Editor-in-Chief: Richard "Sal" Salcido, MD
ISSN: 1527-7941
Online ISSN: 1538-8654
Frequency: 12 issues per year
Impact Factor: 1.337

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.  The patient is a 61-year old woman with a history of advanced multiple sclerosis and a recent episode of pneumonia that was treated with appropriate antibiotics.  She presented to the wound clinic with skin lesions in the perianal area.  The lesions looked like fluid-filled blisters and they were described as Stage 2 pressure injuries.  The patient was immobile, incontinent of urine and stool, and slightly malnourished as evidenced by recent weight loss. The unusual aspect of these lesions was the excruciating pain the patient experienced even when the area was not manipulated or touched.   Although the patient may be at risk for pressure injury, she was turned on regular basis and the skin was cleaned meticulously. 

The location of the skin lesions were not really prone to pressure and shear problem, what is the correct diagnosis?


A. On examination, there were clusters of small, tense vesicles appearing on an erythematous base.  A viral culture fluid from the blister was taken and material was obtained from the base of a vesicle for viral culture.  The diagnosis was herpes simplex virus

Herpes simplex virus (HSV), HSV-1 and HSV-2, can cause recurrent infection affecting the skin, mouth, lips, eyes, and genitals. Genital and perianal lesions of herpes are usually caused by herpes simplex type II.    After the initial infection, HSV infects the skin and remains dormant in nerve ganglia.  It can periodically emerge, causing lifelong latent infection or eruptions precipitated by physical or emotional stress, immunosuppression, and other unknown stimuli.

An HSV infection may be accompanied by prodromal period (typically < 6 h) of tingling discomfort or itching. The skin lesions often appear in clusters varying in size from 0.5 to 1.5 cm, but may coalesce.  Lesions usually heal completely within 5 to 10 days, however; recurrent lesions at the same site may cause scarring and secondary bacterial infection.   Herpes simplex virus should be distinguished from herpes zoster, which rarely recurs and usually causes more severe pain and larger groups of lesions that are distributed along a dermatome. There is little evidence indicating benefit from treatment of recurrent orolabial herpes, which tends to be mild and infrequent.







In the News

Early versus Delayed Dressing Removal for People with Surgical Wounds

A recent Cochrane review examined trials on clinical outcomes associated with early versus delayed dressing removal for patients with surgical wounds. The authors reviewed the medical literature up to July 2013 and included 4 randomized controlled trials that compared early (permanent removal of dressings within 48 hours of surgery) versus delayed removal of surgical dressings (permanent removal of dressings after 48 hours of surgery with interim changes of dressing allowed). The early removal of dressings from clean or clean contaminated surgical wounds seems to have no detrimental effect on outcomes. Early removal of dressings may lead to shorter hospital stays and lower treatment costs than delayed removal of dressings.  Leaving a wound exposed without a dressing, however, may aid prompt assessment of an impending problem and allay fears of what might be underneath the dressing. Nonetheless, current decision making about dressings may need to be led by practical issues, such as wound symptom management and costs.

Topical Skin Creams for Low-risk Superficial BCC

Basal cell carcinoma (BCC) is one of the most common skin cancers, accounting for more than 80% of all cases. More than 2 million cases a year are diagnosed in the United States, and the lifetime risk of developing a BCC before the age of 85 years is 1 in 5 people.

Although most types of BCC require surgery, superficial BCC can be treated topically with noninvasive treatments such as photodynamic therapy (PDT), imiquimod cream, fluorouracil cream, cryosurgery, or electrodessication and curettage. Noninvasive treatments are preferred in light of good cosmetic outcome, preservation of surrounding tissue, and potential for home applications.

Investigators in the Netherlands reported the results of a 3-year follow-up of a randomized controlled trial that compared 3 noninvasive treatments, including PDT, topical imiquimod cream, and topical fluorouracil cream.  After 3 years, the clearance rate was around 80% for patients after imiquimod treatment, 68% for patients treated with fluorouracil, and 58% for individuals receiving PDT.  Fluorouracil has the advantage of being less expensive than imiquimod, and PDT is the preferred treatment for an individual patient with a superficial BCC on the lower extremities in older patients, according to the study.

Vegetable-based Polyphenol Enhances Wound Healing

Researchers from Osaka University had identified cinnamtannin B-1, or vegetable-based polyphenol that promotes the migration of mesenchymal stem cells (MSCs) in circulation to improve wound healing. The plant polyphenol is able to increase mobilization through the activation of enzymes surrounding MSC membranes.  It is anticipated that these results will be used for stem cell treatments for cutaneous disorders associated with various damage and lesions.

Sealant System Approved to Help Prevent Pneumothorax

Lung biopsies are a critical diagnostic step for clinicians to determine specific treatments for patients, and with more tumor-specific therapies available, there is a growing desire for larger tissue samples.  However, clinicians are concerned that large needles may increase the incidence of pneumothorax, occurring in 15% to 42% of patients with CT-guided percutaneous lung biopsy. Pneumothorax can require additional treatment costs and interventions, including chest tube placements, additional radiographs, inpatient admission or emergency department visits, delayed time to ambulation, and hospital discharge. To help reduce this risk, the recently approved BioSentry Tract Sealant System delivers a hydrogel plug placed into the lung along the biopsy needle tract.  The gel plug expands to prevent air from leaking out and creating a pneumothorax. In a prospective, randomized, multicenter clinical trial of 339 patients, the system was found to significantly reduce the risk of pneumothorax by a relative risk reduction of greater than 50%

Tissue-integrating Biosensors Provide Health Monitoring

Profusa Inc has unveiled the first biointegrated sensors for long-term continuous monitoring of body chemistry, according to the company, making health and disease monitoring as easy as turning on one's smart phone. Each biosensor is a flexible fiber that is 3- to 5-mm long and approximately 500 microns in diameter, comprised of a bioengineered "smart hydrogel" forming a porous, tissue-integrating scaffold that induces capillary and cellular in-growth from surrounding tissue. The smart gel is linked to a light-emitting molecule that continuously signals the presence of a body chemical, such as oxygen, glucose, or other biomarker.  Rather than being isolated from the body, the biosensors work fully integrated within the body's tissue—without any metal device or electronics—overcoming the effects of the foreign body response for more than 1 year.


















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From the Lippincott Library ... The Diversity Issue

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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: 2/9/2016 What Are Wound Care Specialists?

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

Latest Entry: 1/15/2016 HBO Nugget 16

Quick Poll
Should wound tunnels be irrigated?
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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!