Advances in wound care最新文献

{"title":"Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting.","authors":"Evania Lok, Timothy Oe, Sally Ng","doi":"10.1089/wound.2023.0133","DOIUrl":"10.1089/wound.2023.0133","url":null,"abstract":"<p><p><b>Significance:</b> Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. <b>Recent Advances:</b> Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. <b>Critical Issues:</b> The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. <b>Future Directions:</b> The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AURKA Activates <i>FOXO3a</i> to Form a Positive Feedback Loop in the Proliferation and Migration of Keloid Fibroblasts.","authors":"Xi Chu, Jiaqi Sun, Siya Dai, Yehua Liang, Xifei Qian, Jinghong Xu, Jufang Zhang","doi":"10.1089/wound.2024.0055","DOIUrl":"10.1089/wound.2024.0055","url":null,"abstract":"<p><p><b>Objective:</b> Keloids are benign fibroproliferative disorders with invasive growth exceeding the wound boundary. Aurora kinase A (AURKA) is a serine/threonine kinase highly expressed in various tumors, facilitating tumor growth and invasion. Currently, the role of AURKA in keloid remains unclear. <b>Approach:</b> Fibroblasts were isolated from keloid and normal skin samples. AURKA was evaluated by qPCR, Western blot, and immunohistochemistry. Transcriptome sequencing and dual-luciferase reporter assays were applied to figure out targets of AURKA. Following expression alteration and MLN8237 (an AURKA kinase inhibitor, AKI) treatment, phenotypical experiments were conducted to clarify biological functions of AURKA along with its target, and to probe into the clinical potential of AURKA inhibition. <b>Results:</b> AURKA was upregulated in keloid tissues and fibroblasts. Forkhead box O 3a (FOXO3a) was verified as a downstream of AURKA. Further experiments demonstrated that AURKA transactivated <i>FOXO3a</i> by binding to FOXO3a, while FOXO3a directly transactivated <i>AURKA</i>. Functionally, AURKA and FOXO3a cooperated in enhancing the proliferation and migration of keloid fibroblasts <i>via</i> protein kinase B (AKT) phosphorylation. Although MLN8237 weakened the proliferation and migration in keloid fibroblasts, the transactivation of AURKA on <i>FOXO3a</i> was independent of kinase activity. <b>Innovation:</b> This study reveals that AURKA and FOXO3a compose a transactivation loop in enhancing the proliferative and migrative properties of keloid fibroblasts, and proposes AURKA as a promising target. <b>Conclusion:</b> AURKA/FOXO3a loop promotes the proliferation and migration of keloid fibroblasts <i>via</i> AKT signaling. Despite the anti-keloid effects of AKIs, AURKA acts as a transcription factor independently of kinase activity, deepening our understanding on AKI insensitivity.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incisional negative pressure wound therapy vs primary wound suturing after intestinal ostomy closure: a systematic review and meta-analysis.","authors":"Michał Kisielewski, Karolina Richter, Magdalena Pisarska-Adamczyk, Michał Wysocki, Nikola Kłos, Tomasz Stefura, Tomasz Wojewoda, Wojciech M Wysocki","doi":"10.1089/wound.2024.0100","DOIUrl":"https://doi.org/10.1089/wound.2024.0100","url":null,"abstract":"<p><strong>Objective: </strong>Wound infection after intestinal ostomy closure is common postoperative complication. An alternative to primary suturing (PS) of the wound is incisional negative pressure wound therapy (iNPWT). The aim of the article was to assess and compare clinical outcomes after PS and iNPWT.</p><p><strong>Approach: </strong>Strategy was aimed to find relevant data comparing outcomes of iNPWT and PS after ostomy closure. Search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases. Authors conducted a meta-analysis of parameters: wound healing time, surgical site infections, complications, length of stay.</p><p><strong>Results: </strong>The analysis revealed that iNPWT and control group did not differ significantly in wound healing time (OR = -2.06; 95% CI = -5.99-1.87; p=0.30, I2=4%). Meta-analysis of surgical site infection incidence revealed a significant difference favoring the incisional NPWT group versus observational (OR = 0.42; 95% CI = 0.25-0.72; p=0.002; I2=14%). Patients in iNPWT group had significantly lower incidence of complications than observational group (OR = 0.52; 95% CI = 0.35-0.77; p=0.001, I2=71%). Subgroup analysis limited to randomized studies only also presented significant differences favoring the iNPWT group against observational (OR = 0.27; 95% CI = 0.14-0.52; p<0.001, I2=67%). Our analysis revealed that LOS was not significantly different between groups among patients treated with iNPWT (IV=0.19; 95% CI = -0.66 -1,04; p=0.76, I2=0%). Subgroup analysis of randomized studies also did not present a significant difference (IV=0.25; 95% CI = -0.80 -1,30; p=0.33, I2=10%).</p><p><strong>Innovation: </strong>Study shows that the use of iNPWT can reduce surgical site infections with other complications (wound hematomas, wound seromas, wound dehiscence, fistulas, ileus) in patients undergoing intestinal ostomy closure without extended hospital stay.</p><p><strong>Conclusions: </strong>Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate of the most common complication after ostomy closure.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing the Open Abdomen: Selecting an Appropriate Treatment Strategy.","authors":"Pablo Ottolino","doi":"10.1089/wound.2023.0121","DOIUrl":"10.1089/wound.2023.0121","url":null,"abstract":"<p><p><b>Significance:</b> The laparotomy is a common surgical procedure with a wide range of indications. Ideally, once the goals of surgery were achieved, the incision edges could then be approximated and the abdomen primarily closed. However, in some circumstances, it may be impossible to achieve primary closure, and instead the abdomen is intentionally left open. This review discusses the indications and objectives for the open abdomen (OA), summarizes the most common techniques for temporary abdominal closure, and illustrates treatment algorithms grounded in the current recommendations from specialty experts. <b>Recent Advances:</b> Still a relatively young technique, multiple strategies, and technologies have emerged to manage the OA. So too have the recommendations evolved, based on updated classifications that take wound characteristics into account. Recent studies have also brought greater clarity on recommendations for managing infection and malnutrition to support improved clinical outcomes. <b>Critical Issues:</b> The status of the OA can change rapidly depending on the patient's condition, the wound quality, and many other factors. Thus, there is a significant need for comprehensive treatment strategies that can be adapted to these developing circumstances. <b>Future Directions:</b> Treatment recommendations should be continuously updated as new technologies are introduced and old techniques fall out of use.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141496839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Complex Thoracic and Abdominal Trauma Patients: A Review of Literature and Negative Pressure Wound Therapy Treatment Options.","authors":"Luis G Fernández","doi":"10.1089/wound.2023.0113","DOIUrl":"10.1089/wound.2023.0113","url":null,"abstract":"<p><p><b>Significance:</b> In trauma care, extensive surgical intervention may be required. Damage control surgery (DCS) is applicable to patients with life or limb-threatening conditions that are incapable of tolerating a traditional surgical approach. <b>Recent Advances:</b> The current resuscitation strategy for complex trauma patients includes limiting crystalloid fluids, balanced mass transfusion protocols, permissive hypotension, and damage control resuscitation. Recent technological advancements in surgical critical care have improved outcomes in these critically ill patients. <b>Critical Issues:</b> DCS, which is often required in patients with trauma injuries, is typically followed by surgical correction of the injury once the immediate patient survival procedures have been completed. However, DCS and the subsequent injury repair procedures have a high risk for postsurgical complication development. <b>Future Directions:</b> Negative pressure therapy modalities can offer clinicians additional adjunctive and cost-effective tools for the management of the trauma care patient, as these systems can be utilized during both the DCS and the postoperative injury management phases of trauma care.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10170220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Innovation in Negative Pressure Wound Therapy: A Review of Burn Wound Management.","authors":"Edin Nuhiji","doi":"10.1089/wound.2023.0114","DOIUrl":"10.1089/wound.2023.0114","url":null,"abstract":"<p><p><b>Significance</b>: Burns result in irretrievable cell damage, which can occur upon exposure to hot surfaces, liquids, gases, ultraviolet or ionizing radiation, and through friction. Standard of care in burn management involves protecting the patient, limiting burn progression, and achieving wound closure. Negative pressure wound therapy (NPWT) and NPWT with instillation and dwell time (NPWTi-d) are two wound management options that have been shown to improve outcomes for burn patients in recent years. This work provides a general review of NPWT and NPWTi-d use in burn wound management. A literature search was performed using PubMed and Embase for peer-reviewed publications and conference abstracts written in English and reporting on burn management using NPWT and/or NPWTi-d from a single manufacturer between 2000 and 2021. All burn types were included. <b>Recent Advances:</b> Thirteen studies and 308 patients were available for assessment. Use of NPWT was reported in a majority of studies (<i>n</i> = 11). When conventional NPWT was applied, graft take of >90% was observed and consistent final wound closure was achieved. Two studies described NPWTi-d use for burn wound management. NPWTi-d use promoted granulation tissue development in burn wounds. <b>Critical Issues:</b> Limited high-level prospective evidence exists for use of NPWT and NPWTi-d in burn wound management. <b>Future Directions:</b> Available literature on the use of NPWT and/or NPWTi-d in burn care has reported improved outcomes in wound bed preparation, which can ultimately lead to final wound closure. The use of these modalities should be considered in management of burn care patients.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and Future Directions in Fluorescence Imaging-Guided Debridement.","authors":"Rachael Orkin, Arjun Sharma, Johnson V John, David G Armstrong","doi":"10.1089/wound.2024.0067","DOIUrl":"10.1089/wound.2024.0067","url":null,"abstract":"<p><p><b>Significance:</b> Sterility and reduction of the bioburden are crucial for healing in chronic wounds such as diabetic foot ulcers. Although there are methods for measuring bioburdens, such as semiquantitative analysis of swab/biopsy samples, microbiological sampling, and molecular diagnostics, these tools are less accessible owing to costs or not being as quick as other methods. These methods are also dependent on clinical assessment by the clinician, and high bacterial burden may appear asymptomatic. <b>Recent Advances:</b> Autofluorescence (AF) imaging is a novel technology for identifying and quantifying chronic inhibitory bacterial load in chronic wounds. Eighty-seven percent of bacteria that frequent chronic wounds have fluorophores that fluoresce under violet light as red or cyan, depending on the type of fluorophore. Therefore, AF image-guided treatment is becoming increasingly effective for physicians to implement wound dressing changes and debridement because bacterial burdens are difficult to locate clinically. <b>Critical Issue</b>: Products such as the commercially available MolecuLight i:X and MolecuLight DX function as handheld cameras for physicians to use as a reference but require additional work to ensure that the photograph will be taken with adequate lighting. <b>Future Directions:</b> Designs for Vision Inc. introduced a device called REVEAL, an AF imaging form factor that allows the device to be worn on top of a pair of glasses, which the physician would wear intraoperatively. The benefits of this form factor include not requiring certain lighting conditions and not having to interpret the results using a handheld camera, allowing the device to be used during active surgical debridement.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141544340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Electrical Stimulation Prevent Recurrence of Keloid Scars? A Scoping Review.","authors":"Robert E George, Caroline C Bay, Sarah M Thornton, Jessieka T Knazze, Nicole C Kane, Kip A Ludwig, D'Andrea T Donnelly, Samuel O Poore, Aaron M Dingle","doi":"10.1089/wound.2023.0203","DOIUrl":"10.1089/wound.2023.0203","url":null,"abstract":"<p><p><b>Objective:</b> Keloids represent a symptomatic, aberrant healing process that is difficult to treat with high recurrence rates spanning from 55% to 100% if treated <i>via</i> excision without adjuvant therapy. Electrical stimulation (ES) has demonstrated findings that suggest it could reduce the recurrence rate of keloids after resection. Therefore, the aim of this study is to conduct a scoping review to investigate ES as an adjuvant therapy for decreasing keloid recurrence after excision. <b>Approach:</b> A scoping review was performed using PubMed and Web of Science databases. The search strategy encompassed terms linking keloids and various aspects of electrical stimulation. <b>Results:</b> Our search yielded 2,229 articles, of which 115 articles were analyzed as full text and 1 article met inclusion criteria. Despite this, ES has demonstrated other evidence that suggests its utility. ES has been shown to counter keloidic features by reducing mast cell counts, shifting wound composition from M2 to M1 macrophages, promoting angiogenesis, and controlling fibroblast orientation and location. An alternating current will orient fibroblasts perpendicular to the current without unintended migration. <b>Innovation:</b> Our study indicates that, based on a compilation of clinical and preclinical <i>in vitro</i> data, the optimal scenario for ES in the role of keloid treatment is after excision with a biphasic pulsed application and square waveform. <b>Conclusions:</b> ES could serve as a multifaceted, adjuvant treatment after keloid excision, steering the healing process away from keloid-associated characteristics. Its cost-effectiveness means it could be adopted globally, providing a strategy to mitigate the burden of keloids irrespective of other available treatments or economic conditions.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Hydrogel Biomaterials in the Intervention of Wound Healing and Skin Regeneration via Exosomes: A Systematic Review and Meta-Analysis of Preclinical Animal Studies.","authors":"Yujia Yang, Jinlei Cui, Yajie Kong, Yu Hou, Haixia Zhang, Cuiqing Ma","doi":"10.1089/wound.2024.0058","DOIUrl":"10.1089/wound.2024.0058","url":null,"abstract":"<p><p><b>Significance:</b> The combination of hydrogel biomaterials with exosomes to facilitate wound healing and skin regeneration is a promising approach. <b>Recent Advances:</b> Recent preclinical animal studies have focused on investigating the efficacy of hydrogel-based delivery systems for exosomes in promoting wound healing and skin regeneration. <b>Critical Issues:</b> Despite encouraging results, critical issues remain unresolved, such as optimizing hydrogel properties to enhance the efficacy of combined therapy with exosomes for wound and bridging the translational gap between preclinical and clinical applications. <b>Future Directions:</b> Future research endeavors should concentrate on refining hydrogel design to enhance exosome delivery efficacy, conducting rigorous clinical trials to assess the safety and efficacy of exosome-loaded hydrogels in human wound healing and skin regeneration, and exploring innovative strategies to maximize therapeutic outcomes.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardized Reporting of Research on Exosomes to Ensure Rigor and Reproducibility.","authors":"Anita Yadav, Yi Xuan, Chandan K Sen, Subhadip Ghatak","doi":"10.1089/wound.2024.0093","DOIUrl":"10.1089/wound.2024.0093","url":null,"abstract":"<p><p><b>Significance:</b> The study of extracellular vesicles (EVs), especially exosomes, has unlocked new avenues in understanding cellular communication and potential therapeutic applications. <b>Recent Advances:</b> Advancements in EV research have shown significant contributions from the International Society for Extracellular Vesicles (ISEV), in establishing methodological standards. The evolution of the Minimal Information for Studies of Extracellular Vesicles (MISEV) guidelines from 2014 to 2023 reflects enhanced research rigor and reproducibility. The launch of EV-TRACK platform promotes uniformity and reproducibility by providing a centralized repository for data sharing and standardization practices. Furthermore, databases like EVpedia and ExoCarta have facilitated data sharing and collaboration within the scientific community. Concurrently, exosome-based therapies have emerged as a forefront area within regenerative medicine and targeted drug delivery, showcasing the potential of exosomes in promoting tissue regeneration. <b>Critical Issues:</b> Despite advancements, the field grapples with challenges such as vesicular heterogeneity, EV isolation complexity, and standardization. These issues impact research reproducibility and clinical applications. The inconsistency in exosomal preparations in clinical trials poses significant challenges to therapeutic efficacy and safety. <b>Future Directions:</b> The review outlines critical areas for future research, including the need for technological innovation in EV isolation and characterization, the establishment of standardized protocols, and a deeper understanding of exosome biology. The review also highlights the need to reassess guidelines, develop new EV isolation and characterization technologies, and establish standardized protocols to overcome current limitations. Emphasis is placed on interdisciplinary research and collaboration to address the complexities of EV biology, improve clinical trial design, and ultimately realize exosome's therapeutic and diagnostic potential. Continued evaluation and rigorous scientific validation are essential for successful exosome integration.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}