Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.
Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.
Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.
While opioids are routinely prescribed for painful and chronic wounds, the effects of the medications are not well described in literature. Past studies suggest that stimulation of mu-opiate receptors on keratinocytes may induce transforming growth factor-beta (TGF-beta) and cytokeratin 16 (CK16), which are molecules that appear in wound healing environments. However, other studies suggest opioids may impede immune activation and negatively affect healing.
Venous leg ulcers (VLUs) affect 3% of all people aged 65 years and older. After healing, the recurrence rate can be as high as 69%, making the treatment of VLUs costly to the healthcare system. In Australia alone, VLUs cost the healthcare system $400-500 million per year. VLUs are problematic for patients beyond the physical ulceration of their feet because they create social and psychological challenges. Therefore, treating a VLU entails not only closing the ulcer with full epithelialization, but also taking the correct measures to prevent its recurrence.
Wound healing occurs in four phases: hemostasis, inflammation, tissue growth, and tissue remodeling. The process of wound healing can be affected by multiple factors, including oxygenation, age, stress, and disease such as diabetes. Wound healing in patients with diabetes can be further complicated by neuropathy and vascular disease. Typical treatments for diabetic wounds, like wound dressings, cell therapy, and oxygen therapy, are not entirely successful because diabetes slows and impairs the healing process. The authors of this study propose the use of a non-thermal atmospheric pressure plasma treatment as a novel therapy for diabetic wounds. Unlike conventional methods, this treatment can accelerate tissue repair without negatively affecting normal tissue. Using atmospheric plasma accelerates tissue repair because the plasma produces reactive oxygen and nitrogen species, which are key for the inflammatory response. It also induces neovascularization and enhances epidermal layer formation.
Diabetic foot ulcers often present in patients with diabetes mellitus, and are a serious and challenging complication that often requires time and costly procedures to treat. Diabetic foot ulcers are very difficult to heal and often become chronic, which increases the incidence of progressing to infection. The goal of diabetic foot ulcer management is to promote reepithelization of ulcerative areas, as well as address deficits of the ulcer such as necrotic tissue, inadequate perfusion, and inflammation.
Temple University School of Podiatric Medicine Journal Review Club
Keloids are fibrous lesions made of collagen types I and III that arise from an area of wound healing, outside the margins of the original wound and are an unfortunate consequence of irregular wound healing. Treating keloids is difficult because there is limited understanding on why they arise, which is why many treatments fail to prevent their recurrence. It has been shown that no single treatment modality is effective to treat keloids; therefore, a multifaceted approach must be taken to lower recurrence rates.
Chronic wounds are clinically defined as wounds that have failed to proceed through a healing process in a timely and biologically efficient manner. They are easily identified due to their presence of a raised, hyperproliferative, and non-advancing wound margin. They often are not responsive to initial therapy, and still continue to exist even with adequate wound treatment and sharp debridement.
Chronic wounds and ulcerations induced by complications associated with diabetes mellitus have proven to be a burden to the patients themselves, as well as the healthcare system as a whole. This burden has required physicians to not only find interventions that work better, but are also more cost effective. In the population with diabetes, 1 out of 4 will have an ulceration of the lower extremity at some point in their life. It’s also important to state that these foot ulcers can lead to some form of amputation in 20% of these patients. Standard wound care typically involves moist dressings, debridement, wound offloading, infection control, and in some cases, advanced therapies. The authors of this study looked into two of these advanced therapies, bioengineered skin substitutes (BSS) and dehydrated human amnion/chorion membranes (dHACM.) The primary objective of the study was to see which worked best, as compared to standard wound care (SWC), while the secondary objective was to see which had the lowest costs.
One fourth of the approximately 22.3 million patients with diabetes in the United States are expected to develop a diabetic foot ulcer (DFU) at some point during their lives, and it is estimated to affect 1-8% of diabetics annually. DFUs have shown to be challenging to treat, and often result in extended hospital stays, increased risk of infection, and subsequent amputation in certain patients. A major concern regarding amputees is a 5-year mortality rate that rivals that of patients with colon cancer. In addition, DFUs contribute heavily to the financial load of payers, with an estimated annual medical cost of up to $13 billion.
Wounds tend to follow a certain algorithm when healing, which can be summed down to three distinct phases: hemostasic/inflammatory, proliferative, and remodeling. Chronic wounds are characterized as wounds that do not follow this pattern and fail to heal within 8 weeks. They tend to occur in patients that have uncontrolled comorbidities causing the healing cycle to get "stuck" in the inflammatory phase. There are roughly 6.5 million cases of chronic wounds noted annually in the United States. Thus, the need for better products that may induce quicker healing are highly sought after.
Wounds with exposed bone and tendon are a major concern for physicians due to the significant morbidity that they can cause. The primary focus of this study is to determine the efficacy and safety of a biologically active, cryopreserved human skin allograft for the treatment of wounds of this nature.
Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.
Within the last decade, the rise of diabetes in the U.S. population has been matched with a rise in diabetic foot ulcers requiring amputations. Because many of these diabetic foot ulcers develop secondary to poor wound healing and susceptibility to infection after surgery, some important risk factors have been evaluated. Stress, among other factors, has been shown not only to affect the psychological state of a patient, but also biologically to impair immunity and induce an inflammatory microenvironment within patients.
Staphylococcus aureus is a primary cause of post-operative surgical site infection. S. aureus produces hyaluronidase, which degrades hyaluronic acid (HA). HA is important in wound healing because it prevents bacterial proliferation and provides anti-inflammatory properties. Although early bactericidal antibiotic treatment is important for wound infection, systemic antibiotics often do not prove to be entirely beneficial for wound penetration. Therefore, newer treatment methods that are not at risk of antibiotic resistance are necessary.
A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.
Twenty-five percent of all diabetic patients will develop a diabetic foot ulcer (DFU), the major reason for hospitalizations in diabetic patients. The current standard of care (SOC) for DFUs consists of debridement, glycemic control, antimicrobial therapy, and imaging. DFUs often become infected, and with improper healing they require more advanced care and possibly lower extremity amputation. This study evaluated the usefulness of a perfusion-decellularized porcine hepatic-derived wound matrix (PDPHD-WM) in treating difficult-to-heal ulcers, or DFUs of greater than three months’ duration that had been treated with at least one other advanced method.
Temple University School of Podiatric Medicine Journal Review Club
Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.
Diabetes mellitus is frequently associated with chronic non-healing wounds, many of which result in amputation. The combination of peripheral vascular disease, neuropathy, and impaired immune function contributes to a higher risk of injury and deficiency in healing. Wound healing is a complex process comprising eight important factors: (1) collagen synthesis, (2) cell migration, (3) cell cycle and differentiation, (4) angiogenesis and growth hormone, (5) blood clotting, (6) extracellular matrix and focal adhesion, (7) calcium ion signaling, and (8) immune and inflammatory response. In the diabetic cell, all these processes malfunction, with the exception of collagen synthesis, cell migration, and cell cycle or differentiation.
