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1.
Int Wound J ; 21(5): e14898, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38745257

RESUMO

Determine how healthcare professionals perceive their role in nutrition assessment and management, and explore barriers and enablers to assessment and management of nutrition in individuals with DFU. Mixed methods including a cross-sectional online survey derived from current international guidelines and theoretical domains framework, and semi-structured interviews with conventional content analysis was performed. One hundred and ninety-one participants completed the survey, with 19 participating in interviews. Many health professionals are not confident in their ability in this area of practice, are uncertain their nutrition advice or management will be effective in assisting wound healing outcomes and are uncertain their intervention would result in adequate behaviour change by the individual with DFU. Major barriers to implementation of nutrition assessment and management were: inadequate time, lack of knowledge and lack of clinical guidance and enablers were as follows: professional development, a standardised clinical pathway and screening tool and a resource addressing wound healing and diabetes management. Nutrition assessment and management in individuals with DFU is not consistently applied. Whilst health professionals believed nutrition was important for wound healing, they lacked confidence in implementing into their practice. Further dissemination of existing guidance and implementation of education programs and resources would help overcome cited barriers.


Assuntos
Atitude do Pessoal de Saúde , Pé Diabético , Avaliação Nutricional , Cicatrização , Humanos , Cicatrização/fisiologia , Estudos Transversais , Pé Diabético/terapia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pessoal de Saúde/psicologia , Inquéritos e Questionários , Idoso
2.
Wounds ; 36(4): 124-128, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38743858

RESUMO

BACKGROUND: Managing complex traumatic soft tissue wounds involving a large surface area while attempting to optimize healing, avoid infection, and promote favorable cosmetic outcomes is challenging. Regenerative materials such as ECMs are typically used in wound care to enhance the wound healing response and proliferative phase of tissue formation. CASE REPORT: The case reported herein is an example of the efficacious use of an SEFM in the surgical management of a large complex traumatic wound involving the left lower extremity and lower abdominal region. The wound bed was successfully prepared for skin grafting over an area of 1200 cm2, making this among the largest applications of the SEFM reported in the literature. CONCLUSION: This case report demonstrates the clinical versatility of the SEFM and a synergistic approach to complex traumatic wound care. The SEFM was successfully used to achieve tissue granulation for a successful skin graft across a large surface in an anatomic region with complex topography.


Assuntos
Avulsões Cutâneas , Virilha , Transplante de Pele , Coxa da Perna , Cicatrização , Humanos , Cicatrização/fisiologia , Transplante de Pele/métodos , Avulsões Cutâneas/cirurgia , Masculino , Resultado do Tratamento , Lesões dos Tecidos Moles/cirurgia , Adulto
3.
Wounds ; 36(4): 129-136, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38743859

RESUMO

BACKGROUND: Recently, micronized adipose tissue (MAT) grafts have shown promising results in wound healing, including diabetic ulcers. OBJECTIVE: To assess the possibility of using 3D printed MAT niche grafts in the management of skin and soft tissue defects resulting from non-melanoma skin cancer (NMSC) resections. MATERIALS AND METHODS: A retrospective feasibility study was conducted on patients with skin and soft tissue defects resulting from NMSC resections. Twenty-one patients were treated using either artificial dermis (n = 11) or MAT niche (n = 10) grafting. Healing time and POSAS scores were compared. The Mann-Whitney U test and the Pearson chi-square test were used in statistical analysis to compare between and within groups based on preoperative and postoperative measurements. RESULTS: Wounds in the MAT niche group reepithelialized significantly faster than those in the artificial dermis group (mean [SD] 39.2 [11.4] days vs 63.7 [34.8] days; P = .04). In the 21 scar parameters evaluated, the MAT niche group demonstrated significantly superior outcomes in only 2 parameters based on operator assessment scores: relief (mean [SD] 1.6 [0.7] vs 2.2 [0.6]; P = .047) and scar contracture (mean [SD] 1.3 [0.5] vs 2.5 [1.0]; P = .011). CONCLUSION: This study proves the feasibility of exploring the effects of MAT niche grafting following NMSC excision on healing time and specific parameters of scarring, including scar relief and scar contracture.


Assuntos
Tecido Adiposo , Estudos de Viabilidade , Neoplasias Cutâneas , Pele Artificial , Cicatrização , Humanos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Projetos Piloto , Masculino , Cicatrização/fisiologia , Feminino , Estudos Retrospectivos , Tecido Adiposo/transplante , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Transplante de Pele/métodos
4.
Sci Rep ; 14(1): 10854, 2024 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-38740788

RESUMO

Unlike adult mammalian wounds, early embryonic mouse skin wounds completely regenerate and heal without scars. Analysis of the underlying molecular mechanism will provide insights into scarless wound healing. Twist2 is an important regulator of hair follicle formation and biological patterning; however, it is unclear whether it plays a role in skin or skin appendage regeneration. Here, we aimed to elucidate Twist2 expression and its role in fetal wound healing. ICR mouse fetuses were surgically wounded on embryonic day 13 (E13), E15, and E17, and Twist2 expression in tissue samples from these fetuses was evaluated via in situ hybridization, immunohistochemistry, and reverse transcription-quantitative polymerase chain reaction. Twist2 expression was upregulated in the dermis of E13 wound margins but downregulated in E15 and E17 wounds. Twist2 knockdown on E13 left visible marks at the wound site, inhibited regeneration, and resulted in defective follicle formation. Twist2-knockdown dermal fibroblasts lacked the ability to undifferentiate. Furthermore, Twist2 hetero knockout mice (Twist + /-) formed visible scars, even on E13, when all skin structures should regenerate. Thus, Twist2 expression correlated with skin texture formation and hair follicle defects in late mouse embryos. These findings may help develop a therapeutic strategy to reduce scarring and promote hair follicle regeneration.


Assuntos
Feto , Folículo Piloso , Regeneração , Pele , Proteína 2 Relacionada a Twist , Cicatrização , Animais , Folículo Piloso/metabolismo , Camundongos , Cicatrização/genética , Cicatrização/fisiologia , Feto/metabolismo , Pele/metabolismo , Proteína 2 Relacionada a Twist/metabolismo , Proteína 2 Relacionada a Twist/genética , Camundongos Knockout , Camundongos Endogâmicos ICR , Feminino , Fibroblastos/metabolismo , Proteínas Repressoras , Proteína 1 Relacionada a Twist
5.
Transl Vis Sci Technol ; 13(5): 3, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38696180

RESUMO

Purpose: The biosynthetic Symatix membrane (SM) was developed to replace fresh human amniotic membrane (hAM) in ocular surgical applications. The purpose of this study was to test the biocompatibility of the SM with human limbus-derived epithelial cells with regard to their physical and biological properties. Methods: Different physical properties of SM were tested ex vivo by simulation on human corneas. In vitro, primary limbal epithelial cells from limbal explants were used to test biological properties such as cell migration, proliferation, metabolic activity, and limbal epithelial cell markers on the SM, hAM, and freeze-dried amniotic membrane (FDAM). Results: The surgical handleability of the SM was equivalent to that of the hAM. Ultrastructural and histological studies demonstrated that epithelial cells on the SM had the typical tightly apposed, polygonal, corneal epithelial cell morphology. The epithelial cells were well stratified on the SM, unlike on the hAM and FDAM. Rapid wound healing occurred on the SM within 3 days. Immunofluorescence studies showed positive expression of CK-19, Col-1, laminin, ZO-1, FN, and p-63 on the SM, plastic, and FDAM compared to positive expression of ZO-1, Col-1, laminin, FN, and p63 and negative expression of CK-19 in the hAM. Conclusions: These results indicate that the SM is a better substrate for limbal epithelial cell migration, proliferation, and tight junction formation. Altogether, the SM can provide a suitable alternative to the hAM for surgical application in sight-restoring operations. Translational Relevance: The hAM, currently widely used in ocular surface surgery, has numerous variations and limitations. The biocompatibility of corneal epithelial cells with the SM demonstrated in this study suggests that it can be a viable substitute for the hAM.


Assuntos
Âmnio , Movimento Celular , Proliferação de Células , Humanos , Âmnio/metabolismo , Células Cultivadas , Limbo da Córnea/metabolismo , Limbo da Córnea/citologia , Epitélio Corneano/metabolismo , Epitélio Corneano/citologia , Cicatrização/fisiologia , Células Epiteliais/metabolismo , Procedimentos Cirúrgicos Oftalmológicos/métodos , Laminina/metabolismo , Proteína da Zônula de Oclusão-1/metabolismo
6.
Invest Ophthalmol Vis Sci ; 65(5): 8, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38700874

RESUMO

Purpose: In the present study, we aim to elucidate the underlying molecular mechanism of endoplasmic reticulum (ER) stress induced delayed corneal epithelial wound healing and nerve regeneration. Methods: Human limbal epithelial cells (HLECs) were treated with thapsigargin to induce excessive ER stress and then RNA sequencing was performed. Immunofluorescence, qPCR, Western blot, and ELISA were used to detect the expression changes of SLIT3 and its receptors ROBO1-4. The role of recombinant SLIT3 protein in corneal epithelial proliferation and migration were assessed by CCK8 and cell scratch assay, respectively. Thapsigargin, exogenous SLIT3 protein, SLIT3-specific siRNA, and ROBO4-specific siRNA was injected subconjunctivally to evaluate the effects of different intervention on corneal epithelial and nerve regeneration. In addition, Ki67 staining was performed to evaluate the proliferation ability of epithelial cells. Results: Thapsigargin suppressed normal corneal epithelial and nerve regeneration significantly. RNA sequencing genes related to development and regeneration revealed that thapsigargin induced ER stress significantly upregulated the expression of SLIT3 and ROBO4 in corneal epithelial cells. Exogenous SLIT3 inhibited normal corneal epithelial injury repair and nerve regeneration, and significantly suppressed the proliferation and migration ability of cultured mouse corneal epithelial cells. SLIT3 siRNA inhibited ROBO4 expression and promoted epithelial wound healing under thapsigargin treatment. ROBO4 siRNA significantly attenuated the delayed corneal epithelial injury repair and nerve regeneration induced by SLIT3 treatment or thapsigargin treatment. Conclusions: ER stress inhibits corneal epithelial injury repair and nerve regeneration may be related with the upregulation of SLIT3-ROBO4 pathway.


Assuntos
Proliferação de Células , Estresse do Retículo Endoplasmático , Epitélio Corneano , Regeneração Nervosa , Receptores Imunológicos , Proteínas Roundabout , Transdução de Sinais , Cicatrização , Animais , Humanos , Camundongos , Western Blotting , Movimento Celular/fisiologia , Células Cultivadas , Estresse do Retículo Endoplasmático/fisiologia , Ensaio de Imunoadsorção Enzimática , Epitélio Corneano/metabolismo , Limbo da Córnea/citologia , Regeneração Nervosa/fisiologia , Proteínas do Tecido Nervoso/genética , Proteínas do Tecido Nervoso/metabolismo , Receptores de Superfície Celular/metabolismo , Receptores de Superfície Celular/genética , Receptores Imunológicos/genética , Receptores Imunológicos/metabolismo , Transdução de Sinais/fisiologia , Cicatrização/fisiologia
7.
Clin Oral Investig ; 28(6): 303, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38714559

RESUMO

OBJECTIVES: We aimed to establish a risk profile for intraoral wound healing disorders based on measurements of microcirculation in gingival tissues. MATERIALS AND METHODS: Oxygen saturation (SO2) and blood flow in gingival tissues were measured with tissue spectrometry and laser doppler spectroscopy in 37 patients before/after tooth extractions. Patients were assigned to four groups: anamnestically and periodontally healthy patients (n = 7), anamnestically healthy but suffering from periodontitis (n = 10), anamnestically healthy but smoking and suffering from periodontitis (n = 10) and suffering from diabetes and periodontitis (n = 10). Measurements were performed at three different time points: Baseline measurement (T0), one day post extractionem (p.e.) (T1) and seven days p.e. (T2). RESULTS: Baseline SO2 values were higher in control patients (p = .038). This effect was most evident in comparison to smokers suffering from periodontitis (p = .042), followed by diabetics suffering from periodontitis (p = .09). An opposite trend was seen for blood flow. Patients suffering from periodontitis demonstrated higher blood flow values (p = .012). Five patients, which belonged to the group of smokers suffering from periodontitis, showed clinically a delayed wound healing. CONCLUSION: Differences in SO2 and blood flow of gingival tissue could be detected in different groups of patients with existing periodontitis compared to control patients. CLINICAL RELEVANCE: Lower baseline SO2 values could be a warning signal for possible wound healing disorders after oral surgery.


Assuntos
Gengiva , Fluxometria por Laser-Doppler , Microcirculação , Periodontite , Extração Dentária , Cicatrização , Humanos , Cicatrização/fisiologia , Projetos Piloto , Masculino , Feminino , Gengiva/irrigação sanguínea , Pessoa de Meia-Idade , Adulto , Estudos Longitudinais , Fatores de Risco , Saturação de Oxigênio , Fumar , Idoso
8.
FASEB J ; 38(10): e23626, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38739537

RESUMO

Transplantation of adipose-derived stem cells (ASCs) is a promising option in the field of chronic wounds treatment. However, the effectiveness of ASCs therapies has been hampered by highly inflammatory environment in chronic wound areas. These problems could be partially circumvented using efficient approaches that boost the survival and anti-inflammatory capacity of transplanted ASCs. Here, by application of mechanical stretch (MS), we show that ASCs exhibits increased survival and immunoregulatory properties in vitro. MS triggers the secretion of macrophage colony stimulating factor (M-CSF) from ASCs, a chemokine that is linked to anti-inflammatory M2-like macrophages polarization. When the MS-ASCs were transplanted to chronic wounds, the wound area yields significantly faster closure rate and lower inflammatory mediators, largely due to macrophages polarization driven by transplanted MS-ASCs. Thus, our work shows that mechanical stretch can be harnessed to enhance ASCs transplantation efficiency in chronic wounds treatment.


Assuntos
Tecido Adiposo , Macrófagos , Cicatrização , Cicatrização/fisiologia , Macrófagos/metabolismo , Animais , Tecido Adiposo/citologia , Humanos , Camundongos , Estresse Mecânico , Células-Tronco/citologia , Células-Tronco/metabolismo , Células Cultivadas , Masculino , Fator Estimulador de Colônias de Macrófagos/metabolismo , Transplante de Células-Tronco/métodos , Inflamação/terapia , Camundongos Endogâmicos C57BL
9.
Ann Med ; 56(1): 2337871, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38738394

RESUMO

Tendons are fibroblastic structures that link muscle and bone. There are two kinds of tendon injuries, including acute and chronic. Each form of injury or deterioration can result in significant pain and loss of tendon function. The recovery of tendon damage is a complex and time-consuming recovery process. Depending on the anatomical location of the tendon tissue, the clinical outcomes are not the same. The healing of the wound process is divided into three stages that overlap: inflammation, proliferation, and tissue remodeling. Furthermore, the curing tendon has a high re-tear rate. Faced with the challenges, tendon injury management is still a clinical issue that must be resolved as soon as possible. Several newer directions and breakthroughs in tendon recovery have emerged in recent years. This article describes tendon injury and summarizes recent advances in tendon recovery, along with stem cell therapy, gene therapy, Platelet-rich plasma remedy, growth factors, drug treatment, and tissue engineering. Despite the recent fast-growing research in tendon recovery treatment, still, none of them translated to the clinical setting. This review provides a detailed overview of tendon injuries and potential preclinical approaches for treating tendon injuries.


Assuntos
Terapia Genética , Traumatismos dos Tendões , Engenharia Tecidual , Cicatrização , Traumatismos dos Tendões/terapia , Traumatismos dos Tendões/fisiopatologia , Humanos , Cicatrização/fisiologia , Animais , Engenharia Tecidual/métodos , Terapia Genética/métodos , Plasma Rico em Plaquetas , Tendões , Transplante de Células-Tronco/métodos , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo
10.
Swiss Dent J ; 134(1): 105-122, 2024 Feb 19.
Artigo em Alemão | MEDLINE | ID: mdl-38739046

RESUMO

A papilloma is a benign tumor arising from an epithelial surface. Mostly a papilloma appears as an asymptomatic intraoral lesion and is often associated with the human papilloma virus (HPV). In this case report two similar, verrucous papules, sessile bilateral on the back of the tongue, were surgically removed in a 65-year-old male patient. Thereby two different methods of treatment were compared. On the right side of the back of the tongue, excision by scalpel, as the gold standard treatment modality, was performed. On the left side a surgical removal by a CO2 laser was performed. In a photothermal procedure, without direct contact to the tissue, the laser beam is cutting through the mucosa. Secondary wound healing can take place. Both methods were compared in relation to their application, wound healing, quality of the biopsy and morbidity. Postoperative less discomfort and a slightly faster wound healing could be seen after scalpel removal. The histopathological examination was comparable for both methods.


Assuntos
Lasers de Gás , Papiloma , Neoplasias da Língua , Humanos , Masculino , Idoso , Lasers de Gás/uso terapêutico , Neoplasias da Língua/cirurgia , Neoplasias da Língua/patologia , Papiloma/cirurgia , Papiloma/patologia , Terapia a Laser/métodos , Terapia a Laser/instrumentação , Cicatrização/fisiologia
11.
Invest Ophthalmol Vis Sci ; 65(5): 21, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38739085

RESUMO

Purpose: Aging is a risk factor for dry eye. We sought to identify changes in the aged mouse corneal epithelial transcriptome and determine how age affects corneal sensitivity, re-epithelialization, and barrier reformation after corneal debridement. Methods: Corneal epithelium of female C57BL/6J (B6) mice of different ages (2, 12, 18, and 24 months) was collected, RNA extracted, and bulk RNA sequencing performed. Cornea sensitivity was measured with an esthesiometer in 2- to 3-month-old, 12- to 13-month-old, 18- to 19-month-old, and 22- to 25-month-old female and male mice. The 2-month-old and 18-month-old female and male mice underwent unilateral corneal debridement using a blunt blade. Wound size and fluorescein staining were visualized and photographed at different time points, and a re-epithelialization rate curve was calculated. Results: There were 157 differentially expressed genes in aged mice compared with young mice. Several pathways downregulated with age control cell migration, proteoglycan synthesis, and collagen trimerization, assembly, biosynthesis, and degradation. Male mice had decreased corneal sensitivity compared with female mice at 12 and 24 months of age. Aged mice, irrespective of sex, had delayed corneal re-epithelialization in the first 48 hours and worse corneal fluorescein staining intensity at day 14 than young mice. Conclusions: Aged corneal epithelium has an altered transcriptome. Aged mice regardless of sex heal more slowly and displayed more signs of corneal epithelial defects after wounding than young mice. These results indicate that aging significantly alters the corneal epithelium and its ability to coordinate healing.


Assuntos
Envelhecimento , Epitélio Corneano , Camundongos Endogâmicos C57BL , Transcriptoma , Cicatrização , Animais , Epitélio Corneano/metabolismo , Feminino , Camundongos , Cicatrização/genética , Cicatrização/fisiologia , Masculino , Envelhecimento/fisiologia , Reepitelização/fisiologia , Reepitelização/genética , Lesões da Córnea/genética , Lesões da Córnea/metabolismo , Desbridamento , Regulação da Expressão Gênica/fisiologia , Modelos Animais de Doenças
12.
Swiss Dent J ; 134(1): 144-157, 2024 Apr 05.
Artigo em Alemão | MEDLINE | ID: mdl-38741457

RESUMO

The clinical impact of platelet-rich fibrin (PRF) and plasma rich in growth factors (PRGF®) respectively has been studied extensively in the field of regenerative dentistry during the last two decades. Literature supports evidence for additional benefits in regenerative periodontal therapy, alveolar ridge preservation, management of extraction sockets, implantology including guided bone regeneration as well as defect management in oral surgery. Regarding gingival wound healing and soft tissue regeneration, there is sufficient evidence for their positive effects which have been confirmed in several systematic reviews. The effects seem less clear in conjunction with osseous regenerative treatments, where the inter-study heterogenity in terms of different PRF-protocols, indications and application forms might hinder a systematic comparison. Nevertheless there is evidence that PRF might have beneficial effects on hard-tissue or its regeneration respectively.For being able to facilitate conclusions in systematic reviews, precise reporting of the used PRF-protocols is mandatory for future (clinical) research in the field of autologous platelet concentrates.


Assuntos
Fibrina Rica em Plaquetas , Plasma Rico em Plaquetas , Humanos , Regeneração Tecidual Guiada Periodontal/métodos , Plaquetas/fisiologia , Regeneração Óssea/fisiologia , Regeneração Óssea/efeitos dos fármacos , Cicatrização/fisiologia , Cicatrização/efeitos dos fármacos , Medicina Regenerativa/métodos
13.
Swiss Dent J ; 134(1): 130-143, 2024 Apr 05.
Artigo em Alemão | MEDLINE | ID: mdl-38741455

RESUMO

The use of autologous platelet concentrates (APC) such as platelet-rich fibrin (PRF) and/or plasma rich in growth factors (PRGF®) is considered an established treatment modality in re-generative dentistry. The possibility of delivering growth factors over aclinically relevant time of several days seems particularly interesting in the context of wound healing.The growing body of evidence in the field of APC requires a continuous and actual knowledge of the literature for being able to make evidence-based treatment recommendations with a realistic assessment of possible advantages of this technology.PR(G)F can be applied in solid or liquid form, pure or in combination with other biomaterials. Both appear to be reasonable, depending on the clinical indication and/or desired treatment outcomes. Because of the many different factors that can affect the PR(G)F products final characteristics, a basic understanding of these parameters is desirable for choosing the most suitable product and/or optimizing its clinical application. This review aims to provide an over-view of relevant theoretical, practical, legal and biologic aspects of APCs.


Assuntos
Fibrina Rica em Plaquetas , Humanos , Plasma Rico em Plaquetas , Plaquetas/fisiologia , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Cicatrização/fisiologia
14.
JCI Insight ; 9(9)2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38564292

RESUMO

Central for wound healing is the formation of granulation tissue, which largely consists of collagen and whose importance stretches past wound healing, including being implicated in both fibrosis and skin aging. Cyclophilin D (CyD) is a mitochondrial protein that regulates the permeability transition pore, known for its role in apoptosis and ischemia-reperfusion. To date, the role of CyD in human wound healing and collagen generation has been largely unexplored. Here, we show that CyD was upregulated in normal wounds and venous ulcers, likely adaptive as CyD inhibition impaired reepithelialization, granulation tissue formation, and wound closure in both human and pig models. Overexpression of CyD increased keratinocyte migration and fibroblast proliferation, while its inhibition reduced migration. Independent of wound healing, CyD inhibition in fibroblasts reduced collagen secretion and caused endoplasmic reticulum collagen accumulation, while its overexpression increased collagen secretion. This was confirmed in a Ppif-KO mouse model, which showed a reduction in skin collagen. Overall, this study revealed previously unreported roles of CyD in skin, with implications for wound healing and beyond.


Assuntos
Colágeno , Fibroblastos , Camundongos Knockout , Peptidil-Prolil Isomerase F , Pele , Cicatrização , Animais , Feminino , Humanos , Masculino , Camundongos , Movimento Celular , Proliferação de Células , Colágeno/metabolismo , Ciclofilinas/metabolismo , Ciclofilinas/genética , Modelos Animais de Doenças , Fibroblastos/metabolismo , Tecido de Granulação/metabolismo , Tecido de Granulação/patologia , Queratinócitos/metabolismo , Peptidil-Prolil Isomerase F/metabolismo , Peptidil-Prolil Isomerase F/genética , Pele/metabolismo , Pele/patologia , Suínos , Cicatrização/fisiologia
15.
Sensors (Basel) ; 24(8)2024 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-38676030

RESUMO

Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.


Assuntos
Pé Diabético , Estresse Mecânico , Humanos , Pé Diabético/fisiopatologia , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Prospectivos , Fenômenos Biomecânicos , Idoso , Estudos de Viabilidade , Pé/fisiopatologia , Cicatrização/fisiologia , Pressão
16.
World J Surg ; 48(1): 186-192, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38686792

RESUMO

BACKGROUND: There are few studies that examined the relationship between preoperative zinc (Zn) concentrations and postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). METHODS: Data from 98 patients who underwent DP between January 2016 and April 2022 were retrospectively reviewed. Patients' clinicopathological and surgical outcomes were analyzed, and we examined the relationship between Zn and clinically relevant POPF (CR-POPF) after DP. RESULTS: In this series, 41 (41.8%) patients had POPF and 31 (31.8%) patients had CR-POPF. The cut-off value for the preoperative Zn concentration was 74 µg/dL for POPF and CR-POPF. Patients with low Zn concentrations were significantly related with high age, low albumin concentrations, higher CRP concentrations, higher NLR, lower PNI, higher rates of POPF and CR-POPF, longer POPF healing time, longer hospital stay, and postoperative complications than patients with high Zn concentrations. The healing time of POPF after DP was significantly negatively correlated with serum Zn concentrations. A multivariate logistic regression analysis showed that preoperative lower Zn concentrations and a prolonged operation time were independent predictors of CR-POPF and the healing time of POPF after DP. The POPF healing time in patients with high Zn was significantly shorter than that in patients with low Zn concentrations. CONCLUSIONS: This retrospective study showed the association between the preoperative Zn concentrations and the occurrence of POPF and the healing time after DP. Zn is a simple biomarker for malnutrition, which may lead to POPF after DP.


Assuntos
Pancreatectomia , Fístula Pancreática , Complicações Pós-Operatórias , Zinco , Humanos , Feminino , Masculino , Fístula Pancreática/sangue , Fístula Pancreática/etiologia , Fístula Pancreática/epidemiologia , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Zinco/sangue , Pessoa de Meia-Idade , Estudos Retrospectivos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Idoso , Período Pré-Operatório , Adulto , Cicatrização/fisiologia , Fatores de Tempo , Biomarcadores/sangue
17.
Wounds ; 36(3): 67-72, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38684120

RESUMO

BACKGROUND: NPWTi-d of a topical wound solution has been shown to benefit healing in a variety of wound types. This therapy has traditionally been applied via a standard ROCF-V. In 2017, a new ROCF-CC was introduced at the practice of the authors of the current manuscript for adjunctive management of patients with wounds with thick exudate and/or nonviable tissue and in cases in which surgical debridement is not available or not appropriate. OBJECTIVE: To compare the efficacy of NPWTi-d with ROCF-CC dressing (treatment) vs NPWTi-d with ROCF-V dressing (control). MATERIALS AND METHODS: An observational retrospective cohort study of hospital records of patients with VLUs treated with NPWTi-d who received ROCF-CC dressings (n = 11) vs standard ROCF-V dressings (n = 11) was conducted. NPWTi-d was chosen to promote wound healing in VLUs that were not fully responsive to advanced dressings and/or compression bandage. Solution dwell time was 10 minutes, followed by 2.5-hour NPWT cycles at -125 mm Hg. Dressings were changed every 72 hours. RESULTS: Overall, mean ± SD duration of therapy and hospital length of stay were shorter in the treatment group vs the control group (duration of therapy, 8.63 days ± 7.05 vs 11.72 days ± 17.41, respectively; P = .05, and length of stay, 9.9 days ± 2.98 vs 12.81 days ± 4.26, respectively; P = .08), but these differences were not statistically significant. Mean wound area reduction was greater in the treatment group than in the control group (14.63 cm2 ± 13.24 and 10.72 cm2 ± 14.06, respectively; P = .51), but this was not significant. CONCLUSION: ROCF-CC dressings were a useful tool in assisting wound bed preparation and reducing time to skin graft closure in this series of complex VLUs.


Assuntos
Bandagens , Tratamento de Ferimentos com Pressão Negativa , Cicatrização , Humanos , Tratamento de Ferimentos com Pressão Negativa/métodos , Estudos Retrospectivos , Cicatrização/fisiologia , Masculino , Feminino , Resultado do Tratamento , Pessoa de Meia-Idade , Idoso , Úlcera Varicosa/terapia
18.
Wounds ; 36(3): 95-107, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38684125

RESUMO

BACKGROUND: Wounds that become complex and hard-to-heal are a challenge for all health care systems. Identifying and understanding the nature of these wounds is necessary to allow appropriate intervention. OBJECTIVE: To present the epidemiological outcomes of the VIPES study. MATERIALS AND METHODS: The prospective, observational VIPES study aimed to describe the use and investigate the performance of 2 wound dressings-a silicone foam and a gelling fiber-in the management of chronic and acute wounds in a community setting in France. RESULTS: Of 407 patients recorded, 285 were included in the analysis. The 184 chronic wounds included ulcers (venous/arterial/mixed, diabetic foot, and pressure) and malignant wounds. The 101 acute wounds included surgical and traumatic wounds. Of all wounds, 98.2% were exuding and 77.9% showed exudate pooling. Unhealthy wound edges and periwound skin were reported in 57.2% and 35.4% of wounds, respectively. Of all wounds, 78.6% were in treatment failure (poor exudate management or stagnant wound). The silicone foam dressing (n = 86) and the gelling fiber (n = 199) were generally used in wounds with low or moderate exudation, or moderate or high exudation, respectively. CONCLUSIONS: The VIPES study highlights that wounds can be complex and that community care practices in France warrant improvement. Practical and up-to-date wound management recommendations are needed.


Assuntos
Bandagens , Cicatrização , Ferimentos e Lesões , Humanos , França/epidemiologia , Feminino , Estudos Prospectivos , Masculino , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Pessoa de Meia-Idade , Idoso , Adulto , Idoso de 80 Anos ou mais
19.
Adv Skin Wound Care ; 37(5): 1-9, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38648247

RESUMO

OBJECTIVE: To synthesize the effects of oxygen-based therapy on patients with a chronic wound. DATA SOURCES: The authors searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials from database inception. Investigators measured risk of bias using the Cochrane Collaboration's Risk of Bias tool. STUDY SELECTION: The included randomized controlled trials focused on the effects (short- or long-term wound healing, amputation rate, percentage of reduction in ulcer size, and poststudy transcutaneous oxygen measurement [TcPO2]) of oxygen-based therapy (including hyperbaric oxygen therapy, topical oxygen therapy, and continuous diffusion of oxygen) on patients with a chronic wound. DATA EXTRACTION: Researchers extracted information regarding participant characteristics and primary and secondary outcomes from the included studies. DATA SYNTHESIS: Pooled effects of 31 included studies showed that patients treated with oxygen had better short-term wound healing (risk ratio [RR], 1.544; 95% CI, 1.199 to 1.987), a higher percentage reduction in the ulcer area (standardized mean difference [SMD], 0.999; 95% CI, 0.439 to 1. 599), lower amputation rates (RR, 0.529; 95% CI, 0.325 to 0.862), shorter wound healing time (SMD, -0.705; 95% CI, -0.908 to -0.501), and higher poststudy TcPO2 (SMD, 2.128; 95% CI, 0.978 to 3.278) than those in the control group. For long-term wound healing, there was no statistically significant difference (RR, 1.227; 95% CI, 0.976 to 1.542). CONCLUSIONS: Oxygen-based therapy improves short-term parameters of wound healing in patients with chronic wounds.


Assuntos
Oxigenoterapia Hiperbárica , Cicatrização , Humanos , Doença Crônica , Oxigenoterapia Hiperbárica/métodos , Oxigenoterapia Hiperbárica/estatística & dados numéricos , Oxigênio/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Cicatrização/fisiologia
20.
Cutis ; 113(3): 125-131, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38648584

RESUMO

Wound healing is crucial for survival, prevention of infection, and restoration of tissue function. The immune system drives this process with 3 main phases: inflammation, proliferation, and remodeling. Keloids and hypertrophic scars reveal disruptions in these phases, underscoring the balance needed for healing. Limb amputation, a life-changing event, demands careful consideration for healing and function. Factors such as amputation level, surgical technique, and prosthetic fitting shape outcomes, while complications such as heterotopic ossification challenge recovery. Treatment advances including statins and stem cell therapy hold promise, with dermatologists poised to contribute substantially to postamputation care.


Assuntos
Amputação Cirúrgica , Cicatrização , Humanos , Cicatrização/fisiologia , Queloide/terapia , Queloide/etiologia
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