Porcine bladder extracellular matrix in paediatric pilonidal wound care: healing and patient experience evaluation

2019 ◽  
Vol 28 (Sup5) ◽  
pp. S12-S19
Author(s):  
Sarah B. Cairo ◽  
Jane Zhao ◽  
Minje Ha ◽  
Kathryn D. Bass
Keyword(s):  
Extracellular Matrix ◽  
Wound Healing ◽  
Patient Satisfaction ◽  
Chart Review ◽  
Wound Care ◽  
Pilonidal Disease ◽  
Site Specific ◽  
Phone Calls ◽  
Specific Tissue

Objective: Pilonidal disease (PD) with inflammation and abscess formation occurs frequently in adolescents. The management of pilonidal disease, time to wound healing, and patient satisfaction, however remains variable despite advances in wound care methods. Porcine bladder extracellular matrix (PBEM) facilitates site-specific tissue deposition/re-growth for the management of a variety of wounds. The aim was to describe the use and outcomes of PBEM in PD at a single centre. Method: A retrospective chart review of adolescent patients who underwent treatment of pilonidal disease with PBEM between 2012 and 2016 at a single institution, was undertaken. Patient demographics and clinical characteristics were collected and compared with historical controls and literature regarding traditional wound therapies. Results: We reviewed 52 pilonidal disease wounds on 41 patients. Of these 36 were treated with PBEM. The average age was 16 years old at the time of operation with 39% male. Furthermore, 85% were being treated for recurrent pilonidal disease. Follow-up was available by chart review for 89% of patients with documented complete wound healing in 78% of patients treated with PBEM at an average of two months. Subjective reports included majority positive experience with PBEM dressing, minimal pain and overall high levels of patient satisfaction. There were three patients in which pilonidal disease recurred within two years of initial treatment and underwent repeat treatment with PBEM. There was one patient who transitioned to wet-to-dry saline dressings because of difficulty keeping the PBEM dressing intact. Conclusion: Advances in wound care technology include materials such as PBEM to promote site-specific tissue deposition. Follow-up phone calls and a prospective study to compare alternative wound care with porcine PBEM in the management of pilonidal disease is underway to better quantify time to wound healing and patient satisfaction.

Umbilical Herniorrhaphy Reinforced with Biologic Mesh

2010 ◽  
Vol 76 (11) ◽  
pp. 1205-1209
Author(s):  
David S. Edelman ◽  
Charles F. Bellows
Keyword(s):  
Extracellular Matrix ◽  
Patient Satisfaction ◽  
Umbilical Hernia ◽  
Enterocutaneous Fistula ◽  
Synthetic Mesh ◽  
Biologic Mesh ◽  
Preliminary Evaluation ◽  
Umbilical Hernia Repair ◽  
Preliminary Study

The true recurrence rate after umbilical hernia repair in not known. After simple closure, the reported rate of recurrence in the literature is as high as 54 per cent. With synthetic mesh repair, the recurrence rates are lowered to less than 10 per cent. However, synthetic mesh is associated with complications such as enterocutaneous fistula and mesh infections. This preliminary study looks at the safety and effectiveness of biologic extracellular matrix mesh reinforcement in the repair of umbilical hernias. We retrospectively reviewed all patients who underwent repair of an umbilical hernia defect (2-3 cm) with primary approximation of the margins and reinforced using a biologic mesh placed beneath the umbilical fascia from 2007 to 2009. Demographic data were collected. Patients were followed prospectively at 2 weeks, 8 weeks, 6 months, and 1 year. Data were reviewed for postoperative complications, hernia recurrence, and patient satisfaction. During the study period, 16 patients completed the 1 year follow-up. There were 10 men and six women. Ages ranged from 28 to 75 years with a mean age of 47.6 years. The hernias were 2 to 3 cm in size. Complications were minimal. Overall patient satisfaction with the procedure was high. There were no mesh infections. During a mean follow-up of 12 months, only one patient had recurrent hernia (6%). This preliminary evaluation shows promise for an alternative treatment of umbilical hernias using biologic extracellular matrix mesh added as an underlay to reinforce a primary closure. The biologic mesh has a low incidence of infection and complications and results in high patient satisfaction. This preliminary study begs for a randomized, prospective evaluation with long-term follow-up.

The effect of hyperbaric oxygen therapy on gene expression: microarray analysis on wound healing

2020 ◽  
pp. 31-37
Author(s):  
Jakub Tlapák ◽  
◽  
Petr Chmátal ◽  
Boris Oniščenko ◽  
Vojtěch Pavlík ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Gene Expression ◽  
Extracellular Matrix ◽  
Wound Healing ◽  
Hyperbaric Oxygen ◽  
Wound Care ◽  
Genomic Analysis ◽  
Live Animal ◽  
Elevated Expression ◽  
Hbo2 Therapy

Background: Hyperbaric oxygen (HBO2) therapy canhave a positive effect on wound healing, angiogenesis and blood flow. No prior study has described the effects of HBO2 therapy and gene expression of this process. The goal of our research was to show the effects of HBO2 and its impact at the molecular level on angiogenesis, proliferation, differentiation, oxidative stress, inflammation, and extracellular matrix formation. Live animal subjects were used for simulating the process of wound healing under standard conditions and under the influence of HBO2. Methods: Two experimental groups were created using injured rabbits (N=24), one group (N=12) treated with hyperbaric therapy twice a day and one (N=12) with standard wound care management. Wounds were surgical, uninfected, and in healthy animal test subjects. We compared the whole genomic analysis of the transcriptome with the use of microarray technology at three intervals during treatment. Results: The induction of the wounds in rabbit skin increased expression of hundreds of genes in both treatment groups. The numbers of elevated and decreased genes gradually reduced as the wound healed. Gene expression analysis showed elevated expression of several genes associated with inflammation in both groups of injured animals. Genes connected to the process of angiogenesis, proliferation, differentiation, oxidative stress and extracellular matrix formation were without statistically significant changes. Conclusion: The evidence did not support that HBO2 had any significant effect on gene expression during wound healing. Additionally, there was no evidence to support that there were changes in gene expression in either treatment group.

The Impact of Telephonic Follow-Up Within 2 Business Days Postdischarge on 30-Day Readmissions for Patients With Heart Failure

2021 ◽  
pp. JDNP-D-19-00079
Author(s):  
Victoria M. Chestnut ◽  
Karen Vadyak ◽  
Matthew M. McCambridge ◽  
Michael J. Weiss
Keyword(s):  
Heart Failure ◽  
Chart Review ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
Hospital Discharges ◽  
Phone Calls ◽  
Adult Participants ◽  
Patients With Heart Failure ◽  
The Impact

BackgroundHeart failure (HF) is a chronic condition associated with high rates of hospital readmissions. The prevalence and costs of HF are expected to rise dramatically by 2030 (Heidenreich,et al., 2013).ObjectiveA 24-month, retrospective study was conducted using electronic medical record (EMR) chart review, seeking to identify if postdischarge follow-up phone calls decreased 30-day readmissions in individuals with HF.MethodsThe study included 705 adult participants who were admitted to the hospital for HF. Some received a postdischarge call within 2 business days of discharge, and some did not.ResultsParticipants who received the postdischarge call were less likely to be readmitted (20.1%) than participants who did not receive a postdischarge call (28.8%; p = .007). Participants who received the postdischarge call were more likely to have a follow-up visit within 14 days (70.1%) than participants who did not receive a postdischarge call (30.2%; p < .001).ConclusionsThe findings from this study may help to drive future transitional care strategies for individuals diagnosed with HF.Implications for NursingNurse-led transitional care interventions offer potential solutions to ensure safe, effective hospital discharges.

Abstract 211: A Patient-Centered Approach to Improve Outcomes after Cardiac Electrophysiological Device Implantation

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Natalia Hernandez ◽  
Andrew P Aiken ◽  
Joan M Mitchell
Keyword(s):  
Chart Review ◽  
Wound Care ◽  
Self Care ◽  
General Information ◽  
Patient Centered ◽  
Device Implantation ◽  
Flow Map ◽  
Improve Patient ◽  
Monitoring Activity

Objective: Infection associated with cardiac implantable electrophysiological device (CIED) implantation or revision occurred in our facility in 17.8% of CIED recipients, leading to hospitalization and device explantation in 5.2% of patients. Our objective was to reduce the incidence of CIED-associated infections, number of hospitalizations and device explantations by 25%. Methods: At baseline, a peri-procedural follow-up occurred on as needed basis. A new patient-centered program was initiated and lead by a nurse-practitioner (NP) (refer to flow map). Patients were seen 1 week prior to CIED implantation, provided with general information, familiarized with the procedure and self-care techniques. On the day of CIED implantation, NP visited patients at bedside and provided a self-care checklist. A follow up visit was scheduled 1 week after the procedure to provide local wound care, discuss symptom monitoring, activity limitations and review self-management techniques supported by a checklist. If any evidence of CIED site infection was discovered, antibiotics were initiated with a weekly follow-up until infection was resolved. If no evidence of infection was noted, further plan of care consisted of a consultation for the patients hospitalized with CIED-related infections by NP, and a chart review at 6 months after implantation in cases when no hospitalizations occurred. Data on incidence of post-CIED implantation infections, hospitalizations and explantations was collected by chart review of 152 patients prior and 66 patients after establishment of the patient-centered program. Results: With initiation of our patient-centered program, incidence of CIED site infections was reduced by 23.5%, and both, the number of hospitalizations and CIED explantations, decreased by 42.4%. Conclusions: Patient education and engagement in post-CIED implantation care combined with a close surveillance by NP can be an effective tool to improve patient outcomes by reducing frequency of CIED site infections, need for hospitalization and device explantation.

Management of Diabetic Foot Ulcer with MA–ECM (Minimally Manipulated Autologous Extracellular Matrix) Using 3D Bioprinting Technology – An Innovative Approach

2021 ◽  
pp. 153473462110456
Author(s):  
Rajesh Kesavan ◽  
Changam Sheela Sasikumar ◽  
V.B. Narayanamurthy ◽  
Arvind Rajagopalan ◽  
Jeehee Kim
Keyword(s):  
Extracellular Matrix ◽  
Wound Healing ◽  
Diabetic Foot ◽  
Wound Care ◽  
Foot Ulcer ◽  
Test Group ◽  
Wound Dressings ◽  
Foot Ulcers ◽  
Control Group ◽  
3D Bioprinting

Chronic foot ulcers are the leading cause of prolonged hospitalization and loss of social participation in people with diabetes. Conventional management of diabetic foot ulcers (DFU) is associated with slow healing, high cost, and recurrent visits to the hospital. Currently, the application of autologous lipotransfer is more popular, as the regenerative and reparative effects of fat are well established. Herein we report the efficacy of minimally manipulated extracellular matrix (MA-ECM) prepared from autologous homologous adipose tissue by using 3D bioprinting in DFU (test group) in comparison to the standard wound care (control group). A total of 40 subjects were screened and randomly divided into test and control groups. In the test group, the customized MA-ECM was printed as a scaffold from the patient autologous fat using a 3D bioprinter device and applied to the wound directly. The control group received standard wound care and weekly follow-up was done for all the patients. We evaluated the efficacy of this novel technology by assessing the reduction in wound size and attainment of epithelialization. The patients in the test group (n = 17) showed complete wound closure with re-epithelialization approximately within a period of 4 weeks. On the other hand, most of the patients in the control group (n = 16) who received standard wound dressings care showed a delay in wound healing in comparison to the test group. This technique can be employed as a personalized therapeutic method to accelerate diabetic wound healing and may provide a promising potential alternative approach to protect against lower foot amputation a most common complication in diabetes.

The Skin and the Physiology of Normal Wound Healing

2020 ◽  
Author(s):  
Timothy W. King ◽  
Sahil K. Kapur
Keyword(s):  
Extracellular Matrix ◽  
Wound Healing ◽  
Growth Factors ◽  
Wound Care ◽  
Normal Wound Healing ◽  
Inflammatory Phase ◽  
Complex Process

This review presents normal wound healing as a complex process that is generally carried out in three overlapping stages: an inflammatory phase, a proliferative phrase (made up of fibroplasia, contraction, neovascularization, and granulation), and a remodeling phase. In addition, wound healing occurs under the influence of multiple cytokines, growth factors, and extracellular matrix signals. Figures show the layers of the skin and the cycles of wound healing.  This review contains 6 highly rendered figures, 8 tables, and 47 references Keywords: wound, wound care, healing, epithelialization, migration, granulation

scholarly journals Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess

2017 ◽  
Vol 99 (2) ◽  
pp. 134-136 ◽  
Author(s):  
Y Jain ◽  
MA Javed ◽  
S Singh ◽  
S Rout ◽  
H Joshi ◽  
...  
Keyword(s):  
Wound Healing ◽  
Minimally Invasive ◽  
Postoperative Morbidity ◽  
Pilonidal Disease ◽  
Invasive Technique ◽  
Female Ratio ◽  
Novel Approach ◽  
Complete Wound Healing ◽  
Pilonidal Abscess

INTRODUCTION Pilonidal abscess is a common surgical emergency. Conventional treatment with incision and drainage is associated with significant postoperative morbidity. We report our initial experience of using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT). MATERIALS AND METHODS A prospective database of all patients undergoing EPAT between January 2015 and March 2016 at Whiston Hospital was maintained. Data regarding patient demographics, peroperative variables and postoperative follow-up were recorded. RESULTS Nineteen patients were included, male to female ratio was 53 : 47 and median age of the cohort was 24 years (interquartile range 22–25 years). EPAT was the primary procedure for 10 patients and 9 had EPAT for recurrent pilonidal abscesses. There were no readmissions and none needed further surgery within 6 weeks of having the procedure. In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain (median postoperative visual analogue scale score 1) and immediate return to the activities of daily life. Four of the nineteen patients (21%) required definitive intervention for pilonidal disease in the follow-up period. CONCLUSIONS EPAT is a novel, minimally invasive technique for the treatment of acute pilonidal abscesses. It is safe, associated with reduced postoperative morbidity, recurrence rate and quick wound healing. Initial encouraging results require further investigations on a larger group of patients in a multicentre setting.

Wound Care With a Porcine Extracellular Matrix After Surgical Treatment of Rhinophyma

2020 ◽  
Vol 24 (3) ◽  
pp. 253-258 ◽  
Author(s):  
Lutz Schmitz ◽  
Schapoor Hessam ◽  
Lisa Scholl ◽  
Sarah Reitenbach ◽  
Marc H. Segert ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Wound Care ◽  
Severity Index ◽  
Clinical Findings ◽  
Wound Dressings ◽  
Wound Area ◽  
Scar Assessment ◽  
Aggressive Action ◽  
Care Procedure

Background Rhinophyma surgery is commonly associated with prolonged wound healing and the need for multiple wound dressings. Objectives To evaluate clinical outcome with a porcine extracellular matrix (ECM) after shave excision of rhinophyma compared with common wound care procedure. Materials and methods Retrospective analysis of patients with common dressings (CD) compared with patients with additional ECM (OASIS) application. Clinical findings were assessed prior to treatment and at follow-up visit using the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), and Rhinophyma Severity Index (RHISI). Results Overall, 28 patients (67.5 ±9.0 years) with a mean wound area of 33.9 (±8.5) cm² were included. After a mean follow-up period of 132 (±73) days, scales of POSAS, VSS, and RHISI showed significant ( P< .0001) reductions of 47.0% (±11.1), 56.0% (±12.0), and 62.3% (±14.3), respectively. Subgroup analysis showed no significant differences of aforementioned parameters between the ECM group ( n= 17) and CD group ( n= 11). In contrast, the number of dressing changes were significantly ( P< .006) less in the ECM group (1.4 ±0.8) compared with CD group (4.1 ±2.6). The ECM group showed a significant ( P< .017) shorter time to re-epithelization (10.5 ±1.7 days) than the CD group (13.1 ±2.2 days). Conclusions The application of porcine ECM is practicable and reduces the number of dressing changes and time to re-epithelization clearly. Crusts are scaling off spontaneously without any aggressive action needed. Our findings indicate that ECM application is a promising approach for rhinophyma wound care.

Outcomes of Unroofing with Limited Excision and Structured Postoperative Care for Pilonidal Disease

2017 ◽  
Vol 83 (10) ◽  
pp. 1045-1049 ◽  
Author(s):  
Farees Ricky Tavangari ◽  
Jennifer Amy Lee ◽  
David Garza ◽  
Talar Tejirian
Keyword(s):  
Postoperative Care ◽  
Recurrent Disease ◽  
Wound Care ◽  
Pilonidal Disease ◽  
Surgical Techniques ◽  
Complete Healing ◽  
Skin Closure ◽  
Chronic Abscess ◽  
Healing Wounds

Despite a wide variety of surgical techniques to treat chronic pilonidal disease, high rates of recurrence are common. The current study analyzes the outcome of unroofing with limited excision combined with structured postoperative wound care for pilonidal disease. We performed a retrospective review of all patients who were treated with this technique over a seven year period. Ninety-four patients aged 11 to 63 (mean age 26) received this treatment for pilonidal disease. Eighty-nine patients were treated for primary pilonidal disease and five were treated for recurrent disease after procedures such as flaps. There were 66 males (70%) and 28 females (30%). The operation was performed by unroofing the entire pilonidal sinus along with its pits and area of chronic abscess cavity. All granulation tissue was removed and the base of the sinus was completely cauterized. No wide local excisions were performed. The cavity was packed with dry gauze and the dressing was changed twice daily. Patients were seen postoperatively on a weekly basis in clinic. The area was shaved; the cavity was cleaned and often treated with silver nitrate. In the event of premature skin closure starting to form, unroofing was easily performed in the office. The median time to achieve complete healing was 53 days requiring, on average, seven visits. With a mean follow-up of 40 months, there were two recurrences (2.1%) and reoperation for two (2.1%) inappropriately healing wounds. This study demonstrates that unroofing with limited excision and structured postoperative care for pilonidal disease is a safe and effective treatment approach with a very low recurrence and complication rate.

scholarly journals Feasibility and performance of a patient-oriented discharge instruction tool for heart failure

2019 ◽  
Vol 8 (3) ◽  
pp. e000489 ◽  
Author(s):  
Toni Schofield ◽  
Heather Ross ◽  
R Sacha Bhatia ◽  
Karen Okrainec
Keyword(s):  
Heart Failure ◽  
Patient Satisfaction ◽  
Signs And Symptoms ◽  
Care Group ◽  
Discharge Instructions ◽  
Discharge Instruction ◽  
Adherence To Diet ◽  
Phone Calls ◽  
And Performance

BackgroundThe provision of patient-centred discharge instructions is a pivotal goal for improving quality of care for patients with heart failure (HF) during care transitions. We tested the feasibility and performance of a novel discharge instruction tool co-designed with patients and adapted for HF; the patient-oriented discharge summary (PODS-HF) with the aim of improving communication, comprehension and adherence to discharge instructions.MethodsAn iterative process was used to adapt and implement an existing patient instruction tool for patients with HF (PODS-HF). A mixed methods approach was then used to explore patient experience, feasibility and performance using a pre–post study design among eligible patients admitted for HF over a 6-month period. Outcome measures included: the documentation of patient-centred instructions, a locally derived Average Discharge Score (ADS) based on the inclusion of instructions in nine key areas, patient satisfaction and understanding and adherence to instructions at 72 hours and 30 days determined using follow-up phone calls.Results19 patients were enrolled. The ADS increased by 68% with more consistent documentation. Patient satisfaction remained high. Patients provided PODS-HF reported receiving written information about HF related signs and symptoms to watch for (two out of five patients in the usual care group vs seven out of seven patients in the PODS-HF group; p=0.045). Patients also felt more confident to manage their own health and 30-day adherence to diet and exercise instructions improved while reducing the need for unscheduled visits. Quantitative results were supported by themes identified during follow-up calls, namely, the utility of written instructions and the importance of a follow-up call.ConclusionPODS-HF is a feasible tool for the delivery of patient-centred discharge instructions for patients with HF. The individual benefits of clarification and reinforcement made during follow-up calls among patients receiving this tool remains to be clarified.

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