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PubMedDate not supplied

Increased collagen deposition in an uncomplicated surgical wound compared to a minimal subcutaneous test wound.

Little information is currently available concerning the relationship between results obtained in humans from surgical test wounds and results from wound models. Therefore, to evaluate human wound healing parameters, tubings of expanded polytetrafluoroethylene were implanted in a subcutaneous test wound in the arm of 47 volunteers and 20 patients undergoing hernia repair. The surgical patients also had implants left in the surgical wound cavity. After 10 days the deposition of collagen in the tubings as expressed by hydroxyproline content was 30% higher in the surgical wound than in the test wound, p < 0.05. The amount of collagen deposited in the tubing within the surgical wound did not correlate with measurements in the test wound, whereas a significant correlation of proline levels was found between the two sites, p < 0.05. Deposition of proline and total protein in the model was equivalent. In both wound types age negatively correlated with levels of protein, but not collagen. The variability of the results was 40% lower in the subcutaneous test wound than in the surgical wound. There was no significant difference in hydroxyproline deposition between the volunteers and the patients undergoing hernia repair. In patients undergoing minor surgery without signs of compromised healing the expanded polytetrafluoroethylene test wound in the arm reflects the deposition of non-collagenous protein, but not collagen, within the surgical wound.

Adult↗
PubMed2005

Postoperative deep wound infections in adults after spinal fusion: management with vacuum-assisted wound closure.

OBJECTIVE: Vacuum-assisted wound closure (VAC) exposes the wound bed to negative pressure, resulting in removal of edema fluid, improvement of blood supply, and stimulation of cellular proliferation of reparative granulation tissue. It has been used to treat open wounds in the extremities, open sternal wounds, pressure ulcers, and abdominal wall wounds. This study retrospectively reviewed instrumented spine fusions complicated by surgical wound infection and managed by a protocol including the use of VAC in order to evaluate the efficacy of applying vacuum therapy on patients with deep spine infections and exposed instrumentation. METHODS: Twenty consecutive patients with deep wound infections after undergoing spinal fusion procedures were studied. There were 12 men and 8 women with an average age of 55 years (31-81 years). Eight patients had undergone concomitant anterior and posterior arthrodesis, nine patients had a posterior spinal fusion, and three patients had a transforaminal lumbar interbody fusion. Seven patients had a decompression with exposed dura. Sixteen patients presented with a draining wound within the first 6 weeks postoperatively (average 24 days). There were four patients who presented with back pain and temperature after 1 year postoperatively (average 3 years). All patients were taken to the operating room for irrigation and debridement followed by placement of the VAC with subsequent delayed closure of the wound. RESULTS: There was an average of 1.8 (1-8) irrigation and debridement procedures prior to placement of the VAC. Once the VAC was initiated, there was an average of 2.2 (2-3) procedures until and including closure of the wound. The wound was closed an average of 7 days (5-14 days) after the placement of the initial VAC in the wound. All patients tolerated the VAC without adverse effects. All patients were kept on a 6-week course of intravenous antibiotic therapy. The average follow-up was 10 months (6-24 months). There were no cases of uncontrolled sepsis once the VAC was initiated. All patients achieved a clean closed wound without removal of instrumentation at a minimum follow-up of 6 months. CONCLUSION: VAC therapy is an effective adjunct in closing complex deep spinal wounds with exposed instrumentation.

Adult↗
PubMed1993

In vitro large-wound re-endothelialization. Inhibition of centrosome redistribution by transient inhibition of transcription after wounding prevents rapid repair.

Rapid, efficient re-endothelialization of large wounds is characterized by a specific sequence of cytoskeletal events that occur after wounding. Wounds 1.5 mm wide were created down the middle of confluent porcine aortic endothelial monolayers to study regulation of repair. The wounded cultures were incubated for short periods with cycloheximide or actinomycin D to test the hypothesis that transient inhibition of translation and transcription at the time of wounding disrupts rapid repair by interfering with centrosome redistribution to the front of the cell, an early event associated with cell migration. Although centrosome reorientation did not occur when protein synthesis was inhibited with 20 micrograms/mL cycloheximide for 1 hour before and for up to 4 hours after wounding, reorientation did occur by 2 hours after cycloheximide was washed out. The times taken for the wound to close for cycloheximide-treated and control cells did not differ (60 +/- 1.1 vs 60 +/- 0.8 hours). When transcription was inhibited with 0.25 micrograms/mL actinomycin D for 1 hour before and for 1 hour after wounding, re-endothelialization was dramatically reduced. The time taken for the wound to close was almost five times longer (288 +/- 5.3 hours) than for control cells. The cells moved very slowly, maintaining a flattened, spread-out shape, as opposed to being elongated. The centrosomes did not reorient to the front of the cell throughout the entire period. However, addition of actinomycin D for 2 hours when centrosomes had already moved to the front of the cells (4 hours after wounding) did not reduce subsequent wound repair (60 +/- 1.3 hours). This study supports our hypothesis that centrosome redistribution is essential for efficient wound repair and suggests that redistribution is regulated by transcription of essential gene(s) that is induced immediately after wounding by an unknown short-lived signal. Two possible signals are the loss of cell contact and/or a soluble substance released from the cells at the time of wounding. When the signal is unable to induce transcription, dysfunctional repair occurs by a very slow centrosome-independent process.

Animals↗
PubMed2001

Characterization of proliferation and cellular wound fill in periodontal cells using an in vitro wound model.

BACKGROUND: The therapeutic success of periodontal regenerative therapy may be compromised by our limited understanding of the wound healing process. Wound healing requires the coordination of complex cellular and molecular interactions. Recently, using an in vitro wound model, our laboratory has shown that gingival fibroblasts (GF) fill an in vitro wound more rapidly than periodontal ligament cells (PDL). This suggests that there may be differences in the levels of proliferation for these 2 cell types during the wound healing process. Such specific cell type differences may be significant in clinical outcomes of regenerative therapy. Therefore, the aim of this research was to characterize and compare the levels of both proliferation and cellular wound fill between GF and PDL using our in vitro wound model. METHODS: Primary cultures of human PDL and GF cells were established from explanted tissue, and passaged to 12-well tissue culture plates. Triplicate cultures of both cell types were grown to confluence and in vitro wounds were mechanically created, removing a 3 mm wide band of the cell layer across the diameter of the wells. The wells were then incubated for 2, 6, or 9 days in media containing either 0.1% or 10% fetal bovine serum (FBS). At each time point, cells were pulsed with 5-bromo, 2-deoxyuridine (BrdU), fixed, and nuclei stained to measure DNA synthesis (as a measure for proliferation). Cells were counter stained with cytoplasmic stain to measure cell number. Quantitative analysis distant from (area of interest [AOI 1]), next to (AOI 2), and within the wound boundaries (AOI 3 and 4) was accomplished using computer-assisted histomorphometry. RESULTS: The levels of proliferation and cellular fill for each cell type were assessed relative to time and AOI. Overall, the PDL displayed greater (P <0.01) levels of proliferation than the GF. For both cell types, proliferation was found to be significantly (P<0.001) greater at day 2 compared to other time points. PDL displayed greater levels of proliferation than GF in all AOI, with this difference reaching significance (P<0.02) within the cell layer (AOI 1 and 2). When comparing levels of cellular fill in 10% FBS, GF displayed greater wound fill than the PDL. This difference was significant at day 6 (P <0.05) for both the marginal (AOI 3) and central (AOI 4) portions of the wound. CONCLUSIONS: These findings, demonstrating unique differences between PDL and GF with respect to proliferation and wound fill in an in vitro model, suggest that there may be cell-specific differences in cellular activity critical to periodontal wound healing. In addition, the results of this study show that the cellular proliferation response may not accurately reflect the overall wound healing response.

Adult↗
PubMed2005

Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure.

PURPOSE: Neoadjuvant radiation therapy has been used increasingly to downstage rectal cancer and decrease local recurrence. Despite its efficacy, preoperative radiation therapy may inhibit healing and contribute to wound complications. This study was designed to evaluate perineal wound complications after abdominoperineal resection. METHODS: The clinical records of a consecutive series of patients who underwent abdominoperineal resection for rectal carcinoma between 1988 and 2002 were reviewed. Demographic data, disease stage, and use of preoperative radiation therapy were recorded. Major wound complications included delayed wound healing (>1 month), wound infection requiring drainage/debridement, or reoperation. RESULTS: A total of 160 patients underwent abdominoperineal resection with primary closure of the perineal wound (mean age, 63 +/- 12 years); 117 (73 percent) patients received preoperative radiation therapy; 114 received radiation therapy for rectal cancer (radiation therapy + chemotherapy = 107, radiation therapy alone = 7); 3 received radiation therapy for other pelvic malignancies. Median radiation dose was 5,040 (range, 900-5,400) cGY. Overall wound complication rate was 41 percent. Major wound complication rate was 35 percent. Delayed healing was the most common complication (24 percent), followed by infection (10 percent). Radiation therapy increased the risk of any wound complication (47 vs. 23 percent; P = 0.005), risk of a major wound complication (41 vs. 19 percent; P = 0.021), and risk of infection (14 vs. 0 percent; P = 0.015). Risk of wound complications did not correlate with age, gender, disease stage, smoking, or diabetes. CONCLUSIONS: Wound complications are frequent after abdominoperineal resection and primary closure of the perineum. Preoperative radiation therapy doubles the rate of total and major perineal wound complications. Alternatives to primary perineal closure should be considered, particularly after radiation therapy.

Aged↗
PubMed1997

Octylcyanoacrylate tissue adhesive versus suture wound repair in a contaminated wound model.

BACKGROUND: Octylcyanoacrylate tissue adhesive is a topical wound closure that precludes the need for foreign bodies (sutures) to close wounds. It also has an in vitro antimicrobial effect when standard disc sensitivity tests are used. METHODS: To determine whether contaminated wounds closed with octylcyanoacrylate tissue adhesive will have a lower infection rate compared with wounds closed with 5-0 monofilament sutures, we designed a randomized, blinded, experimental animal study. Two incisions were made on 20 albino guinea pigs. The wounds were contaminated with 10(5) Staphylococcus aureus ATCC 12600 and randomly assigned to be closed with either topical octylcyanoacrylate tissue adhesive or percutaneous 5-0 polypropylene suture. Five days later the adhesive and sutures were removed, and a section of the wound was given to a histopathologist blinded to the type of wound closure. The wound was determined to be infected if inflammatory cells with intracellular cocci were seen. The rest of the wound was opened and examined for clinical evidence of infection. Quantitative bacteriologic analysis was performed. RESULTS: Five wounds in the tissue adhesive group were sterile on day 5, whereas all sutured wounds had positive cultures (25% versus 0%, p < 0.05). Fewer wounds in the tissue adhesive group were determined to be infected by histologic and clinical criteria (0% versus 55%, p < 0.001, and 20% versus 65%, p < 0.01, respectively). Agreement on the determination of infection by histologic and clinical criteria yielded a kappa coefficient of 0.46 (95% confidence interval [GI], 0.19 to 0.73). An infection criterion of 10(5) colony-forming units/gm of tissue correlated poorly with clinical and histologic infection rates (0.19 [95% CI, -0.06 to 0.44] and 0.13 [95% CI, -0.05 to 0.31], respectively). CONCLUSIONS: Contaminated wounds closed with sutures had higher infection rates compared with those reported with topical tissue adhesive. The amount of colonization may not be an accurate method to determine infection.

Animals↗
PubMedDate not supplied

Enhanced wound contraction in fresh wounds dressed with honey in Wistar rats (Rattus Novergicus).

BACKGROUND: Due to reports that honey accelerates wound healing, an investigation on its role in wound contraction in fresh wounds inflicted on wistar rats was carried out. METHOD: Twenty adult male wistar rats had 2cm by 2cm square wound inflicted on their right dorsolateral trunk. They were divided into two groups. The experimental group had their wounds dressed with honey while the control group had normal saline dressing. Wound dressing was done every five days and measurements taken at each dressing. Wound morphology was also assessed. RESULTS: Dressing with honey significantly enhanced percentage wound contraction on day 10 with value of 79.20+/-2.94 compared to control value of 53.50+/-4.32. p=0.0. The mean wound measurement on day 10 reduced significantly in honey group, 1.15+/-0.18 compared to control group 2.38+/-0.28. p=0.002. However, there was no significant difference in fibroblast count per high power field in honey group 68.0+/-2.59 compared to control 90.2+/-17.40, p=0.242. Honey dressing increased mean blood vessel count per high power field, 18.8+/-3.77 albeit non significantly when compared to control value of 13.4+/-2.44, p=0.264. Also honey dressing caused increased granulation tissue formation in wounds dressed with honey compared to control group. CONCLUSION: Our study suggests that honey dressing enhances wound contraction in fresh wounds which is one of the key features of wound healing.

Administration, Cutaneous↗
PubMed1988

[Wound healing and wound dressing].

This review article intends to discuss the clinical management of wounds in respect to a pathophysiological background. Recent results of research in the field of wound healing are demonstrated. Wound healing can be seen as aseptic inflammatory response to a traumatic stimulus. The activation of the clotting cascade by the trauma induces a sequence of humoral and cellular reactions. Platelets, granulocytes and macrophages are activated stepwisely. In the first phase of wound healing the wounded tissue area will be prepared for phagocytosis by enzymatic degradation of ground substance and depolymerisation of protein macromolecules (wound edema). Following the phagocytic microdebridement mesenchymal cells proliferate and produce matrix substance. Microcirculation within the traumatized area will be restored by angiogenesis, macroscopically observed as new formed granulation tissue. This leads to the wound healing phase of scar tissue formation. In this complexity of reactions naturally many possibilities of impairment are given. The most common complication during wound healing is the infection. It can be seen as self reinforcing process. The therapy of the impairment of wound healing consists in the disruption of the specific vicious circle, in the case of an osseus infection that would be a macrodebridement (that is necrectomy) and biomechanical stabilization. The surgical management of wounds principally consists in ensuring an undisturbed sequence of the healing process. This can be done by the wound excision that supports the phagocytic microdebridement. A further possibility is to avoid overwhelming formation of edema by eliminating the traumatic stimulus, by immobilization of the injured region and by ensuring a physiological microenvironment with a primary suture if possible. There are up to the present no drugs available to enhance cell proliferation and to regulate wound healing but it seems that experimental research is successful in characterizing substances as growth factors and mediators. A second way of managing is to prevent the wound healing from troubles by using preventive measures: unbroken aseptic chain, stopping bleeding exactly and introducing sufficient drainage, avoiding of ischaemia and last not least inserting foreign substances into the tissue as few as possible.

Animals↗
PubMed1993

A comparative study of wound dressings on full-thickness wounds in micropigs.

Eight full-thickness (to the depth of adipose tissue) skin wounds were surgically inscribed on the backs of four Yucatan micropigs (32 wound sites in total). Wound sites were created to allow for controlled comparative evaluation between wound sites, wound dressings, and specified postoperative healing time. The wounds were dressed with either ClearSite hydrogel dressing (New Dimensions in Medicine, Dayton, Ohio) or Duoderm hydrocolloid wound dressing (ConvaTec Inc., Princeton, New Jersey). Tracings and photographs of each wound site were made and computerized planimetry was done to compare the rate of epithelialization for like wounds and like wound dressings. Histomorphometric measurements were also made to compare the effects of the dressing on the wounds at the cellular level. The results of this study indicate that the wounds covered with the hydrogel dressing exhibited a more rapid rate of closure and reepithelialization as compared with the hydrocolloid wound dressing.

Animals↗
PubMed1999

Keratinocyte growth factor-2 accelerates wound healing in incisional wounds.

BACKGROUND: Keratinocyte growth factor-2 (KGF-2) also described as fibroblast growth factor-10 (FGF-10) is a newly identified member of the fibroblast growth factor family. KGF-2 is 96% identical to the recently identified rat FGF-10 and specifically stimulates growth of normal human epidermal keratinocytes. The present study was undertaken to examine the effects of topically applied KGF-2 in an incisional wound healing model. KGF-2 treatment resulted in an improvement in incisional wound healing as characterized by an increase in breaking strength, collagen content, and epidermal thickness. METHODS: KGF-2 was topically applied to linear incisions made in the dorsal skin of Sprague-Dawley rats. Biomechanical testing was done using an Instron tensiometer for breaking and tensile strength determinations. Wound collagen content was determined using the Sircol collagen assay. Epidermal thickness measurements were conducted using Masson's trichrome-stained sections of the wound. RESULTS: A single topical application of KGF-2 at the time of wounding resulted in an increase in wound breaking and tensile strength at Day 5 after wounding. Breaking strength of KGF-2-treated wounds was significantly higher compared with the buffer control (1 microgram, 222.1 +/- 13.5 g, P = 0.0007; 4 microgram, 248.7 +/- 15.4 g, P = 0.0001; 10 microgram, 247.2 +/- 21.9 g, P = 0.001; buffer, 141.0 +/- 9.7 g). Epidermal thickness and wound collagen content were significantly increased following treatment with KGF-2. CONCLUSIONS: Based on our findings, KGF-2 is a potent stimulator of wound healing as demonstrated by increased mechanical strength accompanied by an increase in wound collagen content. KGF-2 could be an important cellular mediator responsible for the initiation and acceleration of wound healing and may enhance the healing of surgical wounds.

Animals↗
PubMed1990

Studies in fetal wound healing, VI. Second and early third trimester fetal wounds demonstrate rapid collagen deposition without scar formation.

The mechanisms that underlie the lack of scarring in fetal wounds are unknown, but probably relate to the control of collagen fibrillogenesis. The role of collagen in the fetal wound matrix is controversial, and several wound implant models have been used to evaluate collagen deposition in fetal wounds. Unfortunately, these models create an artificial wound environment and may thereby affect the results. In order to study fetal wound collagen deposition in linear wounds without artificially altering the wound environment, we applied a highly sensitive immunohistochemical technique that uses antibodies to collagen types I, III, IV, and VI. We found that collagen was deposited in fetal wounds much more rapidly than in adult wounds. Wound collagen deposition occurred in a normal dermal and mesenchymal pattern in second and early third trimester fetal lambs. These findings are consistent with the observation that the fetus heals rapidly and without scar formation. In contrast, wounds in late gestation fetal lambs showed some evidence of scar formation. Further studies may suggest ways to alter the adult wound so that it heals in a fetal manner.

Animals↗
PubMed1997

Wound size and gestational age modulate scar formation in fetal wound repair.

The early-gestation fetus heals incisional skin wounds rapidly and scarlessly. The morphology with which the fetus heals excisional skin wounds remains unclear. To characterize excisional fetal wound repair, and to determine whether there is a developmentally regulated wound-size threshold beyond which fetal skin heals with scar, the authors created excisional wounds in fetal lambs of varying gestational age. Time-mated pregnant ewes carrying 22 fetuses at 60 to 90 days' gestation (term, 145 days) underwent laparotomy and hysterotomy. An incisional wound and four circular, punch biopsy wounds of 2, 4, 6, and 10 mm in diameter were placed on the back of each fetal lamb and marked with India ink. The wounds were harvested at 14 days' postwounding and examined grossly and microscopically after serial sectioning and histological staining. Morphological features of all wounds were graded. By 14 days' postwounding all fetal wounds had healed completely. for lambs at each gestational age, increasing wound size was strongly associated with an increase in the frequency of scar. Also, as gestational age increased from 60 to 90 days' gestation the frequency of scarless repair decreased. By understanding the cellular and molecular processes that mediate scar formation with increasing wound size and advancing gestational age, the authors hope to gain further insight into the mechanisms of scarless fetal wound repair.

Animals↗
PubMed2000

Comparison of carbon dioxide laser, erbium:YAG laser, dermabrasion, and dermatome: a study of thermal damage, wound contraction, and wound healing in a live pig model: implications for skin resurfacing.

BACKGROUND: Advances in laser technology allow for precise tissue removal and minimal thermal damage. However, mechanisms for cosmetic improvement have not been determined. Investigators have suggested that ablation, collagen shrinkage, and new collagen deposition all contribute to the clinical outcome. OBJECTIVE: In a live farm pig, we examined gross and microscopic effects of thermal and mechanical ablation devices to characterize immediate and long-term mechanisms in skin rejuvenation. METHODS: Two CO(2) lasers, an erbium:YAG laser, a dermabrader, and a dermatome were used to treat flank skin in a farm pig. There were 14 different treatment groups based on device type and working parameters. One to five sites were treated for each group. Wound surface areas were measured before treatment, immediately after treatment, and 7, 17, 23, 30, and 60 days thereafter. Biopsies were performed immediately after irradiation and 2, 7, 17, and 60 days after treatment. RESULTS: For the CO(2) laser-induced wounds, surface area measurements showed that immediate and final wound contraction tended to increase with initial residual thermal damage (RTD) for a range of values, above which immediate contraction remained relatively constant. Although there was no immediate wound contraction with mechanical ablation devices, long-term wound contraction in the dermatome and dermabrasion sites increased with depth of ablation. The erbium:YAG laser sites healed in a manner similar to that of mechanically induced wounds. Wound contraction profiles over time were dependent on depth of RTD and depth of ablation. Sixty days postoperatively, histologic examination showed varying degrees of fibroplasia. Overall, there was greater compaction and horizontal orientation of collagen fibers in those wounds with more than 70 microm of dermal RTD. Grossly, all wounds were similar after 60 days, with the exception of the deep dermabrasion sites, at which clinical scarring was observed. CONCLUSION: Our results show that CO(2) laser resurfacing produces short- and long-term wound contraction that is greater than that induced by purely ablative methods for the same total depth of injury. The erbium laser produced wound contraction profiles similar to those produced by mechanical wounding. The data suggest that initial collagen contraction and thermal damage modulate wound healing.

Animals↗
PubMed2000

Low-level laser therapy for wound healing: feasibility of wound dressing transillumination.

OBJECTIVE: The purpose of this study was to assess the feasibility of exposing wounds during low-level laser therapy (LLLT) by transillumination of the wound dressings. BACKGROUND DATA: LLLT has been associated with accelerated wound healing in chronic ulcers. The usual approach is to remove wound dressings prior to exposure and to treat three to five times weekly. Frequent change of wound dressings is time consuming and costly; it disrupts the healing process, increases the risk of wound infection, and may be traumatic for the patient. METHODS: A double integrating sphere setup was employed to quantify the diffuse transmittance and reflectance of various wound dressings. Differences in transmittance for large area sources and point sources were demonstrated through the use of a diode laser and an incoherent light source. RESULTS: There were a number of gels and membrane style wound dressings with diffuse transmittance of more than 50%. Hence, for these dressings the prescribed radiant exposure to the wound surface could be achieved by increasing the exposure duration, while maintaining reasonable overall treatment times. CONCLUSIONS: Although LLLT by transillumination of wound dressings is feasible for a variety of wound dressings without significant commitments in additional treatment time, the specific transmission of products not included in this study needs to be determined at the intended treatment wavelength. A transillumination approach may facilitate a faster rate of wound healing than LLLT applied to exposed wounds by reducing trauma and the risk of infection.

Absorption↗
PubMed2002

Topical platelet-derived growth factor enhances wound closure in the absence of wound contraction: an experimental and clinical study.

The effects of platelet-derived growth factor (PDGF) on wound healing in animal and human models were investigated. Four 1-cm2 wounds were made on the dorsum of 3 rats. A 0.5-cm punch wound was made behind each ear of 4 patients. Half the wounds were treated daily with vehicle, controls, and the rest were treated with PDGF. Treated wounds closed faster than the controls (animals: 16 +/- 3.2 days vs. 17.8 +/- 2.17 days; p < 0.05) and (patients: 16 +/- 0.67 days vs. 19.5 +/- 0.33 days; p < 0.05). Biopsies were taken at day 20 for polarized light-Sirius red histological analysis. The granulation tissue of PDGF-treated wounds showed fine collagen fibers with weak birefringence, characteristic of immature granulation tissue, deposited throughout the healed wound site. Such a pattern indicates wound closure by reepithelialization and filling in with scar. Control wound biopsies showed a small area of immature granulation tissue surrounded by intact dermal thick collagen fibers with strong birefringence. Such a pattern indicates wound closure by wound contraction. This shows that PDGF enhances wound closure by reepithelialization and the prevention of wound contraction.

Animals↗
PubMed2005

Evaluation of diabetic wound classifications and a new wound score.

We review seven classification systems for foot wounds in patients with diabetes and evaluate them in a table format based on 10 criteria judged to be the most important for assessing their effectiveness. Criteria include such factors as objectivity, versatility, ability to measure progress, validity and reliability, and five other grading parameters. Concomitantly, the Wound Score, a paradigm for evaluating the problem wound, is described in detail and evaluated on the same ten criteria. Five assessments including appearance of the wound base, size, depth, bio-burden, and perfusion are each graded on a 0 to 2 scale and summated to generate the Wound Score. From the score three levels of seriousness become apparent: "healthy wounds" with scores of 8 to 10, "problem wounds" with scores of 4 to 7 and "futile wounds" with scores of 0 to 3. Because of its simplicity, user friendliness, ability to integrate wound and patient information, and design to reflect progress, the Wound Score scored better on the 10 evaluation criteria than any other foot wound evaluation system for patients with diabetes. The objectivity of grading the five assessments used to generate the Wound Score make this scoring system ideal for evaluating treatment interventions and outcomes of wounds of equal seriousness.

Diabetic Foot↗
PubMed1992

Characterization of biologic properties of wound fluid collected during early stages of wound healing.

The clinical effects of occlusive dressings on wound healing are well documented. However, the underlying biologic mechanisms associated with moist healing are not well understood. Experimental studies and clinical experience have shown enhanced eschar and clot removal, re-epithelialization, and collagen synthesis under occlusion, suggesting the possibility of elevated activities of proteinases and other effectors, e.g., growth factors, in the moist wound environment. To gain an insight into the biology of early wounds under occlusion, we have carried out biologic and biochemical analyses on fluids from occluded full- and partial-thickness wounds. Metalloproteinase activities were detected in the wound fluid samples. When applied to cultured dermal fibroblasts, mitogenic activity was observed with fluids from full-thickness wounds. Wound fluid-stimulated accumulation of urokinase-type plasminogen activator by fibroblasts was also observed in a time-dependent manner. Stimulation of metalloproteinase accumulation by fibroblasts was also observed. We have further demonstrated the presence of platelet-derived growth factor-like and basic fibroblast growth factor-like factors in wound fluid by antibody neutralization of their biologic activities. Proteinase presence and proteinase stimulatory activity of wound fluid retained in the occluded wound may contribute to an enhanced proteolytic environment in these wounds in comparison to non-occluded "dry" wounds. The presence of growth factors and the potential abilities of proteinases to activate latent growth factors and generate chemotactic peptides through connective tissue breakdown may also contribute to the enhanced healing of occluded wounds.

Animals↗
PubMed2001

The role of "wound burden" in determining the costs associated with wound care.

Because of the tremendous resources they require to heal, patients with severe wounds present significant challenges to our healthcare system. This study was undertaken to introduce the concept of "wound burden" and its predictive value in anticipating the costs associated with inpatient care for patients with wounds. Wound burden is a new concept that can be used to represent the severity of a patient's skin breakdown; it is defined in this study in terms of number, size, and stage. A computerized system of wound cost tracking measured the costs involved in delivering optimal wound care to 240 patients in a long-term acute care facility. Patients were stratified in a system that accounted for "wound burden" to determine the degree to which wound burden is related to costs. Costs that pertained to supplies, specialty beds, nutrition, labs, and extra personnel time required to document and care for the wounds were recorded. The concept of "wound burden" was presented and found to be very important in predicting actual costs. Patients with the highest level of wound burden were found to have significantly higher wound costs and total stay costs (P > 0.0001). As payment systems change, having data available to justify the resources necessary to allow facilities to continue to care for the most highly wound burdened patients will become increasingly important.

Analysis of Variance↗