Hollister

Abstract:

Increased bacterial burden and formation of biofilm has been recognized as one of the key factors contributing to delayed wound healing. There is a toolbox of topical antimicrobial wound dressings that incorporate silver, iodine, polyhexamethylene biguanide, methylene blue/gentian violet, and honey. This article reviews a diverse range of evidence to discuss the advantages and disadvantage of topical antimicrobial dressings. Discussion will provide guidance on when and how to use topical antimicrobial dressings to achieve optimal outcomes and cost-effective wound care. Chronic wounds do not follow a predictable and expected healing trajectory, and they may persist for months or years due to underlying disease processes, recurrent injury, and comorbidities.1 With an aging population and increased prevalence of chronic diseases, the majority of wounds are refractory to healing, placing a significant burden on the health system and individual patients. Bacterial burden and biofilm have been recognized as key factors contributing to persistent inflammation, tissue destruction, delayed wound healing, and other serious complications (especially in individuals who are frail and immune-compromised).2 It has been demonstrated that when bacterial growth reaches a critical threshold of 105 bacteria per gram of tissue, bacterial toxins can cause tissue damage in the superficial wound compartment, delaying healing.2 In the literature, this phenomenon is referred to as critical colonization, increased bacterial burden, superficial infection, or localized infection. According to a recent review, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized infection

Authors:

Kevin Y. Woo, PhD, RN, FAPWCA, Assistant Professor, School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada, Tarik Alam, RN, BScN, ET, MClSc, Product Manager, Wound Care, Hollister Limited,Aurora,  Ontario, Canada, Joseph Marin, BSCH, BNSc, Student, Queen's University, Kingston, Ontario, Canada

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Abstract:

Introduction: Skin grafts have long been an important tool in reconstructive surgery. However, traditional autografts have several disadvantages, including the need for a surgical procedure with anesthesia, creation of a second wound at the donor site, difficulty in obtaining uniform graft thickness, scarring, and pain. Epidermal skin grafts offer an alternative to split- and full-thickness skin grafts in that only the epidermal skin layer is removed at the donor site, resulting in minimal to no bleeding, minimal scarring and donor site pain, improved cosmetic outcome, and no need for anesthesia. Although epidermal grafts have been successfully used for many decades in treating pigmentation disorders, its expanded use for wounds has been limited largely due to lack of a reliable method of harvesting patient epidermal skin. We present our experience using a new automated, epidermal harvesting system to harvest epidermal grafts in patients with multiple comorbidities; an overview of the history and mechanisms of epidermal grafting is
included to help inform clinical practice. The epidermal harvesting system applies heat and suction concurrently to normal skin to induce epidermal microdome formation within 30 to 45 minutes, and harvested epidermal grafts are transferred to recipient sites via a film dressing. In this patient series, donor sites healed completely without scarring within one to two weeks. Complete reepithelialization occurred in three of four wounds, and 50% re-epithelialization occurred in one wound. New technology in epidermal grafting offers a simple, relatively quick, low-risk option that can be performed by a non-surgically trained clinician in an outpatient setting.

Authors:

Allen Gabriel, MD, FACS, Chief of Plastic Surgery, Rachel V. Sobota, RN, CNOR, RNFA, Manish Champaneria, MD, PeaceHealth Medical Group Plastic Surgery, Vancouver, WA, Rachel Sobota, RN, PeaceHealth Medical Group Plastic Surgery, Vancouver, WA

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Abstract:

Hallux rigidus is marked by degenerative osteoarthritis of the first metatarsophalangeal (MTP) joint with pain and stiffness in the joint, with first ray plantarflexion and dorsiflexion, swelling and inflammation surrounding the first MTP joint, and reduced sagittal plane motion. Treatment of mild cases of hallux rigidus focuses on conservative, nonsurgical treatments such as rigid orthotic devices, physical therapy, pain relievers, and corticosteroid injections. Hallux rigidus recalcitrant to conservative management can be treated with dorsal cheilectomy to palliate pain at extremes of motion. Post-cheilectomy scarring and stiffness of the joint result in a diminished arc of motion over time. This clinical problem is not readily addressed by current treatment methods. Amniotic membrane/umbilical cord has the potential to modulate adult wound healing by suppressing stromal cellular-based inflammation and reducing scarring. Cryopreserved amniotic membrane/umbilical cord (AM/UC) tissue has been successfully used for minimizing postoperative inflammation, pain, and adhesion formation following various soft tissue reconstructive procedures, particularly in ophthalmology. Recently, the therapeutic potential of cryopreserved AM/UC has been expanded for use in lower extremity reconstructive procedures, specifically where wound healing and adhesion prevention are of clinical significance. This article reviews a bilateral case report experience of the novel utility of cryopreserved AM/UC tissue as an adhesion barrier and inflammatory modulator in conjunction with dorsal cheilectomy for treatment of hallux rigidus.

Authors:

John Kent Ellington, MD, Orthopaedic Surgeon, OrthoCarolina, Charlotte, North Carolina, Chad M. Ferguson, MD, Orthopaedic Surgery Resident, Carolinas Medical Center, Charlotte, North Carolina

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Abstract:

This article presents a literature review undertaken to identify advantages of vacuum-assisted closure (VAC) methods compared with other temporary abdominal closure (TAC) methods for septic peritonitis open abdomen (OA) management. A literature review was conducted through the U.S. National Library of Medicine at the National Institutes of Health. OA management and septic peritonitis were the main topics considered for this purpose. Online available information from papers discussed at relevant meetings and congresses was also included for review. The search was designed following the Patient Intervention Comparison Outcome Criteria. All shortlisted articles were reviewed by two authors independently. The review resulted in 79 items. Only one randomized study was found and considered for review. A large variety of TAC methods for OA are reported in the available literature to date and are described with a heterogeneous set of names. VAC methods allow the possibility of draining and accounting for fluids collecting in the peritoneal cavity. VAC may offer a solution to fascial closure problems. VAC helps prevent peritoneal contamination. Intra-abdominal hypertension prevention is one factor undoubtedly favoring VAC methods against non-VAC ones for OA management in septic peritonitis.

Authors:

Stefano Rausei, MD, PhD, General Surgery Consultant, Department of Surgery, Insubria University, Varese, Italy, Francesco Amico, MD, General Surgery Registrar, Department of Surgery, Insubria University, Varese, Italy, Research Fellow, Department of Medicine, University of Melbourne, Melbourne, Australia, Francesco Frattini, MD, Consultant General Surgeon, Department of Surgery, Insubria University, Varese, Italy, Francesca Rovera, MD, General Surgery Consultant, Department of Surgery, Insubria University, Varese, Italy, Luigi Boni, MD, FACS, General Surgery Consultant, Department of Surgery, Insubria University, Varese, Italy, Gianlorenzo Dionigi, MD, FACS, Director, 1st Division of General Surgery, Department of Surgery, Insubria University, Varese, Italy

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Abstract:

Human amniotic membrane and umbilical cord tissues (AM/UC) are fetal tissues that contain proteins, cytokines, and growth factors that, when transplanted, can modulate inflammation and promote healing. Lyophilized, particulate AM/UC tissues can be used as wound coverings for chronic dermal ulcers or defects to promote granulation tissue formation and rapid re-epithelialization. This study reviews a case series of 5 patients presenting with chronic nonhealing wounds that received particulate AM/UC tissues (NEOX® FLO, Amniox Medical, Atlanta, GA). For all cases, wounds were debrided in the office setting and a single application of lyophilized particulate was used with minimal additional dressings. The lyophilized AM/UC tissue was placed within the wound bed and a dressing consisting of Adaptic®, 2x2 or 4x4 (Systagenix, Quincy, MA), Kling® (Johnson & Johnson, New Brunswick, NJ), and ACE™ (3M, St. Paul, MN) wrap were applied. Dressings were kept in place until weekly follow-up appointments in which a new Adaptic, 2x2 and Kling were applied. Overall, healing of wounds was noted to have a mean of 5 weeks to complete epithelialization. Upon complete healing patients were able to return to planned postoperative care and rehabilitation. Wound complications occur despite the best standard of care. Chronic wounds that remain weeks after surgery inhibit patients from progressing to physical rehabilitation and significantly affect patients both physically and mentally. These case presentations demonstrate how use of human AM/UC tissue may help wounds heal quickly and help patients return to normal function.

Authors:

Jennifer Swan, DPM, Podiatric Surgeon, Orthopedic Foot and Ankle Surgery, Westerville, Ohio

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