Abstract:

As the prevalence of chronic wounds continues to rise, the need for point of care wound assessment has also increased. While a variety of technologies have been developed to improve diagnostic abilities and monitoring of wounds, none have proven completely effective in all settings. Further, many of the stalwart wound management techniques remain costly, time consuming, and technically challenging. The two key pivotal events of ischemia and infection can lead to limb loss. A relatively new crop of fluorescence-based technologies, including devices that measure pathogenic auto-fluorescence, fluorescence angiography, or map cutaneous oxygenation, are increasingly being utilized for adjunct wound assessment—both clinical and operative settings can address these events. These technologies offer rapid, efficient, visual, and quantitative data that can aid the wound provider in evaluating the viability of tissues, ensuring adequate perfusion, and optimizing wound bed preparation. In the following review, pathogenic auto-fluorescence is compared to gross evaluation of wound infection and culture based diagnostics, indocyanine green fluorescence angiography is compared to various methods of visual and physical assessments of tissue perfusion by the practitioner, and cutaneous oxygenation is compared to clinical signs of ischemia. We focus on the current applications of fluorescence technologies in wound management, with emphasis placed on the evidence for clinical and operative implementation, a safety analyses, procedural limitations, and the future direction of this growing field of wound assessment.

Authors:

Daniel E. Wainstein, MD, Staff Surgeon, Pirovano Hospital, Buenos Aires, Argentina, Pablo Sisco, MD, Chief Surgeon, Pirovano Hospital, Buenos Aires, Argentina, María L. Deforel, MD, Medical Staff, Pirovano Hospital, Buenos Aires, Argentina, Mariano Irigoyen, MD, Staff Surgeon, British Hospital, Buenos Aires, Argentina, Jorge Devoto, MD, Concurrent, Pirovano Hospital, Buenos Aires, Argentina, Juan M. Zarate, Resident, Pirovano Hospital, Buenos Aires, Argentina

For Direct IP Access please click this link

Abstract:

Hyperbaric oxygen (HBO) therapy is a versatile modality that has applications across several medical fields. HBO therapy has become a valuable asset in the management of compromised tissue grafts and flaps. Although classified together, grafts and flaps are distinctly different, in that grafts depend on the wound bed for revascularization, whereas flaps have an inherent blood supply. Evidence has shown that in a compromised graft suffering from hypoxia, HBO can maximize viability and reduce the need for repeat grafting. By comparison, compromised flaps can suffer from both ischemic and reperfusion injury, which can also be attenuated by HBOT to maximize viability. The beneficial effects of HBO occur by several mechanisms, including hyper-oxygenation, fibroblast proliferation, collagen deposition, angiogenesis, and vasculogenesis. Animal studies have demonstrated several of these mechanisms, including an increase in the number, size, and growth distance of blood vessels after HBO. Likewise, clinical studies have found positive responses in multiple types of tissue grafts and flaps, with some cases involving irradiated fields. Altogether, the data emphasizes that early identification of flap or graft compromise is absolutely critical, with maximized chance for viability when HBO is initiated as soon as possible.

Authors:

Lisa J. Gould, MD, PhD, FACS, Medical Director, Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, RI, Affiliate Professor, Department of Molecular Pharmacology and Physiology, University of South Florida Tampa, Florida, Todd May, DO, Fellow, Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, RI

For Direct IP Access please click this link

Abstract:

As the prevalence of chronic wounds continues to rise, the need for point of care wound assessment has also increased. While a variety of technologies have been developed to improve diagnostic abilities and monitoring of wounds, none have proven completely effective in all settings. Further, many of the stalwart wound management techniques remain costly, time consuming, and technically challenging. The two key pivotal events of ischemia and infection can lead to limb loss. A relatively new crop of fluorescence-based technologies, including devices that measure pathogenic auto-fluorescence, fluorescence angiography, or map cutaneous oxygenation, are increasingly being utilized for adjunct wound assessment—both clinical and operative settings can address these events. These technologies offer rapid, efficient, visual, and quantitative data that can aid the wound provider in evaluating the viability of tissues, ensuring adequate perfusion, and optimizing wound bed preparation. In the following review, pathogenic auto-fluorescence is compared to gross evaluation of wound infection and culture based diagnostics, indocyanine green fluorescence angiography is compared to various methods of visual and physical assessments of tissue perfusion by the practitioner, and cutaneous oxygenation is compared to clinical signs of ischemia. We focus on the current applications of fluorescence technologies in wound management, with emphasis placed on the evidence for clinical and operative implementation, a safety analyses, procedural limitations, and the future direction of this growing field of wound assessment.

Authors:

Ersilia L Anghel, BS, BA, Diabetic Limb Salvage Research Fellow, Department of Plastic Surgery, Georgetown University Hospital, Washington DC, Reuben A Falola, MPH, Medical Student Research Scholar, Department of Plastic Surgery, Georgetown University Hospital, Washington DC, Paul J Kim, DPM, MS, Associate Professor, Director of Research, Department of Plastic Surgery, Georgetown University Hospital, Washington DC

For Direct IP Access please click this link

Abstract:

Persistence of skin wounds due to underlying disease, bacterial contamination, and/or repeated trauma, causes a chronic condition where a functional extracellular matrix (ECM) cannot be established and the normal wound-healing cascade is unable to progress. These open chronic wounds leave the body susceptible to infection and present a major healthcare problem. To this end, a broad range of biologic ECM scaffolds have been developed that can provide other therapeutic options aside from traditional wound care approaches. These tissue engineered ECM scaffolds aim to facilitate the restoration of functional skin-like tissue by altering the chronic wound environment and facilitating cellular attachment, proliferation, and differentiation. This discussion will center on reviewing current ECM scaffolds and highlighting their properties and mechanism of action with respect to the clinical application in chronic, non-healing wounds.

Authors:

Thais O. Polanco, MD, Vascular Surgery Research Fellow, Mount Sinai St. Luke’s-West Hospitals, New York, NY,Joanna Xylas, PhD, Professional Affairs and Medical Education, Regenerative Orthopedics & Tissue Technologies, Integra LifeSciences, Plainsboro, NJ, John C. Lantis II, MD, Vice Chairman Department of Surgery, Chief of Vascular/Endovascular Surgery, Mount Sinai St. Luke’s-West Hospitals, New York, NY

For Direct IP Access please click this link