Acell

Abstract:

Negative Pressure Wound Therapy (NPWT) is an important clinical tool with multiple published studies reporting more rapid formation of granulation tissue and a decreased time for wound healing. Since the induction of NPWT systems in 1995, there has been wide usage of the device for treatment of wounds. However, the past 18 years has also witnessed a significant shift in the way NPWT is utilized. Meeting the demands and wound care needs of an ever-growing population has resulted in several other companies releasing their versions of the NWPT device. Although there is a significant body of literature supporting the science and clinical advantages of the KCI system, the newer systems differ in terms of suction devices, connecting tubing, and wound interface materials. It cannot be assumed that the newly developed devices have the same science and clinical advantages as the KCI System. The purpose of this article is to review the science behind NPWT, assess and compare the currently available devices, and examine the scientific literature supporting the efficiency and application of NPWT in wound reconstruction.

Authors:

Stephanie C. Wu, DPM, MS, FACFAS, Associate Dean of Research, Associate Professor of Surgery, Associate Professor, Stem Cell and Regenerative Medicine, Dr. William M. Scholl College of Podiatric Medicine , Rosalind Franklin University of Medicine and Science, Director, Center for Lower Extremity Ambulatory Research, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, Melissa K. Skratsky, DPM, Assistant Professor, Department of Podiatric Medicine and Radiology, Dr. William M. Scholl College of , Podiatric Medicine, Rosalind Franklin University, North Chicago, Illinois, Charles A. Andersen, MD, FACS, Chief, Vascular, Endovascular, Limb Preservation Surgery Service, Medical Director of Wound Care Clinic, Clinical Professor of Surgery UW, USUHS, Madigan Army Medical Center, Tacoma, Washington

PMID: 23975442

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B. Braun

Abstract:

Diabetes-related foot complications are a major cause of amputation. The presence of peripheral arterial disease (PAD) identifies those at increased risk of ulceration, failure to heal an ulcer, and amputation. This systematic review assesses the ability of noninvasive screening tests to detect PAD in patients with diabetes mellitus. A database search was performed using the OVIDSP Web site, from 1946 to June 30, 2012 (MEDLINE®), and from 1974 to June 30, 2012 (EMBASE), to identify studies assessing the utility of screening tests in detecting PAD or predicting clinical outcomes in patients with diabetes mellitus. Thirteen studies were identified that reported sensitivity and specificity data on screening tests. No single screening test was reliable in identifying or excluding peripheral arterial disease in patients with diabetes. Although the evidence base is limited, transcutaneous oxygen measurements appear to be predictive of ulcer or surgical wound healing. The diagnosis of PAD (and the decision to revascularize) in patients with diabetes is unreliable using screening tests. Therefore, all patients with diabetes-related foot ulceration should be assessed by a multidisciplinary diabetes foot team that has access to a vascular specialist. A low threshold for noninvasive diagnostic imaging seems appropriate in patients with diabetes-related foot ulceration.

Authors:

Baris A. Ozdemir, BSc, MRCS, Clinical Research Fellow, Specialist Registrar in Vascular Surgery, Jack R. Brownrigg, BSc, Academic Core Trainee Doctor, Keith G. Jones, MS, FRCS, Consultant Vascular Surgeon, Matt M. Thompson, MD, FRCS, Professor/Consultant in Vascular Surgery, Robert J. Hinchliffe, MD, FRCS, Senior Lecturer/Consultant in Vascular Surgery, St. George’s Vascular Institute, St. George’s Healthcare NHS Trust, London, United Kingdom

PMID: 23975445

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Abstract:

The heel is a common site of pressure ulcers. The amount of pressure and time needed to develop these wounds is dependent on various factors including pressure surface, the patient's anatomy, and co-morbidities. We studied the use of the hemoglobin saturation ratio as a means of assessing heel perfusion in various pressure settings. The mixed perfusion ratio in the heels of 5 volunteers was assessed on 3 pressure surfaces and at the time of off-load. The surfaces studied included: stretcher pad, plastic backboard without padding, and pressure reduction gel. Each surface was measured for 5 minutes with a real-time reading. On the stretcher, the average StO2% decrease for each pressure surface was 26.2 ± 10 (range 18-43). The average StO2% decrease on the backboard was 22.8 ± 12.3 (range 8-37), and 24.0 ± 4.8 (range 19-30) on the gel pad. The StO2% drop plateaued with the stretcher and gel pad, but with the backboard there was a continued slow drop at 5 minutes. This study demonstrates that hemoglobin oxygenation ratio may be effective in assessing a tissue's direct perfusion in the setting of tissue pressure and may also be beneficial to better assess the effects of pressure-reduction surfaces. Further studies will be needed to determine time to skin breakdown as it pertains to pressure and tissue oxygenation.

Authors:

Kristen A. Aliano, MD, Research Fellow, Steve Stavrides, PA-C, LIPSG Physician Assistant, Thomas Davenport, MD, Attending Physician, Long Island Plastic Surgical Group, Garden City, New York

PMID: 23700185

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3 M

Abstract:

Leg ulceration, often caused by venous stasis, arterial insufficiency, or both, is a common chronic health condition often associated with a prolonged healing trajectory and frequent recurrence. It is estimated that approximately 1.5 to 3.0 per 1,000 adults have active leg ulcers, and the prevalence continues to increase due to an aging population. Management of chronic edema using compression is crucial to promote healing of venous leg ulcers. The principle of compression therapy is simple, involving the use of external pressure in the forms of bandages or wraps to move the fluid from the interstitial space back into the intravascular compartment and prevent reflux. This article synthesizes and appraises the evidence for various types of compression therapies. It also addresses best practice recommendations for the management of leg ulcers when arterial circulation is considered suboptimal.

Authors:

Kevin Y. Woo, PhD, RN, FAPWCA, Assistant Professor, School of Nursing, Queen’s University, Kingston, Ontario, Canada, Afsaneh Alavi, MD, FRCPC, Lecturer, University of Toronto, Toronto, Ontario, Canada, Robyn Evans, MD, CCFP , Director, Wound Healing Clinic, Women's College Hospital, Toronto, Ontario, Canada, Marc Despatis, MD, MSc, RVT, FRCSC, Chief of Vascular Surgery and Transplantation, Centre Hospitalier de Sherbrooke, Sherbrooke, Quebec, Canada, Jill Allen, MCISc ,WOCN/ET, RN, Professional Services Specialist, 3M Canada Company, London, Ontario, Canada

PMID: 24081848

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