The Topical Effect of rhGDF-5 Embedded in a Collagen–Gelatin Scaffold for Accelerated Wound Healing

The application of exogenous growth factors such as the recombinant human growth and differentiation factor 5 (rhGDF-5) represents a major research topic with great potential for the treatment of complex wounds. In a randomized, controlled minipig study, the topical effect of rhGDF-5 on full-thickness skin defects was evaluated. A total of 60 deep dermal wounds were either treated with rhGDF-5 embedded in an innovative collagen scaffold or another commonly used collagen matrix or left untreated. Wound healing was analyzed by planimetric analysis to determine wound closure over time. After 21 days, the areas of the initial wounds were excised, and the newly formed tissue was examined histologically. In comparison to untreated wounds, all examined matrices accelerated dermal wound healing. The largest acceleration of wound healing was seen with the high-dose rhGDF-5-treated wounds, which, compared to the untreated wounds, accelerated wound healing by 2.58 days, improved the neoepidermal thickness by 32.40 µm, and increased the epidermal cell density by 44.88 cells. The innovative collagen scaffold delivered rhGDF-5 adequately, served as a template to guide proliferating and restructuring cells, and accelerated wound healing. Thus, this composite product offers a novel tool for developing effective wound dressings in regenerative medicine.

Traumatic wound difficult to heal: use of negative pressure therapy: case report

The skin is one of the largest organs of the anatomy. It is the barrier between the exterior and the first line of defense against aggression. A wound is a loss of continuity of the soft parts of the organism generating an interruption in the structure of the tissue, as a consequence of this loss of continuity, there is a loss of sterility existing inside and infection can occur. Another consequence of discontinuity are possible lesions in adjacent tissues or organs. Trauma results in complex wounds that are difficult to manage due to large skin loss or avulsion of large areas of tissue. Among the factors that can prevent proper healing can be systemic (malnutrition, chemotherapy, steroids) or local (infection, prosthetic material, bone exposure). Among the therapeutic options for complex wounds is negative pressure therapy which generates wound contraction, stabilization of the environment, reduction of edema, removal of exudate and micro-deformations of the surface, increase of angiogenesis, granulation tissue formation and decreased bacterial count. We described a clinical case of traumatic injury at the level of the right pelvic limb in a 70-years-old woman with diabetes and hypertension, in which surgical washing was performed, debridement and use of negative pressure therapy with adequate evolution in a second level public hospital.

Acellular fish skin grafts for the management of wounds in dogs and cats: 17 cases (2019–2021)

OBJECTIVE To report the clinical outcomes of the use of acellular fish skin grafts (FSGs) for the management of complex soft tissue wounds of various etiologies in dogs and cats. ANIMALS 13 dogs and 4 cats with complex wounds treated with FSGs between February 2019 and March 2021. PROCEDURES Medical records were reviewed for information regarding cause, location, size of the wound, management techniques, complications, and clinical outcomes. RESULTS In dogs, the number of FSG applications ranged from 1 to 4 (median, 2 graft applications). The time between each application ranged from 4 to 21 days (median, 9.5 days). Time to application of the first FSG ranged from 9 to 210 days (median, 19 days). Wounds closed by second-intention healing following the first fish skin application between 26 and 145 days (median, 71 days; n = 12). In cats, 1 or 2 FSGs were used, and the wounds of 3 of 4 cats healed completely by secondary intention. The wounds of 1 dog and 1 cat did not heal. There were no adverse events attributed to the use of the FSGs. CLINICAL RELEVANCE For dogs and cats of the present study, complete healing of most wounds occurred with the use of FSGs, the application of which did not require special training, instruments, or bandage materials.

Biodegradeable temporising matrix use in a traumatic chest wound

The Welsh Centre for Burns and Plastic Surgery is responsible for a population of 10 million people in Wales and England. We describe the use of biodegradable temporising matrix (BTM) in a large traumatic chest wound in a 23-year-old woman. BTM is a synthetic dermal substitute and has been utilised to achieve soft tissue coverage in complex wounds. This wound was sustained after the patient fell from a tractor into a large silage rake, resulting in injuries to her chest and limbs. Following meticulous debridement, her resulting full thickness skin defect measured 30 × 30 cm extending from the sternal notch to the upper abdomen, with bone, muscle and breast tissue exposure. The central chest area is complex to reconstruct due to the contours of the breasts and tendency to contracture following skin graft reconstruction. We demonstrate the first reported use of BTM for breast reconstruction, as far as we are aware.

Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction

Complex wounds are a major burden for healthcare professionals. Patients with complex wounds are often referred to hospitals or wound expertise centres. Complex wound care could be organised in primary care, but very little published evidence for this is available. In this study, members of a primary healthcare organisation were interviewed to ascertain how the wound care was organised. Patient characteristics and data regarding wound care, healing rates and costs were collected from medical records. Patients filled in a questionnaire concerning accessibility, communication, medical counselling and the overall experience of their treatment. This study followed 25 patients with a total of 42 wounds. Some 82% of the wounds were healed within a mean treatment duration of 9.7 weeks. Mean treatment costs were calculated at €155 (£130) for healed patients. Patients were generally very satisfied with their treatment, illustrated by an overall 8.7 out of 10 scoring on an amended survey based on the Consumer Quality Index. Treating complex wounds in primary care seemed adequate, with high patient satisfaction and tolerable costs.

Management of complex wounds treatment with a hydrofiber dressing in a public hospital in Bogota (Colombia)

Objective. To evaluate the efficacy of the use of a last generation hydrofiber dressing with silver, for the treatment of complex wounds that are difficult to heal.Materials and research methods. A prospective observational case-follow-up study was carried out, which included patients with acute or chronic wounds that were difficult to heal, treated in the plastic surgery service of a public hospital in Bogota-Colombia, who underwent healing with hydrofiber dressings reinforced, with silver ions, benzethonium chloride and EDTA (Aquacel Agplus®, ConvaTec). The wound was monitored, evaluating infection control, exudate and biofilm, as well as the number of required dressings and the time required for the complete closure of the wound.Research results. A total of 55 patients were included, with a median age of 44 years. In all cases, a follow-up was carried out until the definitive closure of the wound. At the end of the study, it was observed that, in 35 (63.6 %) patients, the wounds evolved to complete closure by second intention in an average of 59.3 days, requiring 12.5 dressings. 20 (36.4 %) patients had adequate wound bed preparation for definitive surgical coverage with grafts, flaps or dermal substitutes, in an average of 31.4 days, requiring 6.5 dressings on average.33 (60.0 %) wounds were infected and adequate infection control was achieved on average with 5 dressings. A decrease in the direct and indirect signs of biofilm was achieved after 6 dressings.Conclusion. The results show that the dressing studied is effective to control exudate, infection and biofilm, as well as to prepare the bed for a definitive surgical coverage.

Cost-Effectiveness of Hypochlorous Acid Preserved Wound Cleanser versus Saline Irrigation in Conjunction with Ultrasonic Debridement for Complex Wounds

Objective: Low-frequency ultrasound debridement with irrigation is an effective method of wound bed preparation. A recent clinical study compared hypochlorous acid preserved wound cleanser (HAPWOC) to saline and found HAPWOC to be a more effective adjunct to low frequency ultrasound debridement. However, HAPWOC has an added cost. The primary objective of this study was to assess the cost-effectiveness of HAPWOC as an irrigation modality with low-frequency ultrasound debridement for the treatment of severely complex wounds that were destined to be closed primarily via a flap. The secondary objective of this study was to estimate the number needed to treat (NNT) to avoid a wound-related complication and its expected cost per NNT. Methods: A patient-level Monte-Carlo simulation model was used to conduct a cost-effectiveness analysis from the US health system perspective. All clinical data were obtained from a prospective clinical trial. Cost data were obtained from the publicly available data sources in 2021 US dollars. The effect measure was the avoidance of wound-related complications at 14-days post-debridement. The primary outcome was the incremental cost-effectiveness ratio (ICER), a measure of the additional cost per benefit. The secondary outcomes were the NNT and expected cost per NNT to avoid one complication (complementary to the ICER in assessing cost-effectiveness). Deterministic and probabilistic sensitivity analyses (PSA) were performed to gauge the robustness and reliability of the results. Results: The ICER for HAPWOC versus saline irrigation was US$90.85 per wound complication avoided. The expected incremental cost per patient in the study and effect was US$49.97 with 55% relative reduction in wound-related complications at day 14 post debridement procedure. The NNT and cost per NNT were 2 and US$99.94, respectively. Sensitivity analyses demonstrated that these results were robust to variation in model parameters. Conclusion: HAPWOC was a cost-effective strategy for the treatment of complex wounds during ultrasonic debridement. For every two patients treated with HAPWOC, one complication was avoided.