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Annals of Surgery Dec 2009Modern war ballistics and blast injuries inflict devastating extremity injuries, violating soft tissue, bone, and neurovascular structures. Despite advances in complex... (Comparative Study)
Comparative Study
BACKGROUND
Modern war ballistics and blast injuries inflict devastating extremity injuries, violating soft tissue, bone, and neurovascular structures. Despite advances in complex wound management, appropriate timing of war wound closure remains subjective. In addition, the pathophysiology of acute wound failure is poorly defined.
METHODS
Patients with penetrating extremity wounds sustained during combat were prospectively studied and followed for 30 days after definitive wound closure. The primary outcome was wound healing. Wound dehiscence was defined as spontaneous partial or complete wound disruption after closure. Serum, wound effluent, and wound bed tissue biopsy were collected at each surgical wound debridement. Serum and wound effluent were analyzed with a multiplex array of 22 cytokines and chemokines, and wound tissue for corresponding gene transcript expression.
RESULTS
Fifty-two penetrating extremity war wounds in 33 male patients were investigated. Nine (17%) wounds dehisced. Concomitant vascular injury, increased wound size, and higher injury severity score correlated with wound dehiscence. Both serum and wound effluent cytokine and chemokine protein profiles were statistically associated with healing outcome at various time points. Wound biopsy gene transcript expression demonstrated increased tissue inflammation associated with wound failure. Multiple protein and gene transcript biomarkers predictive of wound healing were identified.
CONCLUSIONS
The cytokine and chemokine protein and gene transcript expression patterns demonstrate a condition of inflammatory dysregulation associated with war wound failure. A molecular biomarker panel may predict combat wound healing outcome and warrants prospective validation.
Topics: Afghan Campaign 2001-; Biomarkers; Chemokines; Cytokines; Follow-Up Studies; Gene Expression Regulation; Hand Injuries; Humans; Inflammation; Iraq War, 2003-2011; Leg Injuries; Male; Military Personnel; Prognosis; Prospective Studies; RNA; ROC Curve; Trauma Severity Indices; Wound Healing; Wounds, Penetrating; Young Adult
PubMed: 19953718
DOI: 10.1097/sla.0b013e3181b248d9 -
Advances in Skin & Wound Care Mar 2005To provide physicians and nurses with an overview of factors to consider in determining wound etiology. (Comparative Study)
Comparative Study Review
PURPOSE
To provide physicians and nurses with an overview of factors to consider in determining wound etiology.
TARGET AUDIENCE
This continuing education activity is intended for physicians and nurses with an interest in understanding how determining wound etiology affects wound care.
OBJECTIVES
After reading the article and taking the test, the participant should be able to: 1. Describe the etiology and characteristics of pressure ulcers, skin tears, and diabetic ulcers. 2. Describe the etiology, characteristics, and management of venous and arterial ulcers. 3. Identify factors needed to determine the etiology and management of specific atypical wounds.
Topics: Anti-Bacterial Agents; Combined Modality Therapy; Debridement; Diabetic Foot; Education, Medical, Continuing; Female; Humans; Male; Pressure Ulcer; Prognosis; Risk Assessment; Severity of Illness Index; Skin Care; Skin Transplantation; Surgical Wound Dehiscence; Treatment Outcome; Varicose Ulcer; Wound Healing; Wounds and Injuries
PubMed: 15788915
DOI: 10.1097/00129334-200503000-00014 -
Therapeutische Umschau. Revue... Sep 2007New techniques and devices have revolutionized the treatment of wounds during the last years. For the treatment of wounds we have nowadays a great variety of new... (Review)
Review
New techniques and devices have revolutionized the treatment of wounds during the last years. For the treatment of wounds we have nowadays a great variety of new gadgets, tools and methods. Complex wounds require specific skills, given the fact that a great number of different promising methods are on the market to enable an optimal wound management. Well educated "wound experts" are required to overcome the problems of very complicated and chronic wound problems. The importance of an interdisciplinary team increases while facing the problems of special wound disorders such as a diabetic food, food ulcers or the problems of open abdomen in case of severe peritonitis. In this overview the main principles of modern wound treatment are outlined. The aim of this article is to present a good summary of wound judgement and treatment for the practioner. Increasingly important is it to point out the situation of complexe wounds which should be judgded and treated with the help of a "wound expert".
Topics: Bacterial Infections; Biological Dressings; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'; Surgical Wound Dehiscence; Switzerland; Wound Healing; Wounds and Injuries
PubMed: 18075140
DOI: 10.1024/0040-5930.64.9.473 -
Advances in Skin & Wound Care May 2016To discuss how patient considerations and the initial wound environment can affect wound treatment and summarize the way in which the initial US Wound Registry measures... (Review)
Review
OBJECTIVES
To discuss how patient considerations and the initial wound environment can affect wound treatment and summarize the way in which the initial US Wound Registry measures capture aspects of the DIME (Debridement/devitalized tissue, Infection or inflammation, Moisture balance, and wound Edge preparation/wound depth) principles.
DISCUSSION
The treatment of chronic wounds often involves extended hospital stays and long-term outpatient follow-up visits with costly advanced therapeutic interventions. As complex care is required for chronic wounds, treatment guidelines such as DIME have evolved to include consideration of patient-centered concerns and etiology, as well as features of wound bed preparation. The US healthcare system is in the midst of transitioning to a quality-based system. However, as wound care is not yet a recognized specialty, it is poorly represented in the current approved quality-based measures.
CONCLUSION
This article helps to identify the practice guidelines that are not currently represented by quality metrics.
Topics: Female; Humans; Male; Patient-Centered Care; Practice Guidelines as Topic; Quality of Health Care; Risk Assessment; Surgical Wound; Surgical Wound Dehiscence; Surgical Wound Infection; Treatment Outcome; United States; Wound Healing; Wounds and Injuries
PubMed: 27089149
DOI: 10.1097/01.ASW.0000482354.01988.b4 -
Annals of Plastic Surgery Feb 2013Patients transferred to Plastic Surgery Departments for sternum osteomyelitis have a high morbidity of about 3%. Despite several known options for sternal wound coverage...
BACKGROUND
Patients transferred to Plastic Surgery Departments for sternum osteomyelitis have a high morbidity of about 3%. Despite several known options for sternal wound coverage and salvage operations, wound dehiscence or wound necrosis can occur, increasing patient morbidity.
PATIENTS AND METHODS
One hundred thirty-five patients admitted between January 2007 and December 2010 were evaluated in a retrospective study for wound dehiscence after salvage wound coverage at our institution. Various flaps were applied, such as pectoralis major myocutaneous pedicled flaps, pectoralis major muscle pedicled flaps, latissimus dorsi pedicled flaps, greater omental flaps, and vertical rectus abdominis muscle and transverse rectus abdominis muscle flaps. Inclusion criteria were sternal wound infection, bacterial wound infection, previous wound debridement outside our institution, vacuum-assisted closure device wound treatment at our institution, and secondary flap closure of the sternal defect at our institution. A multivariate regression analysis was performed.
RESULTS
One hundred thirty patients met the inclusion criteria. In all patients, bacterial wound colonization was shown. Forty patients showed wound dehiscence after closure at our institution. Reasons for wound dehiscence were attributed to wound size, >4 different species of bacteria colonizing the wound, gram-negative bacteria, Candida albicans, intensive care unit stay, and female gender. Interestingly, wound dehiscence was not significant correlated to obesity, smoking, atherosclerosis, renal insufficiency or type of closure influenced significantly, or necrosis.
CONCLUSIONS
Female patients after CABG, with large sternal wounds infected with gram-negative bacteria and candida, have an 85% risk of wound dehiscence after flap coverage for sternal wound infection.
Topics: Aged; Aged, 80 and over; Coronary Artery Bypass; Female; Humans; Middle Aged; Osteomyelitis; Reoperation; Retrospective Studies; Sternum; Surgical Flaps; Surgical Wound Dehiscence; Wound Infection; Wounds and Injuries
PubMed: 22274149
DOI: 10.1097/SAP.0b013e31823b67ec -
Plastic and Reconstructive Surgery Jan 2017After studying this article, the participant should be able to: 1. Discuss the approach to and rationale for pressure injury management, including specific techniques... (Review)
Review
LEARNING OBJECTIVE
After studying this article, the participant should be able to: 1. Discuss the approach to and rationale for pressure injury management, including specific techniques for prevention and preoperative evaluation. 2. Develop a management algorithm for these wounds that includes operative and nonoperative modalities. 3. Understand how to identify and manage the complications of surgical intervention for pressure injuries, including recurrence.
SUMMARY
Pressure injuries are a common problem associated with great morbidity and cost, often presenting as complex challenges for plastic surgeons. Although the cause of these wounds is largely prolonged pressure, the true pathogenesis involves many other factors, including friction, shear, moisture, nutrition, and infection. This article outlines a systematic approach to evaluating and staging pressure injuries, and provides strategies for treatment and prevention. Critical to surgical intervention is thorough débridement, including any involved or causative bony tissues, and postoperative management to prevent wound dehiscence and recurrence.
Topics: Adult; Evidence-Based Medicine; Humans; Infections; Male; Postoperative Complications; Pressure; Pressure Ulcer; Wounds and Injuries
PubMed: 28027261
DOI: 10.1097/PRS.0000000000002850 -
Journal of Wound Care Jun 2016The potential impact of biofilm on healing in acute and chronic wounds is one of the most controversial current issues in wound care. A significant amount of... (Review)
Review
The potential impact of biofilm on healing in acute and chronic wounds is one of the most controversial current issues in wound care. A significant amount of laboratory-based research has been carried out on this topic, however, in 2013 the European Wound Management Association (EWMA) pointed out the lack of guidance for managing biofilms in clinical practice and solicited the need for guidelines and further clinical research. In response to this challenge, the Italian Nursing Wound Healing Society (AISLeC) initiated a project which aimed to achieve consensus among a multidisciplinary and multiprofessional international panel of experts to identify what could be considered part of 'good clinical practice' with respect to the recognition and management of biofilms in acute and chronic wounds. The group followed a systematic approach, developed by the GRADE working group, to define relevant questions and clinical recommendations raised in clinical practice. An independent librarian retrieved and screened approximately 2000 pertinent published papers to produce tables of levels of evidence. After a smaller focus group had a multistep structured discussion, and a formal voting process had been completed, ten therapeutic interventions were identified as being strongly recommendable for clinical practice, while another four recommendations were graded as being 'weak'. The panel subsequently formulated a preliminary statement (although with a weak grade of agreement): 'provided that other causes that prevent optimal wound healing have been ruled out, chronic wounds are chronically infected'. All members of the panel agreed that there is a paucity of reliable, well-conducted clinical trials which have produced clear evidence related to the effects of biofilm presence. In the meantime it was agreed that expert-based guidelines were needed to be developed for the recognition and management of biofilms in wounds and for the best design of future clinical trials. This is a fundamental and urgent task for both laboratory-based scientists and clinicians.
Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Bandages; Biofilms; Burns; Debridement; Diabetic Foot; Disease Management; Humans; Pressure Ulcer; Surgical Wound Dehiscence; Surgical Wound Infection; Varicose Ulcer; Wound Infection; Wounds and Injuries
PubMed: 27286663
DOI: 10.12968/jowc.2016.25.6.305 -
The Journal of Bone and Joint Surgery.... Mar 2008Despite technological advances in the treatment of severe extremity trauma, the timing of wound closure remains the subjective clinical decision of the treating surgeon....
BACKGROUND
Despite technological advances in the treatment of severe extremity trauma, the timing of wound closure remains the subjective clinical decision of the treating surgeon. Traditional serum markers are poor predictors of wound-healing. The objective of this study was to evaluate the cytokine and chemokine profiles of severe extremity wounds prior to closure to determine if wound effluent markers can be used to predict healing.
METHODS
Serum and effluent (exudate) samples were collected prospectively from adult volunteers with multiple high-energy penetrating extremity wounds sustained during military combat. Samples were collected prior to definitive wound closure or flap coverage. Wounds were followed clinically for six weeks. The primary clinical outcome measures were wound-healing and dehiscence. Control serum samples were collected from normal age and sex-matched adult volunteers. All samples were analyzed for the following cytokines and chemokines: procalcitonin; eotaxin; granulocyte macrophage colony stimulating factor; interferon (IFN)-gamma; interleukin (IL)-1 through 8, 10, 12, 13, and 15; IFN-gamma inducible protein-10; monocyte chemotactic protein-1; macrophage inflammatory protein-1alpha; the protein regulated on activation, normal T expressed and secreted (RANTES); and tumor necrosis factor (TNF)-alpha.
RESULTS
Fifty wounds were analyzed in twenty patients. Four of the fifty wounds dehisced. An increased rate of wound dehiscence was observed in patients with a concomitant closed head injury as well as in those with an associated arterial injury of the affected limb (p < 0.05). Among the serum chemokines and cytokines, only serum procalcitonin levels correlated with wound dehiscence (p < 0.05). Effluent analysis showed that, compared with wounds that healed, wounds that dehisced were associated with elevated procalcitonin, decreased RANTES protein, and decreased IL-13 concentrations (p < 0.05). No wound with an effluent procalcitonin concentration of <220 pg/mL, an IL-13 concentration of >12 pg/mL, or a RANTES protein concentration of >1000 pg/mL failed to heal.
CONCLUSIONS
Effluent procalcitonin, IL-13, and RANTES protein levels as well as serum procalcitonin levels correlate with wound dehiscence following closure of severe open extremity wounds. These preliminary results indicate that effluent biomarker analysis may be an objective means of determining the timing of traumatic wound closure.
Topics: Adult; Afghanistan; Blast Injuries; Calcitonin; Calcitonin Gene-Related Peptide; Chemokine CCL5; Chemokines; Cytokines; Female; Humans; Interleukin-13; Iraq War, 2003-2011; Lower Extremity; Male; Military Personnel; Pilot Projects; Prospective Studies; Protein Precursors; Surgical Wound Dehiscence; United States; Upper Extremity; Wound Healing; Wounds, Gunshot; Wounds, Penetrating
PubMed: 18310708
DOI: 10.2106/JBJS.G.00265 -
Der Chirurg; Zeitschrift Fur Alle... Aug 1967
Review
Topics: Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Burns; Debridement; Drainage; Humans; Sepsis; Surgical Wound Dehiscence; Surgical Wound Infection; Suture Techniques; Tampons, Surgical; Tetanus; Wound Healing; Wound Infection; Wounds and Injuries
PubMed: 4874601
DOI: No ID Found -
Wound Repair and Regeneration :... 2014An interrupted stitch type with favorable tissue characteristics will reduce local wound complications. We describe a novel high-strength, low-tension repair for the...
An interrupted stitch type with favorable tissue characteristics will reduce local wound complications. We describe a novel high-strength, low-tension repair for the interrupted closure of skin, cartilage, and muscle, the double loop mattress stitch, and compare it experimentally with other interrupted closure methods. The performance of the double loop mattress technique in porcine cartilage and skeletal muscle is compared with the simple, mattress, and loop mattress interrupted sutures in both a novel porcine loading chamber and mechanical model. Wound apposition is assessed by electron microscopy. The performance of the double loop mattress in vivo was confirmed using a series of 805 pediatric laparotomies/laparoscopies. The double loop mattress suture is 3.5 times stronger than the loop mattress in muscle and 1.6 times stronger in cartilage (p ≤ 0.001). Additionally, the double loop mattress reduces tissue tension by 66% compared with just 53% for the loop mattress (p ≤ 0.001). Wound gapping is equal, and wound eversion appears significantly improved (p ≤ 0.001) compared with the loop mattress in vitro. In vivo, the double loop mattress performs as well as the loop mattress and significantly better than the mattress stitch in assessments of wound eversion and dehiscence. There were no episodes of stitch extrusion in our series of patients. The mechanical advantage of its intrinsic pulley arrangement gives the double loop mattress its favorable properties. Wound dehiscence is reduced because this stitch type is stronger and exerts less tension on the tissue than the mattress stitch. We advocate the use of this novel stitch wherever a high-strength, low-tension repair is required. These properties will enhance wound repair, and its application will be useful to surgeons of all disciplines.
Topics: Animals; Cartilage; Dermatologic Surgical Procedures; Microscopy; Muscles; Skin; Suture Techniques; Sutures; Swine; Tensile Strength; Wound Healing; Wounds and Injuries
PubMed: 24698436
DOI: 10.1111/wrr.12159