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Advances in Therapy Mar 2017Wound healing is a complex, highly regulated process that is critical in maintaining the barrier function of skin. With numerous disease processes, the cascade of events... (Review)
Review
Wound healing is a complex, highly regulated process that is critical in maintaining the barrier function of skin. With numerous disease processes, the cascade of events involved in wound healing can be affected, resulting in chronic, non-healing wounds that subject the patient to significant discomfort and distress while draining the medical system of an enormous amount of resources. The healing of a superficial wound requires many factors to work in concert, and wound dressings and treatments have evolved considerably to address possible barriers to wound healing, ranging from infection to hypoxia. Even optimally, wound tissue never reaches its pre-injured strength and multiple aberrant healing states can result in chronic non-healing wounds. This article will review wound healing physiology and discuss current approaches for treating a wound.
Topics: Chronic Disease; Humans; Patient Care Management; Skin Ulcer; Wound Healing
PubMed: 28108895
DOI: 10.1007/s12325-017-0478-y -
International Wound Journal Jul 2016Treatment of wounds of different aetiologies constitutes a major part of the total health care budget. It is estimated that 1·5-2 million people in Europe suffer from... (Review)
Review
Treatment of wounds of different aetiologies constitutes a major part of the total health care budget. It is estimated that 1·5-2 million people in Europe suffer from acute or chronic wounds. These wounds are managed both in hospitals and in community care. The patients suffering from these wounds report physical, mental and social consequences of their wounds and the care of them. It is often believed that the use of wound dressings per se is the major cost driver in wound management, whereas in fact, nursing time and hospital costs are together responsible for around 80-85% of the total cost. Healing time, frequency of dressing change and complications are three important cost drivers. However, with the use of modern, advanced technology for more rapid wound healing, all these cost drivers can be substantially reduced. A basic understanding of the terminology and principles of Health Economics in relation to wound management might therefore be of interest.
Topics: Bandages; Cost-Benefit Analysis; Health Care Costs; Health Services Needs and Demand; Humans; Outcome Assessment, Health Care; Skin Ulcer; Wound Healing; Wounds and Injuries
PubMed: 27460943
DOI: 10.1111/iwj.12623 -
Diagnostic Criteria of Ulcerative Pyoderma Gangrenosum: A Delphi Consensus of International Experts.JAMA Dermatology Apr 2018Pyoderma gangrenosum is a rare inflammatory skin condition that is difficult to diagnose. Currently, it is a "diagnosis of exclusion," a definition not compatible with...
IMPORTANCE
Pyoderma gangrenosum is a rare inflammatory skin condition that is difficult to diagnose. Currently, it is a "diagnosis of exclusion," a definition not compatible with clinical decision making or inclusion for clinical trials.
OBJECTIVE
To propose and validate diagnostic criteria for ulcerative pyoderma gangrenosum.
EVIDENCE REVIEW
Diagnostic criteria were created following a Delphi consensus exercise using the RAND/UCLA Appropriateness Method. The criteria were validated against peer-reviewed established cases of pyoderma gangrenosum and mimickers using k-fold cross-validation with methods of multiple imputation.
FINDINGS
Delphi exercise yielded 1 major criterion-biopsy of ulcer edge demonstrating neutrophilic infiltrate-and 8 minor criteria: (1) exclusion of infection; (2) pathergy; (3) history of inflammatory bowel disease or inflammatory arthritis; (4) history of papule, pustule, or vesicle ulcerating within 4 days of appearing; (5) peripheral erythema, undermining border, and tenderness at ulceration site; (6) multiple ulcerations, at least 1 on an anterior lower leg; (7) cribriform or "wrinkled paper" scar(s) at healed ulcer sites; and (8) decreased ulcer size within 1 month of initiating immunosuppressive medication(s). Receiver operating characteristic analysis revealed that 4 of 8 minor criteria maximized discrimination, yielding sensitivity and specificity of 86% and 90%, respectively.
CONCLUSIONS AND RELEVANCE
This Delphi exercise produced 1 major criterion and 8 minor criteria for the diagnosis of ulcerative pyoderma gangrenosum. The criteria may serve as a guideline for clinicians, allowing for fewer misdiagnoses and improved patient selection for clinical trials.
Topics: Area Under Curve; Biopsy; Consensus; Delphi Technique; Humans; Neutrophils; Pyoderma Gangrenosum; ROC Curve; Skin; Skin Ulcer
PubMed: 29450466
DOI: 10.1001/jamadermatol.2017.5980 -
Journal of Wound Care Feb 2019
Topics: Humans; Skin Care; Skin Ulcer; Surgical Wound Infection
PubMed: 30767635
DOI: 10.12968/jowc.2019.28.Sup2.S3 -
CMAJ : Canadian Medical Association... Aug 2019
Topics: Anti-Bacterial Agents; Ceftriaxone; Critical Care; Debridement; Humans; Male; Metronidazole; Middle Aged; Skin Ulcer; Tetanus; Tetanus Toxoid
PubMed: 31451526
DOI: 10.1503/cmaj.190161 -
International Wound Journal May 2022The study spotlights a severe uncommon post-burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to... (Review)
Review
The study spotlights a severe uncommon post-burn complication, Marjolin's ulcer, in upper Egypt plastic and wound care centres. This problem is mainly related to inadequate medical care and awareness. No community or race is immune. The underlying malignant transformation mechanism remains unclear. The study aims, according to our experience, to review the prognostic factors through the management protocol of Marjolin's ulcers. This prospective study was conducted in the Aswan University Plastic & Burn surgery department in South Egypt between 2013 and 2020 and investigated 226 patients with chronic post-burn ulceration. Nineteen cases were proved to have Marjolin's ulcer, and the other cases that had been excluded from being malignant went for reconstruction with split-thickness skin graft with/without flap after adequate ulcer debridement. The surgical, oncologic, radiologic indications, and prognostic factors were reviewed according to our management outcome-the assessment with follow-up period extended over 5 years. Histopathology of ulcers ranged among mild, moderate, and poorly differentiated squamous cell carcinoma. One scalp ulcer case showed basosquamous pathology. Most cases presented at age above 50, but no age was immune. The mean latent period was 29 years on average. The lesions' sites varied in their anatomic location where they involved the upper extremity, the scalp, and the lower extremity that had a predilection. Although surgical excision is the primary management line for tumour ablation, other factors may change the management course. During the follow-up period, neoplasm recurrence in the form of lymph node enlargement and/or locoregional metastasis was detected in eight cases. Within 1 year after the intervention, six recurrent cases died, and two were saved. In addition to the case study, this paper reviewed the literature and provided our team a good experience in light of the NCCN protocol for non-melanotic cutaneous carcinoma, although we suffered limited medical resources. It is concluded that early accurate diagnosis, low-grade malignancy, and well-planned individualised surgery with adjuvant radiotherapy were the best prognostic factors. The close follow-up for an early sign of disease recurrence is paramount.
Topics: Carcinoma, Squamous Cell; Cicatrix; Humans; Neoplasm Recurrence, Local; Plastics; Prospective Studies; Skin Neoplasms; Skin Ulcer; Ulcer
PubMed: 34535972
DOI: 10.1111/iwj.13690 -
Actas Dermo-sifiliograficas Mar 2024
Topics: Humans; Ulcer; Skin Ulcer
PubMed: 37356547
DOI: 10.1016/j.ad.2022.10.050 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Feb 2018Ozone was discovered in the mid-nineteenth century and is proven to have many therapeutic effects, including its common application as a disinfectant to kill... (Review)
Review
Ozone was discovered in the mid-nineteenth century and is proven to have many therapeutic effects, including its common application as a disinfectant to kill microorganisms in various conditions. Ozone therapies have been utilized for various purposes ever since it was discovered. Extensive studies over a century have verified its therapeutic effects, consistency, and safety with minimal and preventable side effects in medical care. Emerging evidence revealed that ozone also plays important roles in the management and prevention of various skin disorders including infectious skin diseases, skin related allergic diseases, erythema scaly diseases, wound healing and ulcer recovery. Herein, the author now summarizes the recent clinical applications of ozone therapy in dermatology and provide commentary on what we have learned in our practice. Our focuses are the efficacy and safety of ozone therapies as well as the application prospects of ozone on various skin disorders. In addition, the author discusses the potential mechanisms involved in ozone therapy and the efforts we should make for.
Topics: Humans; Ozone; Skin Diseases; Skin Ulcer; Wound Healing
PubMed: 29559592
DOI: 10.11817/j.issn.1672-7347.2018.02.002 -
Journal of Wound Care Mar 2019
Topics: Consensus; Decision Support Systems, Clinical; Humans; Skin Care; Skin Ulcer; Wound Healing
PubMed: 30840552
DOI: 10.12968/jowc.2019.28.3.131 -
International Wound Journal Oct 2016
Topics: Arm Injuries; Burns, Electric; Humans; Leg Injuries; Male; Middle Aged; Occupational Injuries; Skin Ulcer; Treatment Outcome
PubMed: 24869481
DOI: 10.1111/iwj.12307