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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 12/95
Impact Factor: 1.438

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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. A patient with diabetes presents to the clinic with maceration between his toes. He does not know what caused the maceration.

What is your diagnosis?

 

 

A. One of the common causes of interdigital maceration is tinea pedis or fungal infection of the feet. Other clinical presentations may include scaling and fissuring of the skin, local redness, itch, and odor. Tinea pedis is common in the 4th and 5th web spaces where moisture and heat tend to accumulate due to occlusion.

Fungi or dermatophytes feed on the keratin on the surface of the skin; the result is skin breakdown creating a portal for bacteria to enter into the deeper structure of the skin. It is important to be vigilant of secondary bacterial infection especially for people with diabetes. Remember that a number of conditions can also produce white maceration and skin erosion in the interdigital areas, including (1) dermatophytosis, (2) candidiasis (yeast infection), (3) erythrasma (bacterial infection), and (4) psoriasis. Check the rest of the feet and nails to see if there are other clinical signs consistent with tinea.

Dermatophyte infections can also be diagnosed based on potassium hydroxide microscopy, Wood's lamp examination, and fungal culture or histologic examination. To avoid tinea pedis, patients should be informed to wash their feet daily, dry areas between the toes thoroughly, wear socks that are made of breathable material, and avoid walking barefoot.

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Save the Date!

Mark your calendars now for the Clinical Symposium on Advances in Skin & Wound Care, October 24-27, 2013, at Disney's Contemporary Resort in Orlando, Florida. Visit www.symposiumonwoundcare.com for more details. See you in Orlando!

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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: 6/19/2013 Wound Cleansing and Reader Results

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

Latest Entry: 6/11/2013 HBO Nugget 6

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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 Awarded Impact Factor
Advances in Skin and Wound Care has made its debut in the current Journal Citation Report with an Impact Factor ranking of 1.438. With this first impact factor, the journal also was ranked 13th out of 97 journals in the report’s “Science” category. 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

 

Clay Used as an Effective Antimicrobial Agent

Researchers at Arizona State University's Biodesign Institute have discovered that certain types of clay have effective, topical antibacterial properties against a range of pathogens, including Escherichia coli and methicillin-resistant Staphylococcus aureus. Clays have been used for centuries as topical treatments for surgical wounds, demonstrating their beneficial effects for pain management, inflammation, putrefaction, and healing processes.  The antimicrobial effect of the clays is partly due to low pH and particular metal ions. The study identified that metal ions, including iron, copper, cobalt, nickel, and zinc, in the clay are likely responsible for its potent antibacterial properties.  Kaolinite, talc, and smectite clay minerals are highly absorptive. Upon application to skin and wounds, clays offer mechanical protection similar to a bandage, sealing out external physical or chemical agents, as well as absorptive properties that assist in removing devitalized tissue and excessive exudate from a wound.

Calcium Helps Trigger Wound Healing

Researchers from the University of Bristol's Schools of Biochemistry and Physiology and Pharmacology in collaboration with a team from the University of Bath in the United Kingdom identified the influx of calcium as an early trigger of the inflammatory process in wounds. Calcium activates an enzyme known as DUOX that synthesizes hydrogen peroxide, providing signals to recruit white blood cells to the wound following tissue damage.

Skin Deep: Fruit Flies Reveal Clues to Wound Healing in Humans

Like human skin, the fruit fly has exoskeleton to protect the underlying tissue against injury, infection, and dehydration. The mesh-works of macromolecules and proteins in the exoskeleton also respond to some of the same signals involved in mammalian wound healing. The similarities render the fruit fly an excellent model to dissect skin repair at a cell and molecular level. The researchers discover that an immune response begins as soon as the cuticle has been breached allowing the injured area to defend itself against bacteria or fungi invasion. The researchers surveyed 84 genes that are turned on and 78 genes that are turned off as the fly embryo responds to wounding.

Implantable and Bioresorbable Electronic Device to Promote Wound Healing

Researchers have developed bioresorbable electronic devices that could be implanted into the body to reduce pain by stimulating certain nerves, prevent bacterial growth, and stimulate bone growth or wound healing. The electronics are enclosed in material that dissolves completely after a certain period of time when exposed to water or body fluids. The number of layers and the time it takes for the encapsulation of the device to dissolve in the body will determine the lifetime of the device. The latest transient electronic devices incorporate zinc oxide that could produce electricity when bent or twisted during movement of muscles in the body, pulsation of blood vessels, or beating of the heart.

New Features Added to Fecal Management System

Fecal incontinence is a common condition that affects a number of patients in intensive care. Recurring and frequent diarrhea increases the risk of skin breakdown and spread of pathogens in fecal material. ConvaTec has launched the new Flexi-Seal Control FMS, a fecal containment system, which incorporates a control valve to avoid overinflation of the device’s retention balloon. The system also introduces an odor barrier and a privacy bag; it is indicated for patients with little to no bowel control and can be used for up to 29 consecutive days.