The growing evidence for the use of platelet‐rich plasma on diabetic chronic wounds: A review and a proposal for a new standard care

Nonhealing chronic wounds and exposed tendons, bones and joints are very challenging to cure specially for diabetic patients. Plastic surgeons have a new weapon to enhance wound healing with the use of autologous growth factors. Recently, the process of fabrication of platelet‐rich plasma (PRP) has been simplified. The goal of this literature review is to summarize the evidenced‐based body of knowledge regarding the treatment of diabetic chronic wounds by PRP. A PubMed and Cochrane search (1978–2015) was performed and all studies assessing the clinical effect of PRP on the healing of diabetic chronic wounds were included. The screening retrieved 7,555 articles and 12 studies were included. On six randomized studies included, five found significant benefits for the use of PRP on diabetic chronic foot ulcers and the sixth randomized study did not publish a statistical analysis but found favorable outcomes. The two other controlled studies included found significant benefits regarding the healing rate and the four uncontrolled studies included showed high rates of healing with the adjunction of PRP. Regarding the method of use, PRP was applied on the wound as a gel twice a week (41.7% of studies) or once a week (33.3% of studies). In conclusion, 87.5% of controlled studies found a significant benefit for the adjunction of PRP to treat chronic diabetic wounds. As PRP may be beneficial, we suggest using PRP on diabetic ulcers which remain unhealed after standard treatment.     

Hyaluronic acid derivatives and their healing effect on burns,epithelial surgical wounds,and chronic wounds: A systematic review and meta‐analysis of randomized controlled trials

Hyaluronic acid (HA) is a polysaccharide common to most species and is found in many sites in the human body, including the skin and soft tissue. A systematic review of the literature and meta‐analysis was performed to identify randomized controlled trials, evaluating the use of HA derivatives in healing burns, epithelial surgical, and chronic wounds. Nine studies were identified, which met the search criteria and clinical endpoints of complete healing and percent wound size reduction when using HA vs. either an active or passive comparator. It was found in the vast majority of randomized controlled trials (eight of nine) that HA derivatives significantly improved the healing of wounds vs. traditional therapies or placebo (either via complete healing or a significant reduction in wound size) occurring from burns, venous insufficiency, diabetes, neuropathic insufficiency, and surgical removal of the epithelial layer (for tattoo removal). In the other remaining trial, one formulation of HA was compared with another, with the higher concentration showing improved application characteristics. Further, it was found in a meta‐analysis in subsets of patients with diabetic foot ulcers (neuropathic) that HA derivatives healed these types of wounds significantly faster than standard of care. These studies in aggregate show that HA derivatives accelerate the healing process in burns, epithelial surgical wounds, and chronic wounds.     

Defining complete wound closure: Closing the gap in clinical trials and practice

We investigate how wound closure is determined in recent randomized controlled wound trials and real‐world studies, identify solutions to the current limitations of wound assessment, and propose a standard methodology to define and assess wound healing in research. We searched PubMed for randomized clinical trials using the terms “complete wound closure” and “wound healing rate” and for real‐world studies using the terms “real‐world wound healing,” “real‐world wound data,” and “wound registries” dating from March 2010 through March 2018. We selected studies that had “complete wound closure” or “healed wound” as an endpoint. Sixty‐five trial articles and 10 real‐world articles met our criteria, from which we extracted the wound type studied, definition of healed wound used, wound assessment method, the number of weeks assessed, the number of wounds, and the percent of healed wounds in the study group(s) and control group. There were 7,194 trial wounds included. The most common definition of healing used by 26 studies (40.6%) was complete/full/100% (re)epithelialization or closure without discharge, drainage/scab, and/or dressing. Fifty‐two studies (81.2%) used blinded wound assessment, and at least 10 studies (15.6%) used blinded adjudication. The real‐world studies analyzed more than 901,396 wounds. Only three studies (33.3%) defined a healed/closed wound, two of which used “complete epithelialization.” Eight studies (88.9%) did not define the wound assessment method; none indicated a blinded assessment. We support the Food and Drug Administration definition: 100% reepithelialization of the wound surface with no discernable exudate and without drainage or dressing, confirmed at two visits 2 weeks apart, and we recommend blinded adjudication for wound assessment. The widespread adoption of a standard wound healing definition and assessment method in wound care research would allow for stronger comparisons of treatment effects across studies to improve the evidence base and strengthen the treatment decision‐making process in clinical practice.     

Effects of platelet‐rich plasma on the healing of sternal wounds: A meta‐analysis

Sternal wound infection (SWI) is a devastating complication after cardiac surgery. Platelet‐rich plasma (PRP) may have a positive impact on sternal wound healing. A systematic review with meta‐analyses was performed to evaluate the clinical effectiveness of topical application of autologous PRP for preventing SWI and promoting sternal wound healing compared to placebo or standard treatment without PRP. Relevant studies published in English or Chinese were retrieved from the Cochrane Central Register of Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of Science, Springer Link, and the WHO International Clinical Trials Registry Platform (ICTRP) using the search terms “platelet‐rich plasma” and “sternal wound” or “thoracic incision.” References identified through the electronic search were screened, the data were extracted, and the methodological quality of the included studies was assessed. The meta‐analysis was performed for the following outcomes: incidence of SWI, incidence of deep sternal wound infection (DSWI), postoperative blood loss (PBL), and other risk factors. In the systematic review, totally 10 comparable studies were identified, involving 7879 patients. The meta‐analysis for the subgroup of retrospective cohort studies (RSCs) showed that the incidence of SWI and DSWI in patients treated with PRP was significantly lower than that in patients without PRP treatment. However, for the subgroup of randomized controlled trials (RCTs), there was no significant difference in the incidence of SWI or DSWI after intervention between the PRP and control groups. There was no significant difference in PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in‐situ recurrences were reported. According to the results, PRP could be considered as a candidate treatment to prevent SWI and DSWI. However, the quality of the evidence is too weak, and high‐quality RCTs are needed to assess its efficacy on preventing SWI and DSWI.     

125“MIST Ultrasound Therapy for Recalcitrant Wounds,A new approach”

The use of adjunctive peri‐wound, ultrasound with either a 1 MgHz or 3 MgHz frequency has been reported on in the literature with variable results. MIST ultrasound therapy is a novel application of direct wound bed application of kilohertz ultrasound waves utilizing a normal saline mist as the coupling mechanism, allowing for no direct patient contact. The mist generated by the system is of relative uniform particle size and acts as a conduit of ultrasound energy. Unlike ultrasonic baths, which dissipate the vibrational energy over a large area, the transducer horn focuses the energy into a smaller area of application. The MIST? system consists of an ultrasonic power supply (generator), a transducer (or alternately referred to as the converter), and an applicator coupled to the transducer. The generator converts voltage to high frequency electrical energy. This electrical energy is transmitted to the piezoelectric transducer within the converter, where it is changed to mechanical vibrations. The generator is designed to operate the converter at 40 kHz with a distal displacement of 60 microns. Published reports have described various biological effects of low frequency ultrasound including VEGF and PDGF production, increased protein synthesis, improved bone and wound healing. Other authors have published abstracts demonstrating clinical efficacy of this device on a broad range of patients with recalcitrant wounds. This report describes the clinical results of a prospective, non‐randomized, efficacy trial, adding MIST ultrasound therapy to current treatment protocols in recalcitrant wounds. Wound healing trajectories before and after treatment will be evaluated and wound healing will be assessed with laser Doppler image analysis and trans‐cutaneous oximetry.     

The application of platelet‐rich plasma in the treatment of deep dermal burns: A randomized,double‐blind,intra‐patient controlled study

Platelet‐rich plasma (PRP) is a fraction of blood with a platelet concentration above baseline. When platelets get activated, growth factors involved in wound healing are released. The application of PRP has shown good results in wound care, however, up to date no substantial research has been performed on the effect of PRP in burn treatment. This randomized double blind intra‐patient controlled study investigates the effect of autologous PRP on wound healing in burns that require surgery with a meshed split skin graft (SSG). Fifty‐two patients with various areas of deep dermal to full thickness burns, receiving surgery with a SSG were included after informed consent. Comparable study areas A and B (intra‐patient) were appointed, randomized and either treated with a SSG and PRP or with a SSG alone. At day 5 to 7 postoperative, the epithelialization and graft take rate were assessed. Three, six, and twelve months postoperative, follow‐up measurements were performed in the form of POSAS‐questionnaires, DermoSpectroMeter, and Cutometer measurements. There was no statistically significant difference between the mean take rate nor the mean epithelialization rate at day 5–7 between the PRP‐treated and control areas. However, PRP‐treated wound areas showed more often better or equal epithelialization and take rates at day 5–7 than the standard treated areas. Minor effects were also seen in the reoperated and early operated subgroups. At 3, 6, and 12 months postoperative, POSAS scores from the patients and the observers, Dermaspectro‐, and Cutometer measurements did not depict a significant difference between the PRP and standard treated areas. Concluding, the addition of PRP in the treatment of burn wounds did not result in improved graft take and epithelialization, nor could we demonstrate better scar quality. There was, however, a considerable variation in our clinical population.     

MANAGEMENT OF NECROTIC NECK WOUNDS WITH A “SANDWICH” PECTORALIS MYOCUTANEOUS FLAP

A modified pectoralis major myocutaneous flap was used to stabilize necrotic neck wounds rapidly in irradiated patients. The flap was a “sandwich” flap that included an overlying “parasternal” pectoral skin paddle for pharyngeal reconstruction, the pectoralis muscle for carotid protection, and a meshed skin graft applied to the undersurface of the muscle to replace cervical skin. This flap has been used to reconstruct seven patients with severe wound necrosis from pharyngeal fistula and infection. All patients had carotid exposure in the infected wound. Reconstruction in all patients accomplished restoration of pharyngeal continuity, carotid protection, and cervical skin replacement. Some patients required more than one procedure for closure. There were no carotid “blowouts” in any of the patients. This technique enables the head and neck surgeon to stabilize these contaminated wounds rapidly and to reconstruct complex defects of the pharynx and cervical skin.     

Extracorporeal shock wave therapy for chronic wounds: A systematic review and meta‐analysis of randomized controlled trials

A growing number of clinical studies demonstrate that extracorporeal shock wave therapy (ESWT) is a feasible noninvasive method for improving chronic wound healing. This systematic review and meta‐analysis aimed to assess the effectiveness of ESWT compared with that of the standard care treatment for the healing of chronic wounds, irrespective of etiology, in clinical practice. Randomized controlled trials that investigated the effect of ESWT on chronic wounds with different etiologies from 2000 to 2017 were included in this review. The methodological quality of each selected article was rated using the Jadad scale. A fixed or random effects model was used to calculate the pooled effect sizes according to the heterogeneity of the studies. The cumulative effect of ESWT on each outcome was illustrated using forest plots. Seven randomized controlled trials involving 301 subjects were included in this review. Meta‐analyses revealed that the use of ESWT as an adjunct to wound treatment could significantly accelerate the impaired healing process of chronic wounds. Compared with the control treatment, ESWT markedly increased the wound healing rate by 1.86‐fold (OR = 2.86, 95% CI: 1.63–5.03, p = 0.0003) and the percentage of the wound healing area by 30.46% (SMD = 30.46; 95% CI: 23.80–37.12; p < 0.00001). In addition, the wound healing time was reduced by 19 days (SMD = ?19.11, 95% CI: ?23.74–(–14.47), p < 0.00001) in chronic wound patients. No serious complications or adverse effects were observed secondary to the application of ESWT. The above data suggested that ESWT as an adjunct to wound treatment, could more significantly improve the healing process of chronic wounds than the standard care treatment alone. More high‐quality, well‐controlled randomized trials are needed to evaluate the efficacy of ESWT in clinical practice.     

Long‐term scar quality in burns with three distinct healing potentials: A multicenter prospective cohort study

The laser Doppler imager is used in cases of indeterminate burn depth to accurately predict wound healing time at an early stage. The laser Doppler imager classifies burns into three estimated healing potentials as follows: high, <14 days; intermediate, 14–21 days; and low, >21 days. At this time, the relationship between these healing potentials and long‐term scar quality is unknown. The objective of this study was to determine the long‐term scar quality of burns with three distinct healing potentials. The secondary objectives were to compare treatment strategies in intermediate wounds, to study the effect of the timing of surgery on low healing potential wounds and to identify predictors of reduced scar quality. Hence, in a prospective cohort study, scar quality was determined in patients whose burns were assessed with laser Doppler imaging. Scar Quality was assessed with objective and subjective measurement tools, including overall scar quality (Patient and Observer Scar Assessment Scale) as a primary outcome and color and elasticity parameters. A total of 141 patients (>19 months postburn) with 216 scars were included. Wounds with high and intermediate healing potential did not significantly differ regarding scar quality. Wounds with a low healing potential had a significantly lower scar quality. Analysis of 76 surgically treated low healing potential wounds showed no significant differences in the primary outcome regarding the timing of surgery (≤14 days vs. >14). Predictors of reduced long‐term scar quality were darker skin type and multiple surgeries. In conclusion, scar quality was strongly related to the healing potential category. Scar quality was very similar in high and intermediate healing potential wounds. No positive effects were found on scar quality or on healing time in surgically treated wounds with intermediate healing potential, advocating a conservative approach. Further studies should focus on the optimal timing of surgery in low healing potential wounds.     

Analysis of run-in and treatment data in a wound outcomes registry: clinical impact of topical platelet-rich plasma gel on healing trajectory

Randomised controlled trials in chronic wounds typically exclude patients with comorbidities and confounding factors. Well‐designed observational studies can provide complementary clinical evidence that randomised trials cannot address. This study determined if wound care registry outcomes could be an alternative data source and if the results would be robust and valid. Changes in wound area and depth were hypothesised to be different between run‐in therapies and platelet‐rich plasma (AutoloGel?, Cytomedix, Inc) treatment. From a treatment registry of 285 chronic wounds, 46 had run‐in and post‐treatment data. Seven chronic wound categories were identified. Mean wound age at study start was 52·4 days. General linear model repeated measures showed a credible and robust data set. Statistically significant differences for wound area and depth were observed between run‐in and post‐treatment period at multiple time points. Wound area and depth ≥50% reduction were analysed using Kaplan–Meier methods. During run‐in, 15% of wound area improved compared to 28% post‐treatment and 11% of wound depth improved during run‐in compared to 39% post‐treatment. Significant clinical outcomes indicated many previously non responsive wounds began actively healing in response to platelet‐rich plasma therapy, indicating that registry data can be used as a complementary source of evidence.     

Knotless “three‐U‐stitches” technique for urethrovesical anastomosis during laparoscopic radical prostatectomy

We describe a new technique for urethrovesical anastomosis that consists of placing three “U” stitches of Monocryl 2‐0 to connect the bladder neck and urethral stump together. The margins are united by a double passage of the suture, without tying any knots. The sutures are tied on the bladder's surface using Lapra‐Ty clips fixed at a certain distance from where to two mucosal margins have been joined. We carried out this technique on 90 patients who underwent laparoscopic extraperitoneal radical prostatectomy. The good joining of the margins, the absence of knots and the minimum trauma to the urethral wall together enable to create an anastomosis that is both “sealed” and “tension free”, allowing a quick “welding” of the margins and an early catheter removal. Regarding urinary continence, 56.6% (51) of patients were continent at catheter removal, 87.6% (78) were continent 3 months later and 98.9% (89) were continent after 6 months. In nine patients (10%), an episode of acute urinary retention occurred within 24 h after the removal of the catheter. We did not encounter any cases of vesicourethral anastomosis stenosis.     

3D‐Printed haptic “Reverse” models for preoperative planning in soft tissue reconstruction: A case report

In reconstructive surgery, preoperative planning is essential for optimal functional and aesthetic outcome. Creating a three‐dimensional (3D) model from two‐dimensional (2D) imaging data by rapid prototyping has been used in industrial design for decades but has only recently been introduced for medical application. 3D printing is one such technique that is fast, convenient, and relatively affordable. In this report, we present a case in which a reproducible method for producing a 3D‐printed “reverse model” representing a skin wound defect was used for flap design and harvesting. This comprised a 82‐year‐old man with an exposed ankle prosthesis after serial soft tissue debridements for wound infection. Soft tissue coverage and dead‐space filling were planned with a composite radial forearm free flap (RFFF). Computed tomographic angiography (CTA) of the donor site (left forearm), recipient site (right ankle), and the left ankle was performed. 2D data from the CTA was 3D‐reconstructed using computer software, with a 3D image of the left ankle used as a “control.” A 3D model was created by superimposing the left and right ankle images, to create a “reverse image” of the defect, and printed using a 3D printer. The RFFF was thus planned and executed effectively, without complication. To our knowledge, this is the first report of a mechanism of calculating a soft tissue wound defect and producing a 3D model that may be useful for surgical planning. 3D printing and particularly “reverse” modeling may be versatile options in reconstructive planning, and have the potential for broad application. © 2014 Wiley Periodicals, Inc. Microsurgery 35:148–153, 2015.     

“Hot tip”: Another method of laser vascular recanalization

This study is a preliminary report evaluating the use of laser radiation to heat a metal-capped fiber for arterial recanalization. The method was compared to the currently used bare-ended fiber for recanalization of occluded vessels. The model used was a human coronary artery xenograft transplanted in the femoral artery of the dog. At 4 weeks following the transplantation, laser recanalization was attempted using the heated metal probe (“hot tip”) in five arteries and the bare fiber in another five arteries. Results: 1) Angiography demonstrated recanalization in all five arteries treated with the “hot tip” and three of the five arteries treated with the bare fiber. 2) Only one perforation occurred with the “hot tip,” whereas three perforations occurred with the bare fiber. 3) The larger metal cap was capable of creating a wider channel in the occluded arterial segment. Although the trend favored the heated metal cap in terms of recanalization and less perforation than the bare fiber, the total number of experiments were not adequate to demonstrate statistical significance. Microscopic examination of the vessels recanalized by either technique was similar. Characteristic charring at the recanalization site was seen regardless of the technique used. These observations suggest that the effect of direct laser radiation on plaques is predominantly a thermal effect. Although these results would suggest utilization of a metal-capped fiber for vascular recanalization, more studies need to be done to confirm these preliminary findings.     

Central venous catheters for chronic hemodialysis: Is “last choice” never the “right choice”?

Since the publication of the first vascular access clinical practice guidelines in 1997, the global nephrology community has dedicated significant time and resources toward increasing the prevalence of arteriovenous fistulas and decreasing the prevalence of central venous catheters for hemodialysis. These efforts have been bolstered by observational studies showing an association between catheter use and increased patient morbidity and mortality. To date, however, no randomized comparisons of the outcomes of different forms of vascular access have been conducted. There is mounting evidence that much of the difference in patient outcomes may be explained by patient factors, rather than choice of vascular access. Some have called into question the appropriateness of fistula creation for certain patient populations, such as those with limited life expectancy and those at high risk of fistula‐related complications. In this review, we explore the extent to which catheters and fistulas exhibit the characteristics of the “ideal” vascular access and highlight the significant knowledge gaps that exist in the current literature. Further studies, ideally randomized comparisons of different forms of vascular access, are required to better inform shared decision making.     

137The cutaneous “Underlying disorder” in diabetic rats

Objective To investigate the histological characteristics and pathophysiological changes in diabetic skin.
Methods : 12 Sprague‐Dawley rats weighing 200–220 g were divided into control and STZ‐induced diabetic groups. The shaved skin specimens from the back of rats were collected on 8 w post STZ‐inducing. The cutaneous histological characteristics were observed. The local contents of glucose, advanced glycation end products(AGEs) and hydroxyproline, the levels of aMMP‐2 and TIMP‐2, and the cell cycles of both keratinocytes and dermal cells were determined.
Results : The thicknesses of epidermis layer and dermis layer were both reduced obviously in diabetic skin, with the morphological characteristics of the obscured multilayer epithelium features and the decreased amount of spinous in epidermis; the atrophied, swollen and degenerated collagen fibers with a focal chronic inflammatory cells infiltration. The results also revealed that contents of glucose, AGEs, the level of aMMP‐2 and the ratio of aMMP‐2/TIMP‐2 in diabetic skin were higher than those in the controls. In diabetic group, the percentages of S stage and G2/M stages of keratinocytes were obviously decreased, while the dermal cells showed the higher percentage of S stage and the normal percentage of G2/M stages, when compared with the control group.
Conclusion : The cutaneous histological and pathophysiological alterations in diabetes mellitus has already been occurred when exogenous damage is not existed, which presented an “underlying disorder” characteristics in diabetic skin. The cutaneous “underlying disorder” in diabetes might be a critical risk factor leading to ulceration and one of the most important mechanisms in the pathogenesis of impaired wound healing.     

Low-power laser light in the healing of burns: a comparison between two different wavelengths (635 nm and 690 nm) and a placebo group

BACKGROUND AND OBJECTIVE: Studies on the influence of low-power laser light on wound healing have shown inconsistent results, or, as in the case of burns, are very scarce. We have studied the effects of two different low-power diode laser lights on the healing of burns in rats. STUDY DESIGN/MATERIALS AND METHODS: Thirty rats were burned on both flanks and randomly allocated to one of three study groups. In group A, both wounds remained untreated; in groups B and C, one wound each was irradiated with 635 nm or 690 nm laser light (1.5 J/cm(2)), whereas the other wound remained untreated. Diameter, redness, and edema of the wounds were examined daily. RESULTS: Between and within groups, diameter, redness, and edema of the wounds were similar throughout the entire observation period. Irradiation of the burns did not accelerate wound healing when compared with control wounds. CONCLUSION: We conclude that neither 690 nm nor 635 nm low-power laser light produced any beneficial effects on the healing processes of burns in rats.     

“Plasma Cell Hepatitis” in Liver Allografts: Identification and Characterization of an IgG4‐Rich Cohort

Plasma cell hepatitis (PCH), also known as “de novo autoimmune” hepatitis, is an increasingly recognized, but suboptimally named and poorly understood, category of late allograft dysfunction strongly resembling autoimmune hepatitis (AIH): They share plasma‐cell‐rich necro‐inflammatory activity on biopsy, autoantibodies and steroid responsiveness, but overlap with rejection is problematic. A retrospective study of clinical, serological, histopathological and IgG4 immunohistological features of PCH (n = 20) in liver allograft recipients, native liver AIH (n = 19) and plasma‐cell‐rich renal allograft rejection (n = 20) showed: (1) high frequency (44%) of HLA‐DR15; (2) less female predominance (p = 0.03) and (3) n = 9/20 PCH recipients showed >25 IgG4+ plasma cells/high‐power field (IgG4+ PCH) versus AIH (n = 1/19, p = 0.008) or plasma‐cell‐rich kidney rejection (n = 2/20, p = 0.03). The IgG4+ PCH (n = 9) subgroup showed lower alanine transaminase (ALT) (p < 0.01) and aspartate transaminase (AST) (p < 0.05) at index biopsy but (a) higher plasma cell number/percentage, (b) more aggressive‐appearing portal/periportal and perivenular necro‐inflammatory activity and (c) more severe portal/periportal fibrosis than IgG4? PCH (n = 11). Significant demographic, histopathologic and plasma cell phenotype differences between PCH and AIH suggest distinct pathogenic mechanisms for at least the IgG4+ PCH subgroup likely representing an overlap between allo‐ and auto‐immunity. IgG4+ PCH was associated with fibrosis, but also highly responsive to increased immunosuppression.

     

Flaminal® versus Flamazine® in the treatment of partial thickness burns: A randomized controlled trial on clinical effectiveness and scar quality (FLAM study)

Although partial thickness burns are the most frequently reported burn injuries, there is no consensus on the optimal treatment. The objective of this study was to compare the clinical effectiveness and scar quality of Flaminal® Forte to silver sulfadiazine (Flamazine®) in the treatment of partial thickness burns. In this two‐arm open label multicenter randomized controlled trial, adult patients with acute partial thickness burns and an affected total body surface area of less than 30% were randomized between Flaminal® Forte and Flamazine® and followed for 12 months. Dressing changes in the Flamazine® group were performed daily, and in the Flaminal® group during the first 3 days post burn and thereafter every other day until complete wound healing or surgery. Forty‐one patients were randomly allocated to Flaminal® Forte and 48 patients to Flamazine®. The primary outcome was time to wound healing, which did not differ between the groups: median 18 days with Flaminal® Forte (range 8–49 days) versus 16 days with Flamazine® (range 7–48 days; p = 0.24). Regarding the secondary outcomes during hospital admission, there were no statistically significant differences between the groups concerning need for surgery, pain scores, pruritus, or pain‐related and anticipatory anxiety. More patients in the Flaminal® group developed wound colonization (78% versus 32%, p < 0.001), but the treatment groups did not differ regarding the incidence of local infections and use of systemic antibiotics. In terms of scar quality, no statistically significant differences between both treatment groups were found regarding subjective scar assessment (Patient and Observer Scar Assessment Scale (POSAS)), scar melanin and pigmentation (DermaSpectrometer®), and scar elasticity and maximal extension (Cutometer®) during 12 month postburn. In conclusion, time to wound healing did not differ, but the use of Flaminal® Forte seemed favorable because less dressing changes are needed which lowers the burden of wound care.     

Novel negative pressure wound therapy device without foam or gauze is effective at −50 mmHg

Negative pressure wound therapy (NPWT) promotes healing in acute or chronic wounds. Conventional NPWT devices consist of a filler (such as foam or gauze) that covers the wound and of a permeable membrane and tubing that connects the space under the membrane to a suction pump. The permeable membrane increases airflow and thus increases the required pump capacity that can cause patient discomfort or even ischemia in wounds with compromised vascularity. In addition, foam or gauze may fragment and become colonized with bacteria over time. To mitigate these, negative aspects, we have developed a new impermeable single layer component membrane dressing to deliver NPWT that does not need a foam or gauze to function. Therefore, the purpose of this study was to introduce this novel NPWT system (platform wound device, PWD) and evaluate its usability and effectiveness in the treatment of porcine full‐thickness burns. A total of 48 burn wounds were created across four Yorkshire pigs on the dorsum. Wounds were created on day 0 and continuous NPWT with ?50 mmHg and ? 80 mmHg was initiated immediately. Subsequently, the burns were debrided on day 3 and animals were euthanized on day 7. The efficacy of the PWD on wound healing and reduction of bacterial burden was measured and compared to wounds that did not receive NPWT. The results showed that PWD promoted wound healing by outperforming the wounds that did not receive NPWT and that PWD was efficient at reducing bacteria from the burn eschar and from the wound bed. In conclusion, this study demonstrated that PWD promoted wound healing with a negative pressure as low as ?50 mmHg, which likely benefits healing and avoids potential safety issues.     

Comparison of “subjective” and “objective” measures of severity of urinary incontinence in women

The aims of this study were to compare “subjective” measures of severity of urinary incontinence to similar “objective” measures, establish their statistical correlation, and determine the effect of specific urodynamic diagnosis on such correlations. Baseline data was available from 265 women entered into a clinical trial studying pharmacologic and behavioral interventions for urinary incontinence. The “subjective” measures of incontinence were obtained by patient recall during history taking and included: the number of incontinent episodes in I week, the number of perincal pads used during I week, and the number ot clothing changes required due to wetness. The “objective” measures of severity included: the number of incontinent episodes per week as recorded on a 7-day diary, the number of perineal pads used per week, also recorded on a diary, and the amount of fluid lost during a standardized pad test Analysis consisted of Pearson correlations and linear regressions to determine equations for the prediction of objective measurement on the basis of the corresponding subjective measure. Significant positive correlations were seen between “subjective” and “objective” measurements for the comparisons of number of weekly incontinent episodes (R = 0.63), and tor the weekly number of pads used (R = 0.81). The comparison between the number of clothing changes and the amount of fluid lost during pad testing was also significantly but less strongly correlated (R = 0.24). For the correlations between subjective and objective determinations of urinary incontinent episodes and for those between clothing changes and pad testing, the urodynamic diagnosis had no effect on the correlation coefficients, but did have a statistically significant effect on the intercept. “Subjective” measures of severity of urinary incontinence will provide a reasonable estimate of “objective” measures of severity of urinary incontinence in women. Therefore in a clinical setting, it seems logical to use “subjective” measures to assess both baseline severity and response to intervention. © 1995 Wiley-Liss, Inc.