Lower Extremity Threatened Limb Classification System is based on grading each of the three major factors: Wound extent, degree of Ischaemia, and foot Infection, or WIfI (Mills et al, 2014). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging and complex heterogeneous population. During the 1990s, most DFUs were considered neuropathic (Armstrong et al, 2011). The Eurodiale Study, which included 1,229 patients presenting with a new DFU between September 2003 and October 2004, found non-plantar ulcers to be most frequent type of ulcers in this group …  read more

Silver-impregnated Dressings for the Treatment of Chronic Wounds

A Scoping Review of the Use of Silver-impregnated Dressings for the Treatment of Chronic Wounds


Topical silver agents and dressings are used to control infection and promote healing in chronic wounds, but reviews published from 2006 to 2011 found heterogeneous results regarding their effectiveness. A scoping review was conducted to examine the extent, range, and nature of research activity surrounding chronic wound care that employed silver-impregnated dressings; identify research gaps in the existing literature; and summarize the evidence to provide recommendations for future clinical studies.


Ten (10) electronic databases and additional sources were screened from their inception to May 2016; search terms for the different databases included but were not limited to silver, chronic, complications, wound, ulcer, and sore. English-language articles that compared silver dressings with an alternate treatment in adults with chronic wounds and that reported clinical outcome measures were included. Of 222 full-text reviewed studies, 27 were included for qualitative analysis. Qualitative analysis was guided by key findings identified among the included studies that were analyzed in aggregate form where appropriate. In comparative analyses of the 26 studies that investigated wound healing … read more

The Role of Hypochlorous Acid in Managing Wounds

Reduction in Antibiotic Usage


by Martha Kelso, RN, HBOT

Numerous brands of hypochlorous acid have emerged in the last few years and have been marketed as “ideal” products for use in wound cleansing. These statements, of course, should draw speculation because it is rare for a single product to be used on all wounds, all clients, in all care settings, all the time, thus making it “ideal.” Let’s explore the role of hypochlorous acid in wound management and wound healing and see how it assists with reduction in antibiotic usage.


In its true native natural state, hypochlorous acid is a biocide produced naturally by the human body through the process of phagocytosis during the oxidative burst pathway. Because hypochlorous acid is an oxidant, it leaves nothing behind for bacteria and viruses to create resistance to and therefore does not contribute to the superbug (multidrug-resistant organisms) dilemma. Manufacturers have found a way to create hypochlorous acid outside the human body and bottle it for commercial use. These products are non-cytotoxic when concentrations (parts per million) and pH levels are acceptable for human use … read more


The use of topical analgesics in the management of painful diabetic neuropathy

Miranda Tawfik


Painful diabetic neuropathy (PDN) affects up to half of patients with diabetes and is a major cause of functional impairment and increased mortality. Its clinical manifestations include sensations such as burning, stabbing and tingling and/or loss of sensation, and it increases the risk for injuries and foot ulceration. Oral pharmacological therapy is the standard approach to management. It is effective in some patients, but its use is limited due to unfavourable side-effect profiles, limited response rates and drug interactions. Increasing evidence of the localized, non-systemic treatment approach of topical analgesics aims to overcome these obstacles and provide valuable, efficacious and safe management of PDN. This article reviews the rapidly expanding field of topical analgesia in managing PDN … read more

The management of diabetic foot: A clinical practice guideline by the Society ….

A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine


Diabetes is one of the leading causes of chronic disease and limb loss worldwide, currently affecting 382 million people. It is predicted that by 2035, the number of reported diabetes cases will soar to 592 million.1 This disease affects the developing countries disproportionately as >80% of diabetes deaths occur in low- and middle-income countries. As the number of people with diabetes is increasing globally, its consequences are worsening. The World Health Organization projects that diabetes will be the seventh leading cause of death in 2030.3 A further effect of the explosive growth in diabetes worldwide is that it has become one of the leading causes of limb loss. Every year, >1 million people with diabetes suffer limb loss as a result of diabetes. This means that every 20 seconds, an amputation occurs in the world as an outcome of this debilitating disease. Diabetic foot disease is common, and its incidence will only increase as the population ages and the obesity epidemic continues … read more

Caring for the Diabetic Foot in Long-Term Care Facilities

by Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary


As a Director of Nursing (DON) in a long-term care facility, do you know where the awareness level of diabetes and its complications is for your staff? Do they realize diabetes doesn’t stop? It is 24/7, 365 days a year. Knowing this reality of diabetes and understanding the disease process may assist with preventing serious health problems such as heart disease, stroke, blindness, kidney disease, and nerve damage that can lead to amputation.


Education is key. We cannot talk about this enough. Assuming someone knows or that common sense will tell people how to take care of these residents is a huge mistake. I don’t believe in common sense; I believe in common knowledge, but it is only common once it is taught. So, teach about diabetes and the care of residents with diabetes often.


Knowing the Risk of Diabetic Foot Ulcers and Diabetic Peripheral Neuropathy
In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes … read more

Wound Debridement Products Market Synopsis 2018

Manufacturers are developing a wide range of products, like scalpels and pads to treat minor wounds. Innovative plans are underway to entice customers into knowing more about these products. The worldwide industry is segmented into products, end-users, and geographies.


The recent market developments has necessitated a ‘see through’ approach so as to avoid the slippery slope generated by the changing paradigms resulting from the powerful forces of economy, business models, competition and others. “Market Research future” presents its latest report titled “World Wound Debridement Products Market –forecast till 2023” to help clear the blur resulting from these developments and to give the reader a clear picture of the possibilities and nuisances lying ahead!


Industry Analysis:

The worldwide debridement products market is reported to be driven by major traumatic wounds and burgeoning aged population. However, it would experience a sole digit growth rate over the forecast period. Debridement products help clear up germs, microbes, dirt, and infections from human injuries. This helps in the faster treatment of the injuries, rendering patients comfortable.


Rising wound patients, chronic diseases, & product-usage are also driving the market. Apart from these, the need for innovative medical technologies and viability of wound care products add market sales … read more

Comparing the performance of mechanical wound debridement products …

Background: Mechanical wound debridement is an essential intervention in the treatment of slough pressure ulcers. Therefore, a lot of products are presented in the current local market as effective tools to perform that procedure. There is a need to revise the clinical performance of the available used products in one of the biggest governmental hospitals in Saudi Arabia to support efficient resource utilisation and suggest clinical practice protocols for pressure ulcer treatment. Objectives: The current retrospective cohort study compares the clinical performance of two products regarding mechanical debridement for sloughy sacral and heel pressure ulcer. Methods: The researchers retrospectively cohort the progress of 32 patients with more than 50% slough pressure ulcer, received mechanical debridement by wound care nurse during hospitalisation in the same setting and using the same pressure ulcer treatment protocols, by using either monofilament debridement pads (Debrisoft®; Lohmann and Rauscher) (16 patients) or mechanical debridement by using impregnated sterile gauze monofilaments (UCS™; WelCare Industries S.p.A) for a period of three continuous weeks. The research used PUSH tools as a data collection tool. The Hospital Institutional ReviewBoard approved the study. Results: Both products show the positive progress of pressure ulcer healing status after 3 weeks of application (P<0.01). Also, the progress mean among the monofilament group was significantly higher than the progress mean among the impregnated sterile gauze (P<0.05). Conclusion: The study recommends monofilament debridement pads for mechanical debridement on sloughy (more than 50% of wound bed) pressure ulcers … read more (log in required)

Understanding Debridement: An Important Part of Wound Healing

During wound healing, the affected area can become overrun with necrotic – or dead – tissue. This can be harmful to the body’s ability to recover and develop new skin, so debridement may be necessary to remove that dead material. In this way, debridement is essential for preparing the wound bed to promote speedy and efficient healing.


Why is debridement important?
Debridement promotes the wound healing process in a variety of ways. Not only does dead skin inhibit the development of healthy new tissue, but it makes the affected area more susceptible to infection. It can also hide the signs of infection, as dead tissue can increase odor and exudate, making it easier for bacteria and other harmful foreign invaders to spread.


How does debridement work?
Sometimes, debridement occurs naturally on its own thanks to the body’s own ability to shed off dead tissue. However, more often, it requires a medical procedure. There are two different categories of debridement: active and autolytic. Autolytic debridement involves application of hydrocolloids and hydrogels to enhance moisture in the affected area in order to degrade it so the body will naturally deslough the dead tissue. Active debridement involves the manual removal of necrotic material, and it comes in several types of procedures, such as … read more

Diabetic Wound Healing and LED Irradiation

Introduction: Light-Emitting Diode Therapy for Chronic Non-Healing Diabetic Wounds


Diabetes mellitus is frequently associated with chronic non-healing wounds, many of which result in amputation. The combination of peripheral vascular disease, neuropathy, and impaired immune function contributes to a higher risk of injury and deficiency in healing. Wound healing is a complex process comprising eight important factors: (1) collagen synthesis, (2) cell migration, (3) cell cycle and differentiation, (4) angiogenesis and growth hormone, (5) blood clotting, (6) extracellular matrix and focal adhesion, (7) calcium ion signaling, and (8) immune and inflammatory response. In the diabetic cell, all these processes malfunction, with the exception of collagen synthesis, cell migration, and cell cycle or differentiation.


Previous studies found an association between diabetes and the precursor protein pro-opiomelanocortin (POMC) gene. POMC is normally expressed in pituitary melanotroph and corticotroph cells and functions to control body weight. Studies have suggested that a mutation in the POMC gene leads to early-onset type 2 diabetes and obesity. This correlation is under investigation for its potential use in diabetic therapy.


Light-emitting diode (LED) phototherapy at 660 and 890nm has been shown to significantly accelerate wound healing in normal, healthy patients. This therapy works through molecules with porphyrin structures that are able to trap photon energy and subsequently activate downstream processes. The current study investigated the results of a range of different LED phototherapies on gene expression and cellular function of diabetic cells compared with normal, healthy cells … read more

Wound Care in Crisis

Chris Farley Wound Care, “Stupid, Stupid, Stupid!”


by Michael Miller DO, FACOS, FAPWCA, WCC

For those of you who cannot remember the now deceased comedian Chris Farley, did not find his humor funny or simply cannot remember any of his memorable performances; I suggest you move on to another, less controversial, “here’s how to use scissors” type of blog.


Michael Miller
Miller Care Group

Chris Farley was a genius. His insights covered many, many topics but their pertinence, I have found, is particularly suited to wound care. Those of you who work in the vicinity of a wound care dabbler, I invite you to cut this blog out and surreptitiously leave it where they cannot miss it or send them the link. I am betting that one or two of the following will strike home but even if not, at least they will get the message that someone (probably many-one) wants them to reconsider their current as-yet-unrecognized (you may substitute the words barbaric, substandard, fraudulent or wasteful) practices. Recently, the shenanigans of several 4-hour-per-week wound management company puppets have led a handful of patients to file complaints with their clinics, hospitals and in two cases, demand that they not be charged (believe it or not, with no coercion, suggestion or turbo charging and actually with a second or two of feigned disbelief on my part).


The basics are simple, so let’s get them out on the table. The keys to success are not just avoiding making mistakes but recognizing that one was made and avoiding making it again. While Mr. Farley inadvertently but repeatedly insults Sir Paul McCartney during an adoration-fueled interview, he rewards each faux pas he commits with a smack to his forehead accompanied by his self-acknowledged cry of “Stupid, Stupid, Stupid.” The resultant laughter from the audience and his embarrassment should result in Chris’ reminding himself not to act stupidly again. Of course, the key to the comedic bit is his ability to say the wrong thing again and again and punish himself for the wrong thing again and again. If only Chris had a check list on which to remind himself what things were safe to ask and what questions or actions would take him into treacherous territory. Fortunately for his audience, he just never got it right … read more

Hypochlorous Acid: an ideal wound care agent …



Chronic wounds and the infections associated with them are responsible for a considerable escalation in morbidity and the cost of health care. Infection and cellular activation and the relation between cells are 2 critical factors in wound healing. Since chronic wounds offer ideal conditions for infection and biofilm production, good wound care strategies are critical for wound healing. Topical antiseptics in chronic wounds remain in widespread use today. These antiseptics are successful in microbial eradication, but their cytotoxcity is a controversial issue in wound healing.


The aim of this study was to investigate the effect of stabilized hypochlorous acid solution (HOCl) on killing rate, biofilm formation, antimicrobial activity within biofilm against frequently isolated microorganisms and migration rate of wounded fibroblasts and keratinocytes.


Minimal bactericidal concentration of stabilized HOCl solution for all standard microorganisms was 1/64 dilution and for clinical isolates it ranged from 1/32 to 1/64 dilutions.


All microorganisms were killed within 0 minutes and accurate killing time was 12 seconds. The effective dose for biofilm impairment for standard microorganisms and clinical isolates ranged from 1/32 to 1/16. Microbicidal effects within the biofilm and antibiofilm concentration was the same for each microorganism.


The stabilized HOCl solution had dose-dependent favorable effects on fibroblast and keratinocyte migration compared to povidone iodine and media alone. These features lead to a stabilized HOCl solution as an ideal wound care agent.

Original article appeared in

Atypical Wounds: Causes and Management

Part 1 in a series discussing the etiology, assessment and management of atypical wounds.


As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.


An atypical wound, also known as a wound of unknown etiology, is caused by a disease or condition that doesn’t cause a wound typically. Inflammatory diseases, infections, chronic illnesses, malignancies, or genetic disorders are examples of diseases that may result in the appearance of a wound. Atypical wounds can also arise from rare causes and usually share uncommon characteristics. In this two-part blog series, I discuss a few atypical wounds, to give you a view of this parallel universe … read more

The Diabetic Foot Syndrome (book)

Frontiers in Diabetes, Vol. 26


In recent years, “diabetic foot” has become the common name given to chronic complications of diabetes mellitus in the lower limb. This book provides an up-to-date picture of the clinical scenario, the latest understanding of the mechanisms in regard to pathology, the current standards of therapy, and the organizational tasks that a modern approach to such a complex pathology warrants. All contributors have delivered articles that are as informative and straight-to-the point as possible, including not only their own experience in the field, but also giving a wider picture to link each article to the other. The Diabetic Foot Syndrome is not only relevant to specialists, but also to all the caregivers involved in the management of the patients at risk for developing the pathology, those affected, and those who are at risk of recurrences.

The Best and Worst Ideas for Open Wounds

Using the right open wound treatment can mean the difference between quick recovery and prolonged healing, excess scars, intense pain, increased risk of infection, or more. Unfortunately, a number of misconceptions and confusions surround open wound care, mostly due to persistent common wound treatment myths and old wives’ tales.


To help set the record straight and ensure that you will have a favorable healing process, here are some of the right and wrong strategies to use when managing your open wound treatment.


Good Idea: Cleaning the Wound Immediately with Mild Solutions
Infections are caused not only by exposure to bacteria and pathogens, but also from contact with the surface that caused the wound. For example, a tree branch that caused an abrasion could have bacteria on its surface, as could a kitchen knife that caused an skin puncture.


Flush the wound surface and interior as you can with a mild solution. A saline solution made from a small amount of salt diluted in water works well since it mimics your body’s internal pH. You can also use mild or diluted soap in water works well or some purified water, then wipe the surface with clean gauze.


Take notice of any debris that may be lodged in the wound and remove it with sterile tweezers if possible. If the debris is deep or dispersed, you should seek emergency care.


Bad Idea: Using Strong Antiseptics to Wash Wounds
Conventional wisdom suggests using disinfectants and antiseptics like hydrogen peroxide, rubbing alcohol, or iodine to clean open wounds. Most of these substances are better suited for disinfecting household surfaces and are far too harsh for use on human tissue. They are more likely to damage tissue than help it heal … read more

Treating Hard-to-Heal Wounds

An Evidence-Based Approach for DFU and Chronic Wounds


This is a brief summary of a presentation given at the annual conference of Wounds Canada, in Mississauga, Ontario, on November 16th, 2017. It has been produced with the financial support of Integra Life Sciences. The presenter was Robert Fridman, DPM FACFAS CWSP, a fellowship-trained podiatric surgeon at the Department of Orthopaedic Surgery at New York-Presbyterian Columbia University Medical Center and the Department of Surgery at New York-Presbyterian Weill-Cornell Medical Center.


Normal Wound Healing
For health-care professionals, standard wound management consists of preparing the wound bed to support the healing process. When treating diabetic foot ulcers (DFUs), health-care professionals must work toward controlling infection, correcting ischemia, optimizing nutrition, correcting hyperglycemia and offloading of the wound.


Offloading is one of the cornerstones of effective management of a diabetic foot ulcer, as it helps to minimize repetitive trauma to the area. Total contact casting (TCC) has been established as the gold standard to achieve offloading while enabling patients to ambulate. TCC enables pressure to be transmitted to the cast wall or rearfoot, resulting in decreased forefoot pressure. The device also reduces gait speed and shortens stride length, resulting in reduction of pressure. Ankle movement and the propulsive phase of gait are reduced, resulting in a reduction in vertical loading forces (see Figure 1). Ninety percent of DFUs have been shown to heal within six weeks when treated with a TCC … read more

Emerging Treatment for Necrotizing Infections

The National Necrotizing Fasciitis Foundation (NNFF), a 501c3 non-profit organization that seeks to raise public awareness of Necrotizing Fasciitis and offer support for those affected, is encouraging a new approach to treating necrotizing infections. The treatment and the referral initiative are crucial advances in the fight against this deadly threat, says Jacqueline Roemmele, executive director of the NNFF. Roemmele co-founded the organization in 1997 with fellow survivor, Donna Batdorff of Grand Rapids, Michigan, after her own years-long struggle with the disease and its aftermath, to offer information and emotional support to other patients and their families.


This approach calls for the use of NeutroPhase® Skin and Wound Cleanser in conjunction with Negative Pressure Wound Therapy. For the physicians who have utilized NeutroPhase with NPWT, not one of their patients has required amputation or suffered loss of life. As the late Dr. Crew described in a paper in the journal WOUNDSNeutroPhase has been shown in laboratory testing to not only kill the bacteria that are known to be present in NF wounds, but also to neutralize the toxins produced by those bacteria. Unless they are neutralized, those toxins continue to destroy tissue even if the bacteria have been killed, explaining why so many patients lose body parts. Dr. Crew extrapolated from those laboratory results to try the NeutroPhase on patients with NF.  “No one I’ve been responsible for treating has lost an arm or leg, or a life,” said Dr. Crew. “We have something that will change the standard of care for this terrible disease.”


NeutroPhase, an FDA cleared 510(k) medical device, is the only skin and wound cleanser with a patented and pure form of hypochlorous acid (HOCl) that doesn’t contain bleach impurities. HOCl is produced by white blood cells as a first defense against microbial invaders. Lab tests show that, in solution, HOCl not only kills bacteria, it also neutralizes the toxins that kill tissue.


The NNFF is a founded in 1997 by two survivors of Necrotizing Fasciitis. The NNFF’s mission is to educate and raise public awareness of NF symptoms and preventative measures, to advocate research, and to offer support for those affected by necrotizing fasciitis. The NNFF supports a hotline where patients suffering from Necrotizing Fasciitis can get support from physicians familiar with treating NF and NeutroPhase to help save their limbs and lives.



Compression therapy for venous leg ulcers

Compression therapy is the mainstay of treatment of venous leg ulcers (VLU). Good wound care and compression therapy will heal majority of small venous ulcers of short duration.[] Goals of compression therapy are ulcer healing, reduction of pain and edema, and prevention of recurrence.[] Compression is used for VLU and narrows veins and restores valve competence and reduces ambulatory venous pressure, thus reducing venous reflux (VR). It also helps decrease inflammatory cytokines, accelerates capillary flow, and lowers capillary fluid leakage thereby alleviating limb edema. It also softens lipodermatosclerosis, improves lymphatic flow and function, and enhances fibrinolysis.



The aim of compression therapy is to improve the venous function without compromising arterial function.



The contraindications of compression therapy are the following[,]

  • Advanced peripheral obstructive arterial disease (ankle brachial pressure index [ABPI] <0.8) (Evidence level A)
  • Systemic arterial pressure <80 mm Hg at ankle
  • Phlegmasia cerulea dolens
  • Uncontrolled congestive heart failure
  • Abscesses
  • Septic phlebitis
  • Advanced peripheral neuropathy.

read more

The International Wound Infection Institute (IWII) is an organisation of
volunteer interdisciplinary health professionals dedicated to advancing
and improving practice relating to prevention and control of wound
infection. This includes acute wounds (surgical, traumatic and burns)
and chronic wounds of all types, although principally chronic wounds of
venous, arterial, diabetic and pressure aetiologies.


Wound infection is a common complication of wounds. It leads to delays in wound
healing and increases the risk of loss of limb and life. Implementation of effective
strategies to prevent, diagnose and manage, is important in reducing mortality and
morbidity rates associated with wound infection.


This second edition of Wound Infection in Clinical Practice is an update of the first edition
published in 2008 by the World Union of Wound Healing Societies (WUWHS). The
original document was authored by leading experts in wound management and endorsed
by the WUWHS. The intent of this edition is to provide a practical, updated resource that
is easy-to-use and understand.

read more (pdf)

Foot Sensation Testing in the Patient With Diabetes

Abstract: Introduction. Sensory testing of patients with diabetes is an integral part of preventing new and recurrent wounds. The Semmes-Weinstein monofilament (SWM) test is considered the gold standard to screen for loss of protective sensation; however, the authors’ experience has shown that it is not only time consuming, but is of negligible value for a patient with a diabetic foot ulcer (DFU).


Methods. This article discusses the shortfalls with regard to the SWM test and reviews other techniques for sensory evaluation. In addition, the Quick & Easy system is introduced, which combines sensory assessment with guidance for anesthesia requirements during wound debridements or other surgical interventions. Results. A scale ranging from grade 2 (normal sensation) to grade 0 (absent sensation) reflects the patient’s responses to wound manipulation, palpation of an underlying deformity, and/or evaluation of the difference between light touch sensation with the patient’s hands compared to the feet. For patients with total loss of sensation (grade 0), no anesthesia is needed for surgical procedures. If there is diminished sensation (grade 1), surgical intervention can be performed following administration of either topical or local anesthesia. For patients with normal sensation (grade 2), complete anesthesia of the surgical site will be required. A preliminary observation was conducted on 50 patients with DFUs using the Quick & Easy system. Anesthetic requirements were accurately predicted in all cases without the need to modify the type of anesthesia during the procedure. Conclusion. The Quick & Easy system serves as a simple sensory evaluation for a patient with a DFU and provides valuable anesthesia guidance for wound care procedures … read more

Pressure Injury Prevention, Is It All About Protein?

by Nancy Munoz, DCN, MHA, RDN, FAND


The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury as localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can manifest as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure, occasionally in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and the condition of the soft tissue.


Pathophysiologic and intrinsic factors at the core of pressure injury development include nutrition. Maintaining adequate nutrition is considered a best practice for both the prevention and treatment of pressure injuries. Individuals with or at risk for developing pressure injuries should strive to achieve or maintain adequate nutrition parameters … read more

Living with a Diabetic Foot Ulcer

Patient Perspective:
An Interview with Robert S. Meyer by Janet L. Kuhnke Robert Meyer lives with diabetes and a foot ulcer. He has attended multiple Wounds Canada events as both a speaker and to learn more about how he can manage his condition, heal his wound and prevent further foot complications. He is interviewed here by wound care clinician and educator Janet Kuhnke.


Janet L. Kuhnke: Robert, you attended the fall 2017 Wounds Canada conference in Mississauga, Ontario. Can you tell me what this was like for you as a patient?


Robert S. Meyer: I was there as a patient and a speaker, but it was not until I got back home that the depth of my message sank in. First, I wanted to do my talk as a tribute to my mother, who had a nasty death due to the complications of diabetes. Second, if my message could help someone, it would be worth it all. Not just for other patients but for other service providers who need to find their own inner voice and become advocates for themselves or others, no matter the issue. Third, telling my story has a profound impact on my own healing journey. Now I know why victims of trauma need to tell their story as part of their healing. The important part is knowing that someone has listened and heard … read more

Flow-through Instillation of Hypochlorous Acid in the Treatment of Necrotizing Fasciitis

Abstract: Introduction. Necrotizing fasciitis (NF) is a rare and rapidly progressing bacterial infection of soft tissues. Bacterial toxins cause local tissue damage and necrosis, as well as blunt immune system responses. A self-propagating cycle of bacterial invasion, toxin release and tissue destruction can continue until substantial amounts of tissue become necrotic. Neutralization of bacterial toxins should improve the results.

Materials and Methods. Pure hypochlorous acid (HOCl) (0.01% w/v) with no sodium hypochlorite impurity in saline pH 4-5, which was recently shown to both eradicate bacteria and neutralize bacterial toxins in vitro, was administered via flow-through instillation to 6 patients with NF 4-6 times daily as needed. Utilizing a vacuum-assisted closure, 5-10 mL of pure 0.01% HOCl with no sodium hypochlorite impurity was instilled and removed frequently to irrigate the wounds. Results. Of the 6 patients, no deaths or limb amputations occurred. All infected areas healed completely without major complications. Conclusion. The toxicity and immune dysfunction caused by bacterial toxins and toxins released from damaged cells may be mitigated by flow-through instillation with saline containing pure 0.01% HOCl with no sodium hypochlorite impurity. Randomized controlled clinical trial research of this relatively simple and inexpensive instillation protocol is suggested for identified cases of NF.



Necrotizing fasciitis (NF), commonly referred to in nonmedical discourse as “flesh-eating” inflammation, is a rapidly progressing involvement of the fascia and subcutaneous tissues that can subsequently extend to the muscles and skin. Type I NF is classified as a polymicrobial infection, whereas type II NF is classified as a monomicrobial infection.1 Bacterial toxins released during the course of necrotic inflammations produce direct cytotoxic effects on surrounding tissues, while also causing immune system dysfunction and localized immunosuppression. The authors’ new therapy incorporates the use of an instillation vacuum-assisted closure procedure, also known as negative pressure wound therapy (NPWT), with pure 0.01% hypochlorous acid (HOCl) with no sodium hypochlorite—commonly known as bleach—impurity.2 As pure 0.01% HOCl (ie, > 97% relative molar distribution of active chlorine species as HOCl) in a 0.9% saline solution at pH 4-5 has been shown to both rapidly kill bacteria and neutralize bacterial toxins in vitro, clinical administration of pure HOCl with no sodium hypochlorite impurity was recently explored … read more

High-above-knee open amputation due to necrotising fasciitis

Necrotising fasciitis is a rare but serious bacterial infection of the soft tissues. It usually affects immunocompromised individuals, and people with diabetes are at particular risk. The lesion often starts as a minor wound and rapidly progresses, becoming life-threatening if not recognised early and treated aggressively. The authors present a severe case of necrotising fasciitis of the right lower limb that led to a high-above-knee amputation with faecal diversion to prevent wound contamination. Split skin grafting was used to close the wound once it had granulated. Faecal diversion can be important in cases where there is inadequate skin cover close to the torso, as stumps can be contaminated with faecal organisms, resulting in sepsis and possibly death.

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Missouri university inventors have new creation to heal chronic wounds

ROLLA, Mo.–There’s a new way to heal chronic wounds that’s been invented in Missouri.


It’s a technique that inventors at Missouri University of Science and Technology are calling one of a kind.


The FDA approved the product called Mirragen and it uses bioactive glass to heal chronic wounds like people with diabetic foot ulcers and bed sores.


The inventors of the product told KOLR-TV of all the ways there are to heal chronic wounds, this is the most effective option for patients that they’ve seen.


Chad Lewis of ETS Wound Care says the bioactive glass product called Mirragen has received rave reviews …. read more

Mirragen info video

HBOT, sham procedure lead to similar wound healing rates

Adults with diabetes and chronic lower limb wounds randomly assigned to 6 weeks of hyperbaric oxygen therapy or a sham procedure met similar amputation criteria and experienced similar wound healing rates at the conclusion of treatment, according to research in Diabetes Care.


In a prospective, double blind, randomized controlled trial, Ludwik Fedorko, MD, PhD, FRCPC, of Toronto General Hospital and University Health Network in Ontario, Canada, and colleagues analyzed data from 107 adults with type 1 or type 2 diabetes and chronic lower limb wounds persisting for a minimum of 4 weeks. Within the cohort, 49 participants were randomly assigned to 30 daily sessions of hyperbaric oxygen therapy lasting 90 minutes each (breathing oxygen at 244 kPa); 54 participants were assigned to a sham procedure (breathing oxygen at 125 kPa; equivalent to breathing 27% oxygen by face mask), in addition to receiving comprehensive wound care …


“The adjuvant [hyperbaric oxygen therapy] care provided no incremental benefit in improving measures of wound healing,” the researchers wrote. “These results are in contrast to several cohort and open-label randomized trials where no sham placebo was used.”  by Regina Schaffer

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Roles of alternative activation of macrophages phenotypes in normal wound healing

Normal wound healing process is characterized by highly organized controlled overlapping phases including haemostasis, inflammation, proliferation, and remodeling; through which acute wounds come to a complete healing with predictable time frame (Schreml et al, 2010). These phases are orchestrated by the interaction of different cell types and biochemical components to regulate and accomplish the different wound healing process such as coagulation, chemotaxis, phagocytosis, synthesis of extracellular matrix components, angiogenesis, epithelial migration, and remodeling components (Velnar et al, 2009). Components of the main cellular wound healing process include macrophages, keratinocytes, endothelial cells, fibroblast, neutrophils, and lymphocytes. These components are recruited, stimulated and activated according to their role in the healing process by which specific generic cytokines, growth factors, chemokines, and respective receptors are created to achieve physiological wound healing of skin wounds (Schreml et al, 2010).

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Study to Explore the Impact of Simulating Extreme Obesity on Health Care Professionals ….

Extremely obese patients pose significant challenges for those who strive to provide care. The prevalence and consequences of weight bias and stigma in health care have been well documented, but research on how to reduce weight bias and stigma is limited. To assess the impact of simulating obesity on the attitudes and perceptions of health professionals toward extreme obesity, a qualitative study involving 6 registered nurses and 1 registered physiotherapist was conducted between November 2015 and May 2016.


Health professionals who had regular contact with persons with obesity were recruited through poster advertisement in 1 hospital and 2 universities. Participants completed a demographic survey that included their physical measurements (height, weight, and waist circumference). They then wore a suit simulating the shape and size of a person with extreme obesity for approximately 2 hours and engaged in activities such as taking public transport or visiting a café. Audiotaped, semistructured interviews were conducted before and after the suit exercise and transcribed verbatim for conventional content analysis that identified 3 main categories: 1) insights into the physical challenges facing people with extreme obesity; 2) awareness of social consequences for people with extreme obesity; and 3) changes in participants’ attitudes toward people with extreme obesity. Following the exercise, personal attitudes were found to be less judgmental and more empathetic. Using a simulation suit may increase awareness among health professionals regarding issues facing persons with obesity and may be a positive influence on diffusing weight stigma and bias in health care settings, particularly in the area of wound prevention … read more

Can Lactic Acid Bacteria Speed Wound Healing?

David G. Armstrong DPM MD PhD

Researchers are showing faster wound healing following the administration of lactic acid bacteria into wounds.


The study, published online in the Proceedings of the National Academy of Sciences of the United States of America, used a mice model to show wound healing.1 Researchers transformed Lactobacilli with a plasmid encoding C-X-C motif chemokine 12 (CXCL12), noting this enhanced wound closure via proliferation of dermal cells and macrophages, also leading to higher transforming growth factor-beta (TGF-β) expression in macrophages. The study notes that bacteria-produced lactic acid reduced the local pH, which inhibited the peptidase CD26 and facilitated a higher availability of bioactive CXCL12.


The authors also note that Lactobacilli delivering CXCL12 improved wound closure in mice with hyperglycemia or peripheral ischemia, conditions associated with chronic wounds.1 The study adds that the treatment showed macrophage proliferation on human skin in an in vitro model of wound epithelialization … read more

Thoughts on Cross Contamination in Wound Care

by Michel H.E. Hermans, MD

A recent article in Mayo Clinic’s Proceedings1 studies contamination of stethoscopes. After a standardized physical examination, several parts of the physicians’ hand were cultured and the results were compared to cultures of the stethoscope diaphragm and tube. As it turned out, fingertip contamination was highest but the diaphragm of the stethoscope showed a higher level than the thenar eminence of the physician’s hand. The conclusion of the article stated that the stethoscope may play a serious role in cross contaminating patients.


The study was executed well and the conclusion valid, which thus raises the question: what do we do about it? Wipe the entire stethoscope (the tubes were contaminated as well), use a diaphragm cover or a separate stethoscope for each patient?


This type of study is not new. The authors themselves quoted a series of similar articles, with one going back to 1972.2 Other studies have shown similar threats from neckties3,4 and white coats. Guidelines on how to minimize the chance of cross contamination are abundant and have been around for a long time. Most hospitals have their own guidelines, many of them based on those issued by the World Health Organization … read more

Electrical Stimulation for Pressure Injuries: A Health Technology Assessment


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 a primary economic evaluation. Finally, we conducted qualitative interviews with patients and caregivers about their experiences with pressure injuries, currently available treatments, and (if applicable) electrical stimulation.


Nine randomized controlled trials and two non–randomized controlled trials were found from the systematic search. There was no significant difference in complete pressure injury healing between adjunct electrical stimulation and standard wound care. There was a significant difference in wound surface area reduction favouring electrical stimulation compared with standard wound care.

The only study on cost-effectiveness of electrical stimulation was partially applicable to the patient population of interest. Therefore, the cost-effectiveness of electrical stimulation cannot be determined. We estimate that the cost of publicly funding electrical stimulation for pressure injuries would be $0.77 to $3.85 million yearly for the next 5 years.

Patients and caregivers reported that pressure injuries were burdensome and reduced their quality of life. Patients and caregivers also noted that electrical stimulation seemed to reduce the time it took the wounds to heal … read more

Peripheral arterial disease and the diabetic foot

In peripheral arterial disease (PAD), atherosclerotic vessels in the periphery 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 (Meru et al, 2006).


The main risk factors for PAD include smoking, diabetes, high cholesterol and family history (Meru et al, 2006). More than 50% of people living with PAD may not show any clinical symptoms, hence proper diagnosis and management is challenging (Hirsch et al, 2007; Norgren et al, 2007). This article will discuss the aetiology, presentation, risk factors, and management of PAD as related to the lower extremities.


Aetiology and presentation
PAD is a macrovascular complication of diabetes mainly caused by atherosclerosis, whereby fatty plaque deposits progressively narrow the lumen of the arteries and decrease vascular perfusion to the lower limbs … read more

Combating Biofilms In The Chronic Wound

Given the complexity of biofilm in lower extremity wounds, these authors offer a closer look on how biofilm develops, keys to eradicating biofilm and emerging modalities that may have an impact in the future.


We all encounter biofilms on a regular basis in our practices. A biofilm is a complex polymicrobal community of bacteria and fungi that develops on foreign materials, necrotic debris, exposed bone, and within the bed of chronic wounds. When James and colleagues examined the biopsies of 50 chronic wound beds, 60 percent contained a biofilm.


Planktonic or free-floating bacteria are more aggressive and divide more rapidly. Changes in gene expression allow them to secrete hydrolase enzymes and exotoxins, resulting in more rapid local tissue invasion. As a bacterial colony develops, environmental stimuli induce the cells to engage in quorum sensing, a gradient-based recruitment strategy used to summon additional bacteria to the developing biofilm and alter the phenotypic expression of bacteria within the community. Free-floating planktonic bacteria adhere to the wound bed using very weak molecular interactions … read more

Wound Temperature and Healing

You’ve probably heard that it’s important to keep wounds moist and warm, But what’s the optimal temperature for healing a wound, and how do you maintain it? Read on for details.


When moisture evaporates from a surface, the surface cools. Sweat operates by this principle. So, unfortunately, do wounds. Whenever a wound loses moisture, the tissues of the wound drop in temperature.


The cells and enzymes of the body function best at normal temperature, around 37° C (98.6° F).  When wound temperature decreases by as little as 2° C, healing can slow or even cease. In shortwhen the temperature drops, the healing stops.


Furthermore, cooled tissues cause vasoconstriction and increase hemoglobin’s need for oxygen. As a result, there’s less oxygen available for the type of white blood cells called neutrophils to fight any potential infection.


Here’s the kicker: once the wound tissues cool– such as when left open to air during a dressing change– the wound base can take up to 4 hours to return to normal healing temperature. If a clinician changes a dressing TID, the wound may be outside of the optimal healing range 50% of the time … read more



As the end-of-year countdown begins, we’re looking at changes that will impact the wound care industry in 2018. For the next several weeks, we’ll be running a series of insightful blog posts from our team of experts. Our first is from Rylan Smith, CFO.


Fall brings vibrant colors, homemade chili, championship baseball – and new CMS regulations for reimbursement! In reviewing upcoming changes for 2018, here are five takeaways that wound centers need to be aware of:


Supervision of hospital therapy services for critical access hospitals and small rural hospitals will reinstate the non-enforcement of supervision requirements. In the 2018 OPPS proposed rule, CMS revisits the moratorium on enforcement of the direct supervision rule for critical access hospitals and small rural hospitals with less than 100 beds. This is a positive development for these hospitals, because physician time is at a premium. The implication for hyperbarics is that it provides for some flexibility with direct supervision. We at Wound Care Advantage always recommend having a physician immediately available when a patient is in the chamber. This rule will extend the moratorium through 2019 … read more


The Healthcare industry experiences a lot more data breaches than any other industry and cyber-attacks are the major cause of these breaches. With the prevalence of cyber-attacks, these data breaches have become consistently high in terms of volume, frequency, impact, and cost.

The HIPAA compliance goes a long way in addressing this issue and protecting medical practices and others in the healthcare industry from cyber intrusions which may pose a threat to Protected Health Information (PHI). Some HIPAA requirements that can specifically assist in curbing cyber-attacks include:

  • Install Anti-Malicious Software Updates and Security Patches Regularly
  • No. 45 Code of Federal Regulations (CFR) 164.308(a)(5)(ii) states that antivirus software and software firewalls should be installed, with regular patching and blocking occurring. Default logins and passwords should be removed from all information technology system and unnecessary services disabled, and ownership permissions should also be set. For larger organizations, network vulnerability scans on systems containing or accessing electronic PHI (ePHI) should occur and intrusion-detection software should be considered.

  • Perform (and Re-perform) the Security Risk Assessment (SRA)
  • As stated in 45 CFR 164.308(a)(1)(ii)(A) All covered entities (CEs) and their business associates are required to conduct an accurate, thorough SRA wherein potential risks to the confidentiality, integrity, and availability to ePHI are evaluated, as set forth by HIPAA's security regulations.

  • Save Security Incident Response and Reporting
  • The Code of Federal Regulations no. 45 CFR 164.308(a)(6)(ii) Recommend CE's to immediately disconnect Wi-Fi and unplug the affected computer from the network during a cyber-attack in order to mitigate damages caused. It is also important to document any response to any security incidents.

  • Implement a Remediation Plan
  • According to the Code of Federal Regulations no. 45 164.308(a)(1)(ii)(B) the remediation plan should grow out of the SRA and be able to identify the highest-risk items in one's organization. It is necessary you set deadlines to complete these items and assign individuals to ensure their completion.

  • Manage Passwords
  • 45 CFR 164.308(a)(5)(ii)(D) stated that you should ensure staff members do not share passwords and also set up policies and procedures in place for creating, changing, and safeguarding passwords.

  • Provide Workforce with Security Awareness Training
  • As stated in No. 45 Code of Federal Regulations 164.308(a)(5) Usually these cyber threats exploit the human element therefore every practice needs a training program that ensures everyone with access to ePHI is trained to efficiently reduce the risk of unauthorized access, use, and disclosure of ePHI.

  • Have a Data Backup Plan
  • As stated in 45 CFR 164.308(a) (7)(ii)(A) it is paramount that you back up all information technology systems with sufficient redundancies. Backups should be kept off premises (or be cloud-based) and take note of the critical data needed to be restored quickly to remain operational.

A review of the scientific evidence for biofilms in wounds

Both chronic and acute dermal wounds are susceptible to infection due to sterile loss of the innate barrier function of the skin and dermal appendages, facilitating the development of microbial communities, referred to as biofilms, within the wound environment. Microbial biofilms are implicated in both the infection of wounds and failure of those wounds to heal. The aim of this review is to provide a summary of published papers detailing biofilms in wounds, the effect they have on infection and wound healing, and detailing methods employed for their detection. The studies highlighted within this paper provide evidence that biofilms reside within the chronic wound and represent an important mechanism underlying the observed, delayed healing and infection. The reasons for this include both protease activity and immunological suppression. Furthermore, a lack of responsiveness to an array of antimicrobial agents has been due to the biofilms’ ability to inherently resist antimicrobial agents. It is imperative that effective strategies are developed, tested prospectively, and employed in chronic wounds to support the healing process and to reduce infection rates. It is increasingly apparent that adoption of a biofilm-based management approach to wound care, utilizing the “antibiofilm tool box” of therapies, to kill and prevent reattachment of microorganisms in the biofilm is producing the most positive clinical outcomes and prevention of infection …. full article available for purchase or rent

Plasma Treatment Continues to Evolve in Wound Healing

The German company COLDPLASMATECH specializes in using plasma to treat wounds. Plasma is the fourth state of matter, one substantially less common than gas, liquid or solid. While plasma has been in use in the health care industry for some time, it continues to improve as a possible treatment for wound victims.


According to Medical Xpress, COLDPLASMATECH utilizes cold plasma, similar to the kind found in lightning, to treat wounds. Early tests found the material to be tissue tolerable and its temperature allows for physicians to better work with its bioactivity.


Cold plasma treatment represents another step forward in plasma being effectively used to treat wounds.


Plasma as a wound treatment
In a study that was published in Clinical Plasma Medicine, experts outlined the difficulty in comparing plasma tests. The problem comes in the various sources for plasma as each produces different biological and physical properties. Nevertheless, medical researchers have been compiling data for years, earning an understanding of each plasma and its effectiveness in wound treatment.


Part of the drive for pushing plasma research forward is its potential to accelerate the healing process. St. George News highlighted how platelet-rich plasma has been used in healing therapy over the last several decades. However, technological improvements have heightened plasma’s effectiveness, enabling it to be a faster-acting wound treatment … read more

$70,000 Amputation or $250 Offloading Procedure

Please choose one

Easy choice right? Not for the Government of Ontario Canada. The vast majority of the 2,000 amputations that occur per year in that country would be preventable with common offloading practices (total contact casting*). Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario was assured three years ago by government ‘premieres’ that they would begin to cover such procedures … that’s three years or 6,000 legs or $420,000,000 ago. “We’re willing to pay for the amputations but we’re not willing to pay for the prevention,” offered Grinspun.

Cost and human suffering aside, mortality rates jump significantly after an amputation especially in older patients, diabetes further increases mortality rates. In one rather grim study** 390 patients that had undergone lower extremity amputations were reviewed, of the patients with diabetes “the median time to death was 27.2 months“.

So if you are suffering from diabetic neuropathy and experience a diabetic foot ulcer and happen to be living in Ontario Canada you need to get your affairs in order. But there is hope as The Ontario Health Technology Advisory Committee is currently assessing total contact casting to treat foot ulcers, check back in three years.
original article

*total contact casting is considered “The Gold Standard of off-loading”. A comparison of the three major off-loading methods (total-contact casts (TCCs), removable cast walkers (RCWs), and half-shoes) reinforces this point. The proportions of healing for patients treated with TCC, RCW, and half-shoe were 89.5, 65.0, and 58.3%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities.

**Mortality and Hospitalization in Patients After Amputation 

Off-Loading the Diabetic Foot Wound
A randomized clinical trial

Biofilms and Inflammation in Chronic Wounds



The incidence, cost, morbidity, and mortality associated with non-healing of chronic skin wounds are dramatic. With the increasing numbers of people with obesity, chronic medical conditions, and an increasing life expectancy, the healthcare cost of non-healing ulcers has recently been estimated at $25 billion annually in the United States. The role played by bacterial biofilm in chronic wounds has been emphasized in recent years, particularly in the context of the prolongation of the inflammatory phase of repair.

Recent Advances

Rapid high-throughput genomic approaches have revolutionized the ability to identify and quantify microbial organisms from wounds. Defining bacterial genomes and using genetic approaches to knock out specific bacterial functions, then studying bacterial survival on cutaneous wounds is a promising strategy for understanding which genes are essential for pathogenicity.

Critical Issues

When an animal sustains a cutaneous wound, understanding mechanisms involved in adaptations by bacteria and adaptations by the host in the struggle for survival is central to development of interventions that favor the host.

Future Directions

Characterization of microbiomes of clinically well characterized chronic human wounds is now under way. The use of in vivo models of biofilm-infected cutaneous wounds will permit the study of the mechanisms needed for biofilm formation, persistence, and potential synergistic interactions among bacteria. A more complete understanding of bacterial survival mechanisms and how microbes influence host repair mechanisms are likely to provide targets for chronic wound therapy.

full article


This course is ideal for beginners or anyone looking to brush up on their wound management skills! This wound care certificate course will serve as the basis for evidence-based wound management.


Foundation for Wound Care Knowledge
Based off of our expertise and valuable feedback from our past customers, we saw a need for a quick wound care course. This course allows professionals to explore their interests in wound care and decide if they should pursue full wound care certification. Our 23-hour course will provide the foundation to later expand your wound care knowledge and practical management … read more

UniSA research flying towards healing chronic wounds

Professor Allison Cowin

Professor Allison Cowin, Research Professor, Future Industries Institute, University of South Australia

The same gene which enables flies to fly could hold the answer to healing chronic wounds.


Professor Allison Cowin is developing the world’s first human therapeutic antibody for the cytoskeletal protein Flii, also known as ‘Flightless I,’ which has been found to improve wound healing. This medical advancement is game-changing for the treatment of wounds and is particularly valuable for children with the debilitating rare skin condition epidermolysis bullosa (EB).


“Our initial experiments have found that Flightless I plays an important role in the development of the skin barrier and thickness – so our antibody has the potential to not only help wounds heal but also to prevent the skin from breaking down again,” Prof Cowin says.


The Flii protein was first discovered by geneticists studying fruit flies who found that by removing this particular protein flies could no longer fly – hence the name Flightless … read more

100 Years of Bedsores: How Much Have We Learned?

ABSTRACT Just over 100 years ago, an article was published describing a plan to treat decubitus ulcers that can shed light upon medical progress and current practices. Key prevention and treatment elements included a dedicated ward, staff continuity, frequent position changes and special surfaces, cleanliness, disinfectants, and dressing changes. The necessity of resource allocation and interdisciplinary collaboration was acknowledged. This article sheds light on not only how much we have learned, but also how far we have to go.


A little over 100 years ago, a Decubitus Division was established at Kings County Hospital in Brooklyn, New York, and a management plan was published in an article in The Hospital Bulletin of the Department of Public Charities of the City of New York.1 This facility was established as an almshouse for the poor and today is a major municipal hospital affiliated with SUNY Downstate College of Medicine and a level I trauma center. We can learn much by examining this century-old plan for preventing and treating bedsores. To understand components of the plan, it must be remembered that antibiotics were decades in the future, and Dakin solution was still being developed on the battlefields of Europe.2 This article uses the terms “decubitus ulcer” and “bedsore,” as the terms “pressure ulcer” and “pressure injury” were not yet in the medical vocabulary.

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A Journey of a Thousand Steps to #ActAgainstAmputation

Diabetes is the sixth leading cause of death in North America. By 2020, an estimated 4.2 million Canadians will be living with the disease and its devastating complications. People with diabetes have an increased risk of developing diabetic foot ulcers (DFUs) as a result of the loss of protective sensation in their extremities. Twenty five percent of individuals with diabetes will have a DFU in their lifetime, increasing their risk of amputation and pushing their five-year mortality rate to surpass that of patients with Hodgkin’s disease, breast cancer or prostate cancer.1,2,3 The direct cost of diabetes in Canada now accounts for about 3.5% of public health-care spending, and this figure continues to rise.4 The cost of DFUs is an enormous strain on health-care systems: about $12.2 billion in 2010. Care for people living with diabetic foot ulcers needs to be holistic and requires addressing all factors that contribute to ulceration, including repeated trauma and pressure. For years, the Canadian wound-care community recognized and understood the importance and value of pressure … read more (pdf)

Iran Unveils Indigenous Polymer Wound Care Dressing

Iranian scientists have managed to produce an artificial vessel and a type of wound care dressing using polymeric materials.


The two technological developments were unveiled in a ceremony attended by the Head of Iran Polymer and Petrochemical Institute (IPPI) Mehdi Nekouhesh.


The polymer wound care dressing was invented as part of larger plan to find a treatment for a particular type of skin wounds, a Farsi report by Mehr said … read more

New! 37,000 Wound Care Jobs

A peek under the Cast a Total Contact Casting Primer

a Total Contact Casting Primer with Dr. Michael Miller
(A diatribe in four verses)


Okay fans, let’s talk about the science behind Total Contact Casting. But before we talk about the science, what is a Total Contact Cast? Well, before we talk about Total Contact Casting, let’s talk about the key to not just healing wounds but preventing them. But before we talk about preventing and healing them, we need to talk about them … wounds that is.


Wound is a term that usually means a defect in the epithelium, which is a five syllable word for skin. Another term you might hear is the word “ulcer”. The simplest way to differentiate these two is to remember that an ulcer arises from the inside and comes out whereas a wound starts on the outside and progresses inside. The key to understanding this is by example’s…


The ill equipped robber whose gun fired while he was walking into the store did not receive a gunshot ulcer, he got a gunshot wound. The bullet caused the damage from the outside, in. 


The person who took too many aspirin every day and started to have terrible stomach pain did not develop a gastric wound, he developed a gastric ulcer. The lining eroded from the inside out.


The beautiful model who could not have her picture taken had a herpes ulcer of her lip, not herpes wound. This ulcer developed from the inside of her lip to the outside


The patient who had his hernia fixed and then bumped the incision causing it to open, does not have a stomach ulcer, they have a stomach wound. The incision opened up from the outside exposing the inside.


Now that we have the definitions done, back to prevention and treatment. Of course the most obvious question that you need to ask is, what is our diagnosis (diagnoses) for either why this wound developed or what is specifically keeping it from healing?

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Altered macrophage phenotypes impair wound healing

One of the defining features of chronic wounds is their high levels of inflammation. Patients present with high levels of inflammation, around 80%, of cells at the wound margin being macrophages and with wound fluid laden with proinflammatory cytokines. The latter is in part responsible for preventing wound closure, along with the low levels of growth factors. In healthy acute wounds, two types of macrophages can be found: pro-inflammatory M1 macrophages and antiinflammatory M2 macrophages, with more M1 cells present early post-injury and M2 appearing later to regulate repair and wound closure. This pro-repair M2 phenotype, that secrete a range of mediators including growth factors that regulate re-vascularisation and closure of a wound, is lacking in chronic wounds, leading to excessive inflammation, enhanced degradation within the wound, reduced matrix deposition and lack of closure …  read more

Texas Health Plano Saving More Limbs with Non-Traditional Procedure

More than two million Americans are living as amputees, and that’s expected to double by 2050. In an attempt to change the projection, Texas Health Plano is trying something different. A new and unique catheterization procedure can help salvage the legs of more would-be amputee patients.


The multidisciplinary program includes emergency physicians, orthopedic surgeons, wound care physicians, podiatry, internal medicine and interventional cardiology. “The goal is to provide a cohesive plan of care for patients presenting to the ER or wound care center with ischemic ulcers of the legs (or) feet,” says Dr. Vijay Ramanath, medical director of Texas Health Plano’s Limb Preservation Program. “We want to prevent leg (and) foot amputations and return patients to a high-quality of life.” read more


How To Ensure Effective Offloading With Total Contact Casting

I recently had the opportunity to speak at a dinner meeting to a group of wound care clinicians. During a question and answer session, the topic of discussion drifted toward the use of total contact casting (TCC). I asked the meeting participants to indicate, with a show a hands, how many of them were using this modality regularly in their practice. I was shocked to see that the number was less than 10 percent.


Numerous authors have described the underlying pathology in the development of lower extremity ulcerations. Perhaps one of the greatest difficulties in managing complex lower extremity ulcerations is offloading the wound site effectively. A review of the literature demonstrates that TCC is the “gold standard” for offloading non-infected, non-ischemic plantar foot ulcerations.1,2


There are several mechanisms that combine to provide the reduction of peak plantar pressures via the use of TCC. Studies have established that the use of TCC decreases altered gait mechanics with shortened stride length and an overall reduction of walking velocity, both of which contribute to the reduction of plantar pressures.3 Furthermore, given the “cone effect” provided by the physical structure of the patient’s leg (an inverted cone), the TCC (a conical receptacle) also allows more even distribution of the patient’s weight read more

Medicare Changes That May Affect You (Tennessee, Alabama, and Georgia)

The Medicare Administrative Contractor (MAC) for Jurisdiction J (Tennessee, Alabama, and Georgia) is transitioning from Cahaba to Palmetto. The Part A transition went into effect January 26, 2018 and Part A providers should already be submitting claims to Palmetto GBA. Cahaba has discontinued the receipt of Part A redetermination, reopening, and ADR submissions via the InSite Web Portal … read more

Managing chronic venous leg ulcers

what’s the latest evidence?


Chronic venous leg ulcers (CVLUs) affect nearly 2.2 million Americans annually, including an estimated 3.6% of people over the age of 65. Given that CVLU risk increases with age, the global incidence is predicted to escalate dramatically because of the growing population of older adults. Annual CVLU treatment-related costs to the U.S. healthcare system alone are upwards of $3.5 billion, which are directly related to long healing times and recurrence rates of over 50%.


CVLUs are not only challenging and costly to treat, but the associated morbidity significantly reduces quality of life. That makes it critical for clinicians to choose evidence-based treatment strategies to achieve maximum healing outcomes and minimize recurrence rates of these common debilitating conditions. These strategies, which include compression therapy, specialized dressings, topical and oral medications, and surgery, are used to reduce edema, facilitate healing, and avert recurrence read more


Spend a Minute, Save a Life

Inlow’s 60-Second Diabetic Foot Screen


Boulton states that “throughout our medical training, we are taught how to manage patients who present with symptoms, which usually leads to a clinical examination, a diagnosis, and a treatment and management plan. However, virtually no time is spent on teaching how to manage patients who have no symptoms because they have lost the ability to feel pain; that is, they have peripheral neuropathy.”1 Clinical experience and the literature1 have shown us that the lack of symptoms Boulton referred to in those with or at risk for diabetic foot complications can have devastating effects on the person, their family and health systems. As clinicians, we have the opportunity, and the obligation, to step in and fill the gap left when peripheral neuropathy is present, or potentially present, in any of our patients. The key is a simple, quick procedure: foot screening … read more

Acute and Impaired Wound Healing

Pathophysiology and Current Methods for Drug Delivery, Part 1: Normal and Chronic Wounds: Biology, Causes, and Approaches to Care


Acute and chronic wounds affect millions of people in the United States and around the world. In recent decades, clinicians have gained a better understanding of the mechanisms of normal wound repair process and causes of delays in healing. This progress has led to significant improvement in the quality of life of affected patients. This article reviews the latest insights and opportunities for wound repair science and innovations in wound care.


Acute wounds are a common health problem, with 11 million people affected and approximately 300,000 people hospitalized yearly in the United States. Typically, acute wound healing is a well-organized process leading to predictable tissue repair where platelets, keratinocytes, immune surveillance cells, microvascular cells, and fibroblasts play key roles in the restoration of tissue integrity., The wound repair process can be divided into 4 temporarily and spatially overlapping phases: coagulation, inflammation, formation of granulation tissue (proliferative phase), and remodeling or scar formation phase … read more


Topical Nystatin Treatment for Candida Infection


Introduction. Wound infection is an important cause of nonhealing wounds and graft rejection. Objective. A series of 5 patients (4 females, 1 male; median age, 50; age range, 1.5–83 years) with nosocomial Candida infection of burns and chronic wounds that were reconstructed with split-thickness skin grafts is presented.


Materials and Methods. This case series was carried out between February 2011 and June 2014. Based on tissue cultures, wounds were treated with 100 000 units/mL of nystatin and 25 mg in 500 cc normal saline of mafenide acetate, which resulted in regression of wound infection symptoms and improvement of skin graft take. Conclusions. The authors propose this simple, nontoxic, and economic topical treatment for wounds and skin grafts with positive Candida cultures.


Infection is a common local factor that impedes wound healing. Hence, a topical antimicrobial dressing is frequently used to control bacterial proliferation.1 Since the introduction of effective topical antibacterial therapy, fungal infections have become more prevalent, especially in burn patients … read more

Scientists Create New Self-Repairing Material

While some people might think comic books are a fun distraction, they’ve made a difference in the real world. Case in point: Several noteworthy characters have inspired exciting new developments in the wound care industry. In spring 2016, a team of scientists from the UK used the web-shooter of the iconic Spider-Man as the basis for a gun that can create customizable dressings.


Now, a group of researchers from the University of California, Riverside have found similar inspiration in Wolverine, a mutant hero with claws and powers of regeneration. It’s the latter ability that most interested the team, and as they detail in a new study in the journal Advanced Materials, they’ve created a self-healing material that has multiple purposes … read more

Venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, pressure …

Are You Confident of the Diagnosis?


Leg ulcers are skin lesions with full-thickness loss of epidermis and dermis on the lower extremities. Among a wide variety of etiologies for chronic leg ulcers, four common types are venous stasis ulcers, arterial ulcers, diabetic neuropathic ulcers, and pressure ulcers. By definition, chronic leg ulcers last greater than 6 weeks. Acute ulcers such as traumatic wounds undergo normal healing in healthy patients without the need for further treatment. As a result, only chronic leg ulcers will be discussed here.


Patients with venous leg ulcers commonly complain of swelling and aching of the legs that is worse at the end of the day and improves with leg elevation. The medial lower leg is the most common site. The borders of venous ulcers are typically saucer-shaped, initially with a shallow wound base. The surrounding skin often exhibits pitting edema, induration, hemosiderosis, varicosities, lipodermatosclerosis, atrophie blanche, and/or stasis dermatitis read more


Assessing footwear in patients with diabetes

Inappropriate footwear is the most common source of trauma in patients with diabetes. Frequent and proper assessment of appropriate footwear is essential for protecting the diabetic foot from ulceration.


Here is a step-by-step process for evaluating footwear. Be sure to evaluate footwear with the patient walking …  read more

Wound Care Manual and Clinical Guidelines for Nurses

When faced with a complex instance of wound care, many first time or novice clinicians will ask, ‘What wound is this? What dressing should I use? How will this wound heal?’


An aspect of wound care management often overlooked is defining the wound itself. The guiding principles of wound care have always been focused around defining the wound, identifying any associated factors that may influence the healing process, then selecting the appropriate wound dressing or treatment device to meet the aim and aid the healing process.


This structured approach is essential, as the most common error in wound care management is rushing in to select the latest and greatest new wound dressings without actually giving thought to wound aetiology, tissue type and immediate aim.


This overview of wounds and dressings will identify some of the most common wound types and guide you in setting your aim of care and selecting a product or device to achieve that aim … read more


Conducting Your HIPAA-Required Security Risk Assessment

A company based in the state of Pennsylvania that develops wireless technology that’s used to assist physicians in the care of their cardiology patients was recently fined in excess of $2 million for a HIPAA breach that occurred when the protected health information (PHI) belonging to nearly 1,400 individuals was compromised after a company employee’s laptop was stolen.  The Office for Civil Rights (OCR), the body within the U.S. Department of Health & Human Services (HHS) tasked with enforcing HIPAA’s privacy and security rules, found, specifically, that “[the company] had insufficient risk analysis and risk management processes in place at the time the theft occurred; failed to conduct an accurate and thorough risk analysis to assess the potential risks and vulnerabilities to the confidentiality, integrity, and availability of [electronic] PHI (ePHI); and failed to plan for and implement security measures sufficient to reduce those risks and vulnerabilities. (Code of Federal Regulations [CFR] 45 164.308(a)(1)).”  This article will discuss the processes of HIPAA risk analysis and risk management to educate providers in the outpatient wound clinic setting on how to better protect their patients’ PHI and ePHI. The authors will also describe the general process of the security risk assessment (SRA) and offer direction and resources for providers to utilize … read more



Wound infection is such a common condition and presents so often that every wound care professional will recognize the major signs and symptoms almost instantly. However, the consequences of diagnosing wound infection late, or missing the signs of wound infection completely, are such that it is worth spending a few moments every now and again to remind ourselves of all the signs of wound infection.


As we are taught during training, the principal signs of wound infection are rubor, calor, tumor, functio laesa, drainage, and a decline in wound status. Rubor in an infected wound describes a poorly defined erythemal border with a disproportionate amount of erythema, while calor describes a magnified localized increase in temperature with warmth extending further away from the site and a possible systemic increase in body temperature … read more


Hyperbaric oxygen add-on may not aid wound healing in diabetes

The addition of hyperbaric oxygen therapy to standard care did not substantially improve outcomes in adults with diabetes with an ischemic wound compared with standard care treatment alone, according to findings published in Diabetes Care.

Dirk T. Ubbink, MD, PhD, of the department of surgery at Academic Medical Center in Amsterdam, and colleagues evaluated data from the DAMO2CLES trial on 120 adults with diabetes and an ischemic wound randomly assigned to standard care with (n = 60) or without hyperbaric oxygen therapy (n = 60) to determine whether hyperbaric oxygen therapy is beneficial for ischemic wound treatment. Participants were recruited between June 2013 and December 2015. The primary outcomes included limb salvage and wound healing after 12 months. Follow-up visits occurred at 3, 6 and 12 months after recruitment … read more

Mathematics Used to Improve Wound Healing

Chandan Sen, a research professor in the surgery department at Ohio State University, teamed up with Avner Friedman, professor of mathematicians at the university, and Chuan Xue, a postdoc at Ohio State’s Mathematical Biosciences Institute, to create a mathematical model for ischemic wounds. This new computational tool should provide predictive guidance on how a given wound might progress, allowing researchers to develop more precise protocols to deal with wounds and dehiscences.


The mathematical model, to date, simulates both non-ischemic wounds – those typical of wounds in healthy people with good circulation – and ischemic wounds. The current model produced results that generally match pre-clinical expectations: that a normal wound will close in about 13 days, and that 20 days after the development of an ischemic wound, only 25 percent of the wound will be healed.

The model also showed that normal wounds have higher concentrations of proteins and cells expected to be present during the healing process … read more

Guidelines for safe negative-pressure wound therapy

Since its introduction almost 20 years ago, negative-pressure wound therapy (NPWT) has become a leading technology in the care and management of acute, chronic, dehisced, traumatic wounds; pressure ulcers; diabetic ulcers; orthopedic trauma; skin flaps; and grafts. NPWT applies controlled suction to a wound using a suction pump that delivers intermittent, continuous, or variable negative pressure evenly through a wound filler (foam or gauze). Drainage tubing adheres to an occlusive transparent dressing; drainage is removed through the tubing into a collection canister. NWPT increases local vascularity and oxygenation of the wound bed and reduces edema by removing wound fluid, exudate, and bacteria … read more

Inflammation in Chronic Wounds

Non-healing chronic wounds present a major biological, psychological, social, and financial burden on both individual patients and the broader health system. Pathologically extensive inflammation plays a major role in the disruption of the normal healing cascade. The causes of chronic wounds (venous, arterial, pressure, and diabetic ulcers) can be examined through a juxtaposition of normal healing and the rogue inflammatory response created by the common components within chronic wounds (ageing, hypoxia, ischaemia-reperfusion injury, and bacterial colonisation). Wound bed care through debridement, dressings, and antibiotics currently form the basic mode of treatment. Despite recent setbacks, pharmaceutical adjuncts form an interesting area of research.


The skin forms an important and effective barrier against the environment. It plays a vital role in protection against insults such as bacteria, xenobiotics and dehydration. When a cutaneous injury occurs, the body initiates a series of complex events to re-establish this protection. Wound healing can be roughly divided into four continuous and overlapping phases: (1) haemostasis; (2) an immediate inflammatory response defined by an infiltration of cytokine-releasing leukocytes with antimicrobial functions; (3) these cytokines kick off a proliferative phase where new epithelium, blood vessels, and extracellular matrix (ECM) are laid down; (4) over a period of weeks to months, the wound contracts as the ECM is remodelled []. These highly regulated cellular, humoral and molecular processes have been described as an orchestral performance—a potential flawless interplay can lead to perfect regeneration; however, human adult wounds undergo a repair process that leads to scarring, and, in some cases, non-healing chronic wounds ….  read more

Self-sealing miniature ‘wound’ created by engineers

Biomedical engineers have developed a miniature self-sealing model system for studying bleeding and the clotting of wounds. The researchers envision the device as a drug discovery platform and potential diagnostic tool.


A description of the system, and representative movies, were published Tuesday online by Nature Communications.


Lead author Wilbur Lam, MD, PhD says that blood clotting involves the damaged blood vessel, platelets, blood clotting proteins that form a net-like mesh, and the flow of the blood itself.


“Current methods to study blood clotting require isolation of each of these components, which prevents us from seeing the big picture of what’s going with the patient’s blood clotting system,” says Lam, assistant professor in the Department of Pediatrics at Emory University School of Medicine and in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University read more

Screenshot from video showing blood cells streaming through a “wound” and a clot forming. The red-stained cells are actually white blood cells. A green extracellular glue can be seen at the top of the wound; this is fibrin, which holds the clot together. See the full video at:

Reducing infection in chronic leg ulcers with an activated carbon cloth dressing

Chronic wounds are likely to have an increased bioburden, which in turn increases the risk of local infection. Indeed, infection is one of the most frequent complications of non-healing wounds, resulting in longer treatment times, increased risk of morbidity, greater resource use (of both dressings and nurse time) and, most importantly, a high personal cost to patients and their families (Cooper et al, 2014). While the ultimate aim is to treat the underlying wound, use of antimicrobial dressings is the cornerstone of the treatment of infected wounds. Most antimicrobial dressings work by killing the bacteria, and are indicated for use only when there are clear signs of increased bioburden and/or clinical signs of infections. As such, their use is assessed after 2 weeks, at which point it is advised that the clinician switches to another type of dressing if the wound is observed to be healing (Cooper et al, 2014) … read more

Unexpected helpers in wound healing

Nerve cells in the skin help wounds to heal. When an injury occurs, cells known as glial cells change into repair cells and disseminate into the wound, where they help the skin to regenerate, researchers from the University of Zurich have shown.

An essential step in skin wound healing is wound closure, which is why shortly after an injury occurs, blood coagulates and seals the wound. For the injury to be able to heal permanently, however, the affected layers of the skin need to be newly formed. For that to happen, a complex, only partially understood interplay takes place between various cell types in our skin. Together with a team from ETH, Lukas Sommer, a professor in the Institute of Anatomy at the University of Zurich … read more

Total Contact Cast Use in Patients With Peripheral Arterial Disease

As the majority of diabetic foot ulcerations (DFUs) occur on the plantar foot, excessive pressure is a major contributing factor to delayed healing. The gold standard for offloading is the total contact cast (TCC); yet, TCC use is contraindicated in patients with ischemia. Lower extremity ischemia typically presents in the more severe end stages of peripheral arterial disease (PAD). As PAD exists on a severity spectrum from mild to severe, designation of a clear cutoff where TCC use is an absolute contraindication would assist those who treat DFUs on a daily basis. Objective. The aim of this study is to determine if a potential cutoff value for PAD where TCC use would be an absolute contraindication could be ascertained from a retrospective case series and a systematic literature review of patients with PAD in which treatment included TCC use … read more


In-home health care is increasingly on the rise. Research shows that 91% of American seniors favor the Medicare home health benefit and 87% of all Americans prefer to receive medical treatment in the comfort of their own home.

Becoming educated in advanced wound care, and achieving an accredited wound care certification can help to skyrocket your career as an independent contractor!

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Cell signals that trigger wound healing are surprisingly complex

In a sharp and pointy world, wound healing is a critical and marvelous process.


Despite a tremendous amount of scientific study, many outstanding mysteries still surround the way in which cells in living tissue respond to and repair physical damage.


One prominent mystery is exactly how wound-healing is triggered: A better understanding of this process is essential for developing new and improved methods for treating wounds of all types.


Using an ultrafast, ultraprecise ultraviolet laser, a team of physicists and biologists at Vanderbilt University has taken an important step toward understanding the nature of these trigger signals. Their new insights are described in a paper titled “Multiple mechanisms drive calcium signal dynamics around laser induced epithelial wounds” published Oct. 3 by the Biophysical Journal read more

Atypical Wounds: Causes and Management

Part 1 in a series discussing the etiology, assessment and management of atypical wounds.

As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.

An atypical wound, also known as a wound of unknown etiology, is caused by a disease or condition that doesn’t cause a wound typically …. read more

DermaStream CST for Active Wound Management

Israel21C is reporting that EnzySurge out of Rosh Ha’ayin, Israel is expecting to begin FDA approval process for the complete DermaStream CST system. The wound healing device is designed to be placed over a wound to provide continuous cleaning and washing away of debris and extravasated fluid. Although the device itself received FDA clearance, the bio-active chemical solution that it is supposed to work with it has yet to get a green light … read more

What you need to know about transparent film dressings

By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS

Transparent film dressings are thin sheets of transparent polyurethane (polymer) coated with an adhesive. These dressings are available in a variety of sizes and shapes.

Transparent film dressings provide a moist, healing environment; promote autolytic debridement; protect the wound from mechanical trauma and bacterial invasion; and act as a blister roof or “second skin.” Because they’re flexible, these dressings can conform to wounds located in awkward locations such as the elbow. The transparency makes it easy to visualize the wound bed … read more

True impact of diabetic foot ulcers

The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research … More than half the patients in the research study did not see their ulcer heal over a year — and one in seven had to have part or all of their foot amputated … Foot ulcers are open wounds and they affect around a quarter of the 3.3 million people in the UK living with diabetes … The wounds develop because diabetes damages the nerves and blood vessels in the feet … These wounds are chronic, slow to heal and prone to infection, and it is infection that normally leads to some of the severe consequences such as losing a limb or multiple amputations … read more

Wound Documentation Dos & Don’ts

Scope of Practice and Standards of Practice guide nurses1 and other members of the interprofessional wound care team2 in caring for patients with wounds. Documentation in the medical record is a key aspect of the Standard of Practice and serves to record he care delivered to the patient. Your documentation should follow your facility guideline for documentation. This WoundSource Trending Topic blog considers general wound documentation dos and don’ts and presents 10 tips for success … read more

New technology for accelerated wound healing discovered

Researchers have found a new way of accelerating wound healing. The technology and the mode of action involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Researchers at Uppsala University and SLU have found a new way of accelerating wound healing. The technology and the mode of action method published in the highly ranked journal PNAS involves using lactic acid bacteria as vectors to produce and deliver a human chemokine on site in the wounds. The research group is the first in the world to have developed the concept for topical use and the technology could turn out to be disruptive to the field of biologic drugs … Treatment of large and chronic wounds are a high cost burden to the health care system since effective tools to accelerate healing are lacking. Wound care is today limited to mechanical debridement, use of different dressings and significant amounts of antibiotics preventing or treating wound infections. With the aging population, occurrence of chronic diseases such as diabetes and the alarming global spread of antibiotic resistance, a treatment that kick-starts and accelerates wound healing … read more

Hollister Inc. shifts away from wound care

Hollister Inc. on Feb. 2 announced its decision to divest portions of its wound care business. Hollister, which manufactures products for not only the wound care market, but also the ostomy, continence and critical care markets, is in the process of transitioning its Hydrofera Blue and Endoform businesses to new owners, according to a press release. The new owners, who plan to continue manufacturing and delivering the products, will be named in a “forthcoming” communication, the release says … read more

Green Fluorescent Protein Helps Therapeutic Proteins …..

Researchers from Harvard University seem to have created a method to overcome the challenge of getting specific proteins to enter mammalian cells through the typically very restrictive cell membranes. The scientists achieved this feat by using highly positive ionizing green fluorescent protein (GFP) and attaching a ligand protein to it. Because of the high positive charge on the GFP, the package gets sucked into the cell’s interior by the negatively charged intracellular molecules called proteoglycans. It is hoped that this methodology will make protein based drugs a lot more effective, as currently they have to rely on doing their signaling work while remaining outside the cell … read more

Seeking Advice Can Be The Foundation of Optimal Wound Care

I purchased a rental home that needed an extensive renovation from the get-go 15 years ago. This same house recently required a complete re-renovation due to extensive moisture damage. I am someone who loves a good challenge, and so I gutted this property not only because it was necessary to make the home livable, but because I was in search of answers as to the “what,” “where,” “why,” and “how” everything came to be. As of this writing, my work on the house is (at least for the time being) finished, the result is better than I had expected, and I believe future problems will be prevented. During this long and physically, emotionally, and financially painful journey, which turned up everything from sluggish and corroded galvanized pipes to rain-damaged structures, many questions were raised in my mind that seemed all too familiar to the questions I ask myself while working as a healthcare clinician, such as: How often do we truly get to the underlying cause of our patients’ problems? How many of us are willing to make superficial “repairs” while forgoing the opportunity to “fix” the deeper, serious issues at large? Are we always willing to ask for help when we are unsure of what the best thing for a particular patient may be?

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Amazon, health care and the first American chaebol

Abe Kasbo, CEO, Verasoni Worldwide.

Abe Kasbo, CEO, Verasoni Worldwide.

Amazon’s recent landmark partnership with Berkshire Hathaway and JPMorgan Chase is yet another example of how certain sectors continue to underestimate Amazon’s imagination, never mind business prowess. I honestly believe some businesses, though fully capable, simply do not know how to respond to Amazon, and therefore don’t even try. Or they may want to try, but are afraid to fail. Amazon has led the way in industries where there’s prodigious inertia, like retail, entertainment, grocery and now health care.


The announcement, which is short on details, spurred a sell-off in some of health care’s most popular stocks like CVS, Cardinal Health, Walgreen and United Healthcare, among others. If the Whole Foods acquisition wasn’t a wakeup call, this particular venture into health care is a shot across the bow to every industry in America. It seems the financial markets were nervous that Amazon and partners will do what no American government could achieve to date: get better control of health care costs and deliver efficiencies and results where they matter. The cornerstone of the announcement, in my estimation, is the intention by this coalition to deliver health care “free from profit-making incentives.” American health care’s long resistance to price transparency seems to be have been dealt a blow with this announcement and that is a good thing for patients, and for health care providers, who can now compete on price, experience and outcomes … read more

Effective Wound Dressing Securement for Infection Prevention

In order to promote rapid healing, improve patient comfort and prevent complications, it is important that healthcare professionals actively work to prevent infection. One key component of that effort is wound dressing securement. Secure, gentle and effective dressings can help prevent the ingress of foreign material, reduce damage during dressing changes and help foster an ideal healing environment. This can help reduce the risk of infection, improving patient outcomes and lowering costs.1 In this post, we will explore the importance of infection prevention and effective dressing securement strategies to help prevent infection … read more

Venous Ulcers: The Evidence for Intervention

Even with optimal treatment of venous ulcers, healing may be prolonged and/or ineffective, and recurrence rates remain quite high. How should wound care clinicians and vascular specialists collaborate with care planning? Venous ulceration represents the most advanced stage of chronic venous disease and is responsible for approximately 70% of all chronic leg ulcers.1-3 These ulcers affect approximately 1% of the population and are responsible for significant morbidity, decreased quality of life, and economic costs. Advanced venous disease may result from primary degenerative disorders or may be secondary to a previous episode of deep vein thrombosis (DVT). Additionally, venous ulceration may arise from venous valvular incompetence (reflux) in the superficial, deep, or perforating veins; from venous obstruction; or from a combination of both. Regardless of the underlying etiology, the final consequence is venous hypertension resulting in activation of the microvascular endothelium; leukocyte activation, adhesion, and migration; and inflammation ultimately leading to skin changes and ulceration … read more

The Death of the Kennedy Terminal Ulcer

The concept of the Kennedy Terminal Ulcer (KTU) has been ubiquitous in attempting to explain the development of pressure based tissue injuries in patients with actual or presumed terminal conditions. The concept is problematic in that it uses factors other than pressure to explain the development and progression of pressure based tissue injuries, specifically the presence of a terminal condition. Based on the most current understanding of how pressure based tissue injuries develop and progress, the concept of The Kennedy Terminal Ulcer appears to be without physiologic basis and based solely on observation. Since systemic factors affect all tissues with relative equality, the development of a single locus of injury must logically be based on a single locus of cause and affect. The presumption that a single locus of injury will develop in an arbitrary location based on a systemic set of factors is untenable. A new concept called Miller Pressure Equivalent Injuries is proposed to refute the concept of a single pressure based tissue injury developing based solely on terminal systemic factors and why these previously presumed terminal condition associated pressure based injuries occur …. read more

New Negative Pressure Wound Care Device from Smith & Nephew

At the ongoing American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas, Smith & Nephew has just introduced a new negative pressure wound therapy system called RENASYS EZ.
Features and functions according to the manufacturer …. In addition to a simple control that varies pressure from 40 to 200 mmHg and the ability to use both foam and gauze dressings, Smith & Nephew designed RENASYS EZ with additional features that enhance the patient experience and facilitate its ease of use … read more

Medicare reimbursement for hyperbaric oxygen therapy

In an atmosphere of changing reimbursement, it’s important to understand indications and utilization guidelines for healthcare services. Otherwise, facilities won’t receive appropriate reimbursement for provided services. This article focuses on Medicare reimbursement for hyperbaric oxygen therapy (HBOT).


Indications and documentation requirements


The Centers for Medicare & Medicaid Services (CMS) National Coverage Determination for HBOT lists covered conditions for HBOT, as do the individual Medicare Administrative Contractor’s (MAC) Local Coverage Determination policies and/or articles. (See Conditions for which CMS approves use of HBOT.) Providers should thoroughly review the indications and utilization guidelines to ensure coverage criteria are met for each clinical condition … read more

The Future of Wound Healing: Autologous Patient Gels

Seems like yesterday that those of us with gaping lacerations were told to “walk it off.” These days, instead of just using sutures, surgeons have been using a natural fibrin glue to close up wounds and secure fractured bones. The next step in the process is actually using a patient’s own wound-healing cells like platelets to pseudo-naturally speed up the process.
A sample of blood is taken from the patient and the red blood cells are removed. The platelets are concentrated and when combined with thrombin, form a very strong gel that is not too different from the body’s natural healing process.
Pilot studies are springing up all over the place demonstrating reduced wound healing … read more

Wound Healing Sped Up by Patient’s Own Platelets

The University of Cincinnati is reporting that a team of clinicians under David Hom, MD, an otolaryngologist, completed a study that demonstrated that a gel containing a patient’s own platelets (autologous platelet gel or APG) is more effective in promoting skin wound healing than a control antibiotic ointment.

It is believed to be one of the earliest preliminary studies comparing the effectiveness of APG on skin wounds in healthy humans.
Four male and four female volunteers aged 21-58 received five full-thickness skin punch wounds (4 mm diameter) on each thigh. APG was applied topically to the punch sites (one to two times) on one thigh and antibiotic ointment to the other, and the wounds were monitored for six months … read more

When and how to culture a chronic wound

Chronic wound infections are a significant healthcare burden, contributing to increased morbidity and mortality, prolonged hospitalization, limb loss, and higher medical costs. What’s more, they pose a potential sepsis risk for patients. For wound care providers, the goal is to eliminate the infection before these consequences arise.


Most chronic wounds are colonized by polymicrobial aerobic-anaerobic microflora. However, practitioners continue to debate whether wound cultures are relevant. Typically, chronic wounds aren’t cultured unless the patient has signs and symptoms of infection, which vary depending on whether the wound is acute or chronic … read more

New Biocompatible Hydrogel for Wound Healing

Researchers at Harvard’s Brigham and Women’s Hospital engineered a new material that looks highly promising for use in accelerating wound healing, building replacement tissues, and growing new blood vessels. The photocrosslinkable elastin-like polypeptide-based (ELP) hydrogel is biocompatible, having characteristics similar to many soft tissues within the human body, and is activated using ultraviolet light. The mechanical properties and swelling of the final material can be controlled ahead of time by changing the concentration of the ingredients, potentially making it viable for use in widely differing applications … read more


Enzymatic debridement: No perfect solution yet

A recently published study on procedures for determining the effectiveness of various enzymatic wound debriding agents illustrates the continuing need for a reliable, cost-effective enzymatic debrider for use in wound care.


Researchers concluded that the automated in vitro procedure used in the study can produce useful information for evaluating the effects topical antimicrobials, wound cleansers, wound dressings, and drug infiltrates have on the effectiveness of debriding agents. The study used porcine skin and muscle tissue as substrates in an automated Franz-type in vitro diffusion cell system … read more


5 Questions to Consider Before Launching Your New Hospital-Based Wound Care Program

Opening a wound clinic is not without its risks and challenges. These five questions will help clinicians and program directors decide if the outpatient wound care service line is truly appropriate for them.


Hospital-based outpatient wound care programs have experienced explosive growth in a relatively short period of time, despite being relatively “new” to the healthcare industry. An aging population has brought significant health concerns among older patients, including type 2 diabetes, venous insufficiency, obesity, increasingly sedentary lifestyles, tobacco use, and other comorbidities that are taxing our healthcare system. Care of chronic wounds provides a cost-effective solution for this patient demographic, with a primary goal of amputation prevention and a secondary benefit of reduced hospital admissions and/or readmissions seen as motivation. The wound care product industry has also driven outpatient care and is expected to grow to $22 billion in the United States by 2022.1 The product industry has largely driven advancements in the field of wound care research while increasing awareness about wound management. Currently, there are approximately 1,500 wound care centers nationwide, based on conservative estimates collected during the authors’ research for this article, with many more hospitals considering adding a wound care program to their outpatient service lines. There’s no question that wound care programs offer a viable solution for hospitals; however, opening and operating an outpatient wound care program is not easily accomplished. It’s a unique service line that takes committed leadership, upfront capital, and a clinical staff that deeply believes in the service line to make it operate successfully and provide long-term value to the community.
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How to assess wound exudate

Exudate (drainage), a liquid produced by the body in response to tissue damage, is present in wounds as they heal. It consists of fluid that has leaked out of blood vessels and closely resembles blood plasma. Exudate can result also from conditions that cause edema, such as inflammation, immobility, limb dependence, and venous and lymphatic insufficiency.


Accurate assessment of exudate is important throughout the healing process because the color, consistency, odor, and amount change as a result of various physiologic processes and underlying complications.


Consistent terminology is crucial to ensure accurate communication among clinicians. Here are terms you should keep in mind when observing the wound and documenting your findings …. read more


Topical gel containing blood pressure drugs shown effective in healing chronic wounds …

Topical Gel Made From Oral Blood Pressure Drugs Shown Effective in Healing Chronic Wounds in Test Animals

An international team of researchers led by Johns Hopkins has shown that a topical gel made from a class of common blood pressure pills that block inflammation pathways speeds the healing of chronic skin wounds in mice and pigs.


A report of the findings, published Oct. 16 in the Journal of Investigative Dermatology, marks efforts to seek approval from the U.S. Food and Drug Administration (FDA) to use the gel application in treatment-resistant skin wounds among diabetics and others, particularly older adults.


“The FDA has not issued any new drug approval for wound healing in the past 10 years,” says Peter Abadir, M.D., associate professor …. read more


New Study, Same Conclusion …

New Study, Same Conclusion. It is time to take another look at Total Contact Casting


Total Contact Cast

Total Contact Cast

The most recent and perhaps the most conclusive study of for treatment of the diabetic foot is a collaboration of three prominent organizations, The Society for Vascular Surgery, the American Podiatric Medical Association and the Society for Vascular Medicine. The guidelines, “The Management of the Diabetic Foot,” were developed after three years of studies and are published online and in print in the Journal for Vascular Surgery. Dr. Anil P. Hingorani is the lead author that researched and wrote the guidelines. With diabetes a major worldwide problem and little data on treatments, the need for detailed, diabetic foot clinical guidelines from multiple disciplines was great, said Hingorani.


The committee synthesized the points of view of the three different medical professions by researching one another’s treatment protocols. Vascular surgeons and vascular medicine specialists read literature from podiatry and vice versa, for example, and all participants concentrated on infectious disease control and guidelines, a large component of the finished document. Collaboration was key, Hingorani said. “We had multiple disciplines looking at the problem to bring the best information from each field to develop the guidelines,” he said, though only limited “high-quality evidence” was available for many of the critical questions.


One of the findings that physicians may find surprising, it was the importance of the total contact cast in the treatment of plantar diabetic foot ulcers, which the committee found was is supported by robust data. Off-loading takes all direct pressure off the ulcer through use of a total contact cast. “total contact casting is so under-utilized,” Hingorani said. “I think some surgeons may find it surprising and it may raise a few eyebrows. Many surgeons are not aware of how strong the evidence is for total contact casting. It is not new but not widely understood or implemented.”
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The Save A Leg, Save A Life Foundation was incorporated as a new non-profit organization in the State of Florida during May of 2015. We are poised and excited to make an impact on reducing the number of amputations. We will shape and build SALSAL to achieve its goals and to make Save A Leg, Save A Life into a universally recognized phrase and concept, one that resonates and “connects the dots” between non-healing wounds, Peripheral Arterial Disease and Amputations, as well as catastrophic events such as heart attack and stroke … website

Docs In Socks

Injectable gel holds promise as wound-healing material


A research team led by UCLA biomolecular engineers and doctors has demonstrated a therapeutic material that could one day promote better tissue regeneration following a wound or a stroke.

During the body’s typical healing process, when tissues like skin are damaged the body grows replacement cells. Integrins are class of proteins that are important in the cellular processes critical to creating new tissue. One of the processes is cell adhesion, when new cells “stick” to the materials between cells, called the extracellular matrix. Another is cell migration, where at the cell’s surface, integrins help “pull” the cell along through the extracellular matrix to move cells into place. However, these processes do not occur in brain tissue that has been damaged during a stroke. This is why scientists are trying to develop therapeutic materials that could promote this form of healing.


The injectable gel-like material, which is called a hydrogel, that the UCLA researchers developed helps this repair process by forming a scaffold inside the wound … read more


Medicare Spending on Wound Care: The First Comprehensive Study

Did you ever wonder how much it really costs to treat and heal various wounds? Patients, family members, and healthcare team members often complain to me that $5/day for nutrition therapy is “too expensive.” Cost is relative, because according to the first comprehensive study of Medicare spending on wound care, it appears that an investment in medical nutrition therapy is a wise investment indeed.


A new study entitled An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds1, demonstrates the economic impact of chronic nonhealing wounds in the Medicare population and highlights the associated need for quality measures and reimbursement models for wound care within the US Centers for Medicare & Medicaid Services (CMS) payment policies. The study analyzed 2014 Medicare data to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type, and by care setting …. read more

Wound Documentation and Measurement with WoundZoom

Does your facility have a system in place for wound documentation and measurement? Our partners at WoundZoom offer an overview of their wound management system. Find out it it’s right for you.

What are you using for wound documentation and measurement? Is it saving you time and helping your patients?


As wound clinicians, we all have the same goal: to reduce wound size and eventually heal them completely. Wound measurement is key to determining our progress and guiding our treatment decisions. In this short slide show, WoundZoom discusses how their wound management system can drive better wound care practices. And as we know, better practices mean better outcomes … read more

Introducing WoundZoom Wound Management System

Introducing WoundZoom Wound Management System

Probiotic supplementation aids wound healing in diabetic foot ulcer

Patients with a diabetic foot ulcer who received probiotic supplementation for 12 weeks experienced faster wound healing coupled with an improved glycemic and lipid profile compared with patients assigned placebo, according to findings from a randomized controlled trial.


Sima Mohseni, of the infectious diseases and tropical medicine research center at Babol University of Medical Sciences in Iran, and colleagues analyzed data from 60 adults aged 40 years to 85 years with grade 3 diabetic foot ulcer, who randomly received either probiotic supplementation (n = 30) or placebo (n = 30) daily for 12 weeks between March and June 2016. Probiotic capsules contained lactobacillus acidophilus, lactobacillus casei, lactobacillus fermentum and Bifidobacterium bifidum. All participants also underwent standard treatment for wound care … read more


Lower Extremity Amputation and Reamputation Predictors ….

Review: Lower Extremity Amputation and Reamputation Predictors in Patients with Diabetic Foot Wounds


A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.


The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included … read more

FDA approves shock wave device for treatment of diabetic foot ulcers

Today, the U.S. Food and Drug Administration permitted the marketing of the Dermapace System, the first shock wave device intended to treat diabetic foot ulcers.


“Diabetes is the leading cause of lower limb amputations,” said Binita Ashar, M.D., director of the division of surgical devices in FDA’s Center for Devices and Radiological Health. “The FDA is dedicated to making technologies available that can help improve the quality of life for those with chronic diseases. Additional options for successfully treating and healing ulcer wounds may help prevent lower limb amputations.”


An estimated 30.3 million people in the United States have been diagnosed with diabetes, according to the Centers for Disease Control and Prevention. Diabetes damages blood vessels and nerves, particularly in the feet, and can lead to severe infections that are difficult to treat. About 25 percent of people with diabetes will experience a foot ulcer in their lifetime. Amputation is sometimes necessary when circulation is so poor that a foot ulcer fails to heal or when treatment fails to stop the spread of an infection … read more

Assessing Stress During Wound Care

Review: Assessing Stress During Wound Care in Real-Time Using Wearable Sensors

Introduction: The Stress Response in Wound Care in Diabetic Foot Ulcers

Within the last decade, the rise of diabetes in the U.S. population has been matched with a rise in diabetic foot ulcers requiring amputations. Because many of these diabetic foot ulcers develop secondary to poor wound healing and susceptibility to infection after surgery, some important risk factors have been evaluated. Stress, among other factors, has been shown not only to affect the psychological state of a patient, but also biologically to impair immunity and induce an inflammatory microenvironment within patients.


Although previous studies have measured stress by using heart rate and respiration rate during a dressing change lasting three to five minutes, no studies have continuously quantified stress in patients with diabetic foot ulcers during a routine visit. This particular study attempted to examine the stress response in patients with diabetic foot ulcers by using a chest-worn sensor displaying heart rate data. The research team relied on an algorithm to estimate stress that used changes in heart rate variability, a measurement that is taken between two consecutive R waves of an electrocardiogram.


Materials and Methods: Electrocardiographic Monitoring of Wound Dressing Changes in Diabetic Foot Ulcers


Twenty patients with diabetic foot ulcers were recruited from a wound care center and were given the BioHarness3, an FDA approved body device to evaluate single-channel electrocardiogram activity, respiration rate, posture, and core body temperature. To ensure quality control, the team used a smart phone to monitor data in a real-time fashion. This smart phone and BioHarness3 system had a biomodule that was linked to the patient’s body via a biopatch and electrocardiogram electrodes.
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Tissue Analytics raises $5M to make wound care more efficient

There’s a problem in healthcare when it comes to quality and accessibility of data in medicine, especially when it comes to chronic wound care, such as bed sores and ulcers that have to be cared for over years. For the most part, it has been done manually and, therefore, inaccurately.

“The old way that a doctor would manage and track the wound was with a ruler. Then they’d have to remember the last visit to figure out how it looked. This was holding the field back,” said Kevin Keenahan, CEO and co-founder of Tissue Analytics, a company that provides a solutions to increase efficiency and accuracy for wound and skin tracking.

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How Technology Is Supporting Smarter Wound Care

Smart bandage technology is something I’ve touched on a few times.  Most of the time, the technology has involved being able to monitor the health of a wound without ‘undressing’ the bandage.  Some take on a more active role however, such as administering insulin to manage blood glucose levels.


A team from the University of Nebraska-Lincoln, Harvard Medical School and MIT believe their smart bandage could eventually heal wounds on its own … read more




HIIN Brings Advanced Wound Care Training To …

Donna Meador has been a nurse for over 30 years. Today, she works at the Kentucky Hospital Association (KHA) to oversee quality and patient safety activities. Along with 34 other state associations, KHA is pursuing ambitious goals under the Health Research & Educational Trust (HRET) Hospital Improvement Innovation Network (HIIN) project. As the project’s director at KHA, Meador is working closely with hospital leadership and teams to ensure hospitals meet the goals set out by Centers for Medicare & Medicaid Services as part of the HRET HIIN project. KHA is striving to reduce inpatient harm by 20 percent and readmissions by 12 percent by 2019. Among the 12 areas of focus for the goals is pressure ulcers.


To ensure hospitals have the training they need to reduce pressure ulcers, KHA and Wound Care Education Institute® (WCEI®) formalized a partnership in June 2017. WCEI will bring the Skin and Wound Management course to a group of KHA member hospital clinicians in a live classroom setting in February 2018 … read more

Diabetic Foot Ulcer Off-loading: The Gap Between Evidence and …


Diabetic Foot Ulcer Off-loading: The Gap Between Evidence and Practice. Data from the US Wound Registry


Off-loading was documented in only 2.2% of 221,192 visits from January 2, 2007, to January 6, 2013. The most common off-loading option was the postoperative shoe (36.8%) and TCC (16.0%). There were significantly more amputations within 1 year for non-TCC–treated DFUs compared with TCC-treated DFUs (5.2% vs 2.2%; P = .001). The proportion of healed wounds was slightly higher for TCC-treated DFUs versus non-TCC–treated DFUs (39.4% vs 37.2%). Infection rates were significantly higher for non-TCC–treated DFUs compared with TCC-treated DFUs (2.6 vs 1.6; P = 2.1 × 10−10). Only 59 clinics used TCC (61%) … read more

Should Patients Buy Offloading Footwear From You?

It is a challenging, common situation: wound care patients require offloading devices for diabetic and/or neuropathic plantar ulcers, but there is no insurance coverage for those items.  You explain that they will bear the cost of the product(s), but they believe the expenses should be covered by you. When you offer to sell the product(s) directly or suggest the patients purchase them elsewhere, they refuse. Ultimately, their wounds worsen or don’t improve.


It is well documented that shoe-based offloading approaches are used more frequently than any other modality in the treatment of plantar diabetic foot ulcers (DFUs).1,2 It is equally well established that supporting data are limited.3 Additionally, since there is no reimbursement for shoe-based offloading, the products and materials that physicians select to create offloading structures may be based as much on acquisition cost and availability than on any empirical review. When a DFU is the sole indication, the only offloading options that are routinely covered by Medicare (or insurance) are total contact casting and Crow walkers, both of which are used infrequently and are not “accepted” by many physicians or patients.1,2 The result of this disconnect between modalities that are reimbursed versus approaches that most physicians use is that there is no broadly recognized standard of care and actual care is highly variable from facility to facility …
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Reexamining The Gold Standard For Offloading Of DFUs

Although the total contact cast can be effective for offloading diabetic foot ulcers, it is not in wide usage. These authors assert the gold standard for offloading lies in the non-removability of the device and offer a closer look at the merits of transitional offloading.


According to the American Diabetes Association, there are approximately 29.1 million Americans, or 9.3 percent of the population, who suffer from diabetes.1 Twenty-one million of these people have already been diagnosed with the disease and 8.1 million remain undiagnosed.


This number, although large, pales in comparison with the 86 million Americans who have been classified as “pre-diabetic” and who are at risk of having diabetes in the near future.1 Each year, 1.7 million Americans 20 years of age or older add to this number. This amounts to 4,660 people per day or one new patient with diabetes every 19 seconds. A full 25.9 percent of Americans age 65 or older suffer from diabetes and its complications. Almost twice as many American Indians (15.9 percent) and African-Americans (13.2 percent) develop the disease as Caucasians (7.6 percent) with Hispanics close behind (12.8 percent). Asian-Americans are not spared as 9 percent of this population will develop the disease and its many complications.


Glycosylation affects all organ systems and leads to complications such as dyslipidemia with an increased incidence of hypertension, and systemic vascular disease. It also leads to the development of a progressive ascending peripheral neuropathy with a loss of sensation and sweat gland function. This in turn leads to ulceration and, in some cases, amputation when infection of the wounds goes unchecked by an immune system that is also compromised by the process …
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Will Mobile Apps Bring Wound Care Technology to the “Cutting Edge”?

For wound care providers and other clinicians, 2017 continued to bring about a chaotic storm of healthcare reform based on quality measures, data registry requirements, and documentation standards. As has been previously stated in this journal, it remains to be seen if wound care practitioners will pool their limited resources and harness the power of their electronic health records to battle the “giant of healthcare reform.”1 This country’s push to enact and substantiate quality of care delivery can be seen through the uniting of clinical practice with increasingly sophisticated digital technology that allows for more accurate documentation and communication. For good reason, the focus of this union is being placed on the perspective of the patient (ie, how the patient receives healthcare information). However, it is becoming increasingly clear that there is a need for clinicians to be armed with devices that more easily and effectively facilitate the means to that end. This article will discuss the proliferation of healthcare-related digital apps that are both patient and clinician focused in an attempt to lay a foundation for wound care clinicians to become more technologically savvy and clinically compliant.

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Research reveals the true impact of diabetic foot ulcers

The prognosis for people with an infected diabetic foot ulcer is worse than was previously thought, according to new research.


More than half the patients in the research study did not see their ulcer heal over a year – and one in seven had to have part or all of their foot amputated.


Foot ulcers are open wounds and they affect around a quarter of the 3.3 million people in the UK living with diabetes.


The wounds develop because diabetes damages the nerves and blood vessels in the feet.


These wounds are chronic, slow to heal and prone to infection, and it is infection that normally leads to some of the severe consequences such as losing a limb or multiple amputations.


The research, led by Professor Andrea Nelson at the University of Leeds, set out to examine the outcomes for people with infected diabetic foot ulcers and the results underline the need for people at risk of foot ulcers to be closely monitored.

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Assessing Wound Depth with Smartphone Sensors

A new technological capability enables clinicians to gauge wound depth and severity using smartphone cameras, according to an announcement today from Swift Medical. The innovation could help to better manage wound outcomes.


The system, called AutoDepth, will be part of the PointClickCare Skin and Wound application, which is powered by Swift’s technology. In many cases, depth can be a key indicator as to whether a wound is healing properly. The system’s algorithms process dynamic changes in depth over time, and it also uses machine learning to improve its accuracy.


Carlo Perez, CEO of Swift Medical, equates the sensory techniques to those that enable autonomous driving.

Gauging wound severity with a smartphone has a few advantages … read more


Wound Care Startup Could Reduce Home Health Time

A biomedical engineer and a health care entrepreneur have teamed up to improve wound care with a product designed to prevent infection and reduce the need for some post-acute care, including home health.


FM Wound Care, LLC, based in Trenary, Michigan, is awaiting U.S. Food and Drug Administration approval on a nitric-oxide-infused, self-sterilizing wound dressing designed to kill bacteria following surgery. The post-op bandage could potentially reduce the need for some care performed by home health care providers, and lower overall wound care costs.


Megan C. Frost, PhD, and entrepreneur Jeff Millin believe their product—the Sentry Wound Dressing—prevents infections by slowly releasing nitric oxide (N.O.) over the course of seven days, allowing patients to wear the same wound dressing for a week.


“If a nurse has to change a dressing, that takes quite a bit of time,” Millin explained to Home Health Care News. “If you only had to do that once every seven days as opposed to once every other day, the savings could be significant.”

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State of the Art Hydrogels for Wound Care and ….

State of the Art Hydrogels for Wound Care and Drug Delivery: Interview with CEO of Alliqua Inc.

Alliqua is a Langhorne, PA medical technology company that uses its proprietary hydrogel platform to develop wound care and drug delivery solutions. The company prides itself in having a broad range of wound care products that are not only different from competing products available on the market, but also in providing multiple options to clinicians to generate optimal wound healing outcomes with minimal risk of infections. Medgadget had the opportunity to interview David Johnson, CEO of Alliqua to learn about the latest products offered by the company and to get a better understanding of the next generation of wound care tools …. read more


Imbed Biosciences prepares to start selling its wound healing dressing …

Imbed Biosciences, Fitchburg, is poised to launch the sale of its wound-healing dressing, Microlyte Ag, a microfilm embedded with silver particles.

Imbed Biosciences, Fitchburg, is poised to launch the sale of its wound-healing dressing, Microlyte Ag, a microfilm embedded with silver particles.

Imbed Biosciences, a young Fitchburg company that has developed an ultrathin film to heal wounds, is poised to launch its product this spring with the help of the latest injection of funds from investors.

A “national wound care company” will partner with Imbed and will market Microlyte Ag, said Ankit Agarwal, Imbed CEO and co-founder. The partner company’s name is not being released yet.

Microlyte Ag is a patented, ultrathin film coated with tiny silver particles that stick to the surface of the wound and kill bacteria. The U.S. Food and Drug Administration cleared it in August 2016 as a medical device, for prescription and over-the-counter use.

Mission Health’s hospital in Asheville, North Carolina is applying Microlyte Ag to 100 patients in a clinical study; results will be presented this spring. In a separate pilot project, doctors in about 25 hospitals across the U.S. are treating patients with the microfilm, Agarwal said.

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Biofilm and Wound Healing

Composition of Biofilm

Biofilm is a complex microbial community containing self- and surface-attached microorganisms that are embedded in an extracellular polymeric substance.1,2 The extracellular polymeric substance is a primarily polysaccharide protective matrix synthesized and secreted by the microorganisms that attaches the biofilm firmly to a living or non-living surface. This protective covering does not allow the body’s immune system to recognize the presence of the microorganism; therefore, the bacteria evade an immune response, avoid detection by standard diagnostic techniques, and avoid destruction by standard treatments. Because of the tenacity of the attached biofilm, the microoganisms are able to resist physical forces, such shear, and are able to withstand nutrient and moisture deprivation, altered pH, and the impact of antibiotics and antiseptics. For the purposes of this discussion we break down the formation and actions of biofilms and discuss their impact on wound healing … read more


This Is Wound Care, the Coolest Specialty in Health Care

There are three little words in health care that without proper treatment can destroy your family’s finances and health. Despite this, the amount of people that have ever heard of the words — non-healing wounds — remains astonishingly low.

We are not talking about simple cuts, scrapes, or boo boos. Wound Care is a raw, gritty, extremely visual, and sometimes nauseating field of health care. It is certainly not for the squeamish. At the same time it is the coolest, most visual, and passion filled specialty of healthcare in which to be employed.

The passion runs deep

The wound care community is a segment of health care specialists that have dedicated their lives to the healing and treatment of non-healing wounds. These people live, sleep, eat, breath, and even dream about wound healing. When they are not doing that, they are posting about it on social media. I know this because I work with these amazing individuals every day at Wound Care Advantage (WCA), a company that runs and manages outpatient wound centers for hospitals. As the director of our S.O.A.R. department it is my job to help educate the nation on the dangers of non-healing wounds …. read more


WCC Recertification: It’s Easier Than You Think

Earning your Wound Care Certified® (WCC®) credential is one of the best feelings in the world. Once the exam is behind you (what a relief!), you can take all that new knowledge back to your practice and continue making a positive impact in wound care. So, it’s completely understandable how tempting it can be to delay even thinking about re-certification … read more


The Miller-Newgent Amputation Scale

A comprehensive scoring system to evaluate patient-centered risk factors regarding lower extremity amputation


Abstract: Care of the patient with a presumed life- or limb-threatening lower extremity wound poses many challenges. The mindset regarding potential outcomes of such conditions is mostly driven by the experiences and expertise of those providing the care. This mindset generally appears as two primary actions presented to the afflicted patient: attempted resolution of the problem via medical, surgical or combination treatment, with the hope of low recurrence risk, or exacerbation and amputation—amputations at a level sufficient to, at least in the mind of the surgeon, eliminate the problem. Achieving the former outcome is dependent on a number of factors associated with both patient and caregiver. If healing is achieved, the secondary goal of prevention of recurrence may be no less arduous, with failure most likely resulting in amputation. Clearly, these considerations appear to be based more on the health professionals perception, of the patient’s physical and medical status rather than on patient-centered considerations. This article will review considerations and recommendations for lower extremity amputation, and the short- and long-term implications. Based on our research, there is clear need for a set of criteria against which to weigh not just the medical issues, but also definitive patient-centered issues when considering a lower extremity amputation. We offer a set of patient-centered, easily verified and recognized criteria that we believe addresses this need. The goal of the Miller-Newgent Amputation Scale (MENACE) is to provide a decision base from which to consider and evaluate all factors in determining the need for a lower extremity amputation. This involves identification of patient-centered issues, which are likely to produce satisfactory short- and long-term physical and quality-of-life outcomes if the amputation does proceed.


Declaration of interest: The authors have no conflict of interest to declare. The lead author, as a Board Certified general surgeon with 23 years’ experience in the field of advanced wound care, has been involved in the different aspects to amputation and its considerations and a common thread my colleagues and I have identified is that the expertise of those attempting to heal and salvage limbs was largely ineffectual. More often than not, the progression of high-risk conditions mandated lower extremity amputation. The progression of technology, science and products to promote healing is thought to improve limb salvage rates; however, there has not been an appreciable reduction in amputations. The thought is that those possessing the skill, knowledge and desire to promote limb salvage (which entails greater time and effort with considerably lower compensation) are few and far between. Despite advances in medical care, the rates of lower extremity amputation are unchanged at best or are even increasing.


Despite educational programmes touting the newest technologies for vascular intervention and advanced wound healing to mitigate those conditions commonly leading to amputation, there has been minimal change in the willingness of health professionals to consider limb salvage and indications for amputation have changed minimally. There is a clear need for a matrix against which to compare and contrast the clinical and non-clinical considerations for amputation. Since the patient is the one undergoing this potentially horrific procedure, it is only fair that all aspects of the procedure must be considered as an integral part of the decisionmaking process. The Miller-Newgent Amputation Scale (MENACE) scale was created to provide a patientcentred guide using simple, easily identified information that directly impacts on all aspects of the amputation decision process.


Background Considerations for the intentional removal of a body part have their roots in antiquity. Matthew 5:29–30, 18:8–9 and Mark 9:43–47 are commonly recognised biblical references to amputation. Lower extremity amputation is one of the oldest known surgical practices with Hippocrates among others providing insights.


In the US, 30,000–40,000 amputations are performed annually. In 2005, there were an estimated 1.6 million individuals living with the loss of a limb; by 2050, this figure is expected to rise to 3.6 million.


In 1954, Silbert and Hamiovici published an article recommending that lower extremity amputation be avoided, preferring more conservative surgeries such as supracondylar amputations as opposed to mid-leg amputations. In the paper they cited the Handbook on Amputations, published in 1942 by the Council on Physical Therapy of the American Medical Association, which expressed the opinion of most surgeons, when it advised the use of supracondylar amputations and warned against mid-leg amputations: an opinion justifiable at the time before the advent of antibiotics.


The Netherlands Society of Physical and Rehabilitation Medicine in October 2012 published its guideline on Amputation and Prosthetics of the Lower Extremities in which it recommended that the interventional radiologist, vascular internist and rehabilitation physician collectively identify and resolve those clinical issues before proceeding with a lower extremity amputation. Further, the guidelines state that treatment by a multidisciplinary team (MDT) involving a surgeon, anaesthesiologist, pain specialist, rehabilitation specialist, and possibly an internist is necessary for treatment of pain, cardiovascular risks, comorbidity and the co-determination of the level of amputation. The article identified many of the clinical indications for lower extremity amputation found in the literature; however, there is the same omission of any patient-centred, non-clinical concerns.

Table 1. Estimated change in metabolic energy expenditure based on level of amputation

Table 1. Estimated change in metabolic energy expenditure based on level of amputation


Reyzelman and Kim presented their idea of acceptable considerations for partial tissue removal (digital amputation) based on presenting conditions including: osteomyelitis, septic arthritis, gas gangrene, ischaemia/ gangrene and an advancing soft tissue infection. The authors concluded that early digital amputation in the appropriate patient allowed patients a return to normal activity with minimal disability.


Kalapatapu attempted to provide a compendium of indications for lower extremity amputation by providing an exhaustive listing of essentially all lower extremity morbidities. He stated:


   ‘Primary amputation may be the only option for
   patients without an anatomic option for
   revascularisation or those with medical risk factors that
   contraindicate revascularisation.’


Recognising that the spectrum of surgical and medical skills is considerable, and that there are an almost limitless number of non-medical factors, even attempting to define specific conditions as the basis for amputations is extremely problematic and potentially precludes the surgeon and thus the patient from any consideration of limb salvage.


A patient presenting with a condition prompting even the slightest consideration for lower extremity amputation likely has other issues related directly or indirectly to the presenting condition itself. It is a small leap of faith to recognise that an increase in metabolic demand places greater stress systemically on the patient with a concurrent risk of exacerbating current comorbidities as well as promoting new ones. These increased energy expenditures clearly mandate the highest scrutiny of a patient’s physical condition, both pre- and postoperatively, before undertaking any surgical consideration including lower extremity amputation. Recognising that the loss of an extremity means a dramatic change in the metabolic as well as mental status of the body, the failure to include these considerations potentially impacts on the ability of the patient to engage in activities of daily living. Estimates of the changes in metabolic energy expenditure based on the level of the amputation are shown in Table 1.


However, the definitive consideration must be the effect of survival from a lower extremity amputation since this takes all factors together under a single irreversible endpoint. Survival rates for individuals with dysvascular pathology undergoing major lower extremity amputations including (above the knee amputation) AKA and BKA (below the knee amputation) have been reported as 69.7% and 34.7% at 1 and 5 years, respectively.12 Mortality was found to be significantly higher for patients who underwent AKA (50.6% and 22.5% at 1 and 5 years) as compared with BKA (74.5% and 37.8% at 1 and 5 years).


Although amputation can be considered a failure of treatment, the actual considerations must be based on a number of factors, even when the initial impression is that salvage of the limb is untenable. There are still general categories of lower extremity conditions in which limb salvage is not appropriate. These would include traumatic limb loss or significant tissue deformation from motor vehicle or industrial accidents, malignancies whose location or dissemination precluded salvage, and congenital malformations precluding use of prosthetics or achieving a functional end result. Excluding the majority of these still leaves a considerable number of lower extremity conditions, in which the end result, amputation, unquestionably puts the patient at a higher risk of morbidity and mortality than before the decision to perform the procedure.


At present, the decision to recommend lower extremity amputation appears to be universally based on objective medical issues. Without recognising and attending to the equally important and pervasive, nonclinical, patient-centred issues, the decision is usually made based on the surgeon’s tunnel vision. The most basic tenet becomes that of removing the problem as the key to resolving the problem. As Ertl aptly stated:


‘The only contraindication for amputation is poor
health that impairs the patient’s ability to tolerate
anaesthesia and surgery. However, the diseased limb is
often at the centre of the patient’s illness, leading to a
compromised medical status. The removal of the
diseased limb is necessary to eliminate systemic toxins
and save the patient’s life.’


Unfortunately, the mere removal of an afflicted lower extremity under the guise of resolving the issue takes on a ‘low-hanging fruit’ mentality as it fails to address equally important patient-centred issues that often define the progress and ultimate outcome.


The identification of any criteria regarding the appropriateness of a lower extremity amputation based on patient-centered, non-clinical criteria has been found to be nonexistent despite an exhaustive literature search. This covered 70 years and approximately 200 citations. Brigham and Women’s Hospital in Boston uses a Pre-Amputation Assessment Checklist that, while comprehensively identifying specific patient expectations and information, does not consider any patient-centered criteria for amputation. Therefore, the Brigham tool does not recognize the potential issues and ultimate outcomes surrounding amputation. In contrast, the MENACE SCALE and its patent-centered components focus the attention on those issues related to non-clinical outcomes when lower extremity amputation is considered.


Table 2

The MENACE scale

It is not enough to objectively quantify only the clinical considerations for lower extremity amputation. The resulting amputation and the effect on quality-oflife must be taken into account. For that reason, there must be a combination of clinical factors together with non-clinical factors. The impact of these patientcentred, non-clinical factors cannot be overstated. The loss of all or part of a limb has a major psychological impact on the patient’s mental status. The psychological effects of amputation can be related to postoperative pain, cosmetic appearance, cultural and social effects, all potentially causing or exacerbating anxiety and depression.


We believe that any initial consideration for lower extremity amputation, regardless of the presenting issues, can be based on two primary factors. Those two factors are intractable pain and functionality in the presence of a potentially life- or limb-threatening condition. While these factors may at first appear to be objective they are equally dependent on the patient’s subjective impressions of their condition.


In considering the issues that ‘open the door’ to amputation, the authors felt that this process is analogous to ‘looking through a keyhole’ from which only a narrowed view is possible. We chose the term ‘keyhole criteria’ to represent this process as initial consideration regarding amputation. The two criteria (Table 2) establish a platform that forms the basis for the critical decision of amputation. These criteria move the decision from one that is based solely on the surgeon’s experience to a more germane one that encompasses considerations of the patient as a whole.


Criterion 1 is significant in that there are lower extremity conditions including neurologic, musculoskeletal or other deficits where attempted preservation would offer no benefit to the patient. When these presentations are associated with debilitating pain, then this criterion would be met and consideration for an amputation at some level would be appropriate. This criterion would require that all attempts be made to mitigate the pain. Thus, an acute presentation (following traumatic accident, postoperative complications from prosthetic implantation, etc.) would arguably require some time to be allowed to pass before accepting these criteria.


The issues regarding criterion 2 include preservation of the patient’s functionality and assumed morbidity and mortality of the presenting condition and that of the procedure. The goal of MENACE is to assure full consideration of all aspects of limb salvage versus amputation. Recognising that lesser procedures may provide both short- and long-term satisfactory outcomes, the issue of when to perform a lesser procedure and what that procedure may be, must be based on preservation of maximum functionality. For these reasons, attention must be directed to the patientspecific issues since information obtained provides the necessary elements required for a successful outcome. For example, the presence of distal pedal gangrenous changes in a diabetic neuropathic ulcer with a history of osteomyelitis poses a daunting problem. Not surprisingly, these findings would, in the vast majority of cases, lead to a strong recommendation for amputation. However, the usual discussion of potential complications and progression of disease state will generally lead to at least a discussion of the ‘benefits’ of simply removing the entire problem-containing lower limb. In contrast, the consideration of functionality is integral because it changes the discussion from one that obviates a potential progression of the presenting problem to one that recognises that retained maximum functionality allows ongoing quality-of-life based on retaining the limb. In simplest terms, if the extremity is still used to bear weight, provide propulsion in a wheelchair, transfer from chair to bed to commode, or even ambulate for any distance, then maintenance of that functionality takes on the highest priority. The goal becomes maximising the longevity and functionality of that extremity.


The authors believe that the two keyhole criteria represent a mandatory check step for medical providers who either perform or refer to those performing lower extremity amputation. These two criteria need to be used to ascertain the appropriateness of amputation for a given patient. This represents a marked departure from the practice that the decision be based on the perception of perceived benefit of amputation.


Initial evaluation of the patient’s presenting status with respect to the keyhole criteria should be undertaken. If the result is a decision to amputate, the MENACE scale assures that patient-centred factors are considered in the decision to amputate. Those factors placing the patient at risk for quality-of-life issues after surgery should be addressed well before amputation.


Table 3

The initial tool used by the authors was the 1–2 point scale to assess patient-centred factors. However, we recognised that the keyhole criteria were needed to focus the attention of the surgeon on what the authors felt were the two critical issues: pain and functionality.


With the focus now placed on the patient, those factors that impact on their lives both pre- and postoperatively need to be considered. While there are an infinite number of both specific and general categories to be considered, we believe that those factors identified in Table 3 represent the most salient, recognising the interrelationship of these factors and others not specifically identified.


The social status of the patient is integral to mental and physical wellbeing. Considerations must include: Who else is in the home? What will be the patient’s functional capacity both before and after the amputation? What is the expected effect on the family after amputation? Is the patient the primary breadwinner/caretaker for the family? Are there others who will be affected by the patient’s amputation status in the same environment (young children, teenagers, young adults, middle-agers)?


Habitation factors must include: where does the patient live (both geographically and in terms of the actual residence)? The geographic location, including changes in elevation (mountainous, or San Francisco hills), whether there are stairs to navigate, or consistently functioning lifts, and old versus new construction (ADA, Standards for Accessible Design related to the Americans With Disabilities Act)15 are all considerations that must be addressed before amputation.


Economic factors are the underpinning of what transpires with the patient and their direct family and friends. How will the patient’s economic status change after the amputation? Financial considerations are the bedrock on which much of the other issues achieve stability. Are they ready for retirement? Are they employable after amputation? Is there another breadwinner? Are they financially able to withstand loss of leg? What about the costs of treatment, prosthetics, devices? Are there accessible and available sources available to provide external financial support and can the patient access them (social security, disability insurance, etc.)? Is there adequate and sustained financial means either through a health insurance or other entity to pay for ongoing care including rehabilitation, care for any complications, medications, therapies, home health care, and if so for how long?


Interpersonal support and functional issues have the potential to create effects that reverberate throughout the entire recuperative period and beyond. What other intrinsic/extrinsic factors do they have to contend with? Do they live with conditions such as a small cluttered house (hoarder), ‘bad’ neighbourhood, difficulty getting to the grocery store, doctors, and social events? Is there inter-family stress such as abusive or uncaring children or relatives?


What psycho-emotional and self-perception issues are present? Do they already have body-centred issues (too fat, too skinny, too old, too sick …)? Is there a history of behavioural or mental health issues (depression, anxiety, obsessive compulsive disorder (OCD), schizophrenia, bipolar disorder, etc.)? How are they dealing with the potential amputation? Do they consider the recommendation for amputation a ‘death sentence’? Is there the opportunity to do something besides see the wound specialist all the time? How will they deal with the resultant disfigurement? The ultimate question is clearly: how important is that toe, foot, or leg to their life?


An exhaustive online search of the available literature identified definitive criteria/guidelines for removal of the gallbladder, appendix and performance of caesarean sections as well as numerous other surgeries. However, regarding amputation of a lower extremity, the overwhelming majority of articles that even entertain the rationale for performing the procedure present surgeon-based clinical considerations as the primary decision criteria and mention patient-centred factors only in passing.


Based on the experiences of the authors, there clearly needs to be a set of patient-centred criteria to juxtapose with the experiences of the surgeon and other providers integral to the decision-making process. We recognise that there are a myriad of compounding factors that affect provider and patient considerations that are easily overlooked and so a set of guidelines for evaluation such as the MENACE scale identifies those factors that can be easily evaluated and rectified.


The MENACE scale including the keyhole criteria has been used by the primary author for 23 years in one form or another. Explanation and review of the MENACE critera has been undertaken with our patients for whom amputation was the only alternative offered before coming to our clinics. In clinical practice, numerous encounters have occurred with patients marked for amputation in which their presenting condition was clearly (and ultimately) salvageable. Based on extensive clinical use, we believe that the appropriate use of this tool can balance the patient’s presentation using both the accepted medical/surgical objective criteria and the less often considered patientcentred criteria. In those situations the decision for amputation gains more credence as evaluation progresses, for those MENACE scale categories in which the highest score (2 points) is not present, appropriate actions and interventions are taken to maximise that score. For example, the patient who lives in an upperfloor apartment with an unreliable lifts should have their residence changed to one with greater accessibility even if this is to occur immediately after the surgery. The planned change allows for the full score for that category to be considered as accomplished despite its implementation postoperatively. The same holds for caregivers needed in the home following surgery. The key to MENACE is to recognise that maximising a successful outcome after the elective performance of a lower extremity amputation must be based on resolving as many patient-centred stumbling blocks as possible. We recognise that the act of doing so may not be appropriate for the surgeon themselves but believe strongly that it can be appropriately achieved by other entities including social workers, local, state and federal entities.


Based on our use of the MENACE scale in our own practices, we believe that a score of less than seven strongly suggests the highest potential for postoperative issues that will have an impact on the patient’s shortand long-term recovery and status. The failure to address identified issues both individually and collectively in the preoperative/perioperative periods may preclude a safe and complication-free recovery. MENACE was created to fill an unmet need. We understand that MENACE will require ‘real-life’ testing and validation. It is our expectation that when used alongside other criteria, it will provide a basis for expansion, revision, confirmation or deletion of the considerations we have proposed when a lower extremity amputation is considered.



The recommendation for, and performance of, a lower extremity amputation appears to be based primarily on criteria that remain undefined despite advances in all aspects of medicine. Although certain lower extremity presentations preclude safe attempts at limb salvage, there is clearly a trend towards performance based more on subjective criteria of the attending health-care providers than on clear objective patient-based criteria.


Lower extremity amputation does not merely remove all or part of the lower extremity. The interdependence of structure and function, both before and after amputation, and the potentially catastrophic consequences of failing to consider these factors, mandates that there be a specific and definitive categorical assessment of patient-centred factors rather than the current criteria, which are based solely on the skill, education and experience of the medical providers. When these decisions are based solely on their own criteria rather than those of the patient—who represents the primary consideration regarding a successful outcome—then failure to identity and resolve potential patient-centred issues means that the patient is not truly the focus of the intended procedure, although they will suffer any untoward effects. The loss of a lower extremity does not merely mean that a pending problem has been resolved but that the potential loss of the limb now presents its own life-affecting challenges well beyond the time that the surgical incision heals.


1 Quality Improvements Organization. Strategies to Help Reduce
Diabetes-Related Lower Extremity Amputations Among Minority
Populations. April 2017, (accessed 7
September 2017)
2 Murdoch G, Bennett-Wilson A Jr, Amputation: Surgical Practice and
Patient Management. Butterworth-Heinemann Medical, 1996.
3 Tooms RE. Amputations. In: Crenshaw AH (ed). Campbell’s Operative
Orthopedics (7th edn) Mosby-Year Book,1987: 597–637
4 Ertl JP. Amputations of the lower extremity. Medscape. 2016. http://bit.
ly/2uUFuEv (accessed 14 August 2011)
5 Zeigler-Graham K, Mackenzie EJ, Ephraim PL et al. Estimating the
prevalence of limb loss in the United States: 2005 to 2050. Arch Phys
Med Rehabil 2008; 89(3): 422-429.
6 Silbert S., Haimovici H. Criteria for the selection of the level of
amputation for ischemic gangrene. JAMA 1954; 155(18): 1554–1558.
7 Book Notices: Handbook on Amputations JAMA 1942; 120(9):724.
8 Netherlands Society of Physical and Rehabilitation Medicine
(Nederlandse Vereniging van Revalidatieartsen – VRA). Guideline: amputation and prosthetics of the lower extremities. Utrect. 2012.
9 Reyzelman A, Kim J. A guide to digital amputations in patients with
diabetes. Podiatry Today. 2011; 24(9). (accessed 14
August 2011)
10 Kalapataku V. Lower extremity amputations. UpToDate. 2017. http:// (accessed 14
August 2017)
11 Karadsheh M. Amputations. 2017. http://www. (accessed 14 August 2017)
12 Brigham And Women’s Hospital Department of Rehabilitation
Services. Physical therapy standard of care: lower extremity amputation.
2011. (accessed 14 August 2011)
13 Hakami, K. Pre-operative rehabilitation evaluation of the dysvascular
patient prior to amputation. Phys Med Rehabil Clin N Am. 2009; 20(4):
14 Bhuvaneswar CG, Epstein LA, Stern TA. Reactions to amputation:
recognition and treatment. Prim Care Companion J Clin Psychiatry 2007;
9(4): 303–308
15 ADA. Information and technical assistance. standards for accessible
design related to the Americans With Disabilities

Demand for wound specialists

Are you considering wound certification? Perhaps you are wondering why you need to advance your education in wound management and validate your knowledge with wound certification?


Then think about these facts…


1. Over the past few years, the need for wound care specialists has increased dramatically. New treatment modalities and products arrive on the market weekly. This, coupled with a rapidly aging population has greatly increased the need for, and the importance of, wound care specialists.


2. To stay competitive, health care organizations must show improved patient outcomes and reduce the cost of the care provided. Wound specialists can help organizations achieve this goal by facilitating evidence-based, state-of-the-art wound management practices. Many healthcare organizations are seeking certified wound specialists specifically to meet this need.


3. Patients are more knowledgeable than ever before. They have access to current guidelines and expect to be treated according to the best standards. As a wound specialist, you will be in a unique position to improve patient satisfaction by ensuring your patients are receiving the most current evidence-based wound care.

4. In this day and age, job demands are high and job burnout is common. Studies show that advancing your knowledge will put you in a position of power, allowing you to have more options, higher income, and greater respect from your peers…all increasing job satisfaction and reducing burnout.


Certified wound care specialists are needed across the board, in every health care industry. By becoming certified, you will meet this increased demand and be in a position of strength in your career, and in your life. Don’t hesitate, register today!

Parable Technology for Wound Care Interview …

Parable is a software platform that allows doctors and home health workers to collaboratively monitor wound healing and to flag any issues. The technology has been designed by Parable Health and allows doctors to assess wound parameters and healing progress from “smart” photos taken using a phone’s camera.

Parable is a software platform that allows doctors and home health workers to collaboratively monitor wound healing

Parable is a software platform that allows doctors and home health workers to collaboratively monitor wound healing

The doctor can schedule virtual check-ins with the patient. The idea is that this will reduce transportation costs in bringing patients to and from health care facilities for regular checkups, streamline data collection, and allow for collaborative care between various healthcare professionals. The technology allows wound size and topography to be measured easily and in a standardized way. The system can also provide alerts to helps doctors care for the most urgent or vulnerable patients. The technology is not just conceived for home use, but is also designed to be used in in-patient units, surgery departments, and for research.

Medgadget had the opportunity to ask Nathan Ie, Founder of Parable Health, some questions about the technology … read more


Malpractice or Obesity: Can a 276-Pound Patient Heal a Pressure Injury?

Obesity presents challenges to wound healing, but with knowledge and appropriate care interventions, we can provide optimal conditions to support the best possible outcome for every patient, no matter what size.


The US obesity epidemic reached a new all-time high in 2016, according to newly released Centers for Disease Control and Prevention data.1 Every single state has an obesity rate greater than 20%, and in five states it’s even greater than 35%. Topping the chart is West Virginia, at 37.7%.


Many of these people end up in the healthcare system because of obesity-related diseases and sometimes develop a wound, such as a pressure injury. As we know, wounds that do not heal after 12 weeks are termed chronic, and lawsuits because of chronic wounds and their consequences are rampant
read more

Electrochemical project wins Defense Innovation Award


A team of WSU researchers was awarded the Defense Innovation Award for developing a bandage-like adhesive with small embedded circuits to treat bacterial infections and facilitate wound healing.


Mia Kiamco, a doctoral candidate in chemical engineering at WSU, contributed to the study, and said the adhesive looks like a bandage, but acts as a wound dressing.


Sujala Saltana, left, and Mia Kiamco attend the Symposium of Advanced Wound Care in spring 2016

Sujala Saltana, left, and Mia Kiamco attend the Symposium of Advanced Wound Care in spring 2016

read more

Five benefits of wound education


As you know, the need for wound certification is growing at a rapid pace so there is no better time to prepare for the wound certification examination. The exam is challenging, but with the stimulating online interactive wound certification courses from, you will have all the tools you need to sail through the exam and begin enjoying the benefits of wound certification.


Some of the highlights and benefits of our program include:
  1. Self-paced, on-demand instruction.  Start and pause at any time.
  2. Interactive lessons that will keep you engaged and help you retain the information.
  3. Registration for a fraction of the cost of traditional seminar programs, while eliminating travel time, travel expenses and extensive absenteeism.
  4. All our courses are nationally recognized.  Every course in the portfolio has been subject to intensive and systematic review by major independent accreditation providers, and all courses have been formally approved for continuing education hours. In particular, our physician, podiatrist, and nurse courses are approved for CME, CE, and CPME credits in all states.
  5. Plus, offers a risk-free guarantee allowing you to retake the course until you pass the wound certification examination.
Register today to begin your journey to becoming an expert in the field of wound management while you secure your position and advance your career.

Low-intensity workouts help wound healing for diabetics

Low-power exercise may be the key to speeding wound healing rates in patients with diabetes, a new study suggests.


Previous research showed moderate-intensity exercise to improve wound healing in both mice and human subjects, but little was known about the impact different intensities could have on healing rates, said researchers from Bowling Green State University.


Their study, published online in November in Wounds
read more

Mobile unit shows off telemedicine for VA patients

The lasers scanned across the large wound in the heel of the foot and soon its exact dimensions popped up in a line down the right hand side of the screen. This and other technologies on display Monday are how the U.S. Department of Veterans Affairs is using telemedicine and interactive devices to try and improve care and access to care for patients.


The Telehealth Education Delivered mobile unit stopped by the Charlie Norwood VA Medical Center in Augusta to show off telemedicine technology that the national VA is using to reach out to provide greater access, particularly through its 700 outpatient clinics. The Augusta VA has seen 2,500 telehealth visits in the last year, primarily through its community clinics in Athens, Aiken and Statesboro, said April Harris, facility telehealth coordinator. And it is looking to do more with what it calls clinical video telehealth, she said …

read more 

Mobile Wound App Captures Patient Wound Data Faster ….

WoundWise IQ, a leader in capturing and analyzing wound care data, today announced their digital wound application performed four times faster than traditional methods and with approximately 96% accuracy.


“The time has come for app-based wound measurement systems and diagnostic predictive devices. WoundWise IQ and SerenaGroup are leading the way. I’m presenting the results of the clinical study this week at the 9th Symposium for Advanced Wound Care,” explained Thomas Serena, MD, FACS, CEO and Medical Director of SerenaGroup™.


“With the growing burden of chronic wounds, wound care providers require precise measurement and tracking to monitor the progress of a treatment plan. Better measurement and more accurate data improves patient care and saves lives,” noted Serena.


“We are excited to be partnering with Dr. Serena at SerenaGroup. Dr. Serena is the President of the Association for the Advancement of Wound Care, and is CEO of a premier wound care research company. He has dedicated his career to improving patient wound care,” noted Gary Ross, CEO, Med-Compliance IQ.


WoundWise IQ measures the planimetric area of a wound and is referred to in the industry as a Digital Wound Planimetric System. (DWPS). The application was developed to address the challenges with traditional measurement and monitoring methods such as the time required to capture and analyze data and the cost of accompanying hardware.


WoundWise IQ is an easy to-use and efficient mobile application which may be downloaded on most web-enabled mobile devices. Patient data is stored securely in the cloud and integrates with other patient data as needed. The clinical study noted above was performed independently by SerenaGroup and Strategic Solutions, Inc.

WoundWise IQ provides a cloud-based, digital mobile application that measures and evaluates wounds. The solution helps improve patient care and saves lives. Learn more about Med-Compliance IQ and WoundWise IQ at


For the original version on PRWeb visit:

Chronic Wound Factors and Management Strategies

What is a chronic wound? What changes must happen within a wound for clinicians to classify it as “chronic”? Is there a time frame for healing chronic wounds? And what should we clinicians do to prevent and/or reverse chronic wounds? These are all great questions that keep us on our toes, from the dedicated seasoned clinician to the clinicians new to our field. In this blog I will define what a chronic wound is, what it consists of, and whether there is a way to convert or reverse a wound.


By definition, a chronic wound is a wound that has “failed to proceed through an orderly and timely process to produce anatomical and functional integrity, or proceeded through the repair process without establishing, a sustained anatomic and functional result.”1 In layman’s terms, a chronic wound is a wound that does not proceed through the four phases of wound healing in an orderly fashion and decides to make one too many pit stops through the journey …

read more 

Organogenesis Highlights Latest Wound Care Research…..

For the first time since the recent acquisition of NuTech Medical, Organogenesis Inc. will present its expanded advanced wound care product portfolio at the Symposium on Advanced Wound Care Fall (SAWC Fall) meeting held this week in Las Vegas.


The newly-integrated company, which now offers a portfolio of products for the advanced wound care and surgical and sports medicine markets, will highlight important research and promote updates to its portfolio during SAWC Fall.

Scientific presentations will feature some of the latest developments regarding the continuum of care in wound healing …

read more 

Awarded first place in the ‘2016 AJN Book of the Year Award’ in the Medical Surgical Nursing category.


The newly expanded and updated Wound Care Essentials: Practice Principles, 4th edition is your go-to clinical guide to assessing and treating the full range of skin and wound conditions–from common to less common, simple to complex, and acute to chronic. This comprehensive, easy-read handbook provides practical guidance on the many aspects of wound care, including the legal, ethical, psychological, and social aspects. This is an essential guide for advanced practice nurses and nurse practitioners, nursing students, physician’s assistants, dermatology physicians, family physicians, and physical therapists. Tap into these evidence-based skills and care strategies, and handle the complexities of wound care with confidence.





Adopt wound care best practices with this fully illustrated, on-the-spot clinical guide …

·         NEW more than 350 full-color photos and illustrations
·         NEW content on areas including: Chronic wound quality-of-life and self-management care models; wound care regulations; skin assessment and skin tears; fistula management; wound bioburden; adjunctant therapies; pressure ulcers; support surfaces; nutrition; palliative care guideline updates

·         NEW chapter featuring 36 photos of wounds with test questions, offering:
o    An essential visual aid for students
o    Crucial training aid for staff at wound centers and in every health care setting
o    Vital preparation for Wound, Ostomy and Continence Nurse (WOCN) certification exam
·         Step-by-step directions and guidance on wound assessment, healing stages, treatment options, dressings, pain management, legal and ethical issues, coping patterns, medical documentation

·         Patient management strategies for all wound types, including: palliative wound care, sickle cell wounds, pressure ulcers, diabetic foot ulcers, surgical wounds, and more

·         Chapter features include:
o    Assessment Guidelines
o    Pre-Chapter Objectives; Post-Chapter Summaries
o    Practice Point boxes
o    Show What You Know – Chapter review questions (with answers at end of book)
o    Patient Teaching boxes


BUY NOW: Wound Care Essentials: Practice Principles

Invention aims at providing cost-efficient wound care globally

Undergraduate team led by fourth-year Engineering student Ashwinraj Karthikeyan emphasizes the importance of finding an alternative solution to wound care.


The Collegiate Inventors Competition gives college students the opportunity to present their inventions to be judged on the basis of degree of originality, development level of the product, potential benefit to society and level of student initiative. A team from the University, headed by fourth-year Engineering student Ashwinraj Karthikeyan and sponsored by Bala Mulloth, assistant professor of public policy, placed in the finals of the competition with an innovative product called “Phoenix-Aid.”


Karthikeyan began working on the project after taking Mulloth’s “Innovation and Social Impact” course in spring of 2016. He maintained contact with Mulloth over the summer and then asked Mulloth to be his faculty advisor in order to apply for grants. As a faculty advisor, Mulloth said he helped Karthikeyan by going over his business plan with him and providing him connections facilitate the growth of his project …

read more 

Molecular Methods to ID Unusual Pathogens in Wound Care

CogenDx recently launched a molecular testing product that it hopes can help expedite treatment of patients with infected wounds by providing a clearer picture of the infecting organisms and their resistance to antibiotics.


According to a 2009 study in Wound Repair and Regeneration, the total costs per year to treat the 6.5 million patients with wound related complications is around $25 billion. CogenDx wants to reduce the costs by offering its rapid tests clinically, providing doctors with information that will help guide antibiotic treatment.


The genetics brand of Millennium Health, CogenDx was established earlier this year to focus on developing genetic technologies of use to clinicians. CogenDx runs a CLIA-certified, full-service clinical lab with a national commercial footprint. Its new product, DxWound, examines the DNA of microorganisms in a patient’s wound that will potentially lead to life-threatening skin and soft tissue infections (SSTIs) …

read more 

Alliqua Announces Purchase Agreement with Celularity

Alliqua BioMedical, Inc. (NASDAQ:ALQA) (“Alliqua or the “Company”), a regenerative technologies company committed to restoring tissue and rebuilding lives, today announced a definitive agreement with Celularity, Inc. (“Celularity”), under which Celularity will acquire all of the property, assets and rights relating to the Company’s advanced biologic wound care business – including Biovance® amniotic membrane allograft and Interfyl® Human Connective Tissue Matrix – and the Company’s UltraMist® Therapy System and other therapeutic ultrasound platform products for an aggregate cash consideration of $29.0 million. No debt or significant liabilities are being assumed by Celularity in the transaction. Alliqua BioMedical’s Board of Directors unanimously approved entering into the agreement …
read more 

Using mechanical forces to improve wound healing

“To some degree when you do an operation it’s much like manufacturing something in a factory,” explains Orgill SM ’80, PhD ’83, who serves as medical director at Brigham and Women’s Hospital’s Wound Care Center and as a professor at Harvard Medical School. “You want to have high quality control and be able to do it as efficiently as you can. Those engineering principles of process control are very important in surgery.”


In the early ’80s, Orgill earned his PhD in mechanical engineering at MIT through the Harvard-MIT Health Sciences and Technology (HST) program. Orgill’s particular course of study within HST was the Medical Engineering and Medical Physics program, which combines a traditional mechanical engineering education with clinical and medical exposure …

read more 

Alliqua BioMedical Buys Celularity Inc.’s Wound Care Business

Alliqua BioMedical, Inc. (NASDAQ: ALQA) today announced a definitive agreement with Celularity, Inc. (“Celularity”), under which Celularity will acquire all of the property, assets and rights relating to the Company’s advanced biologic wound care business – including Biovance® amniotic membrane allograft and Interfyl® Human Connective Tissue Matrix – and the Company’s UltraMist® Therapy System and other therapeutic ultrasound platform products for an aggregate cash consideration of $29.0 million. No debt or significant liabilities are being assumed by Celularity in the transaction. Alliqua BioMedical’s Board of Directors unanimously approved entering into the agreement.


“This is a transformative transaction for Alliqua,” said David Johnson, Chief Executive Officer of Alliqua. “First, we will be able to strengthen our balance sheet by paying our debt in full. Second, we believe we will have an appropriate amount of working capital to drive our operating business forward in a positive way. Finally, we will evaluate the appropriate options to allocate capital to maximize shareholder value.” …

read more 

Imbed Bio raises $1.6M for Infection Preventing Dressing

Imbed Biosciences has raised a funding round of nearly $1.6 million, which the Fitchburg, WI-based startup plans to use to begin selling an ultra-thin wound dressing material later this year, CEO Ankit Agarwal says.

Imbed has spent years working on its product platform, which was used to develop the dressing, Microlyte Ag. It’s underpinned by nanofilm technology that uses silver’s antimicrobial properties to kill infection-causing pathogens, helping wounds heal in a way that does not require treatment with potentially harmful levels of the metal …

read more 

AAWC Recognizes 2017 Corporate Sponsors

MALVERN, Pa., Jan. 3, 2018 /PRNewswire-USNewswire/ — The Association for the Advancement of Wound Care (AAWC) is pleased to acknowledge the generous support of its 2017 corporate sponsors and announces open enrollment for the 2018 sponsorship program.


Corporate support is vital for sustaining the AAWC’s valued, evidence-based and patient-focused programs and activities. The 2017 AAWC Corporate Sponsors include: Acelity, Molnlycke, Smith & Nephew, 3M, Convatec, Hollister, Integra Life Sciences, Medline, Osiris Therapeutics, BioCompression Systems, Boyd Technologies, MiMedx and Wellsense.


AAWC Corporate Sponsorship provides lucrative benefits based on level of support, including the exclusive opportunity for industry sponsors to meet with AAWC officers and other key wound care industry leaders at quarterly Corporate Advisory Panel meetings. As stakeholders with a common purpose of helping patients, the panel focuses on education and public awareness, with the ultimate goal of elevating standards of wound care practice worldwide …

read more 

SANUWAVE to market the dermaPACE® System

Suwanee, GA – January 2, 2018 – SANUWAVE Health, Inc. (OTCQB: SNWV) has announced that the US Food and Drug Administration (FDA) has issued its decision on the de novo submission for the dermaPACE® System. Their decision, dated December 28, 2017, permits the marketing of the dermaPACE System as a Class II medical device used for the treatment of Diabetic Foot Ulcers (DFU) in the U.S., the world’s largest medical device market. This order by FDA is the culmination of intensive clinical studies by SANUWAVE and diligent work by both SANUWAVE employees and their regulatory partners, Musculoskeletal Clinical Regulatory Advisers (MCRA) in successfully submitting documentation and interacting with FDA during the clearance process.


The dermaPACE system was evaluated using two studies under an FDA approved IDE. The studies were designed as prospective, randomized, double-blind, parallel-group, sham-controlled, multi-center 24-week studies at 39 centers. A total of 336 subjects were enrolled and treated with either active dermaPACE plus conventional therapy or sham dermaPACE plus conventional therapy (a.k.a. standard of care). Conventional therapy included, but was not limited to, debridement, saline-moistened gauze, and pressure reducing footwear. The objective of the studies was to compare the safety and efficacy of the dermaPACE System to sham-control application. The prospectively defined primary efficacy endpoint for the dermaPACE System studies was the incidence of complete wound closure at 12 weeks post-initial application of the dermaPACE system (active or sham). Complete wound closure was defined as complete skin re-epithelialization without drainage or dressing requirements, confirmed over two consecutive visits within 12-weeks. If the wound was considered closed for the first time at the 12-week visit, then the next visit was used to confirm closure. Investigators continued to follow subjects and evaluate wound closure through 24 weeks ….

read more 

Malnutrition and Pressure Injuries

Nutrition and Pressure Injury Healing

Current literature has identified more than 100 risk factors for pressure injury (PI) development. Some extrinsic (primary/non-physiological) and intrinsic (secondary/physiological) risk factors that contribute to PI development include diabetes mellitus, peripheral vascular disease, malignancy, prolonged pressure on an area of the body, being 70 years of age and older, smoking, urinary and fecal incontinence, a low body mass index (BMI), and malnutrition.


Pathophysiologic and intrinsic factors at the core of PI formation include nutrition. Maintaining adequate parameters of nutrition is considered a best practice in both the prevention and treatment of PIs. Individuals with PIs or who are at risk for developing PIs should strive to achieve or maintain adequate nutrition parameters. Meeting macronutrient and micronutrient requirements forms the foundation of good health. This translates to consuming wholesome, nutrient-dense foods!

read more 

S&N’s Device Images Bacteria in Wounds

Smith & Nephew’s MolecuLight iX is designed to detect bacteria in hard-to-heal wounds using only light.


Smith & Nephew has begun selling a handheld imaging device that can detect bacteria in hard-to-heal wounds and instantly measure wound surface area.


MolecuLight i:X is already available in Canada, where its inventor stumbled across the idea for the device. Ralph DaCosta, MD, now a principal investigator at Princess Margaret Cancer Center in Toronto, was a PhD student researching fluorescent imaging of gastrointestinal cancer in 2007. The big, expensive device he was using didn’t produce any green images, which would have indicated cancer, but a red image that he couldn’t identify … 

read more 

Prescient Surgical wins FDA nod for CleanCision wound retraction system

Surgical device spin-out Prescient Surgical said today it won FDA clearance for its CleanCision wound retraction and protection system.

The San Carlos, Calif.-based company, which was spun out of the Stanford Byers Center for Biodesign in 2012, said its CleanCision device is the 1st in a new category of irrigating wound protection devices, as classified by the FDA.


Such devices are designed to provide access to the surgical site while protecting the incision with an impermeable barrier to defend against direct contamination.

read more 

How to turn clinicians into makers

In hospitals in North and South America, nurses are hacking medical equipment to improve patient care. Using off-the-shelf materials, they’ve created prescription bottles for the visually impaired, pipe systems to irrigate wounds of burn victims, low-cost feeding-tube holders, and other innovations.


Some of the most creative inventors work in wound care and critical care units, Young says. Jason Sheaffer of the University of Texas Medical Branch, for instance, erected a system of PVC pipes with holes in them over a burn unit tub where burn victims are treated. Running water through the pipes creates an irrigation system to aid in treatment. A wound vacuum kit, developed at the UnityPoint Health in Cedar Rapids, Iowa, has a modular alarm to alert the care team when suction is lost. There’s also a 3-D-printed simulation model, created by Roxana Reyna, a nurse in Corpus Christi, Texas, that has a deep hole in it, representing a wound. Nurses can practice treating the wound on the model, instead of on a live, suffering patient …

read more 

Breakthrough in Digital Wound Measurement

eKare Inc., a provider of digital wound management platform, announces partnership with Netherlands-based Woundworks. eKare Inc., developed the inSight 3D wound camera, which ensures a standardized and validated wound measurement in an easy to use application, and is used in post-acute and research institutions across the US. Woundworks has an extensive European network and expertise developing and marketing products in the wound care space. This partnership will jointly develop the European market to provide integrated wound care services, including care management, product supplies, home health, and workflow optimization to healthcare providers and patients.


Woundworks and its affiliated companies are the market leader in wound management services to major health plans in the Netherlands. Through novel delivery models and data-driven approaches, they have successfully lowered direct costs to payers by an average of 30% and reduced wound related hospitalizations by 45%.


“As an organization fully dedicated to improving wound care, we have been looking for a high quality 3D imaging solution for years. We believe that an easy to use, standardized way of 3D wound measurement is key in improving wound care,” says Kok van der Meij, CEO and founder of Woundworks, Excen, and QualityZorg. “Woundworks has a lot of expertise and experience concerning wound care products, advanced wound care, wound care protocols, and utilizing data analytics to improve outcome. The eKare solution provides unambiguous, comparable, and reproducible data on wound healing progress. Partnering with eKare fits very well with our vision and helps us to innovate and grow to new heights.”


“Woundworks brings a new level of service and management that will disrupt the wound care industry. We are proud to be a long-term partner of the company. We look forward to growing this relationship and helping the medical community improve outcomes and lower cost,” Patrick Cheng, CEO of eKare, remarks.


About eKare


eKare Inc. is dedicated to the design and development of wound assessment solutions, including 3D wound dimensions and tissue classification capabilities, using the latest computer-vision and mobile technology. eKare’s innovative technology is creating new possibilities in how we deliver wound care across the healthcare continuum, from inpatient hospital and skilled nursing facilities to ambulatory clinics and telemedicine. eKare’s mission is to advance the science and delivery of wound care by leveraging mobile and sensor technologies to connect patients, providers, and industry.


About Woundworks


Woundworks is a new company founded and backed by institutions with many years of experience in the field of wound care. Woundworks and its affiliated companies have been very successful in the wound care field and are now combining their strengths to expand their product offering in the European market. Woundworks will distribute the inSight 3D Wound imaging solution throughout Europe and will combine this with different segments of its own products and business lines; ensuring that patients all over Europe can receive the best possible wound care.

What Are Biofilms?

Identifying and managing biofilms have become two of the most important aspects of wound care. Biofilms can have a significant impact on wound healing, by contributing to bacterial infection, inflammation, and delayed wound healing.1 These issues make reducing biofilm presence a critical component of effective wound care. Although over 60% of chronic wounds contain a biofilm, many health care professionals are not able to identify biofilm formation in their patients.2 To manage this challenge effectively, health care professionals must understand what biofilms are, how to identify them, and how to take steps to reduce their impact on wound healing.

Adimarket announces agreement with Alolotl Biologix

Adimarket, a subsidiary of Global Stem Cells Group, has announced an agreement with biotechnology company Alolotl Biologix to distribute biological products for regenerative medicine applications worldwide.


Adimarket, a subsidiary of Global Stem Cells Group (GSCG), and its subsidiary has announced an agreement with Phoenix, Arizona-based Alolotl Biologix to distribute the biotechnology company’s products for regenerative medicine applications worldwide.


Alolotl Biologix focuses on research to optimize the use of human biologicals and to develop biological-related products to foster regeneration and healing for a range of conditions, including orthopedic impairments, wound care, pain management, ophthalmic, cardiovascular, cosmetic, and more.


Adimarket will make the following amniotic liquid products available to qualified practitioners through its online store


AxoBioFluid® C Amniotic Allograft Cryopreserved Liquid, cryopreserved liquid allograft derived from the amniotic membrane that provides structural tissue to advance soft tissue repair, replacement, and reconstruction. Product details:


Human allograft under FDA regulation 21 CFR Part 1271 and section 361 of the PHS
Immune privileged with anti-inflammatory and anti-bacterial properties
A rich source of growth factors, proteins, cytokines, hyaluronic acid, and collagen scaffolds
Contains extracellular matrix components for cellular attachment and proliferation
Cryopreserved for an extended shelf life
AxoBioFluid® physician benefits


Procedures are efficient and do not require special instrumentation.
• The use of AxoBioFluid® is billed as patient pays, which makes it a great alternative revenue source.
• A library of research papers to demonstrate efficacy degenerated tissue is provided.
AxoBioFluid® patient benefits


Relevant Conditions


AxoBioFluidâ C Amniotic Allograft Cryopreserved Liquid, cryopreserved liquid allograft derived from the amniotic membrane that provides structural tissue to advance soft tissue repair, replacement, and reconstruction. Product details:


Human allograft under FDA regulation 21 CFR Part 1271 and section 361 of the PHS
Immune privileged with anti-inflammatory and anti-bacterial properties
A rich source of growth factors, proteins, cytokines, hyaluronic acid, and collagen scaffolds
Contains extracellular matrix components for cellular attachment and proliferation
Cryopreserved for an extended shelf life
AxoBioFluidâ physician benefits


Procedures are efficient and do not require special instrumentation.
• The use of AxoBioFluid® is billed as patient pays, which makes it a great alternative revenue source.
• A library of research papers to demonstrate efficacy is provided.
AxoBioFluid® Amniotic Allograft Cryopreserved Liquid is a cryopreserved liquid allograft derived from the placental components of the amnion to advance soft tissue repair, replacement, and reconstruction. It is classified as minimally manipulated under FDA regulation 21 CFR Part 1271 and section 361 of the PHS. Benefits of AxoBioFluid® AxoBioFluid® is a human allograft fluid derived from the amniotic layer of the placenta. The two primary cell lines which reside in the amnion are human mesenchymal stromal cells (hMSC) and human amnion epithelial cells (hAEC). Both of these cells are considered to be pluripotent stem cells. AxoBioFluid® contains growth factors released while amniotic cells are grown in culture such as epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and transforming growth factor – beta (TGF-β). These proteins are essential for fetal growth and development and express significant therapeutic benefits when used as a treatment for various injuries and degenerative conditions. AxoBioFluid® is immuneprivileged, anti-inflammatory, anti-fibrotic, pro-vascular, and cytoprotective because of the cells being sourced from the amnion. These secreted factors also signal endogenous progenitor cells to promote regeneration and repair of damaged or degenerated tissue.




Degenerative disorders such as osteoarthritis
• Joint pain
• Inflammatory conditions such as:
Soft tissue injuries such as:
Ligament & Tendon sprains
Muscle & Meniscus tears
Wound Care
AxoBioMembrane, a dehydrated allograft membrane patch derived from the amnion that advances wound repair, skin replacement, and reconstruction. Product details:


Human allograft under FDA regulation 21 CFR Part 1271 and section 361 of the PHS
Immune privileged with anti-inflammatory and anti-bacterial properties
Contains extracellular matrix components for cellular attachment and proliferation
Dehydrated and terminally e-beam sterilized for an extended shelf life.
AxoBioMembraneä Amniotic Allograft Membrane, like all allograft tissue products, has been subjected to recovery microbiological study and has been terminally sterilized with electron beam sterilization. It works by forming fibrin-elastin bonds at the wound site, ensuring excellent wound adherence. This generates a barrier that protects exposed nerve endings from irritants, providing pain relief while creating a favorable environment for tissue repair and regeneration. In addition, the AxoBioMembrane™ prevents excessive moisture loss by creating a vapor barrier at the wound surface. Growth factors present in the membrane are released into the wound bed, promoting angiogenesis leading to new blood supply needed for cellular migration, proliferation and ultimately, wound repair. Infection is one of the biggest concerns with chronic wounds. AxoBioMembrane™ functions as a bacteriostatic agent, which can inhibit the growth of bacteria at the wound site and reduce the rate infection. It has also been reported to have anti-fibrotic properties, which can reduce scarring. The membrane contains glycoprtoteins found exclusively in the amnion. AxoBioMembrane™ lacks specific surface antigens, which make it immune-privileged and anti-inflammatory.


AxoBioMembraneä physician benefits


Procedures are efficient and do not require special instrumentation.
AxoBioMembrane™ is billed as patient pays, which makes it a great alternative revenue source.
We provide a library of research and white papers to demonstrate efficacy.
AxoBioMembraneä patient benefits:


Pain Reduction
Wound Adherence
Less Scarring
Faster Healing
Wound Barrier
Immune Privileged
AxoBio products are available to purchase on the Adimarket Website.


For more information, visit the Adimarket regenerative medicine online store website, email, or call 305-560-5337.


About Global Stem Cells Group


Global Stem Cells Group (GSCG) is a worldwide network that combines seven major medical corporations, each focused on furthering scientific and technological advancements to lead cutting-edge stem cell development, treatments, and training. The united efforts of GSCG’s affiliate companies provide medical practitioners with a one-stop hub for stem cell solutions that adhere to the highest medical standards.


Press Contact


Name: Benito Novas
Phone: +1 305 560 5337

The Challenge of Lower Extremity Wounds

Wound clinicians across the nation (and the world) are commonly faced with the difficult task of managing lower extremity wounds. Lower extremity wounds come in many different forms. We are not faced with a generic type, but several—in fact, we never know what we’ll be presented with day-to-day …

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Navamedic ASA: Enters into partnership agreement for distribution of Zorflex® in Sweden and Finland

Navamedic ASA (OSE: NAVA), the Norwegian medtech and pharmaceutical products company, today announced it has entered into an agreement with Chemviron Carbon Ltd. (Chemviron) for the launch and commercialisation of Zorflex® wound care contact dressings in Sweden and Finland. Zorflex®, a naturally antimicrobial, 100 percent activated carbon wound contact dressing, helps accelerate treatment of a wide range of chronic and non-chronic wounds …..
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Hydrogel: An Overused Wound Care Modality?

While I’m on rounds with students I like to ask, “What is the active ingredient of hydrogel?” My query is usually met with puzzled looks. It’s a trick question, because the term “active ingredient” generally applies to pharmacologic agents that undergo metabolic change in biologic systems. The active ingredient of hydrogel which gives this substance its name is water. Compounds are added to thicken the mixture and provide viscosity, such as glycerine. Other ingredients common in cosmetics, such as aloe vera, methyl paraben, hydrogenated castor oil, and propyl paraben, are added to hydrogel depending on the manufacturer …
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Meeting report: antimicrobial stewardship in wound management

At the 27th conference of the European Wound Management Association (EWMA), which was held in Amsterdam on May 3–5, 2017, a joint symposium was held between EWMA and the British Society for Antimicrobial Chemotherapy. The symposium was organised into two sessions. The first focused specifically on wound care issues and the second concerned antimicrobial stewardship programmes.
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Use of ALLEVYN LIFE foam dressing to manage a heavily exudating venous leg ulcer

A 62-year-old man presented with a left lower leg venous ulcer on the shin. The ulcer had high exudate levels, which was resulting in strike-through of dressings and there was some evidence of surrounding skin maceration. Investigations revealed an ankle brachial pressure index (ABPI) of 1.4. ALLEVYN◊ LIFE Non-Bordered foam dressing (Smith & Nephew) was selected to manage and absorb high-levels of exudate and minimise the risk of trauma to the fragile surrounding skin. Multi-layer compression therapy was also used. After 3 weeks, the ulcer had reduced in size and there was a visible improvement in viable skin [Figures 2–5]. The patient found the dressing comfortable with excellent conformability to the lower leg and minimal pain on dressing removal …

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Device Images Bacteria in Wounds

Smith & Nephew’s MolecuLight iX is designed to detect bacteria in hard-to-heal wounds using only light. MolecuLight i:X is already available in Canada, where its inventor stumbled across the idea for the device. Ralph DaCosta, MD, now a principal investigator at Princess Margaret Cancer Center in Toronto, was a PhD student researching fluorescent imaging of gastrointestinal cancer in 2007. The big, expensive device he was using didn’t produce any green images, which would have indicated cancer, but a red image that he couldn’t identify ….
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The Triangle of Wound Assessment

The negative impact of wounds on patients is significant, and includes pain, reduced quality of life and social isolation. Optimal wound healing can reduce the burden of chronic wounds on patients and the health economy. The Triangle of Wound Assessment is a holistic framework that clinicians can use to improve wound assessment, with particular focus on the wound bed, wound edge and periwound skin (World Union of Wound Healing Societies, 2016). This framework can help guide clinicians to select the most appropriate and effective intervention to improve patient outcomes and to ensure prudent use of healthcare resources …
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My Journey as a Certified Wound, Ostomy and Continence Nurse

Nursing has given me great opportunities; some of them I never imagined possible. I started as a medical surgical nurse in an oncology unit where the treatment of the day was gauze soaked in Dakin’s solution for the management of post op radical neck surgery. I moved on to intensive care, travel nursing, Army nursing, and endoscopy. It was in endoscopy and working with the colorectal surgeons, who helped me get my clinical experience while pursuing a master’s degree in nursing, where I found out that it all could be tied together with a certification in wound, ostomy, and continence (WOC), and a wound care nurse is born!

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Skin and tissue trauma caused by self-harm

Patients who deliberately self-harm and cause skin and tissue trauma are increasing in number across primary and secondary care settings (Nice, 2011b). Self-harm has often been considered a taboo subject and an unnecessary burden to the NHS (Kilroy-Findley and Bateman, 2016). Despite the growing need for effective care, services for assessment, diagnosis and intervention are often overstretched and unable to meet the holistic needs of patients who self-harm (National Institute for Health and Care Excellence [NICE], 2011a; Mind, 2013) …
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the Sandy Grading System for Surgical Wound Dehiscence Classification

The worldwide volume of surgery is considerable, with an estimated 234.2mn major surgical procedures carried out every year (Weiser et al, 2008). While contemporary surgical procedures are relatively safe, complications such as surgical wound dehiscence, although not commonplace, are a major disruptor to patient wellbeing and wound healing outcomes. Moreover, the importance of classification, documentation and reporting of this type of wound must not be underestimated. Accurate diagnosis and reporting of the type of dehiscence and underlying aetiology is key to understanding the extent of the problem. This paper presents a novel classification system that uses a systematic approach for the diagnosis of the type of dehiscence following surgery …

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Medical grade honey and diabetic ulcers

The prevalence of diabetes is rising globally with increasing budgetary
burdens from the disease and its complications. In resource-limited
environments, affordable treatment strategies are urgently needed. Wound
care utilises diverse modalities, such as hydrogel, polyurethane and alginate
dressings, as well as silver-containing agents. Honey is a well established
treatment and is cost-effective. In a resource-limited setting, the authors detail
a case report whereby the use of an affordable, easy-to-use agent was used
in conjunction with patient education and self-care, which resulted in rapid
wound healing without side-effects …

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New Study Documents Cost and Impact of Chronic Wounds

October 4, 2017 – A new study published online in the International Society For Pharmacoeconomics and Outcomes Research’s (ISPOR) Value in Health journal demonstrates the economic impact of chronic nonhealing wounds in Medicare patients. The findings highlight the need for Federal research funding, quality measures and reimbursement models that are relevant to wound care. Such measures are not currently included under Centers for Medicare and Medicaid Services (CMS) payment policies, including the Medicare Access and CHIP Reauthorization Act (MACRA).


The study, “An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds,” analyzed the Medicare 5% Limited Data Set for calendar year 2014 and determined that chronic nonhealing wounds impact nearly 15% (8.2 million) of Medicare beneficiaries, far more than suggested by previous studies. Furthermore, conservative estimates for total Medicare annual spending for all wound types ranged from $28.1 billion to $31.7 billion. Treatment and management of infected or re-opened (dehisced) surgical wounds account for the highest per-wound costs. Hospital outpatient care drove the highest site-of-service costs, demonstrating the shift from hospital inpatient to outpatient services in the wound care space …

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How Diabetes Impacts Wound Healing

For individuals with diabetes, all wounds are a serious health concern and require careful attention. Because of diabetic peripheral neuropathy, skin cuts and blisters often go unnoticed until they become more complicated to heal. In addition, internal wounds such as ingrown toenails, skin ulcers, or calluses can cause breakdown of tissue and an increased risk of infection. Even small cuts and insect bites can cause wound healing difficulties in patients with diabetes. Here are common factors of diabetes that impact wound healing …

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Preventative Skin Care in Wound Management

Prevention is one of the most important components of wound and ostomy care. Factors such as hydration, pressure, excessive moisture, cleanliness, and erythema can all affect wound healing rate, patient comfort, and the incidence of new wounds. By taking a proactive stance, health care professionals can reduce the risk of infection, reduce costs, and improve patient outcomes.1

Why Preventative Skin Care is Important

Wounds affect 35% of all hospice patients, and 120,000 new ostomy surgeries are performed each year.2,3 This makes these two of the most prevalent conditions faced by nurses and other health care professionals …

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10 Tips for Effectively Bandaging a Wound

Wrapping wounds is an art, and hence, it comes easily to some and more difficult to others. This post won’t make you a wound dressing artist, but it does provide some tips for good bandaging techniques. The word “bandage” (in the US) often refers to a primary dressing, so “wrap” better describes a bandage that is long, narrow, and may be used to secure a primary dressing or obtain graduated compression on a limb.

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Daniel D. Caviness, DPM will be Noted in the Worldwide Leaders in Healthcare

The International Association of HealthCare Professionals is pleased to welcome Daniel D. Caviness, DPM to their prestigious organization with his upcoming publication in the Worldwide Leaders in Healthcare. Dr. Daniel D. Caviness is a highly trained and qualified podiatrist currently serving patients within the Chico Podiatry Group in Chico, California and affiliated with Enloe Medical Center. Featuring over two decades of experience in his field, he has a special expertise in foot care, podiatric surgery and podiatric wound care.

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AAWC Announces Chief Executive Officer

MALVERN, Pa.Oct. 10, 2017 /PRNewswire-USNewswire/ — The Association for the Advancement of Wound Care (AAWC)announces Victoria E. Elliott, RPh, MBA, CAE, as the new Chief Executive Officer. Ms. Elliott brings a wealth of experience in association management. As a Certified Association Executive (CAE), her qualifications include alliance building, membership growth, volunteer engagement and leadership development. Ms. Elliott has served as Executive Director for the American Neurological Association, Dermatology Nurses’ Association, Attention Deficit Disorder Association, Society For Biomaterials and the Pennsylvania Society of Health System Pharmacists. Most recently she was Director of Development at the University of the Sciences where she focused on individual alumni giving, and student and parent fundraising campaigns.

Victoria E. Elliott, RPh, MBA, CAE, Chief Executive Officer, Association for the Advancement of Wound Care (PRNewsfoto/Association for the Advancement)

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Healthcare is Ready for Alexa, as Soon as HIPAA Issue Resolved

A voice-enabled bathroom scale that can scan for diabetic foot ulcers uses Amazon’s voice service, Alexa, to instruct patients to step on when they’re ready to begin. In one test, a patient responded to Alexa’s prompt by declaring, “Ready when you are.”


Anne Weiler, co-founder and CEO of Wellpepper, a Seattle company that developed the prototype scale as part of its entry in the Alexa Diabetes Challenge, might say the same thing to Amazon (NASDAQ: AMZN) itself.


She’s among those healthcare IT entrepreneurs convinced that the future of healthcare will include human-computer voice interactions—just as soon as Amazon makes its voice services compliant with healthcare privacy laws.

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This student has invented a new wound care technology

InMEDBio LLC, a company founded by University of Virginia fourth-year student Ashwinraj Karthikeyan, will be one of six undergraduate entrants to compete in the prestigious Collegiate Inventors Competition in November.


The competition has promoted innovation and entrepreneurship among college graduate and undergraduate students since 1990. Not only do participants receive encouragement and feedback, but they compete for cash prizes as well. Since its inception, the event has awarded more than $1 million to college students.

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See How Your Smartphone Could Be Used To Activate This Smart Bandage

Smart cars, smart homes, smart cities. We’re living in an era of smart devices that can help us be healthier, safer and live more responsibly. Now, there’s a chance we’ll be able to heal own wounds using a smart bandage we control with our smartphones.

Researchers from the University of Nebraska-Lincoln say they’ve designed a prototype smart bandage that could eventually heal chronic wounds through the medically coated fibers in the bandage.

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At-Risk Patient: Diabetic Foot Ulcers

Patients with diabetes have a higher risk of ulceration, typically on the lower extremities. Other factors contributing to the risk of foot ulceration include peripheral neuropathyperipheral arterial diseaseinfection and pressure.

Symptoms of Diabetic Foots Ulcers

Neuropathy, a major contributing factor in the development of diabetic foot ulcers, may present as a stinging, burning or shooting pain in the lower extremities that over time may progress to a loss of sensation in the feet or may initially develop as a progressive loss of sensation. This loss of feeling can cause patients with diabetes to further injure their feet and legs, opening them to infection and thus, ulceration.

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Review: Comparing the Effectiveness of Cellular and/or Tissue-Based Products for Treating Diabetic Foot Ulcers

One fourth of the approximately 22.3 million patients with diabetes in the United States are expected to develop a diabetic foot ulcer (DFU) at some point during their lives, and it is estimated to affect 1-8% of individuals with diabetes annually. DFUs have shown to be challenging to treat, and often result in extended hospital stays, increased risk of infection, and subsequent amputation in certain patients. A major concern regarding amputees is a 5-year mortality rate that rivals that of patients with colon cancer. In addition, DFUs contribute heavily to the financial load of payers, with an estimated annual medical cost of up to $13 billion.

Prior studies have indicated that wounds that penetrate bone, are prolonged and recurrent, and those associated with peripheral vascular disease pose a great risk for eventual amputation. Studies have shown that, even with proper care of DFUs by podiatric physicians and other clinical personnel, these wounds are slow to heal. Advanced therapies are often explored to improve outcomes.

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Wound Care Basics: Understanding Lymphedema and the Lymphatic System

When I talk to my patients with lymphedema, I often need to tell them about their lymphatic system. Beyond knowing of lymph nodes or glands in their neck, most don’t recall having heard anything about it. Surprisingly, today’s medical students often have less than 1 hour on the lymphatic system education in medical school. In physical therapy school (35 years ago), instruction was woefully inadequate. Today, more is known – and most therapy schools do spend significant time on the lymphatic system and lymphedema. For those who missed it, here is the lymphatic system in a nutshell.

The Lymphatic System: An Overview

The lymphatic system includes the thoracic duct (main vessel), which receives the lymph fluid from smaller vessels called lymph collectors. The latter receive lymph fluid from the initial lymphatic vessels read more

Providing Hope to Patients with Wounds

I have written about so many things over the past years… Maybe now is a good time to announce that I am writing a book called Hear Our Cry, an autobiographical story about 20 years of wound care and limb salvage. The process has had quite an impact on me, reviewing all the pictures and notes from my wound patients from the past two decades.


The Importance of Hope


What a tragedy has been spread out in front of me when I consider all the pain and heartache due to limb wounds and limb loss read more

Wound Consulting Business: How to Get Started

So, you’ve been thinking about starting that wound care business you’ve always dreamed about. What’s next?

First of all, start by taking a look at Wound Consulting Business: Do You Have What It Takes?, to see what factors you should consider before taking the plunge. It’ll help you decide if you’re cut out to be your own boss. Then, if you still think being a wound consultant is for you, let’s talk about getting started … read more

The Next Generation of Negative Pressure Wound Therapy – V.A.C. VERAFLO™ Therapy

I first got to work with V.A.C. VERAFLO™ Therapy in 2015. I had a complex patient who had a very large wound from a surgical wound dehiscence after a lymphedema thigh lobule excision. She was growing a variety of bacteria, and the surgical team managed her wound with Acetic Acid packings BID. After a week and a half of no clinical improvement, heavy nursing time, and use of IV narcotics, they called the wound care team for management. I applied V.A.C. VERAFLO™ Therapy with 100mL of 0.25% acetic acid to her wound and was able to transfer her to a lower level of care within one week … read more

Three Common Reasons You Might Get Sued

Patients often sue for reasons that have nothing to do with the quality of the medical care rendered, but rather for the human care that is perceived as lacking.

The last few weeks were very difficult for my family and friends in the medical sense. I had one family member in an intensive care unit on the West Coast, one friend’s father in a rehab facility on the East Coast, and one friend’s son having problems in the outpatient setting in the Midwest. These patients are male and female, young and old, and have very different medical histories, but they all have one thing in common. They all want to sue about their medical care or lack thereof. These cases illustrate three common reasons you might get sued …. read more

We’ve Always Done It This Way: Flagyl Crushing & Other Wound Care Bad Habits

Off-label drug use and questionable documentation are just two wound care bad habits that can get clinicians into trouble. Don’t just accept it because “We’ve Always Done It This Way” .


As clinicians, we use our knowledge, training and experience to find solutions and take care of patients in the best way possible. We learn about standards of care, scope of practice, and facility policies and procedures to guide our actions and care-giving …

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Top Tips for Best Wound Cleansing Practices

Are your wound cleansing practices up-to-date? Find out with these top tips for cleaning wounds properly and choosing the right cleansers.

Top Tips for Best Wound Cleansing Practices

When you get clinicians together to talk about wounds, dressing choices are usually a popular topic. Wound cleansing? Not so much.

Cleaning a wound thoroughly – and frequently – is a crucial part of wound care. In fact, you should clean a wound every time you change a dressing – unless it’s contraindicated. Why is it so important? Cleaning a wound …. read more

ViroMed Gene Therapy for Non-Healing Diabetic Foot Ulcers Starts Phase III Trial

The first patient has been dosed in a Phase III trial assessing ViroMed’s VM202, the first pivotal study of a gene therapy indicated for patients with nonhealing diabetic foot ulcers (NHU) and concomitant peripheral artery disease (PAD).

The Phase III trial (NCT02563522) is a double-blind, placebo-controlled, multicenter study designed to evaluate VM202 for safety and efficacy in 300 adults with a diabetic foot ulcer and concomitant PAD. Two hundred patients will be randomized to VM202 and the other 100 to placebo, ViroMed’s U.S. division VM BioPharma said yesterday. … read more