Abstract:

While we move toward the brink of being able to regenerate or replace human cells, tissues, or organs to restore or establish normal function, we are not there yet. The techniques that are available and being brought to bear on the field of chronic wounds include: growth factors, gene therapy, stem cell transplantation, tissue engineering, and reprogramming cell and tissue types. We review the biomedical techniques from bench to animal to human application. The clinical approaches from what has been tried in clinical growth factor application to the injection of stem cells or progenitor cells directly into a wound (cell therapy) are also reviewed. In addition, newly opening trials in topical cell therapy, injectable stem cell therapy, and topical autologous growth factor are addressed. Although tissue engineering is a very significant portion of regenerative medicine, it has recently been addressed well by other authors. We focus on why we are spending less time on specific growth factor therapy and more resources on cellular therapy. Finally, we address where negative pressure wound therapy fits into regenerative medicine.

Authors:

John C. Lantis II, MD, FACS, Chief of the Division of Vascular/Endovascular Surgery, St Luke's-Roosevelt Hospital, Associate Clinical Professor of Surgery, Columbia University, New York, New York

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Abstract:

Chronic wounds represent a significant burden to patients, health care professionals, and the health care system. Micro-RNAs (miRNAs) have recently emerged as a novel class of gene expression modulators involved in regulation of multiple biological processes, including development, differentiation, organogenesis, inflammation, cell proliferation, growth control, and apoptosis. Importantly, aberrant expression or activity of miRNAs can lead to a disease state. However, the role of miRNAs in chronic wounds remains to be elucidated. This article reviews available literature on the role of miRNAs in a range of processes important for successful wound healing including epidermal differentiation and proliferation, inflammation and angiogenesis. The potential role of miRNAs in normal wound healing and their contribution to chronic wound pathology has been anticipated. The prospective use of miRNAs as markers for surgical debridement, and as novel diagnostic and therapeutic targets for chronic wounds is also discussed.

Authors:

Irena Pastar, PhD, Research Assistant Professor, Wound Healing and Regenerative Medicine Research Program, Department of Dermatology & Cutaneous Surgery, University of, Miami Miller School of Medicine, Miami, Florida, Horacio Ramirez, BS, Graduate Student, Wound Healing and Regenerative Medicine Research Program, Department of, Dermatology & Cutaneous Surgery, PIBS, Human Genetics and Genomics Program, University of Miami Miller School of Medicine, Miami, Florida, Olivera Stojadinovic, MD, Research Assistant Professor, Wound Healing and Regenerative Medicine Research Program, Department of Dermatology & Cutaneous Surgery, University of Miami Miller School, of Medicine, Miami, Florida, Harold Brem, MD, Professor and Chief, Division of Wound Healing and Regenerative , Medicine, Winthrop University Hospital, Mineola, New York, Robert S. Kirsner, MD, PhD, Professor and Vice Chairman, Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, Marjana Tomic-Canic, PhD, Professor and Director, Wound Healing and Regenerative Medicine Research Program, Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine Miami, Florida

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Abstract:

Most commercial diving operations and naval operations have 24/7, on-site availability of hyperbaric oxygen therapy to perform routine surface decompression or immediate treatment of arterial gas embolism or decompression sickness. Availability and prompt use of hyperbaric oxygen therapy in the field for treatment of divers with dysbaric conditions has demonstrated its efficacy in acute, co-morbid conditions such as acute exsanguination, blast injury, crush injury, and cardiopulmonary arrest affecting those same divers. Hyperbaric oxygen therapy applied in these cases has demonstrated its utility to augment the efficacy of conventional, pre-hospital advanced cardiac life support and advanced trauma life support. Case studies gleaned from actual experience with the diving industry illustrate the use of hyperbaric oxygen therapy in these conditions. The unexpectedly favorable results have been replicated by controlled laboratory animal studies. The deck decompression or saturation multiplace chambers used by offshore diving operations can easily and quickly be converted for use as medical field resuscitative units. Lightweight and mobile hyperbaric chambers can be outfitted for use in ambulances or helicopters to address civilian street injury or military "far-forward" injury. These transport chambers are compact in design to be efficient transport stretchers designed to hold both the patient and the medical support clinician. It is hoped that hyperbaric oxygen therapy will gain an increasing role as an adjunct to pre-hospital advanced cardiac life support and advanced trauma life support resuscitative efforts as a low-cost, high-yield intervention. In this regard HBO as applied to ATLS/ACLS in civilian and military medical systems may be a productive, disruptive new application of technology.

Authors:

Keith Van Meter, MD, Chief, Section of Emergency Medicine, LSU Health Sciences Center, Clinical Professor of Medicine, LSU Health Sciences Center , Clinical Professor of, Surgery, Tulane University School of Medicine, New Orleans, Louisiana

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Abstract:

Harnessing light energy in the form of lasers became possible after the discovery of electricity. Scientists found various uses for lasers beginning in the 1960s. Creating large amounts of pulsed UV light with any device, including a laser, remained difficult until excimer lasers were invented in the following decade. The invention of excimer lasers coincided with the advent of balloon angioplasty, leading physicians to speculate about using laser energy to obliterate obstructing arterial lesions. The first report of laser energy to vaporize an atherosclerotic plaque appeared in 1980. The ensuing decades witnessed dramatic refinements of laser fibers, laser energy sources, and catheter delivery systems. The favorable results achieved with excimer laser angioplasty in the early 2000s led to a renewed interest in this technology and to the current widespread use of these devices to treat peripheral as well as coronary artery disease. This paper provides a review of laser energy principles, traces the history of the use of lasers to treat vascular disease, and reviews the current literature pertaining to laser angioplasty and limb salvage.

Authors:

Steven G. Friedman, MD, Chairman, Department of Surgery, New York Downtown Hospital, Professor of Clinical Surgery, Weill Cornell Medical College, New York, New York

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