Organization of wound healing services: The impact on lowering the diabetes foot amputation rate in a ten-year review and the importance of early debridement

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

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SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study

British Journal of Surgery ◽

10.1093/bjs/znab361.165 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Hannah Elkadi ◽

Eleanor Dodd ◽

Theodore Poulton ◽

William Bolton ◽

Joshua Burke ◽

...

Keyword(s):

Wound Healing ◽

Local Anaesthetic ◽

Surrogate Endpoints ◽

Incision And Drainage ◽

Number Of Patients ◽

Significant Difference ◽

Patient Reported ◽

Before And After ◽

The Impact

Abstract Aims Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses. Methods Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D. Result 133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p < 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921). Conclusion Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.

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Viscoelasticity and cell jamming state transition

10.1101/2021.03.19.436195 ◽

2021 ◽

Author(s):

Ivana Pajic-Lijakovic ◽

Milan Milivojevic

Keyword(s):

Residual Stress ◽

Wound Healing ◽

Cell Migration ◽

State Transition ◽

State Transitions ◽

Collective Cell Migration ◽

Biological Processes ◽

Cell Mobility ◽

Controversial Topic ◽

The Impact

Although collective cell migration (CCM) is a highly coordinated migratory mode, perturbations in the form of jamming state transitions and vice versa often occur even in 2D. These perturbations are involved in various biological processes, such as embryogenesis, wound healing and cancer invasion. CCM induces accumulation of cell residual stress which has a feedback impact to cell packing density. Density-mediated change of cell mobility influences the state of viscoelasticity of multicellular systems and on that base the jamming state transition. Although a good comprehension of how cells collectively migrate by following molecular rules has been generated, the impact of cellular rearrangements on cell viscoelasticity remains less understood. Thus, considering the density driven evolution of viscoelasticity caused by reduction of cell mobility could result in a powerful tool in order to address the contribution of cell jamming state transition in CCM and help to understand this important but still controversial topic. In addition, five viscoelastic states gained within three regimes: (1) convective regime, (2) conductive regime, and (3) damped-conductive regime was discussed based on the modeling consideration with special emphasis of jamming and unjamming states.

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The Impact of Psychological Stress on Wound Healing

Critical Care Nursing Clinics of North America ◽

10.1016/j.ccell.2012.03.006 ◽

2012 ◽

Vol 24 (2) ◽

pp. 201-213 ◽

Cited By ~ 30

Author(s):

Jean-Philippe Gouin ◽

Janice K. Kiecolt-Glaser

Keyword(s):

Wound Healing ◽

Psychological Stress ◽

The Impact

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The The impact of a muscle pump activator on incisional wound healing compared to standard stockings and compression devices in kidney and kidney-pancreas transplant recipients: A randomized controlled trial

Canadian Urological Association Journal ◽

10.5489/cuaj.5822 ◽

2019 ◽

Vol 13 (11) ◽

Cited By ~ 1

Author(s):

Shahid Aquil ◽

Hemant Sharma ◽

Bijad Alharbi ◽

Katharine Pacoli ◽

Patrick P. Luke ◽

...

Keyword(s):

Wound Healing ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Wound Infections ◽

Transplant Recipients ◽

Muscle Pump ◽

Randomized Controlled ◽

Surgery Patient ◽

Complex Wound ◽

The Impact

Introduction: We aimed to evaluate the impact of thrombo-embolic-deterrent + intermittent pneumatic compression (TED + IPC) vs. muscle pump activator (MPA) on incisional wound healing in kidney and simultaneous pancreas- kidney (SPK) transplant recipients. Methods: We conducted a single-centre, randomized controlled trial in which 104 patients (kidney n=94; SPK n=10) were randomly assigned to wear TED + IPC (n= 52) or MPA (n=52) for the first six days following surgery. Patient demographics, postoperative outcomes, and incisional wound images were taken using a HIPAA-compliant application on postoperative days (POD) 3, 5, and 30, and assessed using the validated Southampton Wound Care Score. Results: There were no demographic differences between the groups. The MPA group had a significant improvement in wound healing on POD 3 (p=0.04) that persisted until POD 5 (p=0.0003). At POD 30, both groups were similar in wound healing outcomes (p=0.51). Bayesian inferential analysis revealed that the use of TED + IPC following transplantation had inferior outcomes compared to the use of MPA with sequential moderate evidence. The rate of complex wound infections was significantly greater in the TED + IPC group compared to the MPA group (29% vs. 12%, respectively; p=0.03). Patients were more satisfied with the use of a MPA device than TED + IPC. No major complications were encountered in either group. Conclusions: The use of a MPA device in the immediate postoperative period leads to a significant improvement in immediate and early wound healing, and decreased number of complex wound infections following kidney and SPK transplantation compared to standard TED + IPC therapy. Patients were more satisfied with the use of a MPA device than TED + IPC.

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Peptides from Animal Origin: A Systematic Review on Biological Sources and Effects on Skin Wounds

Oxidative Medicine and Cellular Longevity ◽

10.1155/2020/4352761 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Raul Santos Alves ◽

Levy Bueno Alves ◽

Luciana Schulthais Altoé ◽

Mariáurea Matias Sarandy ◽

Mariella Bontempo Freitas ◽

...

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Methodological Quality ◽

Cellular Proliferation ◽

Opportunistic Infections ◽

Skin Wound ◽

Animal Origin ◽

Skin Wounds ◽

Skin Wound Healing ◽

The Impact

Background. Skin wounds are closely correlated with opportunistic infections and sepsis risk. Due to the need of more efficient healing drugs, animal peptides are emerging as new molecular platforms to accelerate skin wound closure and to prevent and control bacterial infection. Aim. The aim of this study was to evaluate the preclinical evidence on the impact of animal peptides on skin wound healing. In addition, we carried out a critical analysis of the studies’ methodological quality. Main Methods. This systematic review was performed according to the PRISMA guidelines, using a structured search on the PubMed-Medline, Scopus, and Web of Science platforms to retrieve studies published until August 25, 2020 at 3 : 00 pm. The studies included were limited to those that used animal models, investigated the effect of animal peptides with no association with other compounds on wound healing, and that were published in English. Bias analysis and methodological quality assessments were examined through the SYRCLE’s RoB tool. Results. Thirty studies were identified using the PRISMA workflow. In general, animal peptides were effective in accelerating skin wound healing, especially by increasing cellular proliferation, neoangiogenesis, colagenogenesis, and reepithelialization. Considering standardized methodological quality indicators, we identified a marked heterogeneity in research protocols and a high risk of bias associated with limited characterization of the experimental designs. Conclusion. Animal peptides show a remarkable healing potential with biotechnological relevance for regenerative medicine. However, rigorous experimental approaches are still required to clearly delimit the mechanisms underlying the healing effects and the risk-benefit ratio attributed to peptide-based treatments.

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Role of infection in wound healing

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v19i4.46612 ◽

2020 ◽

Vol 19 (4) ◽

pp. 598-602

Author(s):

Malik Asif Hussain ◽

Flavia Huygens

Keyword(s):

Wound Healing ◽

Pathogenic Bacteria ◽

Chronic Wounds ◽

Medical Science ◽

Vascular Diseases ◽

Research Papers ◽

Patients With Diabetes ◽

Research Findings ◽

The Impact

Chronic wounds, particularly infected wounds are clinically very important due to their significant impact on health budgets as well as patients` health worldwide. Patients with diabetes mellitus, vascular diseases especially peripheral vascular disease and pressure ulcers are major categories of patients presenting with chronic wounds. It is known that there are multiple factors determining chronic wound prognosis. The presence of multiple types of pathogenic bacteria, with specific virulence and adherent (biofilm) properties, contribute a significant role to the development of chronic wounds. This review article is based on the research project entitled” An investigation of the impact of bacterial diversity, pathogenic determinants and biofilms on chronic wounds”. The research findings have been published in form of research papers as well as conference posters. The aim of this article is to highlight various important aspects of bacterial impact on wound healing. Bangladesh Journal of Medical Science Vol.19(4) 2020 p.598-602

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The Impact of Glaucoma Medications on Corneal Wound Healing

Journal of Glaucoma ◽

10.1097/ijg.0000000000000279 ◽

2016 ◽

Vol 25 (1) ◽

pp. 122-127 ◽

Cited By ~ 14

Author(s):

Ralph Pinheiro ◽

Claudia Panfil ◽

Norbert Schrage ◽

R. Michael Dutescu

Keyword(s):

Wound Healing ◽

Corneal Wound Healing ◽

Corneal Wound ◽

The Impact

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A genetic variant of cortactin linked to acute lung injury impairs lamellipodia dynamics and endothelial wound healing

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00062.2015 ◽

2015 ◽

Vol 309 (9) ◽

pp. L983-L994 ◽

Cited By ~ 6

Author(s):

Sangwook Choi ◽

Sara M. Camp ◽

Arkaprava Dan ◽

Joe G. N. Garcia ◽

Steven M. Dudek ◽

...

Keyword(s):

Wound Healing ◽

Acute Lung Injury ◽

Lung Injury ◽

Regulatory Protein ◽

Actin Binding ◽

Gap Closure ◽

Sphingosine 1 Phosphate ◽

Endothelial Wound Healing ◽

Genetic Signatures ◽

The Impact

Inflammatory mediators released in acute lung injury (ALI) trigger the disruption of interendothelial junctions, leading to loss of vascular barrier function, protein-rich pulmonary edema, and severe hypoxemia. Genetic signatures that predict patient recovery or disease progression are poorly defined, but recent genetic screening of ALI patients has identified an association between lung inflammatory disease and a single nucleotide polymorphism (SNP) in the gene for the actin-binding and barrier-regulatory protein cortactin. This study investigated the impact of this disease-linked cortactin variant on wound healing processes that may contribute to endothelial barrier restoration. A microfabricated platform was used to quantify wound healing in terms of gap closure speed, lamellipodia dynamics, and cell velocity. Overexpression of wild-type cortactin in endothelial cells (ECs) improved directional cell motility and enhanced lamellipodial protrusion length, resulting in enhanced gap closure rates. By contrast, the cortactin SNP impaired wound closure and cell locomotion, consistent with the observed reduction in lamellipodial protrusion length and persistence. Overexpression of the cortactin SNP in lung ECs mitigated the barrier-enhancing activity of sphingosine 1-phosphate. These findings suggest that this common cortactin variant may functionally contribute to ALI predisposition by impeding endothelial wound healing.

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Encapsulation of Adipose-Derived Mesenchymal Stem Cells in Calcium Alginate Maintains Clonogenicity and Enhances their Secretory Profile

International Journal of Molecular Sciences ◽

10.3390/ijms21176316 ◽

2020 ◽

Vol 21 (17) ◽

pp. 6316

Author(s):

Lucille Capin ◽

Nacira Abbassi ◽

Maëlle Lachat ◽

Marie Calteau ◽

Cynthia Barratier ◽

...

Keyword(s):

Stem Cells ◽

Wound Healing ◽

Mesenchymal Stem Cells ◽

Growth Factor ◽

Calcium Alginate ◽

Healing Process ◽

Spherical Particles ◽

Differentiation Potential ◽

Monolayer Cultures ◽

The Impact

Adipose-derived mesenchymal stem cells (ASCs) are well known for their secretory potential, which confers them useful properties in cell therapy. Nevertheless, this therapeutic potential is reduced after transplantation due to their short survival in the human body and their migration property. This study proposes a method to protect cells during and after injection by encapsulation in microparticles of calcium alginate. Besides, the consequences of encapsulation on ASC proliferation, pluripotential, and secretome were studied. Spherical particles with a mean diameter of 500 µm could be obtained in a reproducible manner with a viability of 70% after 16 days in vitro. Moreover, encapsulation did not alter the proliferative properties of ASCs upon return to culture nor their differentiation potential in adipocytes, chondrocytes, and osteocytes. Concerning their secretome, encapsulated ASCs consistently produced greater amounts of interleukin-6 (IL-6), interleukin-8 (IL-8), and vascular endothelial growth factor (VEGF) compared to monolayer cultures. Encapsulation therefore appears to enrich the secretome with transforming growth factor β1 (TGF-β1) and macrophage inflammatory protein-1β (MIP-1β) not detectable in monolayer cultures. Alginate microparticles seem sufficiently porous to allow diffusion of the cytokines of interest. With all these cytokines playing an important role in wound healing, it appears relevant to investigate the impact of using encapsulated ASCs on the wound healing process.

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