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: 1.6

Current Issue Highlights

Wound CSI: Can You Solve the Case?

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

Q.  A 71-year-old woman with history of bilateral venous leg ulcers below the medial malleoli for the previous 2 years presented to the wound clinic with a superficial ulcer on the left lateral ankle. The ulcer was closed after 3 months of compression therapy. Now, she notices a white scar-like lesion that is exquisitely painful. The ankle-brachial pressure index is 0.9 on both legs, indicating normal arterial circulation. The duplex scan reveals no signs of peripheral arterial disease.  

What is your diagnosis? 





A. This lesion is known as atrophie blanche (AB). Dilated dermal veins, often present as telangiectasia and reticular veins, around the ankle are usually the first sign of venous stasis disease. Increased venous pressure exacerbates capillary filtration and extravasation of blood particles into the tissues, causing hemosiderin (ferritin and ferric iron from red blood cells) deposits and hyperpigmentation of the skin. Accumulation of “trapped” white blood cells, growth factors, and fibrin deposits triggers an inflammatory response, promotes microthrombus formation, and increases the oxygen diffusion barrier. Clinically, venous microangiopathy changes are also responsible for venous eczema, lipodermatosclerosis (inflammation of the skin and fatty tissue causing woody changes of the skin), edema, and difficult to heal ulcers. Approximately 9% to 38% of venous leg patients develop AB or livedoid vasculopathy. Typically, AB appears as a smooth, pearly white, stellate scar with peripheral telangiectasia. It may be caused by microthrombi occlusion of dermal vessels and related to painful purpuric ulcers with reticular pattern of the lower extremities (remember with mnemonic: PURPLE).

The lesion related to AB eventually develops into a highly exudative ulcer. The ulcer was 8 cm in diameter and the surrounding skin showed prominent AB. The ulcer continues to cause intense burning pain, despite the regular use of acetaminophen.

Treatment involves the use of compression therapy and pentoxifylline—a xanthine derivative and a nonspecific inhibitor of cyclic adenosine monophosphate phosphodiesterase. The compound has been reported to increase flexibility of red blood cells and to decrease blood viscosity.



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CME Connection Now Live
ATTENTION PHYSICIANS: Do you need CME STAT? The Lippincott CME Connection website is now live, offering a variety of educational activities for physicians to receive continuing medical education credit. Articles on a variety of topics that have been published in 2014 are available. Visit http://cme.lww.com for immediate results, other CME activities, and your personalized CME planner tool.
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.


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: 7/9/2015 What is the best way to describe pressure ulcers?

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

Latest Entry: 6/26/2015 HBO Nugget 15

Quick Poll

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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!



In the News

Wireless Sensors Help Detect Surgical Site Infection

Surgical site infections are the most common complication following surgical procedures and account for nearly 20% of all healthcare-associated infections. Complications may include additional surgery, implant removal, delayed wound healing, increased use of antibiotics, and death. Researchers from Rensselaer Polytechnic Institute are investigating an antigen-sensitive hydrogel integrated into a small, simple, inexpensive wireless sensor for the detection of surgical site infections associated with orthopedic implants. Early detection has the potential to guide therapy, improve outcomes, and reduce readmissions, revisions, and costs associated with implant-related infections.

Mesenchymal Stem Cell Exosomes Offer Hope in Healing Chronic Wounds

New research at the University of Miami Miller School of Medicine demonstrates how mesenchymal stem cell exosomes could enhance the growth and migration of normal and chronic wound fibroblasts, and induce the development of new blood vessels in vitro.

Cytokines and Wound Failure

A team from the Uniformed Services University Walter Reed Surgical Critical Care Initiative collected blood, tissue and serum samples from 73 patients who sustained 116 life-threatening combat wounds. They analyzed tissue samples that were taken prior to and during each surgical debridement along with biomarker data and clinical observation. By characterizing patterns of inflammation using computer analytic methods, the team was able to determine the presence of cytokines that predicts the likelihood of wound failure. These predictions could help healthcare providers to stratify risks and make critical, time-sensitive decision as to when to close a wound; both premature and late closing can lead to serious complications for the patient.

Mussel Protein-Based Bioadhesive for Wound Closure

Mechanical fasteners like sutures and staples are used to hold body tissues together, but their use is limited when handling delicate tissues and internal organs. They can cause tissue damage, complicated post-treatment management, and scars. Although tissue adhesives have been made available as an alternative that does not require tissue penetration, most surgical glues do not stick in a wet environment. Korean scientists at Pohang University of Science and Technology have developed a bioadhesive that is inspired by the mechanism that allows mussels to attach to underwater surfaces and insects maintain structural balance and flexibility. The so-called mussel adhesive proteins can be activated by blue light, triggering a photo-oxidation reaction. The tyrosine residues are chemically coupled into dityrosine cross-links, giving rise to a new hydrogel substrate that has structural stability and adhesive properties in wet conditions. The new adhesive hydrogel not only closes an open wound on a bleeding site within less than 60 seconds, but also effectively facilitates the healing process without inflammation or a scar.

Integra LifeSciences Holdings Corporation Acquires TEI Biosciences Inc

Integra LifeSciences Holdings Corporation has completed the acquisition of TEI Biosciences Inc and TEI Medical Inc, a Massachusetts-based, privately held, biomedical company. This new acquisition of TEI complements will allow Integra to expand its reconstructive surgery and regenerative wound care product with the addition of the complementary technology platform SurgiMend and Primatrix, both acellular biologic matrices.

Organogenesis to Introduce New Wound Management Products

Organogenesis recently introduced new PuraPly wound management products, including PuraPly and PuraPly Antimicrobial (PuraPly AM), which are the new additions to the firm's portfolio of advanced wound-care products. PuraPly AM is claimed to be the first FDA-cleared purified collagen matrix with polyhexamethylene biguanide hydrochloride antimicrobial agent. Both FDA 510(k)-cleared Class II medical devices have received approval for acute and chronic wound management across different wound types, such as partial- and full-thickness wounds, pressure ulcers, surgical wounds, trauma wounds, venous and diabetic ulcers. Both products are available in different sizes that will meet the needs of a variety of wound types.