Thesis (M.S.)--University of Michigan, 2004. / Includes bibliographical references.

Thesis (Ph. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains xiii, 127 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references.

Bacterial infection in burn wounds can jeopardize healing and can even lead to a patient’s death. Recently using a topical wound dressing with antimicrobial ability has been increasing. An ideal dressing for a burn wound is required to be antimicrobial, pain free and able to control the wound moisture to facilitate healing. In this research, a UV-radiation grafting method for depositing polyacrylamide (PAM) layer was used to improve the non-adherence properties of two commercially available silver based wound dressings. The dressing adherence, evaluated via an in vitro gelatine model, dramatically decreases after the deposition of PAM. This deposition did not negatively affect the antibacterial ability and cytotoxicity of the dressings. Furthermore, a poly(amidoamine) dendrimer based biocide was incorporated into PET dressings coated with poly(acrylic acid-co-acrylamide ) hydrogel. The resulting dressing was able to release a therapeutic dose of the antimicrobial agent in a sustained manner. / February 2016

Sammanfattning Bakgrund: Svårläkta bensår drabbar en procent av Sveriges befolkning och påverkar den enskildes livskvalité negativt. När ett sår inte har läkt på 6 veckor klassificeras det som ett kroniskt sår. För att få ett sår att läkas ska det utredas vad det är för sår så rätt behandling sätts in som evidensbaserad omläggning, nutrition och avlastning som sjuksköterskan har ansvar för. Honung är ett alternativ till såromläggning av kroniska sår. Syfte: Syftet är att studera honungens effekt på sårläkning av kroniska sår. Metod: Allmän litteraturöversikt av 11 artiklar med kvantitativ ansats. Resultat:Fyra av sju artiklar redovisar en snabbare sårläkning och sju av elva artiklar redovisar fler antal läkta sår med honung än vad kontrollgrupper har. Slutsats: Studiens resultat visar på att honung inte är helt effektivt men inte heller sämre än vad de olika kontrollgrupperna är. Mer forskning behövs i ämnet medicinsk honung. Nyckelord: sårläkning, sår, kroniska sår, honung / Summary Background: Leg ulcer affect one percent of the Sweden's population and effects patients’ quality of life. When time to heal a wound is more than 6 weeks, it is classified as a chronic wound. To get a wound to be healed, it is necessary to investigate the best treatment for each wound. The evidence shows that the nurse is in charge of wound dressing, nutrition and relief. Honey is an alternative to wound healing in chronic wounds. Aim: The aim was to study the honeys effect on wound healing of chronic wounds. Method: The work is a literature review on eleven quantitative articles. Result: Four out of seven articles has a faster healing rate and seven out of eleven articles has more healed wounds with honey compared to different control groups. Conclusion:The result of the study shows that honey is not completely effective but also not worse than the control groups. The study shows that more research is needed about medical honey. Keywords: wound healing, ulcer, wound, chronic, honey

Non-healing wounds is a growing medical problem, often associated with pathological conditions such as diabetes and peripheral ischemia. A non-healing wound entails a large amount of suffering for the patient, and demands extensive health care resources. In this thesis, a new drug treatment paradigm for wound healing was developed by transforming Limosilactobacillus reuteri R2LC with a plasmid encoding CXCL12 (LB_CXCL12). The drug candidate was tested for safety and biological effects following topical administration to full thickness wounds in both mice and minipigs. In parallel, different techniques, including 2D and 3D measurements, planimetry, and ultrasound, for assessing wound healing were developed and evaluated.   Murine wounds treated with LB_CXCL12 demonstrated increased proliferation of dermal cells, and an increased density of macrophages of which a larger fraction expressed TGF-β. If macrophages were depleted prior to wounding, the accelerated effect on healing was abolished demonstrating a macrophage-dependent mechanism of action. Importantly, the LB_CXCL12 treatment also accelerated wound healing in mice with impaired healing as a result of hyperglycemia or peripheral ischemia, conditions that in humans are associated with development of non-healing wounds. Wounds in minipigs treated with the freeze-dried formulation of LB_CXCL12, upon resuscitation referred to as ILP100, showed accelerated healing both by increased granulation tissue formation and accelerated re-epithelialization. The treatment with ILP100 was well tolerated with no treatment-related deviations in haematology, urinalysis, and histopathology. Further, we found improved detection of thin layers if newly formed epithelial using planimetry and ultrasound compared to 2D photographs, whereas 3D scans accounting for surface curvatures yielded larger wound areas than 2D photographs of the same wounds.  Development of topical treatments for non-healing wounds are limited by the proteolytic environment of the wound that cause degradation of applied molecules. Our developed technology, a new-in-class candidate, overcomes this by continuous on-site delivery and increased bioavailability of CXCL12, resulting in prolonged instruction of local immune cells to stimulate wound healing.

The purpose of this study was to examine the clinical outcomes of negative pressure wound therapy (NPWT) using reticulated open-cell foam (ROCF) in the adjunctive management of abdominal wounds with exposed and known infected synthetic mesh. A non randomised, retrospective review of medical records for 21 consecutive patients with infected abdominal wounds treated with NPWT was conducted. All abdominal wounds contained exposed synthetic mesh [composite, polypropylene (PP), or knitted polyglactin 910 (PG) mesh]. Demographic and bacteriological data, wound history, pre-NPWT and comparative post-NPWT, operative procedures and complications, hospital length of stay (LOS) and wound healing outcomes were all analysed. Primary endpoints measured were (1) hospital LOS prior to initiation of NPWT, (2) total time on NPWT, (3) hospital LOS from NPWT initiation to discharge and (4) wound closure status at discharge. A total of 21 patients with abdominal wounds with exposed, infected mesh were treated with NPWT. Aetiology of the wounds was ventral hernia repair (n = 11) and acute abdominal wall defect (n = 10). Prior to NPWT initiation, the mean hospital LOS for the composite, PP and PG meshes were 76 days (range: 21-171 days), 51 days (range: 32-62 days) and 19 days (range: 12-39 days), respectively. The mean hospital LOS following initiation of NPWT for wounds with exposed composite, PP and PG mesh were 28, 31 and 32 days, respectively. Eighteen of the 21 wounds (86%) reached full closure after a mean time of 26 days of NPWT and a mean hospital LOS of 30 days postinitiation of NPWT. Three wounds, all with composite mesh left in situ, did not reach full closure, although all exhibited decreased wound dimensions, granulating beds and decreased surface area exposure of mesh. During NPWT/ROCF, one hypoalbuminemic patient with exposed PP mesh developed an enterocutaneous fistula over a prior enterotomy site. This patient subsequently underwent total mesh extraction, takedown of the fistula and PP mesh replacement followed by reinstitution of NPWT and flap closure. In addition to appropriate systemic antibiotics and nutritional optimisation, the adjunctive use of NPWT resulted in successful closure of 86% of infected abdominal wounds with exposed prosthetic mesh. Patient hospital LOS (except those with PG mesh), operative procedures and readmissions were decreased during NPWT compared with treatment prior to NPWT. Future multi-site prospective, controlled studies would provide a strong evidence base from which treatment decisions could be made in the management of these challenging and costly cases.

Gabriel A, Shores J, Bernstein B, de Leon J, Kamepalli R, Wolvos T, Baharestani MM, Gupta S. A Clinical Review of Infected Wound Treatment with Vacuum Assisted Closure ® (V.A.C. ®) Therapy: Experience and Case Series. ABSTRACT Over the last decade Vacuum Assisted Closure ® (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C. ® Therapy and V.A.C. Instill ® with either GranuFoam ™ or GranuFoam Silver ™ Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C. ® Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C. ® Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C. ® Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.

INTRODUCTION: For persons with diabetes, surgery is fraught with complications; of primary concern is postoperative infection. A postoperative infection rate of up to 13% has been noted in patients with diabetes undergoing elective surgical procedures compared with less than 3% in nondiabetic populations. OBJECTIVE: The objective of this study was to provide preliminary evaluation of the efficacy of a novel bioresorbable microfilm matrix (20 µm thick) containing very low amounts of silver (0.16 mg/in²) in preventing surgical site infections when placed at the level of subcutaneous tissue and dermis prior to primary closure in the patient with diabetes undergoing elective surgery. MATERIALS AND METHODS: Twenty-two patients with diabetes undergoing nonemergent or elective foot or ankle surgery and who met at least 1 of the following 6 criteria were included in the study: neuropathy, infection, open wound, history of recurrent infection, nonhealing wound, or peripheral vascular disease. Patients underwent amputation, removal of exostosis, midfoot bone removal, Achilles tendon repair, bunionectomy, or an elevating osteotomy with primary closure of the wound. After hemostasis was obtained and subcutaneous closure achieved, if applicable, the bioresorbable microfilm matrix was applied just deep to the incision at the level of subcutaneous tissue and dermis, and the incision primarily closed. A nonadherent cover dressing was applied over the suture line, and routine follow-up was scheduled for 3 to 5 days later. RESULTS: No patient exhibited signs of infection at initial follow-up, and all adherent patients achieved complete healing during the 3-month follow-up period. Eighteen patients healed at a rate typical for the respective procedure. In 2 patients, time to healing was delayed secondary to weight-bearing dehiscence. Two patients were not included in the results secondary to multiple infractions of nonadherence with the postoperative protocol. CONCLUSIONS: The application of microfilm matrix in surgical incisions at the level of subcutaneous tissue and dermis prior to primary closure is safe for and has the potential to prevent postoperative surgical site infections in at-risk patients with diabetes..

Firearms are present in two-thirds of United States households. As of 2003, roughly 500,000 projectile wounds occur annually in the United States. This costs an estimated 2.3 billion dollars of medical spending. The best treatment of gunshot wounds relies heavily on experience, but even with experience the unpredictable nature of ballistics can make treatment difficult. Wound ballistics studies the injury pattern of a particular bullet. Ballistic gelatin tests are used to analyze this pattern. A block of 10 or 20% ballistic gelatin is set and a bullet is fired through the block. Key characteristics of the wound profile seen in this test include: depth penetration, permanent cavity, and temporary cavity. Even with ballistic gelatin tests, there is still confusion and many unknowns throughout wound ballistic literature. Finite element analysis (FEA) can be used to reproduce the wound profile of a ballistic gelatin test. A .38 lead round nose was chosen to model. The bullet was assigned as an elastic plastic material and the ballistic gelatin block was assigned as an elastic plastic and viscoelastic material. SolidWorks®, TrueGrid®, and LS-DYNA® were used to create the models. Two elastic plastic and two viscoelastic simulations were developed from these models. Elastic Plastic 2 and Viscoelastic 1 were able to reproduce a depth penetration, temporary cavity, and permanent cavity. Elastic Plastic 1 and Viscoelastic 2 were unable to reproduce the temporary cavity. These simulations provided hopeful results, but further investigation is needed for contribution to the advancement of bullet wound treatment.

INTRODUCTION: Negative pressure wound therapy (NPWT) has proved to be a powerful tool in facilitating the healing of difficult wounds of a variety of etiologies. The pediatric experience with NPWT has been limited because of concerns about vascular compression and pain associated with treatment. METHOD: A retrospective review (2004-2014) was conducted at Shriners Hospital for Children-Boston to evaluate the therapeutic effect of NPWT on children with difficult wounds due to burns or soft-tissue trauma. Information was collected on patient demographics, wound size and depth, burn injury etiology, length of hospital stay, number of operating room visits, and other treatment procedures. NPWT was instituted in the operating room under general anesthesia using a commercially available system. NPWT was not initiated until all necrotic material had been removed from the wounds. A negative pressure varying between -50 and -125 mmHg was applied to the wound as continuous suction, with younger children being prescribed the lower negative pressures. NPWT dressings were changed every 5-7 days in the operating room. When wounds were clean and granulated, they were closed with split-thickness skin grafts. RESULTS: Twenty-nine children with an average age of 9.43 +/- 1.95 years (range 2 months to 18 years) were treated with NPWT. The average total wound size was 24.8 +/- 8.9% (range 0%-95%) of the body surface in patients who had suffered burns and non-burn injuries. Injury mechanisms were categorized as hot liquid (2 children), contact with hot object (4 children), electricity (7 children), flame (9 children), and other non-burn injuries such as abrasion and degloving (7 children). Over 90% of the patients required central venous or bladder catheters. Perceived benefits of the treatment included reduced numbers of dressing changes and more rapid wound granulation. There were no episodes of bleeding associated with NPWT. All patients healed their wounds, were successfully grafted, and survived. CONCLUSION: NPWT has a useful role in the pediatric burn unit in facilitating wound healing and improving quality of life. A significant correlation between the size of third-degree burn wounds and the number of negative pressure therapies suggests that NPWT may be more effective in treating complicated burn wounds. Overall, NPWT appears safe and effective when applied to well-debrided wounds, and the treatment does not seem to be associated with excessive bleeding or discomfort in children.