Use of Dehydrated Human Amnion/Chorion Membrane Allografts in More Than 100 Patients with Six Major Types of Refractory Nonhealing Wounds

2018 ◽  
Vol 108 (2) ◽  
pp. 84-89 ◽  
Author(s):  
Matthew Garoufalis ◽  
Darshan Nagesh ◽  
Patrick J. Sanchez ◽  
Robin Lenz ◽  
Sarah J. Park ◽  
...  
Keyword(s):  
Amniotic Membrane ◽  
Chronic Wounds ◽  
Wound Care ◽  
Biochemical Properties ◽  
Complete Healing ◽  
Human Amnion ◽  
Tissue Healing ◽  
Surgical Wounds ◽  
History Of ◽  
Care Practices

Background: Biochemical properties of the amniotic membrane help modulate inflammation and enhance soft-tissue healing. In controlled trials, the efficacy of dehydrated human amnion/chorion membrane (dHACM) allografts has been established. Our purpose is to describe our experience with using dHACM to treat nonhealing wounds of various etiologies. Methods: We conducted a retrospective review of deidentified data from 117 consecutive patients treated in an outpatient clinic with dHACM allografts with wounds of various etiologies over 2 years. The decision to use advanced wound-care treatments is based on rate of healing observed after initiation of standard wound care and patient risk factors. Eligibility for treatments such as amniotic membrane allografts includes wounds without 50% reduction after 4 weeks, or earlier in patients deemed to be at high risk for nonhealing or with a history of chronic wounds. In micronized or sheet formulation, dHACM is applied to the wound weekly after sharp/mechanical debridement as necessary, and wound-care practices appropriate for wound type and location are continued. Results: Thirty-four percent of allograft recipients had diabetic foot ulcers, 25% had venous leg ulcers, 20% had surgical wounds, 14% had pressure ulcers, 6% had ischemic wounds, and 2% had traumatic wounds. Complete healing occurred in 91.1% of treated patients, with a mean ± SD number of weekly applications per healed wound of 5.1 ± 4.2. Conclusions: In addition to wounds of diabetic origin, dHACM can significantly expedite healing in refractory wounds of varying etiologies.

scholarly journals Human amniotic membrane: A biological cost effective dressing in chronic wounds.

2020 ◽  
Vol 27 (06) ◽  
pp. 1249-1254
Author(s):  
Ibrahim Yamin ◽  
Ayesha ◽  
Ramla ◽  
Muhammad Ajmal
Keyword(s):  
Wound Healing ◽  
Amniotic Membrane ◽  
Chronic Wounds ◽  
Biological Membrane ◽  
Case Series ◽  
Cost Effective ◽  
Complete Healing ◽  
Lower Limbs ◽  
Human Amniotic Membrane ◽  
Healing Wound

Objectives: The use of human amniotic membrane is essential new concept in wound healing which functions as a biodegradable scaffold on wound surface, as it is a rich hub of stem cells which play an important role in wound healing. Study Design: Randomized Control Trial. Setting: Department of Surgery THQ Hospital Gojra. Period: 1st January 2019 to 30 September 2019. Material & Methods: Experimental study using clinical trial. A case series of 50 patient cases were picked from surgical OPD. Who fall in criteria of chronic non-healing wound with at least three months duration comprising of diabetic, venous ulcers and traumatic non healing wound and neuropathic ulcers. All located on lower limbs. Results: All 50 patient were treated with standard protocol by applying freshly prepared amniotic membrane out of which 4 chronic wounds more than 4 year duration were not healed and 2 cases escaped from the study. HAM dressing was changed after every 7 days and its effect were studied by seeing measuring the reduction in wound size and improvement in pain, swelling and mental stress. Success rate was found about 90% with complete healing. Conclusion: There is a dire need in developing countries to promote the use of HAM, in chronic non healing wounds which is a biological membrane, readily available (free if fresh) with simple sterilization techniques, easy storage and easy application with ultimate goal in achieving speedy cost effective wound healing.

scholarly journals Case Report: Freeze-Dried Human Amniotic Membrane Allograft for the Treatment of Chronic Wounds: Results of a Multicentre Observational Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Iveta Schmiedova ◽  
Zuzana Ozanova ◽  
Elen Stastna ◽  
Ludmila Kiselakova ◽  
Bretislav Lipovy ◽  
...  
Keyword(s):  
Observational Study ◽  
Amniotic Membrane ◽  
Human Body ◽  
Chronic Wounds ◽  
Chronic Wound ◽  
Wound Care ◽  
Standard Of Care ◽  
Wound Management ◽  
Human Amniotic Membrane ◽  
Freeze Dried

An inability of the human body to heal acute wounds under certain conditions results in the formation of chronic ulcers. Chronic wounds not only cause significant pain and discomfort for patients but also serve as an entry for microorganisms into the human body, which can result in serious life-threatening problems and become a significant burden for the patients and society. The current work present results of a multicentre prospective observational study demonstrating the use of a lyophilized amniotic membrane (AM) in the treatment of chronic wounds (various etiologies). Lyophilized AM produced under the commercial brand Amnioderm® was used as an allograft material for therapy of chronic wounds, in addition to chronic ulcer standard-of-care (SoC) protocols. The duration of wounds considered for the application of AM ranged between 2 months and 11 years. In total, 16 patients were enrolled to the study, of which eight were completely healed, six demonstrated a significantly reduced ulcer size, and two did not respond to the AM therapy. The current study unambiguously demonstrates an effective alternative to the standard of chronic wound care and confirms a significant effect of the AM application for chronic wound management as a new SoC.

scholarly journals 318. Deferring Amputation in Diabetic Foot Osteomyelitis: Doing more Harm than Good?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S231-S232
Author(s):  
Shiwei Zhou ◽  
Brian M Schmidt ◽  
Oryan Henig ◽  
Keith S Kaye
Keyword(s):  
Diabetic Foot ◽  
Medical Management ◽  
Wound Care ◽  
Cohort Analysis ◽  
Severity Of Illness ◽  
Complete Healing ◽  
Knee Amputation ◽  
Management Group ◽  
One Year ◽  
Diabetic Foot Osteomyelitis

Abstract Background Diabetic foot osteomyelitis (DFO) is a leading cause of below knee amputation (BKA). Even when medical treatment is deemed unlikely to succeed, patients with DFO are often resistant to amputation. Methods An observational cohort analysis was done on patients with DFO at Michigan Medicine who were evaluated by podiatry and recommended BKA from Oct 2015 - Jun 2019. Primary outcome was mortality after BKA recommendation. Secondary outcomes were healing of affected limb, rate of BKA or above knee amputation (AKA) and total antibiotic days in the 6 months following. All intravenous antibiotics and oral courses of linezolid and fluoroquinolones were captured. Results Of 44 patients with DFO, 18 chose BKA, 26 chose medical management with wound care. Mean age of the cohort was 61, 68% male, 80% white with a median Charlson Comorbidity Index of 6 (IQR 4,7). The two groups were similar with regards to demographics and comorbid conditions. Those who chose medical management did so because their infection was non-life-threatening and they desired to avoid amputation. One-year mortality was greater in patients who were medically managed compared to those who had BKA (23.1% vs 0%, OR 11.7, 95% CI 0.6–222.9). Considering only the 33 patients who were followed for at least 2 years, 2-year mortality was also greater in the medically managed group compared to the BKA group (38.5% vs 5.6%, OR 10.6, 95% CI 1.2–92.7, Figure 1). Fewer patients in the medical management group had complete healing of their wound/stump compared to the BKA group (46.2% vs 88.9%, OR 9.3, 95% CI 1.8–49.1). In the medically managed group, 18 (69%) patients went on to require BKA or AKA at a median of 76.5 days compared to 2 (11%) in the BKA group who required AKA at 1 and 11 days following recommendation. Median antibiotic days were significantly greater in the medically managed group compared to the BKA group (55 IQR 42,78 vs 17 IQR 10,37, p=0.0017). Conclusion In this cohort of DFO patients where BKA was recommended, medical management was associated with increased mortality, poor healing of the affected limb, and excess antibiotic exposure compared to BKA. These findings are particularly notable as case mix and severity of illness were similar between the two groups. This study can be used to inform providers and patients in cases where BKA is recommended. Disclosures All Authors: No reported disclosures

Effectiveness of biofilm‐based wound care system on wound healing in chronic wounds

2019 ◽  
Vol 27 (5) ◽  
pp. 540-547 ◽  
Author(s):  
Yukie Mori ◽  
Gojiro Nakagami ◽  
Aya Kitamura ◽  
Takeo Minematsu ◽  
Mikio Kinoshita ◽  
...  
Keyword(s):  
Wound Healing ◽  
Chronic Wounds ◽  
Wound Care ◽  
Care System

scholarly journals The fat anchor orchiopexy technique: results and outcomes from 150 cases surgical experience

2021 ◽  
Author(s):  
Claudio Spinelli ◽  
Alessia Bertocchini ◽  
Gianmartin Cito ◽  
Marco Ghionzoli ◽  
Silvia Strambi
Keyword(s):  
Undescended Testis ◽  
Healing Process ◽  
Day Surgery ◽  
Post Surgery ◽  
Post Operative Pain ◽  
Surgical Wounds ◽  
Bilateral Cryptorchidism ◽  
Long Time ◽  
History Of

Abstract Purpose The purpose of the study is to evaluate results and outcomes in a long-time follow-up period, by performing a novel testicular fixation procedure, known as “fat anchor orchidopexy” (FAO), for the treatment of palpable low inguinal undescended testis. Materials and methods We retrospectively reviewed all patients who underwent scrotal orchiopexy technique, from May 2013 to May 2019, at the Pediatric Surgery Division of Department of Surgical Pathology, University of Pisa (Italy). FAO (Spinelli’s technique) consists in anchoring the testicles to sub-scrotal fat with a single trans-scrotal incision. All the patients enrolled had history of unilateral or bilateral undescended testis. Data collected included patient’s age, operative times and complications. Results A total of 150 children with cryptorchidism were treated using a single trans-scrotal orchiopexy. Of them, 130 patients (86.7%) had unilateral undescended testis and 20 (13.3%) bilateral cryptorchidism. Mean patient’s age was 21 months (range: 14–28 months). All the procedures were planned in a day-surgery setting. Trans-scrotal orchiopexy was successful in all cases and no patients required an additional groin incision. No intraoperatively and postoperatively major complications were observed. Patients’ post-operative pain was mild (mean pediatric visual analog scale = 2). In all cases, the healing process was rapid and no surgical wounds infections were reported during the post-operative period, referring excellent cosmesis results. During a mean 48-month follow-up period, no testicular retraction, recurrence or testis atrophy was reported. Conclusion The original Spinelli’s technique (FAO) proves to be a safe and effective method for the treatment of palpable or distal-to-external-inguinal-ring testes. No immediate and delayed post-surgery complications were reported. In all cases, the anchored testicle remained in the scrotal position with normal vascularization. This novel surgical technique could give better options for scrotal fixation in case of low-lying cryptorchid testes.

Identifying New Pathways and Targets for Wound Healing and Therapeutics from Natural Sources

2021 ◽  
Vol 18 ◽  
Author(s):  
Xinchi Feng ◽  
Jinsong Hao
Keyword(s):  
Wound Healing ◽  
Molecular Mechanisms ◽  
Chronic Wounds ◽  
Wound Care ◽  
Healing Process ◽  
Unmet Need ◽  
Wound Dressings ◽  
Wound Healing Process ◽  
Natural Sources ◽  
Viable Approach

: Chronic wounds remain a significant public problem and the development of wound treatments has been a research focus for the past few decades. Despite advances in the products derived from endogenous substances involved in a wound healing process (e.g. growth factors, stem cells, and extracellular matrix), effective and safe wound therapeutics are still limited. There is an unmet need to develop new therapeutics. Various new pathways and targets have been identified and could become a molecular target in designing novel wound agents. Importantly, many existing drugs that target these newly identified pathways could be repositioned for wound therapy, which will facilitate fast translation of research findings to clinical applications. This review discusses the newly identified pathways/targets and their potential uses in the development of wound therapeutics. Some herbs and amphibian skins have been traditionally used for wound repairs and their active ingredients have been found to act in these new pathways. Hence, screening these natural products for novel wound therapeutics remains a viable approach. The outcomes of wound care using natural wound therapeutics could be improved if we can better understand their cellular and molecular mechanisms and fabricate them in appropriate formulations, such as using novel wound dressings and nano-engineered materials. Therefore, we also provide an update on the advances in the wound therapeutics from natural sources. Overall, this review offers new insights into novel wound therapeutics.

Hyperbaric oxygen treatment for University of Texas grade 3 diabetic foot ulcers: a retrospective cohort study

2021 ◽  
Vol 30 (9) ◽  
pp. 722-728
Author(s):  
Rutger C Lalieu ◽  
Willem Mulder ◽  
René D Bol Raap ◽  
Saskia Stolk ◽  
Casper Smit ◽  
...  
Keyword(s):  
Wound Healing ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Wound Care ◽  
Complete Healing ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
University Of Texas ◽  
Complete Wound Healing ◽  
Grade 3

Aim: Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone. Method: A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score. Results: The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03–0.21). Mean QoL increased by 7.6 points (95%CI: 3.9–11.3; p<0.01) and median pain score fell from 3 to 1 (0–3) (p<0.01). Conclusions: The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.

The Expressiveness of SNOMED CT for Wound Care: Mapping a standardised Item Set for Leg Ulcers to SNOMED CT (Preprint)

2021 ◽  
Author(s):  
Jens Hüsers ◽  
Mareike Przysucha ◽  
Moritz Esdar ◽  
Swen Malte JOHN ◽  
Ursula Hertha Hübner
Keyword(s):  
Health Care Professionals ◽  
Information Exchange ◽  
Chronic Wounds ◽  
Wound Care ◽  
Information Model ◽  
Coverage Rate ◽  
Clinical Usefulness ◽  
Leg Ulcers ◽  
Snomed Ct ◽  
Mapping Procedure

BACKGROUND Chronic health conditions are on the rise and are putting high economic pressure on health systems as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations, thus placing particularly high demands on interoperable information exchange that can be achieved using international semantic standards such as SNOMED CT. OBJECTIVE This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions. METHODS A clinically consented and profession independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the international reference terminology SNOMED CT. Prior to the mapping, the NKDUC was transformed into an information model that served to systematically identify the relevant items. The mapping process itself was carried out in accordance with the formalism of ISO/TR 12300. As a result, the reliability, equivalence, and coverage rate were determined. RESULTS The developed information model revealed 268 items to be mapped. Conducted by three health care professionals, the mapping resulted in “moderate” reliability (K=0.512). Regarding the two best equivalence categories, the coverage rate of SNOMED CT was 67.2% overall and 64.3% specifically for wounds. CONCLUSIONS The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical condition and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by post-coordination or the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care and thereby responds to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.

scholarly journals The Role of Wound Care in 2 Group A Streptococcal Outbreaks in a Chicago Skilled Nursing Facility, 2015‒2016

2018 ◽  
Vol 5 (7) ◽  
Author(s):  
Sana S Ahmed ◽  
Kasey E Diebold ◽  
Jacob M Brandvold ◽  
Saadeh S Ewaidah ◽  
Stephanie Black ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Wound Care ◽  
Skilled Nursing Facility ◽  
Prevention Measures ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Group A ◽  
Care Practices ◽  
Transmission Factors

Abstract Two consecutive outbreaks of group A Streptococcus (GAS) infections occurred from 2015–2016 among residents of a Chicago skilled nursing facility. Evaluation of wound care practices proved crucial for identifying transmission factors and implementing prevention measures. We demonstrated shedding of GAS on settle plates during care of a colonized wound.

scholarly journals Effect of Platelet-Rich Plasma and Amniotic Membrane in Patients with Rotator Cuff Repair

2018 ◽  
Vol 39 ◽  
pp. 98-102
Author(s):  
Heri Suroto ◽  
Ameria Pribadi ◽  
Dwikora Novembri Utomo ◽  
Ferdiansyah Mahyudin ◽  
Lukas Widhiyanto
Keyword(s):  
Soft Tissue ◽  
Rotator Cuff ◽  
Pain Score ◽  
Amniotic Membrane ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Soft Tissue Healing ◽  
Disability Score ◽  
Tissue Healing ◽  
Cuff Repair

Rotator cuff disorders are the most common source of shoulder problems, ranging from mild strain to massive tears. Platelet-rich plasma (PRP), an autologous blood with platelets concentration above baseline values represents a source of multiple growth factors that promotes tissue repair. This review examines the potential of using PRP to augment rotator cuff repair. Reporting 4 patients with impingement syndrome and supraspinatus tear who underwent decompression acromioplasty and supraspinatus repair augmented with platelet-rich plasma and amniotic membrane. An evaluation was made 3-24 months postoperative using Shoulder Pain and Disability Index (SPADI). Average preoperative pain score is 64%, disability score 54.58%, and total score 58.19%. Average postoperative pain score is 0%, disability score 0.42%, and total score 0.26% (Minimum Detectable Change at 90% confidence for pain score is 18%, disability score 13%, and total score 11%). This result is consequent with research by Luoay Fallouh, stating that improvement is caused by growth factor effects in platelet-rich plasma which promotes soft tissue healing. It can be concluded that platelet-rich plasma and amniotic membrane have promising effects to enhance soft tissue healing in patients with rotator cuff syndrome. Shoulder function is restored with no limitation on daily activity and pain is no longer present.

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