Category: Articles

LeucoPatch system for the management of hard-to-heal diabetic foot ulcers in

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

 

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

R&D Remains the “Heartbeat” of 3M

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

OnCourse Learning to be acquired for reported $500 million

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

3D Printing Advances are Changing Medicine and Military Safety

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

Wounds Asia: Current issue: Vol 1, No 2

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

AmpliPhi receives positive feedback from FDA for its …

     AB-PA01 product targeting P.aeruginosa infections

 

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

Beverly Hospital Hosts Amputation Prevention Summit

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

 

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

 

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

Negative pressure wound therapy in the treatment of diabetic foot ulcers

     may be mediated through differential gene expression

 

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

One Call Announces New Wound Resource Program with Broadspire®

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

 

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

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

 

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

Osiris Therapeutics, Inc. Announces GrafixPL PRIME™

Launches October 1, 2018

 

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

 

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

 

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

The role of bacteria and biofilms in non-healing wounds

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

 

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

Solsys Medical’s TheraSkin Regenerative Wound Healing

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

 

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

 

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

Supporting Closure: Therapeutic Interventions for Diabetic Foot Ulcers

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

The Diabetic Foot in Remission: Strategies to Make Prevention Pay

September 25, 2018 1:00 pm to 2:00 pm EDT
Presented by: Dr. David G. Armstrong, DPM, MD, PhD

Because neuroischemic complications are associated with a high rate of recurrence, this presentation proposes a slight shift in how health care providers counsel and communicate risk to their patients. If the epidemiology of this problem is comparable with that of cancer, and recurrences are common, then perhaps language commensurate with such risks should follow.

 

After initial healing of an index wound, patients are referred to not as being cured but rather as being “in remission.” This concept is easy for the patient and the rest of the team to understand, and it powerfully connotes the necessity for frequent follow-up and rapid intervention for inevitable minor and sometimes major complications.

This program will review tried-and-true as well as up-to-the-minute advances in biologics, consumer electronics, mechanics, medicine, and surgery that are “pushing the envelope” in extending ulcer-free, hospital-free, and activity-rich days in efforts to make prevention pay.

 

Registrants will learn how to:

  • Identify risk factors for ulceration
  • Identify risk factors for amputation
  • Understand the impact of diabetes on the health care system
  • Understand the impact of diabetic foot complications on the health care system

Diabetic Foot Ulcer Classification and Assessment

Classification of Diabetic Foot Ulcers

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

 

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

Scientists Trial An Unexpected Source To Help Heal Hard-To-Treat Injuries

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

Treating Diabetes with GLP-1 Reduces Heart Disease, Fewer Foot Ulcers

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

Wound Care Weekly Creative Services

We have a full creative / marketing department that offers everything from Animation to Web. Our digital marketing services actually pay for themselves …. guaranteed.

  • Web Design
  • Digital Marketing
  • Brochure Design and Printing
  • Illustration and Animation
  • Forms and Checks
  • Social Media

Call (336) 645-5121 or message us today to see how we can assist your practice.

 

Car crashes and chronic wounds

     The health epidemic no one is talking about

 

Chronic wounds impact the lives of millions of Americans, yet the stories of those suffering are rarely told. As a result, chronic wounds have turned into a silent epidemic that remains largely invisible to the general public. Twenty-five years ago, Kevin Fontenot was one of those people, living his life generally unaware of this horrible condition, which is often caused by other diseases such as renal failure, diabetes, circulatory problems or malnutrition. That is, until he himself fell victim to it … read more

Natural product-based nanomedicines for wound healing purposes:

     therapeutic targets and drug delivery systems

 

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

Using AutoCAD software to measure venous leg ulcers:

     a reproducibility assessment study

 

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

US military explores microbiology of combat wounds

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

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 … read more

Transitioning wound care patients to post-acute care

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

Greater concentration on wound care will save NHS millions

     argues prof of vascular surgery

 

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

 

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

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

Scientists Create a Surgical Sealant for Closing Major Wounds

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

 

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

BEST PRACTICE RECOMMENDATIONS FOR THE Prevention and

     Management of Diabetic Foot Ulcers

 

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

Hemoglobin A1c levels not tied to wound outcomes

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

 

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

Nexodyn Wound Care Solution Launched in the U.S.

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

 

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

 

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

Researchers invent ‘smart’ thread that collects diagnostic data

     when sutured into tissue

 

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

International Conference on Wound Care, Tissue Repair and Regenerative Medicine

With Immense pleasure, Wound Care 2018 along with the Organizing Committee Members invites all the participants from all across the globe to attend “International Conference on Wound Care, Tissue Repair and Regenerative Medicine” which is slated on October 29-30, 2018 at Amsterdam, Netherlands with the theme Advanced wound healing techniques for the cure and care of wounded patients. This year Wound Care Conferences anticipated as two days interactive, stimulating discussion with 10+ keynote lectures, 50+ plenary lectures, 10+ Young Research Forum Lectures, 20 + Poster Sessions. Besides, there will be 3+ workshops and 2+ Symposiums. We also expect to provide technical demonstrations and numerous opportunities for informal networking.

 

Mission, Vision and Values:

Wound Care conferences mission is to provide the exclusive research topics where all the participants can be up to date with the Latest developments in the wound care. Conference on Wound Care ultimate vision is to be the Premier and Exclusive healthcare conference in the worldwide regions. The values of Wound Care 2018 are Innovation, Quality, Integrity, Knowledge and Patient care.

 

Why Amsterdam?

Amsterdam is the capital of the Netherlands. These days the city has a population of just over 790.000 inhabitants and is the largest city in the country. Amsterdam is located in the province ‘Noord-Holland’, situated in the west. It is one of the most popular destinations in Europe, receiving more than 4.5 million tourists annually … read more

A new platform for gaining insight and knowledge in managing wounds

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

Moldable Hyaluronan Hydrogel Enabled by Dynamic

     Metal–Bisphosphonate Coordination Chemistry for Wound Healing

 

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

Oxygen therapies for wound healing: EWMA findings and recommendations

For wounds to heal, it is essential that macro- and microcirculation is restored in the surrounding tissue (Niinikoski et al, 1991; Gottrup, 2004a). One of the most urgent requirements is oxygen, as it is critically important for the reconstruction of new vessels and connective tissue, and also enables resistance to infection … View PDF

Diabetes causes more than 120 foot and toe amputations a WEEK in England

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

 

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

 

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

 

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

Windsor’s Scapa to expand wound care footprint with acquisition

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

 

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

Methodological considerations of investigating adherence

     to using offloading devices among people with diabetes

 

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

SMARTPORE Technology Made Easy

Selecting the appropriate dressing for the individual is essential in promoting optimum healing, symptom management, comfort and overall quality of life for the patient. This Made Easy describes SMARTPORE Technology®, utilised in the BETAplast® dressing range (Mundipharma). SMARTPORE Technology® provides high absorption and retention of exudate, along with an optimal moisture vapour transmission rate (MVTR), creating an ideal option for wound healing.

 


Download:

SMARTPORE TECHNOLOGY MADE EASY

Cell reprogramming converts open wounds into healthy skin

The work focuses on a type of wound known as cutaneous ulcers, which are long-lasting lesions commonly found on sufferers of severe burns, bedsores and diabetes. These complex wounds run deep, through several layers of skin, which often means that they need to be treated surgically by taking grafts of existing skin and layering them over the top.

 

With expertise in plastic surgery, Salk scientists Izpisua Belmonte and Masakazu Kurita started to explore advanced regenerative techniques that could avoid the need for these procedures. Key to their mission were cells called basal keratinocytes, which resemble stem cells in that they serve as a precursor to various types of skin cells … read more

UIC to lead study of negative pressure wound

     therapy in obese and diabetic patients

 

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

 

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

 

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

Wilmington-based company creates smartphone app for wound care

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

 

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

 

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

 

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

 

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

Scientists find way of treating skin wounds without surgery

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

 

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

 

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

 

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

Chitosan-polyvinyl alcohol nanoscale liquid film-forming system

     facilitates MRSA-infected wound healing by enhancing antibacterial and antibiofilm properties

 

Sha Yang,* Yun Yang,* Sixin Cui, Ziqi Feng, Yuzhi Du, Zhen Song, Yanan Tong, Liuyang Yang, Zelin Wang, Hao Zeng, Quanming Zou, Hongwu Sun

 

National Engineering Research Center of Immunological Products & Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Third Military Medical University of Chinese PLA, Chongqing, 400038, People’s Republic of China

 

*These authors contributed equally to this work

 

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most predominant and fatal pathogens at wound infection sites. MRSA is difficult to treat because of its antibiotic resistance and ability to form biofilms at the wound site.

 

Methods: In this study, a novel nanoscale liquid film-forming system (LFFS) loaded with benzalkonium bromide was produced based on polyvinyl alcohol and chitosan.

 

Results: This LFFS showed a faster and more potent effect against MRSA252 than benzalkonium bromide aqueous solution both in vitro and in vivo. Additionally, the LFFS had a stronger ability to destroy biofilms (5 mg/mL) and inhibit their formation (1.33 µg/mL). The LFFS inflicted obvious damage to the structure and integrity of MRSA cell membranes and caused increases in the release of alkaline phosphate and lactate dehydrogenase in the relative electrical conductivity and in K+ and Mg2+ concentrations due to changes in the MRSA cell membrane permeability.

 

Conclusion: The novel LFFS is promising as an effective system for disinfectant delivery and for application in the treatment of MRSA wound infections.

Download Article (pdf)

Antibiotic Resistance Influence on Wound Care

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

 

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

 

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

Role of oxygen in wound healing (webcast)

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

 

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

 

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

 

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

Website

CLICK HERE TO CHECK LOCAL TIMES WORLDWIDE

Complex Wound Management: Diabetic Foot Ulcers

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

Wound Management Tech spins CellerateRX collagen asset into JV with Catalyst Group

Wound Management Technologies (OTC:WNDM), operating under WNDM Medical, said last week it inked a deal to spin out its CellerateRX activated collagen assets into a new joint venture with The Catalyst Group.

 

Fort Worth, Texas-based Wound Management Tech will maintain a 50% ownership interest in the new joint venture, with The Catalyst Group taking up the other half, according to an SEC filing.

 

The newly formed Cellerate JV will maintain an exclusive sublicense to distribute the CellerateRX activated collagen adjuvant into the wound care markets in the US, Canada and Mexico, according to an SEC filing.

 

As part of the agreement, Wound Management Tech issued a 30-month promissory note to The Catalyst Group’s newly formed CellerateRX subsidiary in the princpal amount of $1.5 million with a 5% interest rate, convertible into shares of WNDM Medical at a conversion price of 9¢ per share, according to an SEC filing … read more

Turning wound cells into skin cells may help doctors heal ulcers

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

 

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

Their findings were published Wednesday in the journal Nature.

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

Telehealth technology utilized at Signature HealthCARE

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

 

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

 

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

 

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

Wound Care Patient Outcomes: Establishing Trust to

     Improve Wound Healing Results

 

Last spring, I encountered that specific type of patient we sometimes meet, the one who has been through the chronic wound care revolving door so many times that he or she sets out on his or her own path and refuses any byways diverting from it.

 

Ms. A had stage 3 lymphedema after a left knee replacement opened the hidden trap door of undiagnosed lymphedema several years before her admission to our inpatient rehab facility. Her reason for admission was debility from urinary tract infection (UTI). Comorbidities of obesity, severe arthritis of the right knee, diabetes, and chronic lymphedema wounds on both legs were exacerbating factors making discharge home difficult from the acute hospital … read more

Intravenous Ketamine as an adjunct to procedural sedation

     during burn wound care and dressing changes

 

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

The Diabetic Foot in Remission: Strategies to Make Prevention Pay

Tuesday, September 25, 2018

 

Because neuroischemic complications are associated with a high rate of recurrence, this presentation proposes a slight shift in how health care providers counsel and communicate risk to their patients. If the epidemiology of this problem is comparable with that of cancer, and recurrences are common, then perhaps language commensurate with such risks should follow.

 

After initial healing of an index wound, patients are referred to not as being cured but rather as being “in remission.” This concept is easy for the patient and the rest of the team to understand, and it powerfully connotes the necessity for frequent follow-up and rapid intervention for inevitable minor and sometimes major complications.

 

This program will review tried-and-true as well as up-to-the-minute advances in biologics, consumer electronics, mechanics, medicine, and surgery that are “pushing the envelope” in extending ulcer-free, hospital-free, and activity-rich days in efforts to make prevention pay.

 

Dr. David G. Armstrong
DPM, MD, PhD
University of Southern California

Phase 2 Clinical Trial for Venous Leg Ulcers Nears Completion

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

 

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

Know-how: Canadian hospital first to сure patients with virtual reality

A Calgary hospital has become the first in Canada to treat patients with virtual reality technology. It has seen patients experience a 75-percent reduction in discomfort by escaping their surroundings during painful procedures.

Graydon Cuthbertson, a patient at Rockyview General Hospital, nearly lost his legs from compartment syndrome. Following multiple surgeries on his calf muscle, the 47-year old experienced pain ranging from discomfort to excruciating during wound-dressing changes.

 

Cuthbertson found that utilizing the VR technology helped him to escape his grim hospital surroundings and take in a calming virtual lakeside campground, a prehistoric landscape with dinosaurs, or a tranquil ocean to swim with dolphins.

 

It’s a godsend,” he said. “Even with painkillers, the first time I had wound care after my surgery, the pain was excruciating. But with virtual reality, I got through the next treatment with flying colors. I was focused on what I was seeing and hearing, and not thinking at all about how painful it might be. All of the sudden, one-and-a-half hours go by and it’s all over. It was awesome.” read more

When and When Not to Use An SGLT-2

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

 

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

 

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

Is it a Pressure Injury?

     Factors to Consider When Determining Wound Etiology

 

As specialists in wound, continence and ostomy care, we are forever in a role of wearing many hats. We are educators to patients, staff, and providers… we are patient advocates and supporters of our bedside nurses… we are liaisons in many aspects of care and help to coordinate care and services for our patient population. We are often referred to as the specialist and are called upon when there is a patient with a wound, skin, ostomy, or continence concern. Our peers trust us, and it is important that we possess the knowledge and skills to share with others when determining etiology and treatment of wounds and skin issues.

 

Determining Wound Etiology
An issue we are often faced with as skin specialists is determining the etiology of wounds and skin concerns. When determining the etiology of wounds, it is important to look at the entire picture…and, when doing so, understand that many variables can and do make wounds better or worse, but there is usually an isolated variable that caused the wound.

 

Medical Device-Related Pressure Injuries
Some things to keep in mind: Pressure injuries are usually round, can appear punched out, may be partial- or full-thickness, may have slough or necrotic tissue, and are usually over a bony prominence. In terms of shape, pressure injuries related to devices usually take the shape of that device (think of a linear, fluid-filled blister from Foley catheter tubing on the thigh… a stage 2 medical device-related pressure injury, or a purple or discolored, non-blanchable area on the lip from an endotracheal tube… a mucosal pressure injury). Other devices that may be responsible for pressure injuries are prosthetic devices … read more

Cold Atmospheric Plasmas Used In Wound Healing and Cancer Treatment

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

 

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

The skill behind skilled

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

 

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

Higher proportion of limb salvage and lower amputation rates

     The impact of a wound centre on a vascular surgery practice

 

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

 

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

 

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

Healogics® Announces New Program Aimed at Improving Continuity of Care

JACKSONVILLE, Fla.–(BUSINESS WIRE)–Aug 30, 2018–Healogics®, the wound healing experts, today announced the launch of their newest program: Healogics Specialty Physicians Care Continuum (HSP Care Continuum). The Program is designed to support the patient experience by improving continuity of care, cost-effectiveness, patient outcomes, value and satisfaction for people with chronic wounds who are transitioning from an inpatient to an outpatient setting.

 

 

Healogics Announces New Program Aimed at Improving Continuity of Care

 

The HSP Care Continuum Program provides skilled wound care physicians in the hospital inpatient setting who have specialized training in the management of complex wounds. These physicians will work collaboratively with Certified Wound and Ostomy Nurses and referring specialists needing a specialty consult. Also, Healogics clinical teams educate discharge planners on post-acute options so patients with wounds receive care for this critical co-morbid condition while they are also receiving post-acute care for their primary diagnosis. Healogics has a vast library of educational content that will be made available for patients who can care for their wounds between follow up post-acute visits.

 

“The average hospital stay is 2.4 days longer for patients living with a chronic wound. With better inpatient consults, we believe we can have an impact on care continuity and, in turn, reducing the overall cost of care. We are excited for the launch of this new program, and the positive implications it will have on the overall patient experience,” said David Bassin, Healogics Chief Executive Officer.

 

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20180830005777/en/

NeuroMetrix to Exhibit and Sponsor Symposium on the

Early Diagnosis of Diabetic Peripheral Neuropathy at the Annual Meeting of NEURODIAB

 

WALTHAM, Mass., Aug. 29, 2018 (GLOBE NEWSWIRE) — NeuroMetrix, Inc. (Nasdaq:NURO) today reported that it will be both exhibiting and sponsoring a diabetic neuropathy symposium at the 28th Annual Meeting of NEURODIAB held in Rome, Italy September 4-7.

 

Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, affecting over half of people with diabetes. It causes significant morbidity including pain, increased risk of falling in the elderly, and is the primary trigger for diabetic foot ulcers which may require lower extremity amputations. Early detection of neuropathy allows for earlier clinical intervention to help mitigate the effects of neuropathy on both patient quality of life and cost of care.

 

NEURODIAB is the annual meeting of the Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes (EASD) where thought leaders share ideas and scientific findings on diabetic neuropathy. NEURODIAB is considered the most important annual event in the field of diabetic neuropathy … read more

Caring for the diabetic foot

Patients with psoriasis have a higher risk of developing new onset diabetes mellitus. It’s a risk that’s been described as statistically significant. So, in this article, we examine dermatologic care for diabetic foot infections.

 

Patients with psoriasis have a higher risk of developing new onset diabetes mellitus. The increased incidence of psoriasis and diabetes mellitus was documented in a 2013 study by Usman Khalid, et al. published in Diabetes Care in which authors described the correlation as “statistically significant.” So, in this article, we examine dermatologic care for diabetic foot infections.

Dermatologists must be able to diagnose and manage mild-to-moderate infections in diabetic foot ulcers (DFUs), said Warren S. Joseph, D.P.M., FIDSA, in a presentation at DERMfoot 2018 in Baltimore … read more

True multidisciplinary approach essential for limb preservation

CHICAGO — To prevent amputation, physicians must assemble a comprehensive multidisciplinary team to care for patients at risk for losing their limbs, Ramon Varcoe, MD, MBBS, MS, FRACS, PhD, said at AMP: The Amputation Prevention Symposium.

 

A multidisciplinary approach to limb preservation begins with recognizing the major drivers of amputation. The global public health threat posed by the “tsunami of diabetes,” for instance, is a significant problem, he said.

 

If a patient develops diabetes, his or her risk for amputation is 15 times as high as someone who does not, according to Varcoe.

 

“The impact is more than amputation itself, though; it’s a reduction in life expectancy as well,” he said, noting that studies have linked amputation to an increased risk for death and 5-year rates of death exceeding that of some cancers … read more

New smart bandages could monitor and treat chronic wounds

Researchers in the United States present their findings on research into new smart bandages capable of real-time monitoring and treating chronic wounds.

Chronic wounds develop when a wound fails to heal within the expected time, which might be a couple of weeks or up to several months. They are often caused by diabetic wounds, pressure ulcers, leg ulcers, arterial ulcers, and malignant wounds. Chronic wounds may lead to severe pain, affecting an individual’s quality of life.

 

Chronic wounds affect millions
Currently, chronic wounds are a major health concern in the United States as they are affecting over 25 million people. This number will likely increase owing to the aging population and the continuous increase in the number of diabetes and obesity cases. According to the American Professional Wound Care Association, chronic wounds have caused the nation over 30 billion dollars each year … read more

Liraglutide May Lower Risk for Foot Amputation in Type 2 Diabetes

Patients with type 2 diabetes who took liraglutide were at a lower risk for foot amputation, according to a study recently published in Diabetes Care.

Researchers completed a post hoc analysis on data collected during the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial to determine the effect of liraglutide on rates of diabetes-related foot ulcers in patients who were also at high risk for cardiovascular events. Patients in the LEADER study were randomly assigned to either an intervention arm (n=4668), receiving 1.8 mg of liraglutide a day, or a control arm (n=4672), receiving a placebo. The study continued for 5 years with an average follow-up time of 3.8 years. A diabetes-related foot ulcer was … read more

Deferoxamine Can Prevent Pressure Ulcers and Accelerate Healing in Aged Mice

Chronic wounds are a significant medical and economic problem worldwide. Individuals over the age of 65 are particularly vulnerable to pressure ulcers and impaired wound healing. With this demographic growing rapidly there is a need for effective treatments. We have previously shown that defective hypoxia signaling through destabilization of the master hypoxia‐inducible factor 1α (HIF‐1α) underlies impairments in both aging and diabetic wound healing. To stabilize HIF‐1α, we developed a transdermal delivery system of the FDA‐approved small molecule deferoxamine (DFO) and found that transdermal DFO could both prevent and treat ulcers in diabetic mice. Here, we show that transdermal DFO can similarly prevent pressure ulcers and normalize aged wound healing. Enhanced wound healing by DFO is brought about by stabilization of HIF‐1α and improvements in neovascularization. Transdermal DFO can be rapidly translated into the clinic and may represent a new approach to prevent and treat pressure ulcers in aged patients … read more

Liraglutide May Lower Risk for Foot Amputation in Type 2 Diabetes

Patients with type 2 diabetes who took liraglutide were at a lower risk for foot amputation, according to a study recently published in Diabetes Care.

 

Researchers completed a post hoc analysis on data collected during the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial to determine the effect of liraglutide on rates of diabetes-related foot ulcers in patients who were also at high risk for cardiovascular events. Patients in the LEADER study were randomly assigned to either an intervention arm (n=4668), receiving 1.8 mg of liraglutide a day, or a control arm (n=4672), receiving a placebo. The study continued for 5 years with an average follow-up time of 3.8 years. A diabetes-related foot ulcer was specified as a medical event of special interest, and all complications related to the ulcer were documented.

read more

Texas A&M partnership developing biomedical ‘bandage’ for wounds

University research focusing on building stimuli-responsive material that could release, absorb antibiotics

 

Researchers at Texas A&M University and the Stevens Institute of Technology are working on the next generation of biomedical materials used to treat chronic wounds, including ulcers and wounds caused by diabetes.

 

Svetlana Sukhishvili, A&M professor and director of the soft matter facility, and her research partner at Stevens, Hongjun Wang, have conducted experiments alongside their respective teams and combined them to form one study.

 

“If you have diabetes, for example, your ability to heal wounds may be compromised, and ulcers may occur. What we’re trying to do is give you this bandage-like material that will be able to transform into skin that will help your body overcome the wound and to heal,” said Victoria Albright, a fourth-year doctoral student and lead researcher in the A&M Department of Materials Science and Engineering … read more

Man Bitten By Shark Develops Flesh-Eating Bacteria

A man bitten on the leg by a 7-foot shark quickly gets treatment for his wounds. A week later, he suffers from excruciating pain brought about by flesh-eating bacteria.

 

In early August, Blaine Shelton from Texas was swimming at Crystal Beach in Houston when he spotted a fin, which he immediately knew was not from a friendly porpoise. He was reportedly about 200 yards from the shore, so he began swimming to get away from the shark. It was then that he was bitten on the thigh, just above his knee. Shelton was able to swim ashore after the bite and was immediately taken to the hospital to be treated for his wounds. He later learns that the shark attack was likely from a 7-foot bull shark … read more

MiMedx Announces Statistically Significant Results

     In New Multicenter Clinical Study Of Healing Of Diabetic Foot Ulcers Using EpiFix®

 

MARIETTA, Ga., Aug. 24, 2018 /PRNewswire/ — MiMedx Group, Inc. (NASDAQ : MDXG ), a leading developer and marketer of regenerative and therapeutic biologics, today announced that a new study regarding the use of EpiFix® in the treatment of diabetic foot ulcers (DFUs) has been published in the peer-reviewed journal, International Wound Journal.

 

The paper is entitled “A Confirmatory Study on the Efficacy of Dehydrated Human Amnion/Chorion Membrane dHACM Allograft in the Management of Diabetic Foot Ulcers: A Prospective, Multicenter, Randomized, Controlled Study of 110 Patients from 14 Wound Clinics.” The paper was authored by: William Tettelbach, MD; Shawn Cazzell, DPM; Alexander M. Reyzelman, DPM; Felix Sigal, DPM; Joseph M Caporusso, DPM; and Patrick S. Agnew, DPM. The electronic publication of the article in International Wound Journal can be found at https://onlinelibrary.wiley.com/doi/full/10.1111/iwj.12976.

 

This multi-center randomized and controlled trial was led by William Tettelbach, MD, principal investigator and former Executive System Medical Director of Wound Care and Hyperbaric Medicine Services for InterMountain Healthcare. Dr. Tettelbach is now Associate Chief Medical Officer for MiMedx, a position that postdated the completion of the study.

 

Clinical Study Design and Results

The objective of the study was to determine the safety and effectiveness of EpiFix as compared to standard of care (SOC) therapy for the treatment of non-healing DFUs. The primary efficacy endpoint was the incidence of complete wound closure over a 12-week period. Data from 110 patients meeting study inclusion and exclusion criteria were analyzed in the Intent-to-Treat (ITT) cohort. A total of 98 patients completed the study Per Protocol (Per-Protocol cohort).

 

ITT analysis requires patients to be included even if they did not fully adhere to the protocol. In comparison, in a Per-Protocol analysis, only patients who completed the entire clinical trial according to the protocol are counted towards the final results.

 

In the current study on an ITT basis, 70% of patients who received weekly EpiFix had complete healing by 12 weeks versus 50% of patients only receiving weekly SOC (EpiFix 70% vs. SOC 50%, p=0.0338) … read more

Epidermolysis bullosa: a case report

Epidermolysis bullosa (EB), often referred to as the butterfly disease, is a group of rare genetic conditions characterized by skin that is delicate and fragile as butterfly wings. The skin blisters in response to friction, minor injury, or trauma. In certain types of EB, other organs, such as the esophagus, can also be affected, and secondary complications may require multiple interventions. While there has been significant progress in classifying the disease – identifying genes and proteins involved – there have been few advances in the treatment of the disease. The care of the EB patient focuses on management of symptoms, protecting the skin, and preventing complications. In this case report, the use of a multivalent wound-healing ointment (Terrasil®) was evaluated in a 60-year-old patient with a history of junctional EB. A polymerase chain reaction-based culturing was utilized to quantitatively test for bacteria and fungi at baseline and follow-up visits. Pain assessment and wound area were also documented at each visit. Following the application of the wound care ointment, there was a reduction in wound surface area on central (96%) and distal mid-back (92%) by treatment visit three, and there was a 96% reduction on the left shoulder blade ulcer by treatment visit four. Moreover, there was a noticeable drop in the percentage of bacteria detected by polymerase chain reaction. The wound care ointment was also effective in eliminating the fungal species and reducing pain, itching, blistering, and cracking around the wound … read more

The industry’s BEST TCC Kit is Now Available on Amazon. M-Med provides the most versatile total contact cast on the market with the TCC-Mobility Series. 60% more padding for patient comfort and safety. Click here for more information on TCC-Mobility Series.

 

You can order as many or as few kits based on your need- there’s no minimum order quantity. And, we have the Best Price in the marketplace allowing your practice to maximize value per procedure. M-Med’s TCC kits are fully customizable.

 

Sample Request Form


Dr. Michael Miller

As an advanced wound care specialist for almost 20 years full time, I am a relentless devotee of best practices and the wound care literature. While there are many wound care practices that allow some personal latitude, there are one or two “definites”. The literature has recently become very vociferous in the use of Total Contact Casting as the “Gold Standard” for offloading plantar based Diabetic Neuropathic Foot ulcers. As a non-hospital affiliated wound care specialist, I have no deep pocket entity to support me as I trial device after device searching for ease of use, facilitated patient compliance, and more, best pricing.

 

I found your devices in a search for an equally efficacious TCC that had better pricing than the many on the market. Since no two patients are alike, the many components in your kit allowed me to configure the final product, controlling the height, thickness, weight and even the configuration/position of the walking gasket. More, the pricing for needed large orders made this a less painful expenditure for me. Of course, the rapid shipping came in handy when my staff opened a closet door to discover two casts and four patients on the schedule in 48 hours.

 

I wanted to take the time to let you know how much I appreciate the products you have available for those of us who strive to provide best care using the best products, at what I have found to be best service and pricing.

 

Respectfully yours

 

Michael S. Miller DO, FACOS, WCC
CEO and Medical Director – The Miller Care Group
Indianapolis, IN

Clay fights MRSA, other ‘superbugs’ in wounds

The use of mud or wet clay as a topical skin treatment, or poultice, is a common practice in many cultures. In fact, the concept of using mud as medicine goes back to the earliest times.

 

Now, Arizona State University (ASU) and Mayo Clinic researchers have found that one type of clay, Oregon blue clay, may help fight disease-causing bacteria in wounds, including treatment-resistant bacteria. Their findings appear in the International Journal of Antimicrobial Agents.

 

“The study is an important advance in understanding how clays, specifically blue clay from Oregon, have shown medicinal properties by attaching to pathogenic bacteria,” says Enriqueta Barrera, a program director in the National Science Foundation’s (NSF) Division of Earth Sciences, which funded the research.

 

The scientists identified certain clays that kill bacteria, including many drug-resistant pathogens.

 

“Working with Mayo Clinic, we showed that these clays also diminish populations of bacterial biofilms, as well as bacteria common in wounds that are more resistant to drugs,” says biogeochemist Lynda Williams of ASU, a co-author of the study. “The results support our efforts to design new antibacterial drugs using natural clays.” … read more

Innovation in Wound Care

An interview with Prof. Harding, CBE, and Dr Dixon, PhD, conducted by Alina Shrourou, BSC

 

What is a hard-to-heal wound?

There are many definitions of hard-to-heal. More conventionally, it’s based on underlying etiology of the wound, but in practice it’s any wound that has not healed within a timely fashion. This is often due to a lack of coordinated care. Many of those patients receive multiple courses of antibiotics and antimicrobial therapy, because clinicians aren’t sure what they’re looking at.

 

Not all wounds are necessarily hard-to-heal from the beginning, but because of the need for improvements and coordination of care, many of those patients that are seen in clinical practice become hard-to-heal … read more

MiMedx Announces Statistically Significant Results In New

     Multicenter Clinical Study Of Healing Of Diabetic Foot Ulcers Using EpiFix®

 

– Study Published in International Wound Journal Reported Statistically Significant Evidence of Healing Compared to Control Group

– Intent-To-Treat EpiFix Treated Patients = 70% vs Control 50%, p=0.0338
– Per-Protocol EpiFix Treated Patients = 81% vs Control 55%, p=0.0093

MARIETTA, Ga., Aug. 24, 2018 /PRNewswire/ — MiMedx Group, Inc. (NASDAQ: MDXG), a leading developer and marketer of regenerative and therapeutic biologics, today announced that a new study regarding the use of EpiFix® in the treatment of diabetic foot ulcers (DFUs) has been published in the peer-reviewed journal, International Wound Journal.

 

The paper is entitled “A Confirmatory Study on the Efficacy of Dehydrated Human Amnion/Chorion Membrane dHACM Allograft in the Management of Diabetic Foot Ulcers: A Prospective, Multicenter, Randomized, Controlled Study of 110 Patients from 14 Wound Clinics.” The paper was authored by: William Tettelbach, MD; Shawn Cazzell, DPM; Alexander M. Reyzelman, DPM; Felix Sigal, DPM; Joseph M Caporusso, DPM; and Patrick S. Agnew, DPM. The electronic publication of the article in International Wound Journal can be found at https://onlinelibrary.wiley.com/doi/full/10.1111/iwj.12976.

 

This multi-center randomized and controlled trial was led by William Tettelbach, MD, principal investigator and former Executive System Medical Director of Wound Care and Hyperbaric Medicine Services for InterMountain Healthcare. Dr. Tettelbach is now Associate Chief Medical Officer for MiMedx, a position that postdated the completion of the study.

read more

Type 2 diabetes: Poor sleep slows wound healing

Researchers uncovered a connection between poor sleep and wound healing in type 2 diabetes that could pave the way for new treatments.

 

Diabetes is one of the leading causes of death in the United States.

 

Type 2 diabetes is the most common form of diabetes, and it impacts the ability of the body to produce insulin, the hormone that regulates blood sugar levels.

 

One serious complication of diabetes are ulcers that can form from wounds. Feet are one of the most common places of injury. Small wounds that develop on feet can eventually become ulcers … read more

SGLT2 inhibitor therapies may raise risk for amputation

     diabetic ketoacidosis in diabetes with CVD

 

Adults with type 2 diabetes and established CVD prescribed SGLT2 inhibitor therapy have a twofold increased risk for lower-limb amputation and diabetic ketoacidosis compared with patients prescribed a GLP-1 receptor agonist, according to study findings presented at the European Society of Cardiology Congress.

 

“Sodium glucose cotransporter 2 inhibitors are playing an increasingly prominent role in the treatment of diabetes, following the reduced risk of major adverse cardiovascular events and heart failure outcomes seen in the EMPA-REG Outcome trial with empagliflozin [Jardiance, Boehringer Ingelheim] and in the CANVAS study with canagliflozin [Invokana, Janssen],” Peter Ueda, MD, PhD, from the department of medicine at the Karolinska Institute in Solna, Sweden, said during a presentation here. “Concerns exist regarding the safety of the drugs, with signals of serious adverse events emerging from clinical trials, case reports and observational studies.” … read more

Wound healing work presented at the RCP Innovation in

     Medicine Conference 2018 by Neem Biotech

 

Neem Biotech, a South Wales based R&D pharmaceutical biotech working in the field of novel antimicrobial drug development, and the Welsh Wound Innovation Centre recently attended the Royal College of Physicians’ Innovation in Medicine Conference 2018 where Neem presented their data around wound-relevant biofilms.

 

The promising laboratory data presented reinforces the role of quorum sensing inhibition in virulence factor regulation and biofilm disruption, with implications for management of antimicrobial resistance.

 

Dr Graham Dixon, Neem’s CEO and Prof Keith Harding … read more

Jipmer to treat wounds with marine resource

Doctors at JIPMER have begun using a marine resource sourced from shrimps for wound management. Marine resources are used to help patients with chronic wounds such as burns, diabetic foot ulcers, bed sores, infections, trauma and even surgery-related injury.

 

Jipmer Director, Dr. S Vivekanandam, said the protocol was initiated by the Department of Plastic Surgery. As a forerunner, a Continuing Medical Education (CME) was recently organised on ‘Wound Update-2018’ by the Department of Plastic Surgery to sensitise and to make aware of this technology in wound management.

 

According to the Director … read more

Wound Management Technologies, Inc. (WNDM) Reports

Publication of Clinical Trial Data from CellerateRX(R) Surgical Activated Collagen(R) Peptides

 

WNDM Medical Inc. (: WNDM) today announced the publication of a journal article in Orthopedics: ”The Effects of Platelet-Rich Plasma and Activated Collagen on Wound Healing in Primary Total Joint Arthroplasty” by David Evans, BA and Bruce Evans, MD. This study examined whether two wound additives, platelet-rich plasma (PRP) and activated collagen (CellerateRX Surgical), would improve postoperative wound healing and reduce complications after total knee or hip replacement surgery.

 

Based in Fort Worth, Texas, WNDM Medical Inc. (WNDM) has a management team in place with significant healthcare industry experience that is committed to sales growth by providing efficacious products to improve patient outcomes.

 

Key Points from the Publication

 

• This was an unsponsored, institutional review board (IRB)-approved, prospective, randomized, single-blinded, controlled study with three cohorts of 30 patients each … read more

Bedside Advanced Wound Care in Nursing Homes

As it stands now, we have 1.6 million nursing home residents in the United States; that number is expected to double by the year 2030. Bringing advanced wound care to the long-term care arena is becoming more common throughout the country. Physician-based wound groups can bring their expertise to the patient’s bedside, thereby saving the patient pain during transport to the wound center and lowering costs. However, certain procedures—such as total contact casting and bioengineered skin substitutes—cannot be performed at the bedside because of billing and reimbursement guidelines.

 

Physician-Based Wound Care Groups: Rationale and Challenges in the Long-Term Care Setting

Utilizing a wound care physician-based group has many advantages in long-term care. Residents build a trusting relationship with their providers who come weekly to assess and treat their wounds. Wound rounds are also the perfect opportunity for the physician and nurse to collaborate. However, providers tend to have somewhat of a learning curve, as well as culture shock stepping into the long-term care arena for the first time. Being competent in wound care is not sufficient to work as a provider in this setting. The long-term care arena is surprisingly different from the hospital. The best way to describe it is, you are on their turf. Nursing homes are under a microscope, and federal regulations must be followed accordingly or facilities are at risk for fines and penalties. Providers must be compliant with the state survey process and associated wound care federal tags … read more

Medicare update: new electronic clinical quality measure

The Centers for Medicare and Medicaid Services (CMS) recently released an announcement seeking input from stakeholders on a new electronic clinical quality measure under development titled, “Hospital Harm – Hospital-Acquired Pressure Injury.”

 

This measure assesses the proportion of hospitalized patients 18 years and older who develop a new stage 2-4 pressure ulcer, deep tissue injury, unstageable pressure ulcer, or experience worsening of any of the above during their hospitalization.

 

We read the full description of the measure and provided the following feedback on behalf of APWCA membership … read more

Skin Conditions Frequently Found in Obese Patient Populations

The Centers for Disease Control and Prevention state that in the United States, “…thirty eight percent of adults, and that seventeen percent of children and teens are obese.” It is imperative that the term obesity be differentiated from overweight. Obesity refers to higher than normal body fat, whereas overweight is in reference to an individual weighing more than the standard for height and weight. Although both terms mean that a person’s weight is greater than what is considered healthy for his or her height, obesity has higher negative health-related consequences.

 

Health care professionals are challenged to manage increasingly complex health issues related to obesity, including complex skin conditions. The increase in stored fat associated with obesity can contribute to a variety of changes in skin physiology and is implicated in a range of dermatologic conditions.2 The skin’s ability to manage transepidermal water loss is altered in the obese population. With increased fat stores the transepidermal water loss is increased, resulting in dryness and delayed skin repair. Additionally, sebaceous channels are blocked, leading to an increase in oils and resulting in acne.2 The thick layers of subcutaneous fat in obese individuals may contribute to profuse sweating (hyperhidrosis) when overheated or with activities. Hyperhidrosis can set the stage for profuse skin damage. Moisture trapped in skin folds coupled with friction as body folds rub together … read more

Predictors of lower extremity amputation among

     patients with diabetic foot ulcer in a tertiary health facility in north central Nigeria

 

INTRODUCTION: Diabetic foot ulcer is a complication of diabetes mellitus of great public health importance. It has the potential of leading to the dreaded sequelae of lower extremity amputation. This outcome is associated with significant morbidity and mortality, hence the need to explore its predictors among persons with diabetic foot ulcers.

METHODOLOGY: The study involved the review of the medical records of seventy (70) in-patients who had received treatment for diabetic foot ulcer at the Federal Medical Centre, Keffi, North Central Nigeria. In addition to obtaining sociodemographic and medical history, information on the Wagner grade of the ulcer, the presence of peripheral sensory neuropathy (using the 10g monofilament) and the presence of osteomyelitis (using plain X-ray of the foot) were obtained and documented. The prevalence rate of lower extremity amputation was also determined.

RESULTS: The study population comprised 52.9% males and 42.1% females. The mean age for male and female participants were 53.4±10.5 and 58.8±13.0 years respectively ( t = 2.35; p = 0.061). Majority of study subjects (37.1%) had Wagner grade 2 disease. Prevalence rate of amputation was 38.6%. Among the potential predictors of lower extremity amputation analyzed (Age, sex, foot care education, duration of diabetes, cigarette smoking, walking bare feet, impaired vision, peripheral neuropathy, hypertension, previous foot ulcer, osteomyelitis), none of them demonstrated a significant association with lower extremity amputation.

CONCLUSION: The list of potential predictors of lower extremity amputation considered in this study is by no means exhaustive. More studies involving larger study populations and other potential predictors of lower extremity amputation not considered in this work (such as peripheral artery disease and glycated haemoglobin) are encouraged.

… read more

Application of Viable Cryopreserved Human Placental Membrane

Grafts in the Treatment of Wounds of Diverse Etiologies

There is evidence in the literature that viable cryopreserved human placental membrane (vCHPM) grafts are effective in treating diabetic foot ulcers and venous leg ulcers.

 

Objective. This case series presents 3 cases of chronic ulcerations — 1 arterial ulcer (AU), 1 pressure ulcer (PU), and 1 recurrence of a pyoderma gangrenosum ulcer (PGU) — that had failed previous courses of standard wound care and were subsequently treated with vCHPM to determine if the treatment is an effective modality for treating wounds of these etiologies.

 

Materials and Methods. This retrospective review describes 3 cases in which patients with chronic wounds that had failed standard of care treatments for more than 4 weeks were subsequently treated with weekly applications of vCHPM. Each wound area was recorded and photographed on a weekly basis and wound area reduction also was charted weekly.

 

Results. The PU and AU both reached full closure in 4 and 5 weeks, respectively, without complication. The patient with the PGU achieved 64% closure after 9 applications of vCHPM … read more

Inlow’s 60-Second Diabetic Foot Screen Gets a New Look!

Dr. Shane Inlow wrote a two-page article, published in 2004, to help guide clinicians in assessing and planning care for patients with or at risk for diabetic foot ulcers.1 A few years later, clinicians in Northern Canada indicated that one of their problems was communicating effectively with experts in larger centres about their patients’ foot problems. The article by Dr. Inlow came to mind, and Inlow’s 60-Second Diabetic Foot Screen was created to give clinicians a common language and process to perform such an assessment.2 This tool then underwent a validation study that included interrater and intrarater reliability and predictive validity to determine consistency of risk recognition for development of ulceration independent of specific assessor and practice setting.1,3 Four years later, a growing body of work by the International Working Group on the Diabetic Foot (IWGDF) resulted in a risk-classification tool … read more

Ants care for wounded comrades by licking their wounds clean

A species of ant has become the first known non-human animal to tend the wounds of its fellows. “Nurse” ants lick the wounds of fallen comrades, and this helps them survive.

 

Matabele ants (Megaponera analis) live dangerous lives. Several times a day, parties of 200-600 soldier ants set out to hunt termites, dragging them from their nests and carrying them home. The termites fight back, and their powerful jaws can administer lethal bites, so Matabele ants frequently lose one or more limbs.

 

In 2017, Erik Frank, then at the University of Würzburg, Germany reported that Matabele ants routinely carry their wounded back to the nest. This is odd, as social insects usually treat each other as expendable … read more

Novel tissue engineering scaffolds fabricated via controlled

     ice crystallization

 

A large number of people around the world suffer from chronic skin wounds each year. Often, chronic wounds such as skin ulcers are seen in older people suffering from circulation disorders and diabetic patients whose skin tissue has a poor capacity of regeneration. Currently, many treatment approaches focus primarily on managing the wounds.

 

Researchers have now taken a nanotechnology-based tissue engineering approach to accelerate the regeneration and repair of damaged tissues at the wound site by directing cells and tissues to grow towards the target site. Their hope is that this leads to the development of affordable and functional biodegradable wound dressings for accelerated healing of chronic skin wounds by promoting regeneration of local tissues.

 

“We show that 3D scaffolds with both aligned nanofibers and aligned interconnected macrochannels can be created with various biomacromolecules, including silk fibroin, using a facile guided ice-crystal growth and nanofiber assembly strategy,” Dr. Linpeng Fan, first author of a paper on this work (ACS Nano, “Creating Biomimetic Anisotropic Architectures with Co-Aligned Nanofibers and Macrochannels by Manipulating Ice Crystallization”), tells Nanowerk … read more

Role of oxygen in wound healing Webcast

13 Sep 2018

 

This Wounds International webcast focuses on the role of oxygen in wound healing and how topical oxygen therapy can improve oxygenation and, therefore, healing.

 

In the first presentation, Breda Cullen, Research and Development Director, UK, outlines the vital role that oxygen plays throughout the healing process and the impact that lack of oxygen (hypoxia) can have on the wound. Breda explores the factors that can cause compromised healing and how these can be addressed.
In the next presentation, Hanna Kaufman, Orthopaedic Surgeon, Israel, looks in depth at the clinical evidence and how this can be applied to practice. Hanna identifies the wounds that are suitable for topical oxygen therapy and shares tips for use in practice, drawing on clinical evidence and experience … read more

‘Really Good’ New Guidelines for T2 Diabetes

The diabetes guidelines discussed below are a draft version of a consensus statement to be issued in October at the annual meeting of the European Association for the Study of Diabetes in Berlin, Germany.

 

Hi. I am Dr Anne Peters, and today I’m going to talk about the new ADA/EASD treatment guidelines for managing patients with type 2 diabetes. First off, my “headline” is that I think these are really good guidelines. Although guiding people is difficult, these guidelines actually begin to guide us in the treatment of our patients with type 2 diabetes …. read more

Agony of Britons hit by chronic wounds lasting more than three months

The devastating impact of chronic wounds has been laid bare as research reveals that hundreds of thousands of patients suffer with pain and immobility for more than a year.

 

One in ten sufferers is even taking antidepressants to cope, with many more unable to work or leave the house.

 

About a million patients are undergoing five dressing changes a week, with 90 per cent of those claiming their quality of life is severely affected.

 

More than 2.8 million Britons are living with a chronic wound, defined as one that does not heal within three months.

But the ‘new normal’ is that patients are affected for eight months … read more

Wounds Australia’s Five Point Plan to Reduce the Burden of Chronic Wounds

The burden of chronic wounds for the individual, the health system and the whole community is familiar to the readers of this journal. Improving lives and saving money through better wound care is a common theme across this issue, and in the broader wound care activities.

 

Wounds Australia recognises that to achieve our vision of Quality wound care and prevention for all requires us to inform and engage with a broad audience. During Wound Awareness Week from 15 to 21 July 2018 Wounds Australia will launch our Five Point Plan to Reduce the Burden of Chronic Wounds. Our plan outlines 5 key initiatives to drive the change for best practice wound care for all Australians and reduce the suffering as a result of chronic wounds.

 

1. Medicare funding for treatment of chronic wounds in primary health care. A dedicated MBS item for treatment of chronic wounds to enable GPs, nurses and allied health professionals to deliver the best practice.

2. Subsidised wound products (dressings and related products) for people experiencing long term wound care. Advanced Wound management products often attract a premium cost. Selecting low cost, modest outcome products is a false economy. Research has shown that the use of less expensive dressings actually increases costs of treating a wound … read more

The accuracy of venous leg ulcer prognostic models in a wound care system

Venous leg ulcers are among the most common chronic wounds. Treatment is commonly with a limb compression bandage. Previous small, often single‐center, studies have shown that it is possible to predict which wounds are likely to respond to compression therapy. We designed this cohort study using a dataset of over 20,000 individuals with a venous leg ulcer to investigate the accuracy of several prognostic models. Creating complex models using logistic regression, as well as simply counting prognostic factors, we show that initial measures of wound size and duration accurately predict, as measured by area under the receiver operator curve and Brier score, who will heal by the 24th week of care. For example, a wound that is less than 10 cm2 and less than 12 months old at the first visit has a 29 percent chance of not healing by the 24th week of care, while a wound greater than 10 cm2 …. read more

Oxidized Regenerated Cellulose/Collagen Dressings

     Review of Evidence and Recommendations

 

Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds.

 

Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Chronic wounds affect more than 6.5 million people in the United States. This trend has also been observed in other developed countries, such as Denmark (affecting an estimated 1% of the population), Sweden (prevalence: 2.4 per 1000 people), and the United Kingdom (prevalence: 3.55–3.7 per 1000 people). As populations increase and age, the incidence of chronic wounds is also forecasted to increase, further stressing healthcare systems and providers.

 

Wound healing and tissue regeneration are a complicated series of biochemical processes that create an orderly healing cascade with 4 key phases: hemostasis, inflammation, proliferation, and remodeling. If this process becomes unbalanced, healing stalls and results in chronic, nonhealing wounds. Acute wounds progress through healing in a predictable time frame, culminating in an epithelialized wound. Chronic wounds start out as acute wounds and, unless their chronic causes are removed, either fail to progress through the wound healing process and (most often) stall in the inflammatory phase, or proceed through the repair process without establishing a sustained anatomic and functional result … read more

Molecular study of wound healing after using biosynthesized

     BNC/Fe3O4 nanocomposites assisted with a bioinformatics approach

 

Department of Bioprocess Technology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; Young Researcher and Elite Club, Sabzevar Branch, Islamic Azad University, Sabzevar, Iran; Department of Cell and Molecular Biology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; Department of Microbiology, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; Institute of Tropical Forestry and Forest Products, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 6Young Research and Elite Club, Parand Branch, Islamic Azad University, Parand, Iran; Department of Medical Genetics, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran; Muthayammal Centre for Advanced Research, Muthayammal College of Arts and Science, Rasipuram, Tamilnadu, India … read more

New Products & Practices for Wound Care

Apps, HydroClean and Honey?

According to PR Newswire, the wound care biologics market is expected to earn 1.42 billion US dollars in 2018. That number is expected to skyrocket by the year 2023, when the market is expected to increase to 2.26 billion US dollars.

 

That is a jaw-dropping amount of money that we’re spending on wound care. What’s going on?

 

There are several factors that are driving up the those wound care dollars – primarily diabetic foot ulcers, the aging geriatric population, and a general increase in burn injuries globally.

 

With the ever-increasing number of wounds requiring advanced wound care, there is new products and practices. Here’s a quick update … read more

Elevated obstructive sleep apnoea risk score is associated

     with poor healing of diabetic foot ulcers: A prospective cohort study

 

We studied 94 consecutive people (69% men) with diabetic foot ulcers (Type 2 diabetes,n=66, Type 1 diabetes, n=28) attending a university hospital foot unit. All participants were screened for obstructive sleep apnoea using the STOP‐BANG questionnaire, with a score ≥4 identifying high risk of obstructive sleep apnoea. The primary outcome was poor diabetic foot ulcer healing, defined as diabetic foot ulcer recurrence (diabetic foot ulcers which healed and re‐ulcerated in same anatomical position) and diabetic foot ulcer persistence (no evidence of healing on clinical examination). All participants were evaluated at 12 months … read more

Evaluation of skin perfusion pressure to assess refractory foot ulcers

The number of patients with foot gangrene caused by critical ischaemia and severe infection is increasing significantly in developed countries. The measurement of perilesional skin blood flow by skin perfusion pressure (SPP) is useful to select the appropriate treatment of gangrenous lesions, in that it is not affected by calcifications of blood vessels. However, the prognosis of a foot ulcer may also be affected by the level of blood sugar and infections. This study aimed to validate the use of SPP in cases of foot gangrene and ulcers in patients with and without diabetes mellitus (DM) and infection … read more

Mobile diet and exercise apps for adolescent weight loss

Innovative approaches can encourage healthy eating and activity in adolescents.

 

Takeaways:

  • Nurses can help their adolescent patients with obesity by encouraging a healthy diet and greater activity
  • Smartphone apps for diet and exercise tracking may be an effective tool to help adolescents with obesity lose weight.
  • Recommend apps that are inexpensive and have high user ratings for ease of use and dependability.

By Julie Ludwig, MSN, RN, NP-C, and Christine Galluzzi, MSN, RN, APC-BC

 

Many teens with obesity go on to have obesity as adults. The ramifications of obesity are both physical and psychological, including metabolic conditions, sleep disorders, bullying, anxiety, depression, and low self-esteem. In addition, adolescents with obesity may experience increased school absenteeism and decreased scholastic performance. The result can be lower quality of life and limited life expectancy.

 

You can help your adolescent patients with obesity by encouraging a healthy diet and greater activity. (See Help young patients lose weight.) Engaging your patients in this effort may require some innovative interventions, including the use of technology … read more

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. 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. 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 … read more

This ‘skin printer’ is like a magic wand for healing wounds

Imagine a version of the kind of duct tape dispenser you can buy from your local home Home Depot or white-out tape used for correcting a writing error — only instead of rolling out pieces of tape or white-out material it can produce a sheet of skin tissue to cover a wound. That may sound a couple of phasers away from being a Star Trek gadget, but it’s a very real piece of research coming out of the University of Toronto. Engineers there have developed a 3D skin printer that can apparently, “[form] tissue in situ, depositing and setting in place, within two minutes or less.”

 

According to its creators, the device could serve as a future alternative to regular skin grafts. However, instead of first requiring that a patient has healthy skin removed to be grafted elsewhere, this device can roll out a new layer of “bio ink”-based, 3D-printed skin tissue onto the areas that are required … read more

Breakthrough Evidence on Vomaris Bioelectric Technology’s

     Impact on Wound Biofilm Infection

 

TEMPE, Ariz.Dec. 5, 2017 /PRNewswire/ — Vomaris Innovations, Inc. announced today breakthrough results of the first controlled, preclinical in vivo evidence on the anti-biofilm impact of the Company’s bioelectric antimicrobial technology. The study found that the technology can prevent and disrupt biofilm infection and restore functional wound healing. The manuscript, “Electric Field Based Dressing Disrupts Mixed-Species Bacterial Biofilm Infection and Restores Functional Wound Healing,” was published online in the Annals of Surgery. The research was led by Chandan Sen, Ph.D., Professor of Surgery and Director of the Comprehensive Wound Center at The Ohio State University’s Wexner Medical Center.

 

Bacteria use electrical interactions to communicate with each other in a process called quorum sensing (QS), signaling them to adhere to a wound, multiply, and encase themselves within a protective structural substance known as a biofilm. This protective biofilm barrier impedes the body’s immune defense system and renders the bacteria highly resistant to antibiotics, making biofilm infections extremely difficult to treat.

 

Approximately 80% of infections in chronic and surgical wounds are thought to be caused by bacteria within biofilm.1,2Chronic wounds affect an estimated 6.5 million patients a year and over $25 billion is estimated to be spent annually on their treatment.3 Surgical site infections (SSIs) occur in 2% to 5% of all patients undergoing inpatient surgery and affect up to 300,000 patients a year in the U.S. alone. Annual costs of managing SSIs range from $3.5 billion to $10 billion … full press release

Vomaris Innovations, Inc. website

Wearable Devices For Diabetics At Risk Of Diabetic Foot Ulcers

A US-Qatar joint research project, involving different studies carried out by the Hamad Medical Corporation (HMC), the Qatar Foundation, and several institutions and companies across the US, developed innovative and useful wearable devices for diabetics, which can help the patients either prevent and manage or even treat diabetic foot ulcers.

 

By gathering the data from all the studies, the research project earned the Best Research Project Award at Qatar Foundation’s Annual Research Conference, held earlier in 2018.

 

Research of significant importance for the world
The project, of a considerable importance for Qatar, as the International Diabetes Federations assessed that about 23% of the country’s population has diabetes, while the diabetic foot ulcers are the primary reason for hospitalization, is also massively important for the world, as the nowadays unhealthy dietary habits increase the risks of diabetes development, worldwide … read more

New treatment may dispense old ideas about wound care

Imagine rolling a tape dispenser over a wound, leaving behind a strip of cells that will generate new skin.

 

Researchers at the University of Toronto and Sunnybrook Hospital are getting close. They have designed a handheld machine that can create tissue and deposit in about two minutes, with material similar to human skin … read more

Researchers develop wearable technology for diabetics

A collaborative research project bringing together four separate studies by researchers at Hamad Medical Corporation (HMC), in partnership with Qatar Foundation and several institutions in the US, has led to the development of innovative, wearable devices that could enhance the prevention, management and treatment of diabetic foot ulcers.
The studies, completed over a 10-year period, won the Best Research Project Award at Qatar Foundation’s Annual Research Conference earlier this year, HMC said in a statement yesterday.

HMC’s podiatry clinics treat thousands of patients with diabetes each year, with nearly 15,000 diabetes-related appointments in 2017 alone. The International Diabetes Federation estimates that around 23% of Qatar’s population has diabetes, with diabetic foot ulcers being the main reason for hospitalisation for people with diabetes.
“Between 10% and 20% of people with diabetes will develop a foot ulcer at some point in their life,” explained Dr Talal Khader Talal, head of Podiatric Services at HMC and a lead author of the studies … read more

A super-elastic surgical glue that sticks and seals in vivo

     even when tissues are moving

 

To repair ruptured or pierced organs and tissues, surgeons commonly use staples, sutures and wires to bring and hold the wound edges together so that they can heal. However, these procedures can be difficult to perform in hard-to-reach areas of the body and wounds are often not completely sealed immediately. They also come with the risk that tissues are further damaged and infected. A particular challenge is posed by wounds in fragile or elastic tissues that continuously expand or contract and relax, like the breathing lung, the beating heart and pulsing arteries.

 

To remedy some of these problems, biomedical engineers have developed a range of surgical sealants that can bond tissues to stop leakages. Yet, “currently available sealants are not suitable for most surgical applications and they do not work alone without the need for suturing or stapling because they lack an optimal combination of elasticity, tissue adhesion and strength. Using our expertise in creating materials for regenerative medicine, we aimed to create an actual fix for this problem in a multi-disciplinary effort with clinicians and bioengineers,”

full article

The TIME Model of Wound Bed Preparation: Frequently Asked Questions

On July 24, 2018, I presented a webinar on the topic of the TIME (tissue management, infection or inflammation, moisture balance, and edge of wound) model of wound bed preparation as part of WoundSource’s Practice Accelerator series on wound bed preparation. Preparing a wound for healing is key to ensure that chronic wounds convert to healing wounds. The TIME mnemonic for wound bed preparation assists clinicians and bedside nurses to think critically when making decisions on treatment options. During the image-driven presentation, I discussed such topics as:

  • Use of the TIME mnemonic to evaluate various wound challenges
  • A review of terms related to the TIME wound bed preparation model
  • Visual guidance on different wound types and wound descriptors to determine appropriate next steps for wound healing

read full article

 

Water for wound cleansing

Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective; however, there is an unresolved debate about its use. The objective of this review was to assess the effects of water compared with other solutions for wound cleansing … read more

Identifying and treating foot ulcers in patients with diabetes

     saving feet, legs and lives

 

There has been a great deal of debate around diabetic foot ulcers (DFUs) and pressure ulcers (PUs) on the feet of patients with diabetes, in terms of how to define, detect, assess and treat them. The confusion and lack of evidence in differentiating between these two types of foot ulcers, particularly on the heel, can lead to misdiagnosis, which can increase both financial and patient-related costs.

 

To address and tackle those inconsistencies, the Journal of Wound Care (JWC) has published its first international consensus document, Identifying and treating foot ulcers in patients with diabetes: saving feet, legs and lives. The main objectives of this project were to:

  • Provide information on the differences between a DFU and a PU in patients with diabetes

  • Help reduce misdiagnosis by providing and discussing assessment guidelines

  • Make a difference in practice through improved patient outcomes.

 

With this in mind, an international panel of ten key opinion leaders from Australia, England, Republic of Ireland, Malaysia, Poland, Portugal, Spain, United Arab Emirates and US met on 1 and 2 March 2018 in London. They discussed the definitions of a DFU and a PU, and concluded that one way to distinguish between them is knowing whether the patient is mobile (usually associated with DFUs) or immobile (normally related to PUs), although this should be considered along with simple assessments for ischaemia and neuropathy. To this end, and given the importance of an early and correct assessment, the mnemonic ‘VIPS’ was suggested:

  • V: vascular (ischaemia)

  • I: infection (local signs, odour, exudate, slough, inflammation, etc.)

  • P: pressure (causes mobility or immobility)

  • S: sensation (neuropathy).

read more

Lumicell Launches Wound Care Infection and Perfusion Division

WELLESLEY, Mass.–(BUSINESS WIRE)–Lumicell, Inc., a leader in the field of image-guided cancer surgery, today announced that it has created a new division to drive the expansion of its pioneering technologies to include wound care, infection and perfusion.

 

According to a recent study in the Journal of The International Society for Pharmacoeconomics and Outcomes Research, each year in the U.S. there are about 8.2 million patients being treated under Medicare for chronic wounds with an estimated cost between $31.7 to $96.8 billion per year1. With the rising prevalence of obesity-related diseases, such as diabetes, and an aging population – there continues to be a growth in the number of patients suffering from chronic wounds. And with healthcare professionals making care decisions based on the limited, evidence-based knowledge of wounds and requiring patients to make weekly visits to track progress, this upward trend is predicted to continue.

 

“Chronic wounds have a dramatic impact on affected individuals, their families and the U.S. Health Care System, leading to reduced quality of life, limb loss and loss of life at a significant financial cost,” said Robert S. Kirsner, M.D., PhD, FAAD, Director, University of Miami Hospital and Clinics Wound Center. “Unfortunately, wound care is often a largely overlooked medical need compared to other medical challenges like cancer, despite similar effects on loss of life. There is a need for new technologies to assess the state of a wound, integrate this with clinical data, and support the best treatment, for the right patient, at the right time.”

 

“We created our new wound care, infection and perfusion division for the same reason we launched our pioneering cancer technology — we identified a patient population in desperate need and decided to apply our technology and leverage our world-class team to help people suffering from chronic wounds,” said W. David Lee, CSO of Lumicell. “We believe the biggest healthcare engineering breakthroughs happen outside of the biology lab. As such, Lumicell’s new division will use concurrent engineering – the convergence of engineering and biological research – to accelerate the pace of biological discoveries and create new applications to diagnose and treat patients.”

 

“While it will require significant research and development, it will be well worth the effort,” Lee said. “Lumicell has already established the foundational technology for this forward-thinking approach and assembled a small group of advisors to guide the team through the first stages of development. Our goal is to better understand wound healing and on a molecular level and to create an unbiased, holistic protocol that blends Lumicell’s care-leading technology, artificial intelligence and informed care options.”

 

Lumicell also hopes to create a community of wound care experts, including doctors, nurses, researchers and insurance company executives who are interested in providing expertise, evidence, opinions and guidance. This community will curate the statistics, biology and science needed to ensure the infection and profusion detecting technologies and accompanying standard of care protocols are accessible and adopted across disciplines.

 

Samuel R. Nussbaum MD, Marissa J. Carter PhD MA, Caroline E. Fife MD, Joan DaVanzo PhD MSW, Randall Haught, Marcia Nusgart RPh, Donna Cartwright MPA. An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds. Journal of The International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Value in Health 21 (2018) 27-32

 

About Lumicell, Inc.
Lumicell is a technology leader in the field of image-guided cancer surgery. The company is developing a novel system that enables real-time detection of tumor tissue in patients so that no cancer cells are left behind during surgery. The company’s LUM System has unprecedented ability to see and remove cancer cells remaining in the surgical cavity – beyond the margin of the specimen – and has the potential to significantly improve surgical outcomes and reduce healthcare costs by eliminating the need for repeat surgeries. Lumicell is investigating the LUM System in patients undergoing surgery for breast cancer, prostate cancer, colorectal, esophageal and pancreatic cancers. Additional future indications are planned to include surgeries for lung, ovarian, and brain cancers. For more information, please visit www.lumicell.com.

Contacts

For Lumicell
Ali Buckneberg, 612-334-5960
ali.buckneberg@wordsatwork.com

press release from BusinessWire

Both Wound Care and Decoration Achieved with 3D-Printed Materials

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, customized, 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

Expert Insight: Technology to Help Tackle Diabetic Foot Problems

As I’m sure you all know diabetic foot problems in this country and most western countries represent the commonest cause for patients with diabetes being admitted to hospital. And I think there is much we can do about this, and I really think that ulceration, as it’s so common and recurrence is so common, we should really redesign what we say when the patient is healed. Healing gives the impression that it’s gone away and will never come back. Thus in a recent review article[1] with my good friend David Armstrong, from the USA, and Sicco Bus from the Netherlands, we brought out the term remission rather than heal, because foot ulcers recur up to 40% in the first year and up to 60% after several more years. So we should be talking about the foot being in remission because it may recur.

 

Now what can we do about the foot in remission to prevent recurrence? And I think there’s a lot of exciting data coming through recently. First of all, not recently, it was Dr Paul Brand[2] who worked in leprosy, who observed that the insensitive foot in leprosy, and also in diabetes, tends to heat up before it breaks down. Therefore, the foot warms up because it becomes inflamed … read more

Diabetic Foot and the Bedside Bone Biopsy

This is an edited, translated transcript of a conversation taped on June 24, 2018, during the 78th Scientific Sessions of the American Diabetes Association (ADA) in Orlando, Florida. Prof Ronan Roussel, endocrinologist and diabetologist in Paris, France, spoke with diabetologist Florine Féron and cardiologist Jean-Philippe Kevorkian, both from Hôpital Lariboisière, Paris, about diabetic foot ulcers, amputations, and bedside bone biopsy.

 

Hello, and welcome to Medscape’s set at the 2018 ADA conference in Orlando. Today our webcast is devoted to diabetic foot. It’s not the most often reported complication of diabetes in abstracts or oral presentations at conferences, but there have been some interesting data at this year’s ADA conference. Joining me to talk about a study they presented during an oral session on diabetic foot are diabetologist Florine Féron and cardiologist Jean-Philippe Kevorkian, both from the Department of Diabetology at Hôpital Lariboisière. … read more

Minimizing Scars of Every Type

Under ideal circumstances, a break in the skin would stimulate the skin’s own repair processes to seal up the wound and restore normal skin. Clotting factors in the blood would stop the bleeding by forming a scab. The second deepest layer of the skin (the dermis) would produce new cells called fibroblasts. Those fibroblasts would produce collagen and other proteins to seal up the wound and produce a seamless layer of new skin. In some cases, evidence of the wound skin completely disappears in about a week, leaving no scar at all.

 

For the skin to heal without leaving a scar, healing processes have to occur at exactly the right time in precisely the right degree. However, the body puts a premium on fast healing rather than accurate healing.1 Prehistoric man had a better chance at survival if a wound healed quickly than if it had healed perfectly. The skin had to close quickly to prevent excessive blood loss and infection. When the skin heals quickly, the skin that covers the wound is structurally different from normal skin. The wound heals, but the scar tissue that remains is usually permanent.

read more

Researchers develop portable 3-D skin printer to repair deep wounds

University of Toronto researchers have developed a handheld 3-D skin printer that deposits even layers of skin tissue to cover and heal deep wounds. The team believes it to be the first device that forms tissue in situ, depositing and setting in place, within two minutes or less.

 

The research, led by Ph.D. student Navid Hakimi under the supervision of Associate Professor Axel Guenther of the Faculty of Applied Science & Engineering, and in collaboration with Dr. Marc Jeschke, director of the Ross Tilley Burn Centre at Sunnybrook Hospital and professor of immunology at the Faculty of Medicine, was recently published in the journal Lab on a Chip … read more

Best practice recommendations for the Prevention and

     Management of Diabetic Foot Ulcers

 

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia that
leads to microvascular, macrovascular and neuropathic complications. In 2016, there
were 11 million Canadians living with type 1, type 2 or pre-diabetes, and every three
minutes another Canadian is diagnosed. Certain populations are at higher risk for
developing type 2 DM, including those of Asian, African, Hispanic and Indigenous decent.
The rates of DM are three to five times higher in Indigenous populations, an issue
compounded by unique barriers to care including, but not limited to, a lack of cultural
competency among health-care providers, jurisdictional confusion, limited access to
care, geographical location and language barriers.

 

Foot health should be a major consideration for people with diabetes and for those
who care for them. Foot complications in this high-risk population can lead to a cascade
of negative complications, potentially resulting in loss of limb and life.
The lifetime risk for foot ulceration in people with diabetes is 15 to 25%. According to
the International Diabetes Federation, persons with diabetes are 15 to 40 times more
likely to require lower-leg amputation compared to the general population. Approximately
85% of amputations are preceded by the development of a neuropathic foot
ulcer.

 

Following a lower-limb amputation, people with diabetes not only suffer the
clinical and psychological consequences of limb loss, but also have a five-year mortality
rate of 50%. This is a higher mortality rate than is seen in breast cancer in females,
prostate cancer in males or lymphoma … read more

Hydrogel could totally change treatment of diabetic wounds

A hydrogel that can help the body heal may also be particularly good at treating wounds related to diabetes, new research suggests.

 

Tests on diabetic animal models show that the injectable hydrogel significantly accelerates wound healing compared with another hydrogel often used in clinics.

 

The multidomain peptide (MDP) hydrogel known by its amino acid sequence—K2(SL)6K2—has in a recent study proven useful for the timed release of immunotherapy drugs. It has also been shown to encourage healing all by itself.

 

That quality may be useful for people with diabetes mellitus who often develop chronic wounds in their lower extremities that take longer to heal than normal wounds do … read more

Material could offer ‘smarter’ wound healing

A new study takes a step toward the development of smarter skin grafts that facilitate healing while minimizing infection for chronic skin wounds.

 

“Our group has expertise in developing new polymers and functional surface assemblies for biomedical applications,” says Svetlana Sukhishvili, professor and director of the soft matter facility at Texas A&M University.

 

“At Texas A&M we investigated how to build a stimuli-responsive polymeric material that could absorb and release antibiotics when prompted by a physiologically relevant stimuli,” explains lead researcher Victoria Albright, a graduate student materials science and engineering department … read more

Negative pressure wound therapy no better than standard care for open

     traumatic wounds

 

For open traumatic wounds involving fracture or soft tissue, there is “no clear difference” between standard care and negative pressure wound therapy (NPWT), and the latter is unlikely to be cost-effective, according to a recent Cochrane Review.

 

“All (of our) research led us to conclude there is no clear difference in the rate of healing of open fracture wounds treated with NPWT and those treated with standard care,” she said, “and also that NPWT is likely not a cost-effective treatment for (these) wounds,” Dr. Joanne Dumville of the University of Manchester, UK, told Reuters Health by email on behalf of her colleagues.

 

Dr. Dumville and colleagues searched the literature and various registries and reports through June 2018 for published and unpublished randomized controlled trials using NPWT for open traumatic wounds involving either fractures or soft tissue.

read more

AcryMed’s Oxygenesys for Wound O2 Delivery

AcryMed is touting their latest innovation in wound healing: Dissolved oxygen delivery, via their Oxygenesys system:

 

Our research shows that these new devices deliver significant amounts of dissolved oxygen, which is the biologically relevant form” said Dr. Bruce Gibbins, Founder and Chief Technical Officer at AcryMed. “We conducted studies on human donor skin to show for the first time that through Oxygenesys TDO, sufficient oxygen penetrates deep into tissues to make up for the oxygen deficiency … read more

Silk-based biomaterials in biomedical textiles and fiber-based implants

Biomedical textiles and fiber-based implants (BTFIs) have been in routine clinical use to facilitate healing for nearly five decades. Amongst the variety of biomaterials used, silk-based biomaterials (SBBs) have been widely used clinically viz. sutures for centuries and are being increasingly recognized as a prospective material for biomedical textiles. The ease of processing, controllable degradability, remarkable mechanical properties and biocompatibility have prompted the use of SBBs for various BTFIs for extracorporeal implants, soft tissue repair, healthcare/hygiene products and related needs. The present review focuses on BTFIs from the perspective of types and physical and biological properties, and this discussion is followed with an examination of the advantages and limitations of BTFIs from SBBs. The review covers progress in surface coatings, physical and chemical modifications of SBBs for BTFIs and identifies future needs and opportunities for the further development for BTFIs using SBBs … read more

Keys To Coding When You Are Seeing Patients In Nursing Facilities

The CPT codes 99304–99306 cover initial nursing facility care. Yes, podiatrists can absolutely submit initial nursing facility evaluation and management (E/M) codes for Medicare patients.

 

Medicare does not recognize consultation codes. When Medicare stopped recognizing consultation codes on January 1, 2010, it then instructed specialists, including podiatrists, to use the initial nursing facility codes when seeing a nursing facility patient for the first time during that patient’s admission. Podiatrists should use initial nursing facility codes if that encounter qualified for what the facility would consider a “consult” and even if the specialist was not the admitting/primary doctor. Since there are now multiple doctors using those initial encounter codes, the admitting/primary doctor must use an “AI” modifier on the initial E/M encounter.

 

This change did not alter the fact that in order to submit any E/M code, one must meet the thresholds of complexity for that code. Complexity refers to the key elements of E/M coding (history, exam, decision making) in what you performed, what you documented and what was medically necessary … read more

Inherent variations in the cellular events at the site of amputation orchestrate scar‐free

      wound healing in the tail and scarred wound healing in the limb of lizard Hemidactylus flaviviridis

 

Lizards are unique in having both – regeneration competent (tail) as well as non‐regenerating appendages (limbs) in adults. They therefore present an appropriate model for comparing processes underlying regenerative repair and non‐regenerative healing after amputation. In the current study, we use northern house gecko Hemidactylus flaviviridis to compare major cellular and molecular events following amputation of the limb and of the tail. Although the early response to injury in both cases comprises apoptosis, proliferation and angiogenesis, the temporal distribution of these processes in each remained obscure. In this regard, observations were made on the anatomy and gene expression levels of key regulators of these processes during the healing phase of the tail and limb separately. It was revealed that cell proliferation markers like FGFs were upregulated early in the healing tail, coinciding with the growing epithelium. The amputated limb, in contrast, showed weak expression of proliferation markers, limited only to fibroblasts in the later stage of healing. Additionally, apoptotic activity in the tail was limited to the very early phase of healing, as opposed to that in the limb, wherein … read more

DC Durable Medical Equipment Company Owner Pleads Guilty To Defrauding Medicaid

This week, it was announced that the owner of a company that provided durable medical equipment had pleaded guilty to a federal charge of health care fraud. The defendant carried out a scheme to fraudulently obtain more than $9.4 million in District of Columbia Medicaid payments. 72-year-old Waveney Blackman of Bowie, Maryland pleaded guilty. She is now scheduled to be sentenced on October 18, 2018.

 

The defendant was the sole owner and CEO of WaveCare Health Services LLC, which was also known as WaveCare Healthcare Services LLC. The company provided durable medical equipment, such as wound care and incontinence supplies to Medicaid beneficiaries and others. The company became a Medicaid provider in 2008. Plea documents show that Blackman devised and carried out a scheme to submit false and fraudulent claims to Medicaid for durable medical equipment .. read more

Healing lamp lights the way for improved treatment of chronic ulcers

Chronic skin ulcers such as those associated with diabetes are notoriously difficult to treat. As a result, we’ve seen experimental approaches such as spray-on skin, ultrasound band-aids, and silver-laced dressings. Now, scientists are getting very good results using a high-tech lamp.

 

Developed by a team from Britain’s University of Manchester and Salford Royal NHS Trust, the device has a total of 32 bulbs which emit a combination of infrared, red and ultraviolet light.

 

Led by Dr. Michael Hughes, the researchers tested it on eight patients suffering from systemic sclerosis, a condition in which the immune system attacks the fingers and toes. Each person received two 15-minute treatments per week, for a period of three weeks … read more

Till We Get the Healing Done

It is estimated that in the United States alone, diabetes affects 29 million people. Patients who suffer from this illness are susceptible to chronic leg and foot ulcers. These diabetic wounds are particularly likely to lead to amputations, due to a disruption in the healing process caused by the illness. In this context, finding aids to artificially accelerate the healing process for diabetic wounds is crucial.

 

One presently used technique for accelerating the healing process, is the direct injection of stem cells into the wound. This has been shown to significantly increase the rate of wound healing. However, the injection protocol reduces the lifespan of the cells though mechanical damage. Once the cells have been injected, there is no cell matrix present, further limiting their viability … read more

Trinity University students researching a new diabetic wound care treatment

At Trinity University’s Department of Engineering Science, students aren’t just taking the summer off. Many are doing important research about diabetes that they hope will eventually save limbs and lives.

 

“Everyone is very excited to hear about the work we are doing, and it’s nice to hear that it’s going to impact lives around me,” junior Abbie Jones said.

 

Abbie and her research partner Adil have been working on a way to help common diabetic wounds heal faster using something called a “hydro-gel wound dressing,” which helps heal from the inside out.

 

“With a hydro-gel, you can lay more inside and on top of the wound, instead of a Band-Aid, to help with the wound healing process,” said Jones, adding that research like this is needed because the number of diabetics is skyrocketing. “There are a large number of Type 2 diabetics in the U.S. currently, and many of them have the foot ulcers that are common occurrence with diabetes.”

read more

Diabetes doubles risk for hospital-acquired foot ulcers

Patients with diabetes have at least double the risk for developing hospital-acquired foot ulcers vs. those without diabetes, according to a study published in BMJ Open Diabetes Research & Care.

 

In a prospective, multilevel regression analysis, Frances Wensley, PhD, MBBS,formerly of the Royal Free Hospitals NHS Foundation Trust in London, and colleagues analyzed data from 18,946 patients with 28,642 admissions of at least 2 days to the Ipswich Hospital NHS Trust between October 2008 and September 2010, including 3,076 individuals with diabetes with 5,043 admissions. Patients included in the analysis were aged at least 50 years and developed a hospital-acquired foot ulcer at least 48 hours after hospital admission. For all admissions, the analyses included data on diabetes, heel ulcer, length of stay and other covariates. The researchers compared patients with vs. without diabetes … read more

CMS ends hyperbaric oxygen treatment experiment despite savings

The CMS will not continue an experiment that saved Medicare millions of dollars by reducing the use of non-emergency hyperbaric oxygen therapy.

 

The treatment uses pressurized oxygen to help expedite wound healing, particularly for diabetic wound care. Since the CMS launched the experiment in 2015, its spending per beneficiary per quarter dropped by $60, according to a report released Monday by the CMS. Federal data shows the experiment saved the government $17.6 million by 2017.

 

Only Illinois, Michigan and New Jersey participated in the prior authorization experiment for non-emergency hyperbaric oxygen therapy. Those states were chosen because of their high utilization and improper payment rates.

 

The demonstration ended in February 2018, and the savings it generated didn’t harm quality of care, according to the report … read more

Use of negative pressure wound therapy in a chronic leg wound with

     coexisting rheumatoid arthritis: a case study

 

We present a case of a 69-year-old woman with rheumatoid arthritis. The patient’s condition was managed with steroid therapy for more than 12 years. She had a coexisting infected chronic ulceration in the left leg, which was treated with negative pressure wound therapy for 52 days. Use of this therapy within the wound reduced exudate and the bacterial count, which dramatically accelerated the process of wound healing.

 

The introduction of negative pressure wound therapy (NPWT) in the early 1990s resulted in a change in the concept of care and treatment of wounds of various aetiologies in the hospital and outpatient care settings. NPWT is increasingly being used in primary and home health care because of its non-invasiveness, high efficacy, shortening the time of wound healing, and improving wound healing, thereby greatly reducing the need for hospital treatment.13 NPWT requires specialized equipment with manual control of negative pressure. Negative pressure is maintained in the wound bed with ready-made sterile sets (sponge, proper dressing, adapter, polyurethane foil). Negative pressure causes wound shrinkage and reduction of the bacterial count by evacuating the effusion into a disposable canister placed on the device.4,5 Although the potential of NPWT … read more

Decision Memo for Hyperbaric Oxygen (HBO) Therapy

     (Section C, Topical Oxygen) (CAG-00060R)

 

The Centers for Medicare & Medicaid Services (CMS) received a reconsideration request to remove the coverage exclusion of Continuous Diffusion of Oxygen Therapy (CDO) from NCD Manual 20.29, Section C. This section of the NCD (Topical Application of Oxygen) considers treatment known as CDO as the application of topical oxygen and nationally non-covers this treatment.

 

After examining the evidence, CMS has decided that no National Coverage Determination is appropriate at this time concerning the use of topical oxygen for the treatment of chronic wounds. We will amend NCD 20.29 by removing Section C, Topical Application of Oxygen and Medicare coverage of topical oxygen for the treatment of chronic wounds will be determined by the local contractors.

Summary:

Chronic wounds are prevalent in the Medicare population and cause a disproportionate burden on beneficiaries and their families and caretakers. CMS recognizes the need for new therapies that will heal wounds and the standardization of wound care in general. Overall, since the evidence on chronic wound healing from topical oxygen therapies has increased over the past few years, CMS believes a national non-coverage decision is no longer appropriate.  CMS received 17 public comments and most of the commenters support this position.  However, given the inability to identify the characteristics of chronic wounds that best respond to topical oxygen therapy and the type of patients’ best suited to use this therapy, we are not able to define a patient population that would benefit from topical oxygen therapy in a national coverage determination at the present time.  Ongoing research in the US and Europe and pending publications may provide additional evidence that may support a national determination in the future.  CMS realizes that double blinded RCTs cannot always be used in order to answer questions regarding the outcomes of exposure to various treatment regimens in the wound care space. However we acknowledge that various investigative groups have, and are currently, studying the treatment of chronic wounds by TOT through randomized controlled trials.  CMS reviewed a number of articles from commenters, considered all additional information and has determined to finalize the proposed decision.

 

Conclusion

The Centers for Medicare & Medicaid Services (CMS) received a reconsideration request to remove the coverage exclusion of Continuous Diffusion of Oxygen Therapy (CDO) from NCD Manual 20.29, Section C. This section of the NCD (Topical Application of Oxygen) considers treatment known as CDO as the application of topical oxygen and nationally non-covers this treatment.

 

After examining the evidence, CMS has decided that no National Coverage Determination is appropriate at this time concerning the use of topical oxygen for the treatment of chronic wounds. We will amend NCD 20.29 by removing Section C, Topical Application of Oxygen and Medicare coverage of topical oxygen for the treatment of chronic wounds will be determined by the local contractors.

read more

 

OxyGenesys Dissolved Oxygen Dressing at Northwestern University

Twelve acute wounds (6 on either side of the umbilicus) will be surgically created in the lower abdominal area. One side of the umbilicus will be randomized to Oxygenesys treatment arm and the other side will be receiving a standard Tegaderm treatment arm. Time to wound healing will be observed over 14 days.

 

At least 12 study visits will occur over a 3 month timeframe. Twelve acute wounds (6 on either side of the umbilicus) will be surgically created in the lower abdominal area. One side of the umbilicus will be randomized to Oxygenesys treatment arm and the other side will be receiving a standard Tegaderm treatment arm. Time to wound healing will be observed over 14 days (follow up assessments include wound photography, pain scores, wound biopsies, exudate collection, gene expression and proteomic analysis, scar assessment and adverse event collections. Study visits will occur at:

Prescreening Visit; Day of wounding; Day 2; Day 7; Day 8-14 (until all wounds have healed); Day 28; Day 42; Abdominoplasty Surgery. An abdominoplasty will occur after day 42.

read more

What would our health care system look like if doctors spoke the same

     language as engineers?

 

Medical school students today are trained to diagnose complicated diseases, but they are rarely trained to engineer the solutions themselves. To change that, soon Texas A&M University will start training doctors and nurses to also be engineers.

 

“Our technology [is] is a bandage that generates oxygen from the chemical decomposition of hydrogen peroxide,” Frey said. A chemical reaction between the layers of the bandage creates a concentrated oxygen gas which Frey said helps a wound heal. MedNoxa is seeking FDA clearance to sell the bandages by prescription and over the counter … read more

related: Purdue startup developing restorative oxygenation wound dressings receives $30,000 investment

Not all foams redistribute pressure equally

Recent research demonstrates the effectiveness of various foam dressings for pressure redistribution. Jeffrey Niezgoda, MD (APWCA Vice-President) recently published his findings in a poster presentation (SAWC 2018).  His results demonstrated that all foams are not equivalent in the ability to provide pressure relief in patients at risk for developing pressure ulcers.  OxyBand Rescue out performed all other foam dressings currently on the market, providing superior reduction in average pressures and peak pressures, while at the same time maximizing contact area.  The NPUAP has recently published recommendations advocating the use of foam dressings to provide pressure redistribution in an attempt to reduce the risk of pressure ulcer formation in at risk patients.  A copy of the Poster is provided.

From the The American Professional Wound Care Association® (APWCA) 

Patients With Infected Diabetic Foot Ulcers Need Quick Referral

Patients with an infected diabetic foot ulcer have a far worse prognosis than previously thought, with 15% of patients dying within a year, less than half of the ulcers healing in the same time period, and one in seven individuals having all or part of their foot amputated, results from a new UK study reveal.

 

The analysis of almost 300 patients with infected diabetic foot ulcers also showed that, even if the ulcer healed, nearly 10% experienced a recurrence within 12 months and more than 25% of patients underwent some kind of procedure.

 

It’s therefore crucial that such patients are reviewed quickly and referred for specialist care if required, say Mwidimi Ndosi, PhD, of the University of West Bristol, United Kingdom, and colleagues in their paper published online November 20 in Diabetic Medicine … read more (registration required)

Smart Textiles Offer Development Opportunities In Medical

The medical field benefits from textile innovations, and the rapid development of sensor technology brings new products to the healthcare and wellness market.

 

The textile news has presented a number of stories centered in and around the medical industry in recent months. Whether the news relates to implantables and grafts, coatings and additives for wellness and bacteria protection, or innovative uniform fabrics, the textile industry is playing a role in medical progress. One particular area of note is sensor technology. Rapid development is taking place in the sensor market, and many companies are developing smart textile products for medical and health-related applications.

 

Making Socks Smart
Recently, San Francisco-based health technology company Siren introduced Neurofabric™, a Diabetic Sock and Foot Monitoring System that features microsensors embedded directly into the fabric. Six sensors — three across the ball of the foot, one in the arch and one on the heel — continuously monitor foot temperature looking for variation  … 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

 

This is the first installment of 2 articles that discuss the biology and pathophysiology of wound healing, review the role that growth factors play in this process, and describe current ways of growth factor delivery into the wound bed. Part 1 discusses the latest advances in clinicians’ understanding of the control points that regulate wound healing. Importantly, biological similarities and differences between acute and chronic wounds are considered, including the signaling pathways that initiate cellular and tissue responses after injury, which may be impeded during chronic wound healing.

 

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 … read more

 

 

Medscape Residents Salary & Debt Report 2018

How much are residents earning in 2018, and are they satisfied with their earnings? How much debt do they have? More than 1900 residents in 29-plus specialties told us how much they earn, as well as the hours they work, how much scut work they have, and what their relationships with attendings, nurses, and PAs are like. All participants were enrolled in US medical resident programs. Average resident salary appears to be trending upward. Over the past 3 years, the average salary has increased by about 7%. The average salary for residents overall is $59,300 … read more

 

 

Efficacy of Honeydew Honey and Blossom Honey

    on Full-thickness Wound Healing in Mice

 

The wound healing properties of honey, including blossom honey, are well known; however, the effects of honeydew honey during the wound healing process have not yet been investigated and thus remain unclear.Objective. This study compares the effects of honeydew honey with those of blossom honey. Materials and Methods. A total of 140 mice were divided into 2 control groups, which received either a hydrocolloid dressing (HCD; n = 22) or gauze (n = 22), and 4 experimental groups: honeydew honey (n = 23), Acacia honey (n = 23), Manuka honey (n = 22), and Japanese Pharmacopoeia honey (n = 28). Two circular full-thickness wounds were made and measured for 14 days. Each wound in the experimental groups was treated with 0.1 mL of honey and covered with gauze. Dressings in the control and experimental groups were changed daily. Results. The wounds in all of the honey groups and the HCD group were moist by day 14, while those in the gauze group were dry. The ratio of wound area to initial wound area and the number of inflammatory cells decreased during the inflammatory phase in all honey groups. However, the honey groups exhibited reepithelialization rates of < 40%, numerous neutrophils, weak wound contraction, and impaired collagen deposition in wounds after day … read more

Spider silk could be used to create artificial skin to help heal wounds

Unless your name is Peter Parker, you may not be aware of quite how versatile spider silk is as a material. In fact, aside from spinning webs, spider silk can also be used for a plethora of applications — from improving the quality of microphones in hearing aids to forming incredibly strong-yet-lightweight shields to forming microcapsules for delivering anti-cancer vaccines.

 

Now researchers from Sweden and India have come up with yet another novel use for spider silk’s unusual mix of strength and elasticity: Creating artificial skin and wound dressings for helping heal wounds.

 

“We have developed two types of silk-based constructs: Nanofibrous matrices which serve as bioactive wound dressings, and microporous sponges cultured with human skin cells to serve as artificial skin,” Biman Mandal, an associate professor in the Department of Biosciences … full article in Digital Trends

Healogics Inc. agrees to $22.51 million settlement

Jacksonville-based hyperbaric oxygen therapy company billed Medicare for unnecessary and unreasonable treatments.

 

Hyperbaric oxygen therapy provider Healogics Inc. agreed to pay up to $22.51 million to settle allegations that it violated the federal False Claims Act by knowingly causing wound care centers to bill Medicare for unnecessary and unreasonable treatments.

 

The company, based in Jacksonville, manages more than 700 hospital-based wound care centers in the U.S., including at Baptist Medical Center … read more

Phase 3 CREDENCE Renal Outcomes Trial of INVOKANA® is Being Stopped

     Early for Positive Efficacy Findings

 

– INVOKANA® has the potential to be the first new therapy in more than 15 years for slowing the progression of chronic kidney disease in patients with type 2 diabetes

 

– Worldwide, 160 million patients with type 2 diabetes are at risk for developing chronic kidney disease

 

– CREDENCE assessed INVOKANA® for renal protection by evaluating the risk reduction of the composite endpoint of time to dialysis or kidney transplantation, doubling of serum creatinine, and renal or cardiovascular death, when used in addition to standard of care

 

RARITAN, N.J.July 16, 2018 /PRNewswire/ — The Janssen Pharmaceutical Companies of Johnson & Johnson today announced that the Phase 3 CREDENCE (Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation) clinical trial, evaluating the efficacy and safety of INVOKANA® (canagliflozin) versus placebo when used in addition to standard of care for patients with chronic kidney disease (CKD) and type 2 diabetes (T2D), is being stopped early based on the achievement of pre-specified efficacy criteria.

 

The decision is based on a recommendation from the study’s Independent Data Monitoring Committee (IDMC) that met to review the data during a planned interim analysis. This recommendation was based on demonstration of efficacy, as the trial had achieved pre-specified criteria for the primary composite endpoint of end-stage kidney disease (time to dialysis or kidney transplantation), doubling of serum creatinine, and renal or cardiovascular (CV) death, when used in addition to standard of care … read more

Prevention and Management of Diabetic Foot Ulcers

BEST PRACTICE RECOMMENDATIONS FOR THE Prevention and Management of Diabetic Foot Ulcers

 

Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia that leads to microvascular, macrovascular and neuropathic complications. In 2016, there were 11 million Canadians living with type 1, type 2 or pre-diabetes, and every three minutes another Canadian is diagnosed. Certain populations are at higher risk for developing type 2 DM, including those of Asian, African, Hispanic and Indigenous decent. The rates of DM are three to five times higher in Indigenous populations, an issue compounded by unique barriers to care including, but not limited to, a lack of cultural competency among health-care providers, jurisdictional confusion, limited access to care, geographical location and language barriers.1,2 Foot health should be a major consideration for people with diabetes and for those who care for them. Foot complications in this high-risk population can lead to a cascade of negative complications, potentially resulting in loss of limb and life. The lifetime risk for foot ulceration in people with diabetes is 15 to 25%. According to the International Diabetes Federation … read more (PDF)

Differences in Joint Mobility and Foot Pressures Between

     Black and White Diabetic Patients

 

Limited joint mobility is common in diabetes and is related to high foot pressures and foot ulceration. We have examined the differences in joint mobility and foot pressures in four groups matched for age, sex, and duration of diabetes: 31 white diabetic, 33 white non‐diabetic, 24 black diabetic, and 22 non‐diabetic black subjects. Joint mobility was assessed using a goniometer at the fifth metacarpal, first metatarsal, and subtalar joints. In‐shoe and without shoes foot pressures were measured using an F‐Scan system. Neuropathy was evaluated using clinical symptoms (Neuropathy Symptom Score), signs (Neuropathy Disability Score), and Vibration Perception Threshold. There was no difference between white and black diabetic patients in Neuropathy Symptom Score, Neuropathy Disability Score, and Vibration Perception Threshold. Subtalar joint mobility was significantly reduced in white diabetic patients (22 ± 7°) compared to white controls (26 ± 4°, black diabetic patients (25 ± 5°), and black controls (29 ± 7°), and increased in black controls compared to white controls and black diabetic patients … read more

Study: Diabetic Foot Complications Among The Top 10 Causes Of Disability

David G. Armstrong DPM MD PhD

 

Diabetes-related lower extremity complications are a major cause of global disability, according to a recent study in Diabetic Medicine.

 

The study notes that of the 435 million people worldwide estimated to have diabetes, about 19 to 34 percent will experience a foot ulcer during their lifetimes.1 My coauthors and I note that diabetic foot complications are a leading cause of infection, hospitalization and amputation throughout the world although evidence-based care can prevent these outcomes … read more

Nutrition Management of Individuals with Diabetes and Pressure Injuries

by Dr. Nancy Munoz, DCN, MHA, RDN, FAND

 

The presence of diabetes can have a negative impact on wound healing rates. Increased glucose levels can stiffen the arteries and contribute to narrowing of the blood vessels. This can influence pressure injury development and is a risk factor for impaired wound healing.

 

Overview of Diabetes Mellitus
Diabetes is an illness in which the individual’s blood glucose level is above the established range. Glucose is present in the foods we eat. Most foods contain a blend of carbohydrates, proteins, and fats. The amount of each of these nutrients in the foods we consume determines how quickly the body transforms food into glucose. For instance, consuming carbohydrates affects blood glucose levels one to two hours after the meal. Ingesting protein has very little influence on blood glucose levels, and the glucose from the fat in foods is slowly absorbed and does not contribute to increased glucose levels … read more

CAN WE WOUND BIOFILMS?

These complex 3D structures of bacteria explain many of the challenges clinicians face with wound care, infection and healing. Scientists are fighting back.

 

Antonie van Leeuwenhoek (1632-1723) was the first person to delve into the field of microbiology and document initial observations of bacteria. After this preliminary discovery, microbiology was not actively studied again until the 1800s, when it began to gain a foothold in contemporary medicine. Fast-forward to today’s labs, where clinicians are becoming more knowledgeable in the bacteriology of wound healing, and researchers are identifying new ways to overcome long-standing challenges in wound healing, such as biofilms.

 

Biofilm is a term used to describe a colony of microorganisms, such as bacteria, fungi or yeast, encased by an extracellular polymeric substance (EPS). The EPS forms a shield, often causing the bacteria to be  … read more

KCI Expands Offering of Next Generation

     Negative Pressure Wound Therapy Dressing

 

SAN ANTONIO–(BUSINESS WIRE)– KCI, an Acelity Company, today announced the launch of the V.A.C. VERAFLO CLEANSE CHOICE™ Large Dressing designed for use with V.A.C. VERAFLO™ Therapy to cleanse larger wounds with thick, fibrous exudate and infectious material such as slough, and may be used on patients when surgical debridement must be delayed or is not possible or appropriate. With a unique, three-layer foam design with an array of holes, V.A.C. VERAFLO CLEANSE CHOICE™ Dressing allows for selective wound cleansing beyond traditional negative pressure wound therapy (NPWT) dressings, and provides flexibility in treating wounds of various depths.

 

“As an industry leader, we understand that wound care is incredibly complex and clinicians need more options – the combination of our core V.A.C.® Therapy technology with these new dressings shows remarkable potential for upending the traditional wound care approach, as illustrated by a growing body of clinical data,” said R. Andrew Eckert, President and CEO of Acelity. “Since launching V.A.C. VERAFLO CLEANSE CHOICE™ Dressing last year, we have seen tremendous response from clinicians with rapid adoption of the platform. Innovating for patients and customers is a driving force for our company, and we continue striving to revolutionize wound healing.”

read more

Therapy can accelerate wound healing

Using microcurrent therapy along with traditional wound care approaches significantly reduces wound size and lessens pain, according to a study in the Journal of Wound Care.

 

Harikrishna K.R. Nair, M.D., head of the wound care unit at Malaysia’s Hospital Kuala Lumpur, studied the effect of microcurrents on 100 chronic wound patients over four months in 2016. Their diagnoses included diabetic foot ulcers, venous leg ulcers and pressure ulcers … read more

Doctors who focus on the foot and brain team up on a smart insole

Professors David Armstrong and Charles Liu at first seemed to be an unlikely pair.

But the podiatric surgeon and neurosurgeon clicked on a personal level and promptly realized they had a lot to offer each other as Keck School of Medicine of USC collaborators.

 

Both were already studying how much information a person takes in through the nerves of the feet, how to preserve, repair or replace that information system, and how nerve damage can affect a patient’s mobility.

 

Armstrong is interested in metabolic health, mobility and neuropathy—the loss of nerve sensitivity that can occur in patients with diabetes, Liu noted.

 

“As a neurosurgeon, I’m interested in lower-extremity function and metabolic health, too,” he said. “In my work, I think about how to restore mobility to patients who can’t feel their legs. It’s a similar problem to diabetic foot ulcers.”

read more

A Total Offloading Foot Brace for Treatment of Diabetic Foot Ulcers

     Results From a Halted Randomized Controlled Trial

 

Introduction. Foot offloading is the mainstay treatment for plantar diabetic foot ulcers (DFUs). Objective. This multicenter, single-blinded, randomized controlled trial evaluates the efficacy of a total offloading foot brace for healing plantar DFUs. Materials and Methods. Seventeen patients were randomized to standard therapy (ie, reducing stress and pressure via mechanical offloading) or offloading foot brace. Comparison of plantar pressures was performed using digital pressure sensing films. The ulcers were assessed by physical inspection and digital planimetry of photographs. Results. Reductions in peak plantar pressures ranged from 67.3% to 89.4% (P = .09). Healing at weeks 12 to 15 had minimal differences (brace vs. control: 71.7% vs. 80.3%, respectively). Although not significant, earlier periods of the brace versus the control demonstrated faster wound healing in weeks 2 to 5 (36.0% vs. 6.8%, respectively) and weeks 6 to 9 (50.7% vs. 17.0%, respectively). Conclusions. The total offloading foot brace minimizes plantar pressure, allowing for early healing of DFUs, and optimizations in brace design may enhance healing of plantar DFUs … read more

Controlling Bacterial Burden in Chronic Wounds

Bioburden in chronic wounds can be a principal contributor to inflammation, clinical wound infection, and further delayed wound healing. Clinically diagnosing infection in chronic wounds can be problematic because most individuals susceptible to developing chronic wounds are subject to physiological states that often blunt typical infectious responses in various ways.1 These responses include pain, erythema, febrile state, leukocytosis, edema and increased wound exudate, wound odor, etc. For example, a patient with a neuropathic ulcer and diabetes mellitus may not report pain or fever or present with leukocytosis but will have increased edema and wound exudate. A patient with an ischemic ulcer of peripheral arterial disease may report pain, erythema, fever, and leukocytosis but not have perfusion sufficient to produce edema or increased wound exudate.1 It is imperative to understand how to concurrently manage factors that can contribute to infection, as well as assess for symptoms and implement interventions to prevent infection … read more

Corstrata Announces Availability of New Tech Empowered

     Diabetic Foot Ulcer & Amputation Prevention Solution

 

CORSTRATA, a provider of digital healthcare IT solutions and services for wound management, announced today the availability of the company’s new Diabetic Foot Ulcer & Amputation Prevention Solution. The Solution is designed to prevent costly and complicated wounds from developing and is the first comprehensive program that leverages state-of-the-art technology and a team of top-tier Board Certified Wound Clinicians for the early detection of ulcers that often lead to hard-to-heal wounds and amputations among the growing U.S. diabetic population.

 

Diabetic foot ulcers (DFUs) are a common, limb-threatening and expensive complication of Type 1 and Type 2 diabetes. Today, more than 30M people in the U.S. have diabetes and more than 1.7M suffer from new DFUs per year with a 40% reulceration rate. 80K of these diabetics ultimately require an amputation and the risk of death at 5 years for DFU patients is 2.5 times as high as the risk for a patient with diabetes without a foot ulcer.

 

“The Corstrata Diabetic Foot Ulcer and Amputation Solution offers an important advancement in both the detection and prevention of one of the most costly and complex types of wounds to heal,” said Katherine Piette, Chief Executive Officer and Founder, Corstrata. “The mobile and remote monitoring technology combined with our deep clinical expertise in diabetic foot ulcer prevention and wound management, enable us to help payers and value-based care organizations significantly reduce their risk and costs associated with ulcerations in diabetic members.”

 

The Corstrata program is a comprehensive end-to-end technology-enabled solution that uses the HIPAA compliant, Corstrata Intervention & Engagement mobile app and the industry’s only FDA approved smart thermometric mat. The Solution is designed to help value-based care organizations and payers with the following:

  •     High-Risk Patient Identification
  •     Program Enrollment
  •     Daily Remote Patient Monitoring
  •     Member Engagement & Education
  •     Timely Evidenced-Based Intervention for Prevention of DFU
  •     Empowering Members for Self-Management

 

“Research indicates that the use of early detection technology, coupled with evidence-based interventions, can prevent 75% of foot ulcers in this high-risk population,” said Joseph Ebberwein, Chief Financial Officer and Founder, Corstrata. Lower extremity amputation studies and clinical trials have shown that Diabetic Foot Ulcer and Amputation prevention solutions can greatly reduce costly hospital visits and procedures associated with ulcerations and amputations, including:

  •     Reduction in Hospitalizations
  •     Decreased Hospital Days
  •     Reduction in Amputations
  •     Decreased Emergency Room Visits
  •     Decreased Foot Ulcer Recurrence

 

Corstrata was also recently named a semifinalist in the T1D Exchange 2018 Diabetes Innovation Challenge. A poster depicting the Corstrata DFU solution was showcased at the public event on May 21, 2018, at the Royal Sonesto Boston in Cambridge, MA.

 

Learn more about the Corstrata Diabetic Foot Ulcer and Amputation Prevention Solution at http://www.corstrata.com/Diabetic-Foot-Ulcer-Prevention.

 

About Corstrata
Corstrata was founded in 2015 by two passionate healthcare experts with the goal of improving access to technology enabled, evidence-based care for patients with chronic wounds, which currently costs the U.S. $33B annually. Home health agencies, hospices, self-funded employers, clinically integrated networks of doctors and related practitioners (CINs), and third-party payers (Medicare Advantage, Medicaid MCOs) can benefit from Corstrata’s unique combination of professional expertise, digital technologies and telemedicine to treat wound patients and support practitioners anywhere, any time. The company delivers a Comprehensive Wound Care Management Program, Wound Patient Consultations, and specific services such as wound program assessment, formulary design, treatment guidelines assessment, wound documentation review, and practitioner education. Wound program development is available for Pressure Injury (Ulcer) Prevention and Management, Diabetic Foot Ulcer Prevention and Management, Ostomy Care and Management, and Palliative Wound Management. For more information about Corstrata, visit http://www.corstrata.com.

From PRWeb

Smart Bandages Give Better Treatment to Chronic Wounds

Engineers from Tufts University have developed a new prototype bandage that actively monitors the condition of chronic wounds and delivers the appropriate drug treatments to improve the chances of healing.

 

Chronic skin wounds from burns, diabetes and other medical conditions can overwhelm the regenerative capabilities of the skin and can lead to persistent infections and amputations.

 

However, the researchers designed the bandages with healing elements and thermoresposive drug carries that deliver tailored treatments in response to embedded pH, and temperature sensors that track infection and inflammation … read more

A smart bandage placed on an arm. Temperature and pH sensors in the bandage (right) are read by a microprocessor (left), which may trigger release of drug from the bandage by sending a current through heating elements. Credit: Tufts University

Low-cost prosthetic foot mimics natural walking

Prosthetic limb technology has advanced by leaps and bounds, giving amputees a range of bionic options, including artificial knees controlled by microchips, sensor-laden feet driven by artificial intelligence, and robotic hands that a user can manipulate with her mind. But such high-tech designs can cost tens of thousands of dollars, making them unattainable for many amputees, particularly in developing countries.

Now MIT engineers have developed a simple, low-cost, passive prosthetic foot that they can tailor to an individual. Given a user’s body weight and size, the researchers can tune the shape and stiffness of the prosthetic foot, such that the user’s walk is similar to an able-bodied gait. They estimate that the foot, if manufactured on a wide scale, could cost an order of magnitude less than existing products … read more

How to apply silver nitrate

Topical application of silver nitrate is often used in wound care to help remove and debride hypergranulation tissue or calloused rolled edges in wounds or ulcerations. It’s also an effective agent to cauterize bleeding in wounds. Silver nitrate is a highly caustic material, so it must be used with caution to prevent damage to healthy tissues.

 

Application method
Silver nitrate applicators are firm wooden sticks with 75% silver nitrate and 25% potassium nitrate embedded on the tip. Moistening the tip sparks a chemical reaction that burns organic matter (skin), coagulates tissue, and destroys bacteria.

read more

Retired surgeon leads local diabetes study

SHERIDAN — After working as an orthopedic surgeon for 20 years, Dr. Scott Nickerson was forced into an early retirement by diabetes.

 

After graduating from the Johns Hopkins University School of Medicine, Nickerson moved to Sheridan in 1977 to work as an orthopedic surgeon at Sheridan Orthopaedics, which was a small three-doctor practice at the time.

 

One of the many complications of diabetes is neuropathy, nerve damage that can lead to pain, weakness and loss of sensation in the extremities.

 

Nickerson said after living with diabetes for about 10 years, he began to notice his hands were getting clumsy.

 

“I would drop tools a little bit or just not have quite the sensation you would depend on to do the work,” Nickerson said. “Plus it would hurt me a lot to be on my feet.”

 

Nickerson decided to retire so the effects of his neuropathy would not affect his work as a surgeon … read more

Electrically charged bandages help to heal burn wounds

     combat antibiotic resistance

 

Researchers from the Ohio State University Wexner Medical Center have developed special electrically charged bandages that can prevent infections, combat antibiotic resistance and enable healing in burn wounds. This type of dressing turns electrically active when it comes in contact with bodily fluids. According to Dr. Chandan Sen, director of Ohio State’s Center for Regenerative Medicine and Cell Based Therapies, who led the study with colleagues at the Medical Center’s Comprehensive Wound Center and Center for Microbial Interface Technology, “Drug resistance in bacteria is a major threat, and antibiotic-resistant biofilm infections are estimated to account for at least 75 percent of bacterial infections in the United States. This is the first pre-clinical long-term porcine study to recognize the potential of ‘electroceuticals’ as an effective platform technology to combat wound biofilm infection.”

Read more at: https://gineersnow.com/industries/medical/electrically-charged-bandages-can-fight-infections

Medilight develops light system to heal wounds

European project makes bandage that bathes wound in blue light to speed recovery.

 

With the objective of using light to improve wound healing and within the framework of the European project MEDILIGHT, Swiss company CSEM and six partners have developed a new solution for treating chronic wounds. This portable device delivers blue light to improve and accelerate the healing process. The prototype was first presented this week at the project wrap-up event on July 2nd, at the URGO Laboratories in Dijon, France.

Chronic wounds are often difficult to treat, because they do not follow the typical injury healing process or time-frame. The resulting burden is significant, affecting over 40 million patients worldwide and costing healthcare systems an estimated €40 billion annually.

Blue light is known for its anti-microbial and anti-inflammatory effects in the initial stages of the healing process; it does not damage tissue, unlike the hazardous UV light. However, clear evidence of the beneficial effects of blue-light irradiation in the later stages of wound healing was still missing, thus hindering the development of effective solutions for complete therapy … read more

Heberprot-P to Deliver Effective Treatment Against Amino Acid

Metabolism Disorders; Nestle Health Sciences and Codex Collaboration to Enhance CodeEvolver Enzyme Platform

 

Metabolism is essentially a process that the human body uses to gain energy from food intake. In case of a metabolic disorder, improper food digestion takes place. Amino acids are referred to as building blocks. In case of metabolism disorders, breaking of amino acids becomes difficult that can lead to difficulty in getting them in cells. These complications can lead to generation of harmful substances in the body that can ultimately lead to life threatening or serious health problems. Such disorders are typically inherited, which makes their early diagnosis followed by effective treatment imperative. New-born babies are screened for such disorders via blood tests. According to analysis of Future Market Insights, the global market for amino acid metabolism disorders treatment is expected to grow at a high CAGR during the forecast period, 2017-2026 … read more

 

 

Superbug-Resistant Bandages

A staple of the news headlines in the UK over the past couple of years has been the periodic outbreak of so-called ‘Superbug’ infections in hospitals, when antibiotic-resistant strains of bacteria cause a high proportion of secondary infections in patients. Although the majority of such infections are relatively mild, they can develop into potentially fatal conditions including sepsis, toxic shock syndrome and necrotizing pneumonia. To keep things in context, the Superbug (or methicillin-resistant Staphylococcus aureus (MRSA)), for all its virulence, is simply the latest and most advanced version of a problem that spans human history – how to effectively combat bacterial infections that develop in wounds or injuries. Such infections were nearly always fatal before the development and wide-scale use of antibiotics; for example, in a military context, secondary infection and disease accounted for a far greater number of casualties than outright combat (at higher than a 2:1 ratio in the US Civil War) in the nineteenth century. In the ongoing medical arms race between diseases and treatment, then, MRSA is the next evolution on the side of the diseases, and a challenge that scientists and medics are working to meet … read more

Restoring the Wound Base: The Role of Tissue Management

Successful utilization of the TIME model for wound bed preparation requires a working knowledge of chronic wound tissue types. In addition, building on this foundational knowledge is the development of accurate wound assessment skills. These components combined will assist the clinician in implementing the appropriate interventions for each wound.

 

Viable Chronic Wound Tissue Types
The term “viable” describes vascular tissue with dynamic biological activity.

 

Epithelium: This should be dry to touch and can appear white or light pink; it is composed of restratified keratinocytes arising from the basement membrane of the dermis.

 

Granulation: This appears light pink to red and should be moist with a bumpy texture. Capillaries give granulation tissue its characteristic color, and collagen made from fibroblasts provides structural support. If granulation tissue is pale (poor perfusion), dark red or ruddy (vascular congestion or stasis), or “bubbly” or friable (bleeds with very gentle contact), it is technically considered non-viable because it will not support migrating epithelial cells … read more

Wound care and leg ulcer advances feature at conference

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

 

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

 

The conference attracted 110 delegates from around the world and they listened to the former Head of Vascular Surgery at Bradford’s Royal Infirmary Professor Peter Vowden, as he gave the opening lecture entitled The Burden of Wound Care.

 

The recently retired wound care expert explained how wounds impose substantial health economic burden on the UK’s NHS.

 

He argued that it was comparable to that of managing obesity, which in 2012/2013 was valued at £5 billion. “Clinical and economic benefits would accrue from improved systems of care and an increased awareness of the impact that wounds impose on patients and the NHS”, said Professor Vowden … read more

Expert explains how wounds impose health economic burden on the UK’s NHS

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

 

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

 

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

The conference attracted 110 delegates from around the world and they listened to the former Head of Vascular Surgery at Bradford’s Royal Infirmary Professor Peter Vowden, as he gave the opening lecture entitled The Burden of Wound Care … read more

Paulsen takes another run at repealing the medical device tax

Rep. Erik Paulsen (R-Minn.), facing a tough re-election campaign, is taking yet another run at repealing the medical device tax.

 

Althought the 2.3% levy on prescribed medical devices was enacted as part of the Affordable Care Act in 2010, it didn’t go into effect until 2012 and was mothballed two years later; that moratorium, extended earlier this year, is slated to end in 2020.

 

Paulsen, who filed his first bill to repeal the tax back in 2010, introduced his latest repeal bid in January 2017. The bill, H.R. 184, or the “Protect Medical Innovation Act of 2017,” aims to “amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices.” The bill has 269 co-sponsors, including 43 Democrats.

Citing “sources familiar with the plan,” The Hill reported yesterday that the U.S. House of Representatives could vote on the Paulsen bill as early as this month … read more

Moldable Hyaluronan Hydrogel Enabled by Dynamic

     Metal–Bisphosphonate Coordination Chemistry for Wound Healing

 

Biomaterial‐based regenerative approaches would allow for cost‐effective off‐the‐shelf solution for the treatment of wounds. Hyaluronan (HA)‐based hydrogel is one attractive biomaterial candidate because it is involved in natural healing processes, including inflammation, granulation, and reepithelialization. Herein, dynamic metal–ligand coordination bonds are used to fabricate moldable supramolecular HA hydrogels with self‐healing properties. To achieve reversible crosslinking of HA chains, the biopolymer is modified with pendant bisphosphonate (BP) ligands using carbodiimide coupling and chemoselective “click” reactions. Hydrogel is formed immediately after simple addition of silver (Ag+) ions to the solution of HA containing BP groups (HA‐BP). Compared with previous HA‐based wound healing hydrogels, the HA‐BP·Ag+ hydrogel is highly suitable for clinical use as it can fill irregularly shaped wound defects without the need for premolding. The HA‐BP·Ag+ hydrogel shows antimicrobial properties to both Gram‐positive and Gram‐negative bacterial strains, enabling prevention of infections in wound care. In vivo evaluation using a rat full‐thickness skin wound model shows significantly lower wound remaining rate and a thicker layer of regenerated epidermis as compared with the group left without treatment. The presented moldable and self‐healing supramolecular HA hydrogel with “ready‐to‐use” properties possesses a great potential for regenerative wound treatment … read more

Patient Assessment and Wound Dressing Considerations

As wound care clinicians, we need to take into consideration many different factors in deciding on a treatment plan for our wound patients. Our patients should be evaluated on an individual basis. If we look at our patient’s socioeconomic status, we will find it varies from patient to patient. Socioeconomic status clearly affects morbidity and mortality rates related to wounds: wound management tends to be lower in quality and follow-up visits tend to be fewer in number when compared with patients with better economic status.

Socioeconomic Factors Affecting Wound Management

Socioeconomic factors can be big stressors for patients. Patients want their wounds to heal but feel helpless. We, as compassionate health care clinicians, feel the frustration for our patients. Patients miss follow-up appointments because they lack gas money, access to transportation, or caregiver support to assist with transportation. What can we do to help? There are some hospitals throughout the country that have free shuttle services to and from the wound center. This helps relieve the burden for the patient and provides more consistent wound management. Most recently, there are companies that are similar to Uber, but for health care needs. The following list provides examples of barriers to wound management … read more

Kent Imaging Inc. and SerenaGroup announce Partnership in wound care

CALGARY, June 27, 2018 /PRNewswire/ – Kent Imaging Inc. and SerenaGroup® today announced a Strategic Partnership to jointly improve tissue assessment in wounds with the use of Near Infrared Imaging technology using Kent’s KD203 device.

 

Oxygenation is widely accepted as the best biomarker of tissue health and healing. Kent’s device is intended for use by healthcare professionals as a non-invasive tissue oxygenation measurement system that reports oxygen saturation (StO2), relative oxyhemoglobin level (HbO2), and relative deoxyhemoglobin (Hb) level in superficial tissue. Kent’s multispectral imaging technology displays two-dimensional color-coded images providing critical information to help clinicians determine at risk tissue and guide treatments to optimize patient outcomes in wound care, plastic surgery, and various other reconstructive applications.

 

This is a great partnership between one of the leaders in building wound care teams and an innovative tissue assessment technology that is easy to use, convenient, and cost effective. SerenaGroup® will adopt Kent Imaging’s technology as the standard of care for assessing wound oxygenation thus wound health. Kent will be integrated into each of the SerenaGroup® managed facilities, included in Hyperbaric training courses curriculum, as well as included in future clinical and preclinical research.

 

“We are pleased to introduce Kent’s imaging system into the wound care protocol at our clinics. One of the most troublesome and elusive criteria in treating wounds is the timely and accurate assessment of viable tissue.” said Dr. Serena MD FACS FACHM MAPWCA, Founder and Medical Director of The SerenaGroup®. “Kent’s device will propel us a long way down the healing path with a technology that has been lacking across the board in the Wound Care space. ”

read more

Healogics Releases Software to Improve Chronic Wound Care Experience

JACKSONVILLE, Fla.–(BUSINESS WIRE)–Healogics®, the wound healing experts, today announced the launch of two new applications that support efforts to improve the patient experience and save time for clinicians and physicians, all while increasing the quality and consistency of patient care. Clinical OptimizationSM and Decision SupportSM, applications on Healogics’WoundSuiteSM platform, enable the critical connection between people living with chronic wounds and their multi-disciplinary healthcare team for collaborative, evidence-based, patient-centered care.

 

“Over the past year, Healogics has been working tirelessly to ensure that the care teams at our Wound Care Centers® have access to the best software available to help more people heal. We are excited about the launch of these new applications, and their ability to support more in-depth documentation, accurate wound measurements and, most importantly, better patient outcomes,” said David Bassin, Healogics CEO.

 

Healogics Clinical Optimization provides clinicians and physicians with patient-focused insights starting with the daily team huddle. Additionally, this application supports them throughout the Healogics Patient Care ProcessSM, a six-sigma lean productivity process used in each Wound Care Center. Clinical Optimization provides a one-click patient summary that eliminates all of the arduous and time-consuming paper processes built around EMRs. By concisely presenting the essential patient information, physicians can now go through medical surveillance, a process designed to monitor patient healing, with case managers before ever walking into a patient’s room. This allows more time for meaningful patient interaction.

read more

Molecular Diagnosis of SSTIs May Yield Better Clinical Outcomes

Molecular diagnostics such as polymerase chain reaction (PCR)–based tests provide faster, more complete results than traditional culture-based tests, and their use may improve outcomes for patients with chronic wounds and skin and soft tissue infections (SSTIs), according to new findings presented at the 21st Annual MAD-ID Meeting held May 9 to 12 in Orlando, Florida.

About 6.5 million individuals were afflicted with chronic wounds and SSTIs in the United States in 2009.1 The costs of treating associated complications reached upward of $25 billion at that time. A more recent study estimated that annual Medicare spending for all wound types ranged from $28.1 billion to a whopping $96.8 billion in 2014.2

“These costs could potentially be mitigated with the use of rapid diagnostics that have the capability to better identify wound pathogens and thus allow clinicians to provide better clinical care through targeted antimicrobial therapy,” said Tanya Moreno, PhD, vice president of research and development at Millennium Health, citing a Mayo Clinic Proceedings article on the hospitalists’ view of treating SSTIs … read more

Skin hydration of the heel with fissure in patients with diabetes:

     a cross-sectional observational study

 

Purpose: Foot fissure should be prevented in patients with diabetes due to the likelihood of subsequent diabetic ulcer. The purpose of this study was to investigate a cutoff point for skin hydration with fissure and the factors associated with low skin hydration in patients with diabetes.

 

Subjects and methods: Subjects were patients with diabetes who visited the diabetic foot clinic and were evaluated for skin hydration on the heel between April 2008 and March 2015. Information about fissure, skin hydration, age, sex, autonomic neuropathy, angiopathy, and tinea pedis were collected from the medical charts. Skin hydration on the heel was measured using a moisture checker. Skin hydration was compared between heels with and without fissure, and a cutoff for skin hydration with fissure was determined using receiver operating characteristic analysis. Based on the determined cutoff, factors associated with lower skin hydration were analyzed using logistic regression analysis.

 

Results: Participants comprised 693 patients. Mean±SD age was 66.8±10.8 years, and 57.0% of subjects were male. The frequency of fissures on the heels was 10.4%. Area under the receiver operating characteristic curve for skin hydration in the presence of fissure was 0.717. Twenty percent was selected as the cutoff point, offering sensitivity of 0.478 and specificity of 0.819. Logistic regression analysis showed correlations between three factors (male sex, tinea pedis, and room temperature) and skin hydration <20.0% (odds ratio [OR] 1.587, 95% CI 1.157–2.178, p=0.004; OR 1.548, 95% CI 1.122–2.135, p=0.005; and OR 0.900, 95% CI 0.823–0.0985, p=0.021, respectively).

 

Conclusion: To prevent heel fissures, moisturizing care should aim at achieving skin hydration of 20%. If skin hydration is <20%, prevention of fissures may warrant not only specialized moisturizing care but also consideration of treatment for tinea pedis.

read more

Eggshell membrane waste beneficial for wound healing

EU research has brought the benefits of eggshell membrane (ESM) protection from the chick to ‘hard-to-heal’ open wounds.

 

Delayed chronic wound healing is the so-called ‘vicious cycle’ of many illnesses. Chronic inflammation, excess protease, a key risk factor in healing, and tissue degradation are the hallmarks of this condition that can lead to further debilitation for the patient including a deterioration in psychological health. What’s more, already high healthcare costs are set to escalate the longer the wound goes unchecked.

 

ESM: Material mastermind behind wound healing

 

ESM is a low-cost alternative to currently used collagen-derived dressings that are often too expensive to use. Based on a novel biomaterial derived from ESM, it is extracted from waste eggshells. Protecting the egg and its chick during development, ESM is a thin, structural protein-rich lining that performs similar key functions in wound healing to the extracellular membrane in skin … read more

Wound Care Clinical Trials: Setting the Record Straight

A recent article by Kaiser Health News misquoted me as saying that we enroll only “healthy” patients in our clinical trials. At moments like this, one feels that something has been overlooked. One of my research coordinators, recalling the serious adverse events (SAEs) of the previous week said, “The only patients sicker than ours are underground.”

 

Anyone who has ever spent more than ten minutes in a wound clinic knows that our patients are anything but healthy. Our acuity levels mirror the dialysis and transplant units. We check the obituaries when our patients miss appointments.

The Chronic Wound Epidemic

Although it should be, this is not just a minor annoyance. A procession of anecdotal observations on the failing health of the wound care space—in a time of flux and disarray—is neither enlightening nor supportive. The article itself focuses on the use of expensive products in wound care. In comparison to other medical specialties, such as oncology or cardiology, our products are inexpensive and cost effective. Chronic wounds are an unacknowledged epidemic. The huge increase in spending has less to do with the cost of wound care products than it does to the staggering number of patients who need them. Why is wound care research so poorly funded? The National Institutes of Health (NIH) does not even have a wound care division … read more

MediWound Completes Enrollment in NexoBrid®

U.S. Phase 3 DETECT Study

YAVNE, Israel, June 11, 2018 (GLOBE NEWSWIRE) — MediWound Ltd. (Nasdaq:MDWD), a fully-integrated biopharmaceutical company bringing innovative therapies to address unmet needs in severe burn and wound management, today announced it has completed enrollment in NexoBrid®U.S. Phase 3 DETECT study. Top-line acute data are currently expected around year end 2018.

 

“We are happy to achieve this important milestone of completing the enrollment in NexoBrid Phase 3 study, which is one of the most comprehensive randomized controlled studies ever conducted in burn care, and we believe it will support our Biological License Application (BLA) submission to the FDA,” said Gal Cohen, president and chief executive officer of MediWound. “Prior studies of NexoBrid have shown positive results and we eagerly await our top-line acute data. Subject to a successful study outcome, we plan to meet with the FDA to discuss the BLA submission plan. We warmly thank our Principal Investigators, their teams and everyone involved in the study for their commitment and dedication in an effort to advance burn care.”

read more

What is a deep tissue injury?

A deep tissue injury is a unique form of pressure ulcer. The National Pressure Ulcer Advisory Panel defines a deep tissue injury as “A pressure-related injury to subcutaneous tissues under intact skin. Initially, these lesions have the appearance of a deep bruise. These lesions may herald the subsequent development of a Stage III-IV pressure ulcer even with optimal treatment.”(NPAUP, 2005). Why is it important to have yet another stage for pressure ulcers? The answer lies in the fact that, even with proper treatment, deep tissue injuries can deteriorate quickly into your worst nightmare.

 

The Problem With Deep Tissue Injuries

The problem with deep tissue injuries is that they are not readily apparent. A patient who has fallen at home and lain on the floor for a day may be admitted to the hospital and have every inch of skin examined upon admission, and then develop the tell-tale area of purplish discoloration several days after admission. In many cases, hospitals and other care facilities are being blamed (and payment is being withheld) when patients end up with a gaping hole in their sacrum that takes several months (and several trips to the OR) to heal, if they don’t succumb to their injury … read more

Wound healing is complex, almost miraculous process

Without the ability to heal wounds every scratch, nick, scrape and cut would remain open, a permanent and painful reminder of the body’s frailty.

 

Yet this basic process of life goes largely unrecognized because it works so effectively.

 

Wound healing requires the activation of over 10,000 genes, a precise, sequential release of hundreds of chemicals and the growth, division and migration of millions of different types of cells. It is usually only when wound healing fails, leaving us with a chronic wound, that we ever are aware of the process.

 

Normal wound healing involves four distinct phases: the clotting of blood, inflammation, proliferation and remodeling. Chemicals released from the cells of the damaged capillaries, the work of platelets and formation of the blood clot initiate the healing process …. full article

Healogics settles False Claims allegations

     agrees to pay up to $22 million

 

Healogics has agreed to pay up to $22 million to settle allegations that it knowingly billed Medicare for medically unnecessary therapies, the Justice Department announced Wednesday.

 

The Jacksonville-based company manages the hyperbaric oxygen therapy centers at more than 700 hospital-based wound care facilities across the country and is one of the largest in the nation. The company has several centers in Central Florida.

 

According to the Justice Department, between 2010 and 2015 Healogics knowingly caused wound care centers to bill Medicare for hyperbaric oxygen therapies that were medically unnecessary and unreasonable.

 

The allegations stem from two whistleblower lawsuits, one filed by a former director for research and quality at Healogics and another filed by several doctors and employees at Healogics-affiliated wound care centers.

 

“Medicare beneficiaries are entitled to care based on their clinical needs and not the financial goals of healthcare providers,” said Chad Readler, the Justice Department’s … read full article

Healogics to Host Scientific Symposium on Diabetic Wound Healing Innovations

The Healogics symposium will include an overview of diabetic wound identification, prevention and care, and a discussion on leveraging data to improve wound care.

 

JACKSONVILLE, Fla., June 19, 2018 /PRNewswire/ — Healogics, Inc., the foremost advanced wound care services provider for hospitals, is honored to be hosting a scientific symposium entitled Innovations in Diabetic Wound Healing at the American Diabetes Association 78th Scientific Sessions. The symposium will be taking place on Saturday, June 23 in Orlando, Florida.

 

The symposium will be led by Healogics Chief Medical Officer, Dr. William Ennis and Organogenesis Vice President of Global and Medical Affairs, Dr. Shabnam Vaezzadeh. There will be presentations from Healogics Medical Director, Dr. Jaime Wise, the Founder and President of the “Save A Leg, Save A Life” Foundation, Dr. Desmond Bell and the Medical Director of the Acute Care Orthopedic Program at Genesis Hospital, Dr. Amy Tucker. The symposium will include an overview of diabetic wound identification, prevention and care, and a discussion on leveraging data to improve wound care. Data will also be shared on wound healing outcomes of more than half a million wounds treated in Healogics outpatient clinics. The use of machine learning and predictive analytics in diabetic wound care will also be discussed … read more

New Products & Practices for Wound Care

Apps, HydroClean and Honey?

According to PR Newswire, the wound care biologics market is expected to earn 1.42 billion US dollars in 2018. That number is expected to skyrocket by the year 2023, when the market is expected to increase to 2.26 billion US dollars.

 

That is a jaw-dropping amount of money that we’re spending on wound care. What’s going on?

 

There are several factors that are driving up the those wound care dollars – primarily diabetic foot ulcers, the aging geriatric population, and a general increase in burn injuries globally.

 

With the ever-increasing number of wounds requiring advanced wound care, there is new products and practices. Here’s a quick update … read more

Wound management in a case of an open amniotic band

     syndrome in a 31-week-old preterm baby

 

This is a case study of a 31-week-old preterm baby presented with severe amniotic band syndrome of the left leg at birth. Circumferential band with skin defect, exposing the subcutaneous tissue and periosteum of the left tibia was visible on the distal third of the left leg. The left dorsalis pedis artery and posterior tibialis artery pulsations were not palpable, but detectable with handheld Doppler ultrasound device. The capillary refilling time of the toes was good. While waiting for stabilisation of patient’s condition due to the poor lung function, wound management played a role in this case to protect the exposed left tibia from dehydration and necrosis as well as prevention of infection via the skin defect. Wound closure of the left leg was successfully achieved in 18 days … read more

Wound Care Challenges: When The Lymphatic System Doesn’t Work

Due to difficulty defining lymphatic markers, difficulty visualizing vessels with traditional methods, and emphasis on the vascular system, research into the development of the lymphatics is still in its infancy–with many theories still to be proven. Without a doubt, it starts development in week 5, perhaps from the veins or the mesenchyme. Then, in weeks 6-9, sacs are formed in the neck, groin, posterior abdominal wall, and in the gut. Ducts grow and connect the different sacs while lymphatic vessels grow peripherally to the head, neck, arms, gut, and legs. The sacs become the lymph nodes, except for the upper portion of the gut sac: the cisterna chyli. Mesenchymal cells infiltrate the nodes and develop channels, capsule, and node framework. Lymphocytes appear just before birth in the nodes from the thymus. Lymph organs form from mesenchymal cells and clumping of lymph nodules.

 

So, from week 5 to the final week of gestation, the lymphatic system is developing. A spontaneous mutation at any point, injury to the fetus, a hereditary malformation, or a preterm delivery can all affect the lymphatic system of a child. This deficit can be apparent at birth, or latently appear at any time in their life, depending on where the deficit is … read more

Dressing Selection: Which Dressing to Choose?

Dressing selections can be overwhelming for clinicians and providers in health care. There are now well over 6,000 wound care products on the market. Ideally, there would be a multifunctional smart dressing that could “do it all” readily available in all settings. Unfortunately, we as health care providers know, that definitely isn’t the case.

 

Dressing category education plays a vital role in wound management. Knowing the functionality and appropriateness of the dressing is key in enhancing the wound healing process. As wound care clinicians, we want to be in a mindset of looking at our whole patient. However, let’s not forget the Wound Care Basics 101: wound bed preparation, monitoring, patient compliance, appropriateness of dressing, and addressing underlying factors or causes.

 

Biofilm formation is also a culprit for impeding wound healing. Most, if not all, ulcers develop a biofilm over time. It is reported 60% to 90% of chronic wounds contain a biofilm. Therefore, selecting the appropriate dressing for effectiveness is imperative … read more

Micelle‐Coated, Hierarchically Structured Nanofibers with Dual‐Release

     Capability for Accelerated Wound Healing and Infection Control

 

Tailoring nanofibrous matrices—a material with much promise for wound healing applications—to simultaneously mitigate bacterial colonization and stimulate wound closure of infected wounds is highly desirable. To that end, a dual‐releasing, multiscale system of biodegradable electrospun nanofibers coated with biocompatible micellar nanocarriers is reported. For wound healing, transforming growth factor‐β1 is incorporated into polycaprolactone/collagen (PCL/Coll) nanofibers via electrospinning and the myofibroblastic differentiation of human dermal fibroblasts is locally stimulated. To prevent infection, biocompatible nanocarriers of polypeptide‐based block copolymer micelles are deposited onto the surfaces of PCL/Coll nanofibers using tannic acid as a binding partner. Micelle‐modified fibrous scaffolds are favorable for wound healing, not only supporting the attachment and spreading of fibroblasts comparable to those on noncoated nanofibers … read more

Molecular Diagnosis of SSTIs May Yield Better Clinical Outcomes

Molecular diagnostics such as polymerase chain reaction (PCR)–based tests provide faster, more complete results than traditional culture-based tests, and their use may improve outcomes for patients with chronic wounds and skin and soft tissue infections (SSTIs), according to new findings presented at the 21st Annual MAD-ID Meeting held May 9 to 12 in Orlando, Florida.

About 6.5 million individuals were afflicted with chronic wounds and SSTIs in the United States in 2009.1 The costs of treating associated complications reached upward of $25 billion at that time. A more recent study estimated that annual Medicare spending for all wound types ranged from $28.1 billion to a whopping $96.8 billion in 2014 … read more

Treatment of Diabetic Foot Ulcers

Diabetic wound is the most common cause of non-traumatic
lower extremity amputation, and response to traditional
interventions is poor in many patients. The lifetime risk of
developing an ulcer among diabetics is 25%, and recurrent
wounds are common after healing. Stigmatization, social
isolation, unemployment, and depression are some of the
negative consequence of Diabetic Foot Ulcer (DFU) on the
quality of life of diabetics. DFU adds a substantial economic
burden to afflicted patients and health systems, primarily
attributable to frequent hospitalization, medication, surgical
procedures, amputation, prosthesis, rehabilitation, and loss of
productivity … read more

Negative-Pressure Therapy No Better for Open Fractures

Negative-pressure therapy does not improve 12 month outcomes compared with standard wound dressings in adults with severe open fractures of the lower limb, according to a study published online June 12 in JAMA.

 

The study is the largest randomized controlled trial (RCT) to compare negative-pressure therapy to standard wound care in this setting.

 

“The findings do not support this treatment for severe open fractures,” write Matthew Costa, PhD, from the University of Warwick, Coventry, United Kingdom, and colleagues with the UK Wound management of Open Lower Limb Fractures (WOLLF) Collaboration … read more

Dressing Selection: Which Dressing to Choose?

Dressing selections can be overwhelming for clinicians and providers in health care. There are now well over 6,000 wound care products on the market. Ideally, there would be a multifunctional smart dressing that could “do it all” readily available in all settings. Unfortunately, we as health care providers know, that definitely isn’t the case.

 

Dressing category education plays a vital role in wound management. Knowing the functionality and appropriateness of the dressing is key in enhancing the wound healing process. As wound care clinicians, we want to be in a mindset of looking at our whole patient. However, let’s not forget the Wound Care Basics 101: wound bed preparation, monitoring, patient compliance, appropriateness of dressing, and addressing underlying factors or causes … read more

APHB: SUCCESSFUL CASE REPORTS PRESENTED FOR AB-SA01 AND AB-PA01

Multiple Case Reports Presented for Patients Treated with AB-SA01 and AB-PA01



On June 7, 2018, AmpliPhi Biosciences Corp. (NYSE:APHB) reported that multiple case reports on patients treated with the company’s lead bacteriophage development products, AB-SA01 and AB-PA01, were presented at the American Society of Microbiology (ASM) Annual Meeting and the 41st European Cystic Fibrosis Conference. Topline results from these cases had previously been announced by AmpliPhi with the presentations providing additional details.

At ASM, a presentation described four cases of severe Staphylococcus aureus infection treated with AB-SA01. Three of the cases involved patients with endovascular infection and one case of severe vertebral osteomyelitis with epidural abscess. For all the patients, medical and surgical therapy options had been exhausted. Patients were treated with 3×109 plaque-forming units of AB-SA01 intravenously twice-daily for two weeks in combination with the best antibiotic therapy available. The bacteriophage therapy was well tolerated in all patients with no reports of serious adverse events … read more

These Plasma Patches Could Replace Antibiotics to Treat Chronic Wounds

The German company Coldplasmatech is using the weirdest state of matter to fight superbugs and accelerate healing.

 

Star Trek is often credited with inspiring real-life technologies, from wireless gadgets to video conferences. Now, a German company called Coldplasmatech has pioneered a “PlasmaPatch” which, much like Star Trek’s “dermal regenerator,” is designed to disinfect and heal wounds.

 

The device leverages the properties of plasma, the least familiar state of matter to humans, which is normally found in high-energy environments such as stars. Plasma can also be artificially generated at lower temperatures by applying electrical currents to a gas or liquid insulator … read more

Osiris Announces Implementation of Prestige Lyotechnology℠

     Preservation Method Allowing Ambient Storage of Living Tissues

 

COLUMBIA, Md., June 04, 2018 (GLOBE NEWSWIRE) — Osiris Therapeutics, Inc.(OTC Pink:OSIR), a regenerative medicine company focused on developing and marketing products for wound care, orthopedics, and sports medicine, announced today the implementation of Prestige Lyotechnology for manufacturing of commercial products.

 

In 2017, Osiris announced the development of Prestige Lyotechnology, a preservation technique for ambient storage of living tissues (see http://www.osiris.com/wp-content/uploads/2017/03/2017-03-30-Prestige-Lyo-Nature-article-PR-FINAL.pdf). In April 2018, studies describing properties of viable lyopreserved tissues were presented at scientific conferences including the Annual Symposium on Advanced Wound Care (SAWC) and Wound Healing Society (WHS) (see http://www.osiris.com/wp-content/uploads/2018/04/2018-04-24-Osiris-to-Present-at-SAWC-Spring-2018-FINAL.pdf).

read more

Atypical Wounds: Scleroderma, Marjolin’s Ulcer

     and Kaposi’s Sarcoma (Part 2)

 

By Martin Vera, LVN, CWS

 

Part 2 in a series discussing the etiology, assessment and management of atypical wounds. Read Part 1 here.

 

As our journey through the exciting and uncharted, choppy waters of atypical wounds comes to a close, I discuss a few more wounds. The purpose and goal of this blog are to create awareness of other wounds that exist and instill the curiosity in my fellow clinicians to get our research done.

 

This blog describes a few atypical wounds, including scleroderma, Marjolin’s ulcer, and Kaposi’s sarcoma (KS). Even with the previous discussion of atypical wounds in this two-part series, many other atypical wounds exist, and I encourage and challenge you to educate yourselves and others, continue doing the research necessary to continue the battle to prevent and heal these wounds, and increase awareness to achieve early detection and have better chances for positive outcomes … read more

These Smart Socks Keep Tabs on People With Diabetes

Diabetes patients are at an increased risk of amputation, so Siren’s Neurofabric socks track the temperature of patients’ feet and alert them about worrying temperature differences.

 

We’ve been hearing about “smart fabrics” that respond to the human wearer for years but little has transpired, apart from floaty dresses that light up with LEDs, or mod-style parkas threaded with charging cords. But something that saves your life? That’s worth a look.

 

PCMag was in San Francisco recently and sat down with Ran Ma, CEO and Founder of Siren, the company behind Neurofabric, a microsensor-embedded textile featured in its Diabetic Socks and Foot Monitoring System. It won a CES 2018 Innovation Award and has seed funding of $3.4 million from DCM, Khosla Ventures, and Founders Fund … read more

Cynata’s Cymerus™ MSCs Effective in Preclinical Model of Diabetic Wounds

MELBOURNE, Australia, June 01, 2018 (GLOBE NEWSWIRE) — Australian stem cell and regenerative medicine company Cynata Therapeutics Limited (ASX:CYP) is pleased to announce that it has received positive data demonstrating the efficacy of its Cymerus™ mesenchymal stem cells (MSCs) in a preclinical model of diabetic wounds (also known as diabetic ulcers). The studies were conducted independently by the Cooperative Research Centre for Cell Therapy Manufacturing (CTM CRC) and were designed to compare cells from various sources.

 

Key Highlights:

  • Cymerus MSCs resulted in significantly faster wound healing than bone marrow-derived MSCs
  • Discussions between Cynata and CTM CRC are underway regarding progressing Cymerus MSCs and CTM CRC’s wound-dressing technology into a clinical trial in human patients with diabetic foot ulcers
  • Diabetic wounds are prevalent among the 400m+ diabetics globally and a significant opportunity exists to improve existing treatments and meet a growing unmet medical need

 

CTM CRC, based in Adelaide, South Australia, is developing an active wound care dressing for the treatment of diabetic wounds. This novel dressing, for which a patent is pending, consists of a polymer-coated silicone dressing seeded with MSCs or similar cells … read more

Healogics Shines a Light on Chronic Wounds with Fifth Annual Wound Care Awareness Week

JACKSONVILLE, Fla.–(BUSINESS WIRE)–Healogics, Inc., the nation’s leading provider of advanced wound care services, is proud to sponsor the fifth annual Wound Care Awareness Week from June 4 to June 8, 2018. Throughout this week, Healogics team members from around the country will be working together to shed light on the chronic wound epidemic and bring awareness to the advanced wound care options available. Unfortunately, the incidence of chronic wounds is only expected to rise over the next decade, making awareness and advanced wound care more important now than ever before.

 

Chronic wounds affect approximately 6.7 million people in the U.S. and an excess of $50 billion is spent annually on treatment. The prevalence of chronic wounds is growing in tandem with an aging population and increasing rates of diseases such as diabetes and peripheral arterial disease, and conditions like obesity and the late effects of radiation therapy. Untreated, chronic wounds can lead to diminished quality of life and possibly amputation of the affected limb. It is in this context that Healogics also created the Wound Science Initiative – a collaborative effort to educate and engage key stakeholders in government and across the healthcare system on the poorly understood and underserved needs of people with non-healing wounds.

 

About Healogics

Headquartered in Jacksonville, Fla., Healogics and its affiliated companies manage a network of 700 outpatient Wound Care Centers® across the United States and multiple locations in the United Kingdom. Healogics currently has more than 3,000 employees, including nearly 300 employed providers (Healogics Specialty Providers). In addition to the company’s network of outpatient Wound Care Centers, Healogics providers partner with over 400 skilled nursing facilities to care for patients with chronic wounds. More than 300,000 patients were treated by Healogics providers in 2017. For additional information, please visit Healogics.com.

 

Contacts

Healogics, Inc.
Leslie Niblock, 904-524-2695
Director, Corporate Communications
Leslie.Niblock@healogics.com

 

Press Release BusinessWire

Acellular Flowable Matrix in the Treatment of Tunneled or Cavity Ulcers in Diabetic Feet:

A Preliminary Report

 

Abstract

OBJECTIVE:

The authors aimed to explore the feasibility and safety of an advanced, acellular, flowable wound matrix (FWM) in patients with diabetes-related cavity or tunnel lesions involving deep structures.

METHODS:

Patients with diabetic foot ulcers were hospitalized at the General and Geriatric Surgery Unit of the University of Campania in Naples, Italy, between March 2015 and December 2015. Twenty-three patients with tunneled or cavity ulcers were treated. The lesions were filled with the FWM. Surgical wound edges were either approximated with stitches or left to heal by secondary intention.

MAIN RESULTS:

After 6 weeks, 78.26% of patients completely healed after a single application of the FWM. The healing time for all healed wounds was 30.85 ± 12.62 days, or 26.11 ± 5.43 days in patients for whom wound edges were approximated by stitches, and 57.66 ± 3.05 days in the patients who healed by secondary intention (P = .01). Permanent tissue regeneration was observed in a high percentage of patients, and shorter healing time was achieved. Study authors observed a low rate of complications such as major amputation and increased hospitalization.

CONCLUSIONS:

The FWM seems ideal for tunneled and cavity ulcers with irregular geometry. This new porous matrix allows closure of the lesion while reducing healing time and demolition surgery

From PubMed

Origami Inspires New Tech for Tissue Regeneration

Origami – the Japanese art of folding paper into shapes and figures – dates back to the sixth century. At UMass Lowell, it is inspiring researchers as they develop a 21st century solution to the shortage of tissue and organ donors.

 

Gulden Camci-Unal, an assistant professor of chemical engineering, and her team of student researchers are designing new biomaterials that could someday be used to repair, replace or regenerate skin, bone, cartilage, heart valves, heart muscle and blood vessels, and in other applications.

 

Using origami as inspiration, Camci-Unal and her team are using plain paper to create centimeter-scale scaffoldings where the cells can grow and then applying microfabrication techniques to generate new biomaterials known as tissue mimetics.

 

“Paper is a low-cost, widely available and extremely flexible material that can be easily fabricated into three-dimensional structures of various shapes, sizes and configurations,” said Camci-Unal … read more

CBIC honors local tech entrepreneurs, students, teachers

Eleven leaders in tech — from high school students to large companies — were honored Thursday night during the Charlottesville Business Innovation Council’s annual awards gala.

 

The CBIC, a nonprofit council of technology-related businesses, organizes the gala every year to celebrate the area’s achievements in innovation.

 

“There’s so many things happening in Charlottesville, but it’s nowhere in one place,” said 2018 CBIC Student Entrepreneur of the Year Ashwinraj Karthikeyan. “Here, you can talk to all sorts of people doing really cool things in the entrepreneurial community.”

 

A recent graduate of the University of Virginia, Karthikeyan founded the chronic wound care company InMEDBio as a student. His award included a $1,000 grant.

 

More than 400 people attended the event at the Paramount Theater, which included a showcase of early-stage startups and an optional dance party.

 

“Two years ago, when I came to my first one of these, that’s where I met the person who helped make our first prototype,” said gala attendee Arjun Dirghangi while manning a table for his medical startup, Scanoptix … read more

Medical Adhesive-Related Skin Injury: Treatment and Prevention

by Holly M. Hovan MSN, APRN-ACNS-BC, CWOCN-AP

Medical adhesive-related skin injury, or MARSI, is a common type of skin injury, often seen in inpatient settings and in vulnerable populations with fragile skin such as older adults (decreased elasticity, usually multiple pre-existing comorbidities) or pediatric patients (skin is not fully developed). MARSI is caused by trauma to the skin from medical adhesives (think of things such as… tape used to secure a dressing after a blood draw, clear film dressings, ostomy pouches, external catheters in men, tube securement devices, surgical dressings, etc.). MARSI is not a pressure injury and is not caused by pressure.

 

Anytime we are consulted or asked to follow up on a new wound, one of the things we are assessing for is the cause of the wound or injury—trauma, pressure, moisture, friction, shear, impaired blood flow, etc. It is important to look at the big picture and what caused the wound or skin injury. Many variables can and do make wounds and skin conditions worse, but when determining the true etiology, we must look at what initially caused the problem … read more

Atypical Wounds: Scleroderma, Marjolin’s Ulcer

     and Kaposi’s Sarcoma (Part 2)

 

By Martin Vera, LVN, CWS

Part 2 in a series discussing the etiology, assessment and management of atypical wounds. Read Part 1 here.

 

As our journey through the exciting and uncharted, choppy waters of atypical wounds comes to a close, I discuss a few more wounds. The purpose and goal of this blog are to create awareness of other wounds that exist and instill the curiosity in my fellow clinicians to get our research done.

 

This blog describes a few atypical wounds, including scleroderma, Marjolin’s ulcer, and Kaposi’s sarcoma (KS). Even with the previous discussion of atypical wounds in this two-part series, many other atypical wounds exist, and I encourage and challenge you to educate yourselves and others, continue doing the research necessary to continue the battle to prevent and heal these wounds, and increase awareness to achieve early detection and have better chances for positive outcomes … read more

Imaging, surgical techniques may advance treatment of the diabetic foot

BARCELONA, Spain — The usual practices of orthopedic surgeons to manage the diabetic foot, including taking a team approach to this condition, have not changed but imaging and new technology and surgical approaches are playing a greater role in helping patients with a diabetic or Charcot foot joint recover, according to a presentation by Önder IKilicoglu, MD, at the EFORT Annual Congress.

 

“This is the real trend: The percent of diabetic patients is increasing in the Mediterranean area,” Kilicoglu, a professor at Istanbul University, said … read more

Efficacy of a New Flowable Wound Matrix in Tunneled

and Cavity Ulcers: A Preliminary Report

 

Abstract: Introduction. In chronic wounds the healing is stagnant, and regenerative surgery is often needed. Many engineered tissues with a conventional bidimensional sheet are ineffective for tunneling wounds, because adherence to the wound bed is not complete. An advanced wound matrix for treating wounds with irregular geometries has been developed (Integra Flowable Wound Matrix, Integra LifeScience Corp, Plainsboro, NJ).

 

Methods and Materials. Between March 2013 and December 2013 the authors treated 18 patients (11 female) with tunneled or cavity ulcers with the advanced wound matrix at the Unit of General and Geriatric Surgery of the Second University of Naples, Naples, Italy. Two patients (11.1%) had postsurgical wounds, two (11.1%) had post-traumatic wounds, and 14 (77.8%) had neuropathic ulcers. After debridement and antibiotic therapy, the lesions were filled with the wound matrix product. Surgical wound edges were either approximated with stitches or left to heal by secondary intention and covered with wet gauze. During the first week, follow-up visits were carried out every 3 days, then once a week until complete healing was achieved. All patients underwent preoperative and postoperative ultrasonography scans and plain radiograph controls. Results. Twenty-one applications were performed. Engraftment was complete in all but 1 patient who had diabetes and graft failure. Three patients needed repeated applications to complete the filling of the lesions. Median (range) pain Visual Analog Scores—on a scale of 0 to 10, where 0 = no pain, and 10 = intolerable pain—were 6.3 (range 3-8) preoperatively and 0.5 (range 0-2) at first follow-up (P ≤ 0.001). All but 2 patients showed a progressive remodeling of the tissue gap at scheduled radiographic controls. Conclusions. To the author’s knowledge, the advanced wound matrix used in this study is the only available biomaterial for the treatment of tunneled lesions. It stimulates tissue regeneration by filling surfaces which cannot be repaired spontaneously or by using conventional biomaterials in the form of sheets. Its application is atraumatic, painless, and safe … read more

Wound Care Nets Reimbursement “Wins” With Bipartisan Budget Act

The signing of the Bipartisan Budget Act of 2018 that took place Feb. 9 received much in the way of national media coverage because it ended the United States’ governmental shutdown. However, the act also provided the wound care industry some “wins” that were not well publicized. This article will focus on the major “wins” that pertain to wound care professionals who work in outpatient provider-based departments (PBDs) as well as various other sites of care and payment models.

 

REMOVED “DIRECT SUPERVISION” IN CRITICAL ACCESS PBDs

 

Hospital-based outpatient wound care PBDs are required to have direct physician supervision when Medicare beneficiaries are receiving therapeutic services. However, these same departments that are housed in critical access hospitals (CAHs) were exempt from the direct supervision requirement until 2014, when the Centers for Medicare & Medicaid Services (CMS) announced that it was going to enforce the direct-supervision requirement for CAHs. At that time, Congress stepped in and prevented CMS from enforcing the direct-supervision requirements for 2014, 2015, and 2016. However, Congress did allow CMS to enforce direct supervision in CAHs effective Jan. 1, 2017. That new requirement surprised many and caught staff members in the CAH space off guard, especially among those who did not have the availability of physicians or other qualified healthcare professionals who could be immediately available when patients were receiving care in the PBDs … read more

Peripheral arterial disease and the diabetic foot

Miranda Tawfik

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

How to Assess Wounds for Tunneling and Undermining

by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS

As part of a thorough wound assessment, in addition to noting location and measuring size, the entire wound bed should be probed for the presence of tunneling and/or undermining. If you are unsure what tunneling and undermining are and how to recognize these phenomena, here’s an explanation of these terms and how to assess wounds for their presence.

Tunneling Wounds

Tunneling is caused by destruction of the fascial planes which results in a narrow passageway. Tunneling results in dead space that has the potential for abscess formation. To measure tunneling, a probe is gently inserted into the passageway until resistance is felt. The distance from the tip of the probe to the point at which the probe is level with the wound edge represents the depth of the tunnel. Clock terms are often used to describe the position of the tunnel within the wound bed. This is helpful in identifying and remeasuring tunnel depth at a later time in order to assess progress of wound healing. Tunneling can occur in any wound, but it occurs most commonly in surgical wounds and wounds occurring from a neuropathic cause … read more

HIPAA calls it: Phone theft costs $650,000

Federal regulators lowered the boom on the former owner of several nursing homes after an iPhone containing the medical records of more than 400 residents was stolen.

 

Catholic Health Care Services of the Archdiocese of Philadelphia will pay $650,000 under settlement terms that also stipulate extensive self-analyses, documentation and improvement plans for patient record policies and practices … read more

Acellular Flowable Matrix in the Treatment of Tunneled or

     Cavity Ulcers in Diabetic Feet: A Preliminary Report

 

Campitiello, Ferdinando, MD; Mancone, Manfredi, PhD, MD; Della Corte, Angela, PhD, MD; Guerniero, Raffaella, MD; Canonico, Silvestro, MD

doi: 10.1097/01.ASW.0000531350.08738.34

 

OBJECTIVE: The authors aimed to explore the feasibility and safety of an advanced, acellular, flowable wound matrix (FWM) in patients with diabetes-related cavity or tunnel lesions involving deep structures.

 

METHODS: Patients with diabetic foot ulcers were hospitalized at the General and Geriatric Surgery Unit of the University of Campania in Naples, Italy, between March 2015 and December 2015. Twenty-three patients with tunneled or cavity ulcers were treated. The lesions were filled with the FWM. Surgical wound edges were either approximated with stitches or left to heal by secondary intention.

 

MAIN RESULTS: After 6 weeks, 78.26% of patients completely healed after a single application of the FWM. The healing time for all healed wounds was 30.85 ± 12.62 days, or 26.11 ± 5.43 days in patients for whom wound edges were approximated by stitches, and 57.66 ± 3.05 days in the patients who healed by secondary intention (P= .01). Permanent tissue regeneration was observed in a high percentage of patients, and shorter healing time was achieved. Study authors observed a low rate of complications such as major amputation and increased hospitalization.

 

CONCLUSIONS: The FWM seems ideal for tunneled and cavity ulcers with irregular geometry. This new porous matrix allows closure of the lesion while reducing healing time and demolition surgery … read more (purchase required)

IMR team receives prestigious award for wound healing with maggots

KUALA LUMPUR: A research team from the Institute of Medical Research (IMR) that made a breakthrough in wound healing with the use of maggots has been conferred the Dr Lee Jong-Wook Memorial Prize for Public Health at the 71st World Health Assembly (WHA).

 

The World Health Organisation (WHO) in Geneva, Switzerland made the announcement on Friday (May 25), said Health director-general Datuk Dr Noor Hisham Abdullah.

 

The WHA president conferred the prize to lead researcher Dr Nazni Wasi Ahmad, from the IMR, for her exemplary contributions in Maggot Debridement Therapy (MDT).

 

It is a type of biotherapy using live, sterile fly larvae or maggots in non-healing wound of a human or animal to remove dead cells and reduce bacterial contamination of the wound and stimulate healing, he said.

 

“It is a safe, effective and affordable alternative treatment that is available at any time and in any healthcare setting, mainly primary healthcare facilities, to treat diabetic foot ulcers.” said Dr Noor Hisham in a statement

Read more at https://www.thestar.com.my/news/nation/2018/05/25/imr-team-receives-prestigious-award-for-wound-healing-with-maggots/#OPMgFDYuWe9IzjPL.99

Wound Debridement Options

     The 5 Major Methods

 

There are five types of non-selective and selective debridement methods, but many factors determine what method will be most effective for your patient.1 Determining the debridement method is based not only on the wound presentation and evaluation, but also on the patient’s history and physical examination. Looking at the “whole patient, not only the hole in the patient,” is a valuable quote to live by as a wound care clinician. Ask yourself or your patient these few questions: Has the patient had a previous chronic wound history? Is your patient compliant with the plan of care? Who will be performing the dressing changes? Are there economic factors that affect the treatment plan? Take the answers to these questions into consideration when deciding on debridement methods.

 

The Primary Methods of Debridement: BEAMS
BEAMS is an mnemonic that is widely used to remember the five types of wound debridement … read more

 

Creating an Ideal Microenvironment for Wound Cleansing

[Sponsored by Angelini Pharma, Inc.]

 

With so much focus on dressing choices, it’s easy to forget the importance of wound cleansing. Wound cleansing can help achieve the goals of wound bed preparation by removing microorganisms, biological and environmental debris to create an environment beneficial to healing as well as facilitating wound assessment by allowing clear visualization of the wound.

read more (registration required)

Diabetic Foot Ulcer Prevention System (DFUPS)

The purpose of this study is to investigate whether regular measurement of skin foot temperature with a novel device (DFUPS) will prevent ulcer recurrence in diabetic patients at high risk of foot ulceration. It is planned to regularly measure the temperature of the feet of people with diabetes who have already had a foot ulcer which has subsequently healed. These measurements should allow the identification of hotspots on the foot and may be helpful when advising about ulcer risk and providing preventative treatment. It is hoped to find out whether the regular use of thermal images taken with the DFUPS device together with standard foot treatment may reduce the number of people with diabetes developing ulcers or even prevent foot ulcers … read more

NATROX® Symposium at EWMA 2018

Inotec AMD hosted a well-attended symposium at the 2018 EWMA Conference in Krakow (Poland).

 

The Symposium focused on the vital role of oxygen in chronic wound healing and the importance of the Inotec’s NATROX® Oxygen Wound Therapy supported by three key speakers of the calibre of Paul Hayes, Hanna Kaufman and Thomas Serena.

 

Paul Hayes, vascular surgeon from the UK, discussed the role of topical oxygen in wound healing presenting the latest evidence on the matter. Hanna Kaufman, orthopaedic surgeon from Israel, shared the intriguing results of her 99-patient NATROX® study on non-healing wounds. Thomas Serena, founder and medical director of SerenaGroup in the US, explored the future of oxygen wound therapy.

 

NATROX® Oxygen Wound Therapy is an innovative, simple and easy-to-use device that has been clinically proven to deliver 98% pure humidified oxygen direct to the wound bed.

post from Natrox Oxygen Wound Therapy

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.”

read more

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.

Read more at: https://www.wearabletechnologyinsights.com/articles/14270/connected-sensors-for-the-prevention-of-chronic-ulcers

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

 

Introduction
On any given day in Australia, the national burden of diabetes-related foot disease (DFD) is
significant:
• 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

download pdf

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 www.nawccb.org.

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

 

Abstract

Objectives

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.

Results

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.

Introduction

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 emsworldexpo.com.

 

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 hmpglobal.com.

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: alyane.vazquez@cigb.edu.cu. 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

 

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

 

Method:
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

Introduction

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.

Methods

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

Abstract

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

Objective

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).

Results

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.

Conclusion

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

Keywords: amniotic membrane, ulcer, placenta, cesarean section

Introduction

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).

An external file that holds a picture, illustration, etc. Object name is ijwh-8-225Fig3.jpg

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).

Results

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.

An external file that holds a picture, illustration, etc. Object name is ijwh-8-225Fig4.jpg

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).

Discussion

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.

Conclusion

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.

Footnotes

Disclosure

The authors report no conflicts of interest in this work.

References

1. Meller D, Pauklin M, Thomasen H, Westekemper H, Steuhl K-P. Amniotic membrane transplantation in the human eye. Dtsch Ärztebl Int. 2011;108:243–248. [PMC free article] [PubMed]
2. Kubo M, Sonoda Y, Muramatsu R, Usui M. Immunogenicity of human amniotic membrane in experimental xenotransplantation. Invest Ophthalmol Vis Sci. 2001;42:1539–1546. [PubMed]
3. Tseng S, Li D, Ma X. Suppression of transforming growth factor-beta isoforms, TGF-beta receptor type II, and myofibroblast differentiation in cultured human corneal and limbal fibroblasts by amniotic membrane matrix. J Cell Physiol. 1999;179(3):325–335. [PubMed]
4. Hao Y, Ma D, Hwang D, Kim W, Zhang F. Identification of antiangiogenic and antiinflammatory proteins in human amniotic membrane. Cornea. 2000;19(3):348–352. [PubMed]
5. Šplíchal I, Trebichavský I. Cytokines and other important inflammatory mediators in gestation and bacterial intraamniotic infections. Folia Microbiologica. 2001;46(4):345–351. [PubMed]
6. Kanyshkova T, Buneva V, Nevinsky G. Lactoferrin and its biological functions. Biochemistry (Moscow) 2001;66(1):1–7. [PubMed]
7. Lo V, Pope E. Amniotic membrane use in dermatology. Int J Dermatol. 2009;48(9):935–940. [PubMed]
8. Kim J, Kim J, Na B, Jeong J, Song S. Amniotic membrane patching promotes healing and inhibits proteinase activity on wound healing following acute corneal alkali burn. Exp Eye Res. 2000;70(3):329–337. [PubMed]
9. Maral T, Borman H, Arslan H, Demirhan B, Akinbingol G, Haberal M. Effectiveness of human amnion preserved long-term in glycerol as a temporary biological dressing. Burns. 1999;25:625–635. [PubMed]
10. Loeffelbein D, Rohleder N, Eddicks M, et al. Evaluation of human amniotic membrane as a wound dressing for split-thickness skin-graft donor sites. Biomed Res Int. 2014;2014:572183. [PMC free article][PubMed]
11. Singh R, Chouhan U, Purohit S, et al. Radiation processed amniotic membranes in the treatment of nonhealing ulcers of different etiologies. Cell Tissue Bank. 2004;5:129–134. [PubMed]
12. Marvin K, Keelan J, Eykholt R, Sato T, Mitchell M. Expression of angiogenic and neuotrophic factors in the human amnion and chorio-decidua. Am J Obstet Gynecol. 2002;187:728–734. [PubMed]
13. Toda A, Okabe M, Yoshida T, Nikaido T. The potential of amniotic membrane/amnion-derived cells for regeneration of various tissues. J Pharmacol Sci. 2007;105:215–228. [PubMed]
14. Mermet I, Pottier N, Sainthillier JM, et al. Use of amniotic membrane transplantation in the treatment of venous leg ulcers. Wound Repair Regen. 2007;15:459–464. [PubMed]
15. Pesteil F, Oujaou-Faïz K, Drouet M, et al. Cryopreserved amniotic membranes use in resistant vascular ulcers. J Mal Vasc. 2007;32(4–5):201–209. [PubMed]
16. Alsina-Gibert M, Pedregosa-Fauste S. Amniotic membrane transplantation in the treatment of chronic lower limb ulcers. Actas Dermosifiliogr. 2012;103(7):608–613. [PubMed]
17. Litwiniuk M, Bikowska B, Niderla-Bielińska J, et al. Potential role of metalloproteinase inhibitors from radiation sterilized amnion dressings in the healing of venous leg ulcers. Mol Med Rep. 2012;6(4):723–728. [PubMed]
18. Sheikh E, Sheikh E, Fetterolf D. Use of dehydrated human amniotic membrane allografts to promote healing in patients with refractory non healing wounds. Int Wound J. 2014;11(6):711–717. [PubMed]
19. Zelen CM, Serena TE, Snyder RJ. A prospective, randomised comparative study of weekly versus biweekly application of dehydrated humanamnion/chorion membrane allograft in the management of diabetic foot ulcers. Int Wound J. 2014;11(2):122–128. [PMC free article] [PubMed]
20. Stacey M, Burnand K, Layer G, Pattison M, Browse NL. Measurement of the healing of venous ulcers. Aust N Z J Surg. 1991;61(11):844–848. [PubMed]
21. Nelzén O, Bergqvist D, Lindhagen A. Leg ulcer etiology – a cross sectional population study. J Vasc Surg. 1991;14(4):557–564. [PubMed]
22. Azuara-Blanco A, Pillai CT, Dua HS. Amniotic membrane transplantation for ocular surface reconstruction. Br J Ophthalmol. 1999;83:399–402. [PMC free article] [PubMed]
23. Gomes J, Romano A, Santos M, Dua H. Amniotic membrane use in ophthalmology. Curr Opin Ophthalmol. 2005;16:233–240. [PubMed]
24. Alio JL, Abad M, Scorsetti DH. Preparation, indications and results of human amniotic member transplantation for ocular surface disorders. Expert Rev Med Devices. 2005;2:153–160. [PubMed]
25. Mamede A, Carvalho M, Abrantes A, Laranjo M, Maia C, Bothelho M. Amniotic membrane; from structure and functions to clinical applications. Cell Tissue Res. 2012;349:2447–458. [PubMed]

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

ACELL, INC. ANNOUNCES LAUNCH OF GENTRIX® INCISIONAL

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.

Contact

Angela Ortado
410-953-8527
angelaortado@acell.com

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

 

Methods
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.

 

Findings
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

Discussion
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

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

 

Method:
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

Abstract:
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.

 

METHODS:
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.

 

RESULTS:
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.

 

CONCLUSION:
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).

read more

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.”

read more

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

 

Assessment

 

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

 

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

Consolidate the coding process with the Coding Companion, your one-stop resource developed exclusively for those who code for podiatric medicine. This comprehensive and easy-to-use guide includes 2018 CPT®, HCPCS, and ICD-10-CM code sets specific to your specialty. Each specialty-specific procedure code includes its official description and lay description, coding tips, terminology, cross-coding to common ICD-10-CM, and relative value units. Getting to the code information you need has never been so easy.

 

Key Features and Benefits

New Code icons. Quickly identify new, revised and add-on procedure codes related to podiatry.

 

New CPT® Assistant references. Identifies that an article or discussion of the CPT code has been in the American Medical Association s CPT Assistant newsletter. Use the citation to locate the correct volume.

 

Optum360 Edge HCPCS procedure codes. Only Optum360 offers HCPCS procedure codes specific to your specialty with the same information as we provide for CPT codes.

 

Quickly find information. All the information you need is provided, including illustrations, lay descriptions, coding tips, terms, cross-coding, Medicare RVUs and Pub. 100 references.

 

Organized by CPT® and HCPCS procedure code. Essential procedures for podiatry are listed by CPT® or HCPCS procedure code, along with crosswalks to common ICD-10-CM diagnosis codes.

 

Easily determine fees for your practice and reinforce consistency in the charges. Relative value units including the practice, work, and malpractice components with total RVUs for non-facility and facility for procedures are included.

 

Avoid claim denials and/or audits. Medicare payer information provides the references to Pub. 100 guidelines, follow-up days, and assistant-at-surgery.

 

CCI edits by CPT® and HCPCS procedure code. CPT® and HCPCS procedure codes with associated CCI edits in a special section and quarterly updates available online.

 

Buy Now

 

CPT® is a registered trademark of the American Medical Association

 

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)