Fluorescent Imaging and Precise Suppression of Bacterial Infection in Chronic Wounds by Porphyrin-Based Metal-Organic Framework Nanorod

The immense burden imposed by chronic wounds—those persisting over 6 weeks despite active intervention—on patients and health services is well recognised. There are various reasons for why a wound fails to progress towards closure, and clinicians must investigate the underlying cause of wound chronicity, as this information guides the management of such wounds. The TIME framework (T=tissue; I=infection/inflammation; M=moisture balance; E=wound edges) is a useful tool for practitioners to systematically undertake wound assessment and product selection. This article discusses chronic wound management based on the TIME framework, examining the aspects to be considered when managing chronic wounds. It also describes the process of dressing selection for overcoming the various barriers to wound healing, specifically discussing the AQUACEL family of dressings.

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Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis

JMIR mhealth and uhealth ◽

10.2196/15574 ◽

2020 ◽

Vol 8 (6) ◽

pp. e15574

Author(s):

Lihong Chen ◽

Lihui Cheng ◽

Wei Gao ◽

Dawei Chen ◽

Chun Wang ◽

...

Keyword(s):

Wound Healing ◽

Cohort Studies ◽

Mobile Phones ◽

Standard Care ◽

Chronic Wounds ◽

Chronic Wound ◽

Meta Analysis ◽

Wound Management ◽

Efficacy And Safety ◽

Chronic Wound Management

Background Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. Objective The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. Methods We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. Results A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. Conclusions Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

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The use of wound dressings as a means to alter the composition of biofilms in a chronic wound model

Access Microbiology ◽

10.1099/acmi.ac2020.po0013 ◽

2020 ◽

Vol 2 (7A) ◽

Author(s):

Gabriela Nedelea ◽

Sarah Maddocks

Keyword(s):

Chronic Wounds ◽

Chronic Wound ◽

Low Ph ◽

Wound Dressings ◽

Wound Management ◽

Chronic Infections ◽

Gram Negative ◽

Negative Shift ◽

Wound Model ◽

Chronic Wound Management

It is estimated that £5 billion are invested yearly into chronic wound management by the NHS. Whilst the demand for treatment rises every year, it has become harder to treat wounds given the burden of antimicrobial resistance. Chronic wounds can easily become harbouring grounds for polymicrobial biofilms in which species interact in specific ways. This study assessed the interactions between two commonly co-isolated chronic wound pathogens: Pseudomonas aeruginosa (ATCC 9027) and Staphylococcus aureus (EMRSA 15), whose biofilm relation initiates a Gram-negative shift. During this phenomenon, P. aeruginosa takes over the majority of the bacterial community, at the detriment of S. aureus. The Gram-negative shift marks the turning point from an acute to a chronic wound. The pH of a chronic wound is typically alkaline, and it was hypothesised that topical dressings with an acidic pH could disrupt the onset of the Gram negative shift, and therefore chronicity. Six different topical dressings with low pH were used in achronic wound model to assess their ability to reverse or delay the Gram-negative shift. It was found that they did not have an impact on the onset of the Gram-negative shift, despite their low pH values. However, the lower the pH of the dressings, the more frequently small colony variant (SCV) bacteria were observed in the biofilm. SCVs are known for causing persistent or chronic infections. It was therefore concluded that low pH dressings alone may not be favourable for managing chronic wound infection.

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Update of Hyperbaric Oxygen Therapy in the Management of Chronic Wound

Journal of Current Medical Research and Opinion ◽

10.15520/jcmro.v3i02.255 ◽

2020 ◽

Vol 3 (02) ◽

pp. 422-425

Author(s):

Ibrahim A Albrethen ◽

Turki M Alshehri ◽

Khalid A Albraithen ◽

Abdullah I Alenezi ◽

Hussein M Alkahtani ◽

...

Keyword(s):

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Management Strategy ◽

Oxygen Therapy ◽

Chronic Wounds ◽

Chronic Wound ◽

Wound Management ◽

Traditional Therapies ◽

Chronic Wound Management ◽

Complex Cases

Hyperbaric oxygen therapy (HBOT) is a type of therapy for wound management that employs pressurized oxygen, which patients breathe for a set period. The aim is to increase the amount of oxygen in a person's body, which should aid the process of wound healing, which is especially crucial for chronic wounds. Multiple evidence from clinical trials and studies suggest that HBOT is more effective when compared to traditional therapies in treating chronic wounds, and especially when managing wounds that develop as a result of diabetes. Additionally, two studies conducted on rats with diabetes and patients with foot ulcers suggest that HBOT can address these complex cases, which can aid in reducing the amputation risk. This paper reviews evidence, which proves that HBOT is an effective chronic wound management strategy.

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Telemedicine in Chronic Wound Management: Systematic Review And Meta-Analysis (Preprint)

10.2196/preprints.15574 ◽

2019 ◽

Author(s):

Lihong Chen ◽

Lihui Cheng ◽

Wei Gao ◽

Dawei Chen ◽

Chun Wang ◽

...

Keyword(s):

Wound Healing ◽

Cohort Studies ◽

Mobile Phones ◽

Standard Care ◽

Chronic Wounds ◽

Chronic Wound ◽

Meta Analysis ◽

Wound Management ◽

Efficacy And Safety ◽

Chronic Wound Management

BACKGROUND Chronic wounds have been a great burden to patients and the health care system. The popularity of the internet and smart devices, such as mobile phones and tablets, has made it possible to adopt telemedicine (TM) to improve the management of chronic wounds. However, studies conducted by different researchers have reported contradictory results on the effect of TM on chronic wound management. OBJECTIVE The aim of this work was to evaluate the efficacy and safety of TM in chronic wound management. METHODS We systematically searched multiple electronic databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) to identify eligible studies published from inception to June 12, 2019. Inclusion criteria were randomized controlled trials (RCTs) and interventional cohort studies that investigated the use of TM in chronic wound management. RCT and observational data were analyzed separately. A meta-analysis and qualitative analysis were conducted to estimate endpoints. RESULTS A total of 6 RCTs and 6 cohort studies including 3913 patients were included. Of these, 4 studies used tablets or mobile phones programmed with apps, such as Skype and specialized interactive systems, whereas the remaining 8 studies used email, telephone, and videoconferencing to facilitate the implementation of TM using a specialized system. Efficacy outcomes in RCTs showed no significant differences in wound healing (hazard ratio [HR] 1.16, 95% CI 0.96-1.39; P=.13), and wound healing around 1 year (risk ratio [RR] 1.05, 95% CI 0.89-1.23; P=.15). Noninferiority criteria of TM were met. A decreased risk of amputation in patients receiving TM was revealed (RR 0.45, 95% CI 0.29-0.71; P=.001). The result of cohort studies showed that TM was more effective than standard care (HR 1.74, 95% CI 1.43-2.12; P<.001), whereas the outcome efficacy RR of wound healing around 1 year (RR 1.21, 95% CI 0.96-1.53; P=.56) and 3 months (RR 1.24, 95% CI 0.47-3.3; P=.67) was not significantly different between TM and standard care. Noninferiority criteria of TM were met for wound healing around 1 year in cohort studies. CONCLUSIONS Currently available evidence suggests that TM seems to have similar efficacy and safety, and met noninferiority criteria with conventional standard care of chronic wounds. Large-scale, well-designed RCTs are warranted.

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Antibiofilm Efficacy of DispersinB® Wound Spray Used in Combination with a Silver Wound Dressing

Microbiology Insights ◽

10.4137/mbi.s13914 ◽

2014 ◽

Vol 7 ◽

pp. MBI.S13914 ◽

Cited By ~ 20

Author(s):

Purushottam V. Gawande ◽

Allie P. Clinton ◽

Karen LoVetri ◽

Nandadeva Yakandawala ◽

Kendra P. Rumbaugh ◽

...

Keyword(s):

Antimicrobial Activity ◽

Methicillin Resistant Staphylococcus Aureus ◽

Chronic Wounds ◽

Chronic Wound ◽

Wound Management ◽

Potential Applications ◽

Mrsa Infection ◽

Chronic Wound Management ◽

Methods Of Treatment

Chronic wounds including diabetic foot ulcers, pressure ulcers, and venous leg ulcers are a worldwide health problem. As the traditional methods of treatment have proven ineffective against chronic wounds involving biofilms, there is an unmet clinical need for developing products with an antibiofilm component that inhibits and/or disrupts biofilms and thus make the biofilm-embedded bacteria more susceptible to antimicrobial therapy. We developed a DispersinB® antibiofilm enzyme-based wound spray for treating chronic wounds in conjunction with an antimicrobial. Under in vitro conditions, the DispersinB® and Acticoat™ combination performed significantly better ( P < 0.05) than Acticoat™ alone, indicating the synergy between the two compounds because of DispersinB® enhancing the antimicrobial activity of Acticoat™. Furthermore, DispersinB® wound spray enhanced the antimicrobial activity of Acticoat™ in a chronic wound mouse model of methicillin-resistant Staphylococcus aureus (MRSA) infection. Thus, this novel combination of DispersinB® and Acticoat™, an antimicrobial dressing, prompts clinical evaluation for potential applications in biofilm-based chronic wound management.

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