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Editor-in-Chief: Richard "Sal" Salcido, MD
ISSN: 1527-7941
Online ISSN: 1538-8654
Frequency: 12 issues per year
Ranking: Nursing 17/103
Impact Factor: 1.5

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Wound CSI: Can You Solve the Case?

Welcome to Wound Clinical Solutions Investigation (CSI). See if you can make the diagnosis.

Q. Nail problems are common across patients of all ages. A 45-year-old patient presents with discoloration of the nail as shown in the picture. What is the most likely diagnosis?

What is your diagnosis? 

  

A.   Although there are a number of possible differential diagnoses, the most likely scenario is fungal infection of the nail. This is often referred to as distal and lateral subungual onychomycosis because of the area of the nail that exhibits discoloration and infection. The infection is predominantly caused by Trichophyton rubrum. Infection usually starts in the large toenail and gradually spreads to other toenails and, less commonly, to the fingernails. As the infection spreads to other parts of the foot, most patients have maceration of the 4th and 5th toe web spaces. The skin on the sole may appear dry and assume a powdery white appearance. The superficial white markings found on toenails are most likely due to Trichophyton mentagrophytes. Colonies of fungus, yeast, or mold sit on the surface, producing chalky white patches and a crumbly surface, without invading the deeper nail plate. If in doubt, nails can be clipped to obtain a sample for culture to help identify the causative organisms. Oral antifungal agents may be required to eradicate onychomycosis, especially in people with diabetes due to a compromised immune system. Fungal infection damages the skin structure and creates an entry point for bacteria to invade into the deeper compartment of the skin.

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New Supplement Available

A supplement to the March 2014 issue, titled "Wound Bed Preparation Meets Dressing Form and Function: The Role of Hydrofera Blue and Endoform," is now available free of change. Read the full supplement articles.

 

Call for Founder's Award Nominees!

The 29th annual Clinical Symposium on Advances in Skin & Wound Care will be held September 28-October 1, 2014, at the Mirage in Las Vegas, Nevada. Preconference workshops will be held September 27 & 28, 2014. An annual event at the symposium is the presentation of the prestigious Sharon Baranoski Founder’s Award. This award recognizes the overall pursuit of excellence in the field of wound management by an individual or group who has enhanced the care of patients with wounds.  

Candidates for the award should be nominated in writing, with supporting data to affirm his/her excellence in innovative educational approaches, cost-benefit approaches to practice, unique treatments that significantly impact patient care, or leadership that has fostered the profession of wound care. The deadline for nominations is July 15, 2014.

Written nominations are now being accepted and should include a letter explaining how the candidate met the award criteria, and any pertinent data, tools, teaching displays, pictures, or other material to support the nomination letter. Letters and supporting materials should be emailed to karyn.cousart@wolterskluwer.com or mailed to Wolters Kluwer Health, Conference Dept, Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103.

The award will be presented in a ceremony at the symposium on September 29, 2014, just before the opening session at The Mirage in Las Vegas, Nevada. The winner will receive a $2,000 grant, 1 complimentary conference registration, 3 nights’ hotel accommodations, and 1 roundtrip airfare to the meeting.

Words on Wounds
Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA
A forum to discuss the latest news and ideas in skin and wound care.

Latest Entry: 4/21/2014 Managing Wound Infection

HBO Nuggets of the Week
Frank L. Ross, MD, FACS
A forum to discuss interesting aspects of hyperbaric medicine.

Latest Entry: 4/16/2014 HBO Nugget 12

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WANTED: Online Exclusive Content!

Advances in Skin & Wound Care is going to offer authors the opportunity to have their article posted online only with free access to all readers. We are seeking a specific scope of article for this special section. Under the heading of “Wound Care around the World,” we’d like to invite articles that detail innovative and resourceful ways that clinicians are helping to heal patients’ wounds in all corners of the globe. Articles should have a “this is how we do it” approach, not present a research study. For example, an article might illustrate how clinicians fashion wound dressings in a remote region where current products and technology may be sparse or unavailable. Send your manuscript ideas to Kathleen Greaves, Senior Managing Editor, at Kathleen.Greaves@wolterskluwer.com. Articles invited for submission will go through the standard peer review and acceptance process. We hope to hear from you!

 

 

ASWC Impact Factor
Advances in Skin & Wound Care has received an Impact Factor Ranking of 1.5 in the current Journal Citation Report.  We extend our thanks to all the authors, editorial board members, and peer reviewers who contribute to the success of the journal.
In the News

Systemic Medication for the Treatment of Diabetic Foot Ulcers

Foot ulcers are a common complication from diabetes than can lead to hospitalization and lower limb amputation. In the prospective randomized, double-blinded, placebo-controlled clinical trial, 216 participants with diabetic foot ulcers free of visible infection were assigned to receive either the tissue repair drug polydeoxyribonucleotide (PDRN) or a placebo. After 2 months, 37% of the patients who were treated with PDRN had their ulcers completely closed, compared with nearly 19% of the patients who received the placebo.

Engineered Skin Grafts Contain Blood and Lymph Vessels

Researchers at the University of Zurich, Switzerland, have successfully engineered a skin graft that is similar to full-thickness skin containing functional blood and lymphatic capillaries. Only a limited area of skin is required to be removed from individual patients to engineer a complex skin graft in the laboratory. There are advantages of a full-thickness graft, including less scarring.  In addition, the lymphatic and blood capillaries will prevent the accumulation of tissue fluid and ensure rapid blood supply to improve the survival of skin graft. This innovation is a major advance in molecular tissue biology and regenerative medicine.

Wound Dressing Incorporate Bioelectriceuticals Technology

Procellera from Vomaris Wound Care is the first wireless microcurrent-generating dressing that produces electrical fields through its matrix of microcell batteries. This dressing and its wireless microcurrents have been found to enhance keratinocyte migration (a critical event in wound re-epithelialization), compared to controls in in-vitro laboratory testing. The substantial potential of this technology has been unveiled through hard core interdisciplinary mechanistic science.  Researchers identified several mechanisms behind potential benefits of bioelectriceuticals in wound care, including hydrogen peroxide production to deter bacteria proliferation; phosphorylation of redox-sensitive IGF1R to facilitate cell migration; and reduction of protein thiols and increase in integrin expression, both of which are known to promote intracellular and extracellular communication. The technology can also increase keratinocyte mitochondrial membrane potential to improve its cell motility capacity.

Health Coaching to Help People with Diabetes

People with diabetes are at a higher risk of suffering oral health problems, such as periodontitis, caries, dry mouth, fungal infections, and wounds. Researchers at the University of Copenhagen Health reported that health coaching have helped people with diabetics to feel empowered, boost their self-efficacy and assume responsibility for their oral health. Motivational health coaching by professionals reaches out to high-risk groups and provides personal guidance on topics like diet, stress management, and dental care. Coaching is superior to patients who simply receive information about dental health from printed brochures. Patients attended coaching achieved a significant decline in blood sugar and periodontitis by as much as 50% over 6 months.

Birch Extract for Wound Healing

Scientists from the Institute of Pharmaceutical Sciences of the University of Freiburg have discovered the molecular mechanism behind the wound-healing effect of an extract from the outer white layer of the tree's bark. The birch bark extract contains betulin, which could enhance the inflammatory response to help remove foreign bacteria and dead tissue in the initial phase of wound healing. During the later phase of wound healing, betulin and lupeol in the birch extract activate proteins that are involved in the restructuring of the actin cytoskeleton, which gives the cell its shape with the help of the structural protein actin. This allows keratinocytes to migrate more quickly into the wound for healing.

Dermagraft Is Sold to Organogenesis

Shire plc announced that it has entered into a definitive agreement pursuant to which it has sold its Dermagraft assets to Organogenesis Inc. Dermagraft is a living skin substitute indicated for use in the treatment of full-thickness diabetic foot ulcers and is approved for use in the United States and Canada.

ConvaTec Launches New Aquacel Ag+ Wound Dressings

A majority of chronic wounds contain biofilm produced by colonies of bacteria to protect themselves.  It is difficult to remove, reforms quickly, and is a key cause of delayed wound healing.  ConvaTec has announced the launch of new Aquacel Ag+ wound dressings in countries in the European Union, Canada, Hong Kong, and Malaysia. The new technology destroys wound biofilm and reduces infection-causing bacteria in an in vitro biofilm model, according to the manufacturer.