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

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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. The patient is an 83-year-old woman with a history of breast cancer 25 years ago.  She is worried because a protuberant growth is found on her right lower cheek.  She stated that the growth has been there for several months and it has been growing very slowly.  The patient did not complain about bleeding or pain. She described it as a nuisance that hurts a little when it gets caught in her pullover sweater when getting dressed. She is anxious to know if this is some kind of cancer.

 What is your diagnosis? 

  

A. This is something called cutaneous horn referring to a conical projection that is primarily composed of compacted keratin, the same material found in fingernails, giving its rigid structure. The cornified skin growth projects above the surface of the skin as the keratin builds up over time. They are yellow/brown in color and the size and shape of the growth can vary considerably. Cutaneous horns are often found on areas such as the face, nose, ears, forearms, and the back of hand in fair-skinned older adults with a history of significant sun exposure. There are a number of possible pathological entities that can be present at the base of a cutaneous horn. Seborrheic keratosis or warty materials are found burrowed under the cutaneous horns at the base in approximately 60% of the cases. They are totally benign. However, squamous cell carcinoma, such as Bowen’s disease, could be discovered in as many as 20% of the cases. The remaining 20% have bases that are related to precancerous changes such as actinic keratosis. Large cutaneous horns with an inflamed and tender base should raise the index of suspicion of malignancy.  In light of the risk of malignancy, cutaneous horn, along with the surrounding tissue at the base, is usually excised and removed. The tissue is sent to pathology for examination. In most cases, further treatment is not required.  Surgery, radiation therapy, or chemotherapy may be necessary for skin cancers.

 

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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.

 

Symposium Travels to New Orleans

Register now for the 30th annual Clinical Symposium on Advances in Skin & Wound Care! This year's conference will be held September 18-21, 2015, at the Hyatt Regency in New Orleans, Louisiana. Visit 1IsmAsW for complete registration and attendee information.

We'll see you in New Orleans! 

 

 

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: 3/19/2015 Wound Packing Poll Results

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

Should wound fluid be evaluated for inflammatory markers (eg, MMPs) on a regular basis?
Should wound fluid be evaluated for inflammatory markers (eg, MMPs) on a regular basis?
Should wound fluid be evaluated for inflammatory markers (eg, MMPs) on a regular basis?
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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

Ionic Fluid to Fight Biofilm

Biofilm-forming bacteria account for approximately 80% of total bacterial infections and the unique structure render bacteria inside biofilm resistant to antibiotics.  A research team from Los Alamos National Laboratory has identified a unique class of materials, known as ionic liquids (eg, choline-geranate) that are more effective than bleach in neutralizing biofilm-forming pathogens with minimal cytotoxicity effects on human cell.  The ionic liquids are able to penetrate through the skin and may also help the transdermal delivery of drugs.

 

Wound Healing Delayed by Neutrophil Extracellular Traps

Delayed wound healing is a common complication of people with diabetes.  According to scientists from the Boston Children’s Hospital’s Program in Cellular and Molecular Medicine, wound healing is impeded by excessive release of neutrophil extracellular traps (NETs) in diabetic mice.  Although NETs are produced by neutrophils as part of an inflammatory response during the healing process, the NETs form a dense, toxic mesh that could interfere with the migration of new skin cells to the wound base.  Mice treated with DNase 1 (an enzyme that breaks up DNA and disables NETs) displayed better healing by 20% compared with untreated animals.

 

Innovative Nitric Oxide Generating Wound Dressing for Diabetic Foot Ulcers

Diabetic foot ulcers are the leading cause of nontraumatic-related amputation and severe disability. EdixoMed Limited (Manchester, United Kingdom) had developed and launched an innovative nitric oxide-generating wound dressing (NOx).  Nitric oxide is a potent vasodilator and broad-spectrum antimicrobial agent and is released by the dressing in a controlled and sustained fashion that mimics the natural physiological production in normal skin. Nitric oxide may correct ischemia and infection.   A randomized controlled clinical study that involved 120 patients with chronic diabetic foot ulcers in the United Kingdom demonstrated promising clinical outcomes. Two-thirds of the patients treated with nitric oxide generating dressing (NOx) achieved wound area reduction by more than 90% compared with one-third of the patients who received standard care.

 

New Products with Dialkylcarbamoylchloride (DACC) Technology

BSN Medical (Hamburg, Germany) has introduced 3 new wound care products that incorporate products dialkylcarbamoylchloride (DACC) technology. DACC Technology attracts bacteria into the dressing material and inactivates them. These products include Cutimed sorbact hydroactive B dressing for wounds with low to moderate exudate levels, Cutimed siltec sorbact foam dressing with siltec foam structure for heavy exudative wounds, and Leukomed sorbact for surgical sites.

 

New Collagen Wound Dressings for Oral Wounds

NovaBone (Jacksonville, Florida) has received approval from the FDA to launch 2 new collagen wound dressings. NovaTape and NovaPlug are designed to manage oral wounds and sores, including dental sores, oral ulcers, periodontal surgical wounds, suture sites, burns, extraction sites, and surgical/traumatic wounds.