THU0339 THE INFLUENCE OF SKIN CALCINOSIS ON THE PROGNOSIS OF DIGITAL ULCERS IN PATIENTS WITH SSC.

Background:Digital ulcers (DUs) are one of the main burdens in patients with systemic sclerosis (SSc) as they have a major impact on quality of life and prognosis. Some DUs are associated with the presence of subcutaneous calcinosis (SC) that may worsen their management, and the prognosis of these DUs is still not well defined.Objectives:To define the characteristics of SSc patients with DUs related to SC and analyze the impact on prognosis and on healing time.Methods:We prospectively collected data from DUs of the hands evaluated in our dedicated wound-care outpatient clinic from October 2018 to August 2019. Fifty-five patients were enrolled (50 females, 18 with limited-SSc and 37 with diffuse-SSc, mean age 62.3±17.2 years). For every DU we collected: presence/absence of calcinosis, pathogenesis (spontaneous, post-traumatic), area of DU, location (fingertip, periungual area, metacarpophalangeal, proximal/distal interphalangeal-PIP/DIP), VAS-pain at the baseline and after two weeks, local signs of infection (edema, redness), deep wound swab results and time to the healing. Additionally, we calculated the wound-bed score (WBS), at the baseline and we correlated the total score with the time of healing. All the ulcers were managed with weekly treatment following a definite protocol: wound cleansing, disinfection, mechanic debridement, application of antiseptic dressing.Results:Out of 98 DUs evaluated, 24 (24.5%) were associated with SC. Patients with SC were older than those without calcinosis (67.1+-16.9 vs 59.4+-16.9 p<0.05) and were more frequently affected by lc-SSc (18 – 75% vs 6 – 25% p<0.001). There were no significant differences between the mean areas of DUs (SC 22mm2vs non-calcinosis 30.8mm2) neither in the localization of the ulcers: fingertip (14-61% vs 34-49.3%), periungual area (4-17.4% vs 16-23.2%), PIP (2-9% vs 13-18.9%), DIP (2-9% vs 9-13%) and MCP (1-4% vs 4-5.8%). The VAS-pain was not statistically different at the baseline (6.0 for SC vs 5.4), neither after 2 weeks (3.8 vs 3.2). Although the presence of local signs of infection was similar (5-20.8% vs 14-18.9%), the positivity for the wound swab was higher in SC compared with those without calcinosis (6-26.1% vs 9-11.5%; p=0.05).All the DUs treated in our outpatient clinic healed but those with SC required more weeks (10.4±7.9 vs. 7.13±5.7; p=0.03). The WBS was similar in the two groups (8.96+-0.46 in SC vs 9.43+-0.33) and was negatively correlated with the time of healing (r=-0.24, p=0.02).Conclusion:Although DUs with calcinosis have a different pathogenesis compared to those without SC, the location, dimensions and DU-related pain are similar in both groups. Despite these aspects, DUs associated with calcinosis are more prone to be infected and require more time to heal; the WBS may represent a simple, easy-calculated score to predict the time for DUs healing. The presence of calcinosis may represent a negative prognostic factor in the management of SSc-DUs.References:[1]Falanga V, Saap LJ, Ozonoff A. Wound bed score and its correlation with healing of chronic wound. Dermatol ther, 2006 Nov-Dec;19(69):383-90Disclosure of Interests:None declared

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Ultrasonic-assisted wound debridement for scleroderma digital ulcers

Italian Journal of Wound Care ◽

10.4081/ijwc.2017.11 ◽

2018 ◽

Vol 1 (1) ◽

Author(s):

Antonella Marcoccia ◽

Carlo Salvucci ◽

Tina D'Alesio ◽

Tarquinia Nuzzo ◽

Anoush Vartanian ◽

...

Keyword(s):

Wound Care ◽

Low Frequency ◽

Healing Time ◽

Procedural Pain ◽

Digital Ulcers ◽

Clinical Effects ◽

Wound Debridement ◽

Ultrasound Waves ◽

Low Frequency Ultrasound ◽

Ultrasonic Assisted

Debridement is a key element of wound care. It involves the removal of devitalized tissue from the wound bed in order to allow wound healing. Microcirculatory ulcers in general and scleroderma ulcers in particular are extremely painful, very reactive and rather unwilling to accept aggressive local treatments of a mechanical type or surgical cleaning which can promote an abnormal phlogistic response with a necrotizing evolution. For the elimination of devitalized tissue is necessary to promote autolytic or enzymatic debridement with slow tendency towards healing frequently exposed to phlogistic infections furthermore slowing healing with high risk of gangrene and amputation. Ultrasonic-assisted wound debridement uses low frequency ultrasound waves showing three clinical effects: atraumatic selective tissue debridement, wound stimulatory effect and antibacterial activity. We compare healing time, infections and procedural pain of ultrasonic debridement with autolytic debridement as for Scleroderma digital Ulcers. There is evidence to show that Ultrasonicassisted wound debridement reduces the time of healing, needing for antimicrobial therapy, the procedural pain and consequently the cost to the healthcare system improving the patients’ quality of life.

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Healing venous ulcers with different modalities of leg compression

Phlebologie ◽

10.1055/s-0037-1622150 ◽

2006 ◽

Vol 35 (05) ◽

pp. 349-355 ◽

Cited By ~ 9

Author(s):

E. O. Brizzio ◽

G. Rossi ◽

A. Chirinos ◽

I. Cantero ◽

G. Idiazabal ◽

...

Keyword(s):

Wound Care ◽

Univariate Analysis ◽

Compression Therapy ◽

Healing Time ◽

Clinical Parameters ◽

Compression Stockings ◽

Local Pressure ◽

Ulcer Size ◽

Venous Ulcers ◽

Unexpected Findings

Summary Background: Compression therapy (CT) is the stronghold of treatment of venous leg ulcers. We evaluated 5 modalities of CT in a prospective open pilot study using a unique trial design. Patients and methods: A group of experienced phlebologists assigned 31 consecutive patients with 35 venous ulcers (present for 2 to 24 months with no prior CT) to 5 different modalities of leg compression, 7 ulcers to each group. The challenge was to match the modality of CT with the features of the ulcer in order to achieve as many healings as possible. Wound care used standard techniques and specifically tailored foam pads to increase local pressure. CT modalities were either stockings Sigvaris® 15-20, 20-30, 30-40 mmHg, multi-layer bandages, or CircAid® bandaging. Compression was maintained day and night in all groups and changed at weekly visits. Study endpoints were time to healing and the clinical parameters predicting the outcome. Results: The cumulative healing rates were 71%, 77%, and 83% after 3, 6, and 9 months, respectively. Univariate analysis of variables associated with nonhealing were: previous surgery, presence of insufficient perforating and/or deep veins, older age, recurrence, amount of oedema, time of presence of CVI and the actual ulcer, and ulcer size (p <0.05-<0.001). The initial ulcer size was the best predictor of the healing-time (Pearson r=0.55, p=0.002). The modality of CT played an important role also, as 19 of 21 ulcers (90%) healed with stockings but only 8 of 14 with bandages (57%; p=0.021). Regression analysis allowed to calculate a model to predict the healing time. It compensated for the fact that patients treated with low or moderate compression stockings were at lower risk of non-healing. and revealed that healing with stockings was about twice as rapid as healing with bandages. Conclusion: Three fourths of venous ulcers can be brought to healing within 3 to 6 months. Healing time can be predicted using easy to assess clinical parameters. Irrespective of the initial presentation ulcer healing appeared more rapid with the application of stockings than with bandaging. These unexpected findings contradict current believes and require confirmation in randomised trials.

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Updated overview on the interplay between obesity and COVID-19

Diagnosis ◽

10.1515/dx-2020-0111 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Diletta Onorato ◽

Giovanni Carpenè ◽

Giuseppe Lippi ◽

Mairi Pucci

Keyword(s):

Disease Severity ◽

Clinical Characteristics ◽

Literature Search ◽

Scientific Literature ◽

Population Sample ◽

Obese Patients ◽

Health Crisis ◽

Keywords Obesity ◽

Negative Prognostic Factor ◽

The Impact

AbstractThe worldwide spread of coronavirus disease 2019 (COVID-19) has generated a global health crisis and more than a million deaths so far. Epidemiological and clinical characteristics of COVID-19 are increasingly reported, along with its potential relationship with overweight and/or obesity. Therefore, we aim here to review the current scientific literature on the impact of overweight and/or obesity among hospitalized patients who have developed severe or critical forms of COVID-19. Following PRISMA guidelines, our literature search identified over 300 scientific articles using the keywords “obesity” and “COVID-19”, 22 of which were finally selected for reporting useful information on the association between overweight/obesity and disease severity. In particular, in 11 out of the 14 studies (79%) which evaluated the association between obesity and disease severity providing also a risk estimate (i.e., the odd ratio; OR), the OR value was constantly >2. Although the studies were found to be heterogeneous in terms of design, population, sample size and endpoints, in most cases a significant association was found between obesity and the risk of progressing to severe COVID-19 illness, intensive care unit admission and/or death. We can hence conclude that an increased body mass index shall be considered a negative prognostic factor in patients with COVID-19, and more aggressive prevention or treatment shall hence be reserved to overweight and/or obese patients.

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Can Optimizing the Mechanical Environment Deliver a Clinically Significant Reduction in Fracture Healing Time?

Biomedicines ◽

10.3390/biomedicines9060691 ◽

2021 ◽

Vol 9 (6) ◽

pp. 691

Author(s):

Jan Barcik ◽

Devakara R. Epari

Keyword(s):

Fracture Healing ◽

Bone Healing ◽

Mechanical Stimulation ◽

Callus Formation ◽

Weight Bearing ◽

Healing Process ◽

Healing Time ◽

Mechanical Environment ◽

Clinically Significant ◽

The Impact

The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.

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Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1720999 ◽

2021 ◽

Author(s):

Marcus Rickert ◽

Michael Rauschmann ◽

Nizar Latif-Richter ◽

Mohammad Arabmotlagh ◽

Tamin Rahim ◽

...

Keyword(s):

Risk Factors ◽

Wound Healing ◽

Wound Infection ◽

Spinal Fusion ◽

Negative Pressure Wound Therapy ◽

Wound Infections ◽

Wound Therapy ◽

Postoperative Wound ◽

Deep Wound ◽

The Impact

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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Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis caused by Leishmania braziliensis

Clinical Infectious Diseases ◽

10.1093/cid/ciab236 ◽

2021 ◽

Author(s):

Tainã Lago ◽

Lucas Carvalho ◽

Mauricio Nascimento ◽

Luiz H Guimarães ◽

Jamile Lago ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Clinical Presentation ◽

Clinical Manifestations ◽

Healing Time ◽

Response To Therapy ◽

Leishmania Braziliensis ◽

Cutaneous Lesions ◽

Cytokine Levels ◽

Cure Rates ◽

The Impact

Abstract Background Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates below 60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. Methods A total of 90 age-matched CL patients were included (30 obese, 30 overweight and 30 with normal BMI). CL was diagnosed through documentation of L. braziliensis DNA by PCR or identification of amastigotes in biopsied skin lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (20mg/kg/day) was administered for 20 days. Results Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After one course of Antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (p<0.01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (p<0.05). Conclusions Obesity modifies the clinical presentation of CL and host immune response, and is associated with greater failure to therapy.

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The Impact of Advances in Skin & Wound Care

Advances in Skin & Wound Care ◽

10.1097/01.asw.0000419402.79012.cd ◽

2012 ◽

Vol 25 (9) ◽

pp. 392

Author(s):

Richard “Sal Salcido

Keyword(s):

Wound Care ◽

Skin Wound ◽

The Impact

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Safety and Efficacy of Collagen-Based Biological Dressings in the Management of Chronic Superficial Skin Wounds in Non-Complex Trauma: A Post-Marketing Surveillance Study

Trauma Care ◽

10.3390/traumacare1030017 ◽

2021 ◽

Vol 1 (3) ◽

pp. 195-205

Author(s):

Francesco De Francesco ◽

Marialuisa De Francesco ◽

Michele Riccio

Keyword(s):

Driving Force ◽

Complex Trauma ◽

Chronic Wounds ◽

Standard Treatment ◽

Wound Care ◽

Healing Time ◽

Therapeutic Tool ◽

Post Marketing Surveillance ◽

Superficial Skin ◽

Post Marketing

Biological dressings such as collagen and hyaluronic acid represent the main advanced tools that plastic surgeons, dermatologists and vulnologists use today to treat chronic wounds or ulcers that do not tend to heal. These types of dressings are important because they create a moist and physiological interface at the wound level, are of natural origin, easy to use, hypo-allergenic, economical and do not create discomfort for the patient during dressing changes. We treated 128 patients (divided into four groups based on type of dressing) with non-complex superficial chronic wounds in comparison with a traditional dressing (fitostimoline gauze or polyurethane foam). We analyzed wound characteristics, healing time, and operator and patient satisfaction. A significantly higher recovery rate was observed in the “Collagen-coated plates” treatment group compared to Standard Treatment. Additionally, a significantly higher probability of recovery was observed compared to the alternative two experimental devices (Collagen-coated plates + HA and Collagen-based spray). However, the main limitation of the randomization of this study is the presence in the “Collagen-based spray” group of localized wounds, mainly in the fingers and hand. No side effects were reported in relation to the procedures or the experimental products. Collagen may be considered as a valuable therapeutic tool in non-complex chronic wounds by virtue of its low immunogenicity, flexibility and applicability in biocompatible scaffolds, and represents driving force toward enhanced wound care.

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Assessment of Frailty In Elderly Patients Attending A Multidisciplinary Wound Care Center: A Cohort Study.

10.21203/rs.3.rs-764391/v1 ◽

2021 ◽

Author(s):

Mariona Espaulella-Ferrer ◽

Joan Espaulella-Panicot ◽

Rosa Noell-Boix ◽

Marta Casals-Zorita ◽

Marta Ferrer-Sola ◽

...

Keyword(s):

Wound Healing ◽

Elderly Patients ◽

Healing Rate ◽

Wound Care ◽

Frailty Index ◽

Healing Time ◽

Venous Ulcers ◽

Healing Wounds ◽

Wound Healing Time ◽

The Relationship

Abstract Background: The incidence of frailty and chronic wounds increases with patients’ age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. Methods: The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centers (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at six months or upon wound healing. Wounds were followed up every two weeks. To analyze the relationship between two variables was used the Chi-square test and Student’s or the ANOVA model. The t-test for paired data was used to analyze the evolution of the frailty index during follow-up.Results: A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at six months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p=0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p=0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p=0.637). Wound healing rate is statically significantly higher in non-frail patients (3,26% wound reduction/day, P25-P75 0.8-8.8%/day) in comparison with frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day; p=0.044). Conclusion: Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.

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597 Opioid-limiting Mandate Did Not Increase Readmissions for a Single Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/iraa024.223 ◽

2020 ◽

Vol 41 (Supplement_1) ◽

pp. S141-S142

Author(s):

Kamil Nurczyk ◽

Sanja Sljivic ◽

Kaylyn Pogson ◽

Lori Chrisco ◽

Rabia Nizamani ◽

...

Keyword(s):

Graft Failure ◽

Discharge Planning ◽

Wound Care ◽

Tertiary Care ◽

Prescription Opioid ◽

Opioid Misuse ◽

Burn Center ◽

Chi Squared ◽

Prescription Opioid Misuse ◽

The Impact

Abstract Introduction Our state’s Strengthen Opioid Misuse Prevention (“STOP”) Act was enacted on January 1 st 2018 to reduce prescription opioid misuse. We sought to evaluate the impact of opioid-limiting legislation on readmission rates among burn patients to our tertiary care burn center related to uncontrolled pain. Methods Patients were identified using an institutional Burn Center registry and linked to clinical and administrative data. All patients admitted between July 1 st, 2014 to June 20 th, 2019 were eligible for inclusion. Injury mechanism categories and reasons for readmissions were evaluated. Statistical analysis was carried out using chi-squared test and significance was accepted as p< 0.05. Results Of the 7872 total admissions, 160 (2%) were readmissions. Mean number of readmissions for every year was 32. There was an increase in number of readmissions in 2018 observed but it was not statistically significant (2014 n=12, 2015 n=35, 2016 n=21, 2017 n=33, 2018 n=40, 2019 n=19). The reasons for readmission included wound progression, graft failure, infection, and pain. There was an increase in readmissions for infection, wound progression and graft failure after January 2018, p< 0.05. The percentage of patients readmitted for pain increased between 2014 to 2019 but it was not statistically significant. Conclusions The primary reasons for readmissions to our burn center were pain, infection, graft failure, and progression of disease. Despite the opioid-limiting law there was not an increase in readmissions related to pain. Applicability of Research to Practice This study demonstrates that our current discharge planning strategies are managing pain expectations for patients. Our focus should be shifted towards improving infection control and wound care.

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