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.



New digital edition!

From the Lippincott Library ... The Diversity Issue

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Interview with Dr. Dimitri Beeckman

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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: 10/20/2015 Best Practice Guidelines

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 quality studies be considered for formulating recommendations for best practice guidelines?
Should quality studies be considered for formulating recommendations for best practice guidelines?
Should quality studies be considered for formulating recommendations for best practice guidelines?
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

Low Concentrations of Acetic Acid to Prevent and Treat Biofilms

Burn wounds are susceptible to infection due to loss of a normal skin barrier. Subsequent sepsis is the leading cause of death among patients with burn wounds. Researchers from the University of Birmingham and the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre demonstrated that topical application of acetic acid in low concentrations (0.16%-0.3%) can be used to prevent and treat biofilms in burn wounds. At a low but effective concentration, topical acetic acid is a cheap alternative antimicrobial agent without causing discomfort. Future studies from the research team will test plain dressings soaked with acetic acid against the more commonly used silver-based dressings.


The American Academy of Dermatology Released New Recommendations

The Academy identifies areas with the greatest potential for overuse/misuse and needs for quality improvement. They release the Choosing Wisely® list with the following recommendations:

·   Don’t use systemic (oral or injected) corticosteroids as a long-term treatment for dermatitis.

·   Don’t routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection. Clinical presentations involving swelling and redness of both legs are most likely related to dermatitis, not cellulitis.

·   Don’t routinely prescribe antibiotics for inflamed epidermal cysts. It is important to confirm infection before treating these cysts with antibiotics.

·   Don’t prescribe oral antifungal therapy for suspected nail fungus without confirmation of a fungal infection.

·   Don’t routinely use topical antibiotics on a surgical wound.


Dressing with Nanofibers of Cellulose Acetate to Promote Tissue Repair

A Research Team from Alexandria University Has Developed an Absorbent Wound dressing with nanofibers from cellulose acetate. Cellulose acetate is an inexpensive semisynthetic polymer used in everything from photographic film to coatings for eyeglasses. It is spun into fibers and incorporated silver nanoparticles to address bacterial burden. The scientists demonstrated that the use of this dressing could promote collagen production and help to recreate normal skin strength as the wound heals in diabetes mellitus.


Research Collaboration to Develop New Drug Based on Plasminogen

The biotech company Omnio, based in Swedish Umeå, launched a research collaboration with the Canadian pharmaceutical company ProMetic to develop a new drug for slow-healing chronic wounds. The collaboration includes funding for clinical studies of a drug based on the blood plasma protein plasminogen.


Stop Bleeding with a Nanofiber Hydrogel Infused with Snake Venom

Bleeding can be stopped in as little as 6 seconds by a hydrogel called SB50 that incorporates batroxobin, which is a venom produced by 2 species of pit viper found east of the Andes in South America. Batroxobin, also known as reptilase, has a similar function to thrombin in platelet aggregation and fibrin clot formation. It is a serine protease that acts on fibrinogen, making it an effective topical hemostatic agent. Unlike thrombin, batroxobin is not inhibited by heparin and other specific cofactors. For this reason, it has also been used as a diagnostic tool to determine blood-clotting time for patients who are receiving heparin therapy. Scientists from the Rice University have learned how to produce batroxobin from genetically modified bacteria and then combine it with their synthetic, self-assembling nanofibers that turns into a gel at the site of a wound.


MolecuLight: Diagnostic Medical Imaging Device for Wound Care

MolecuLight i:X is a novel, handheld fluorescence imaging device that provides real-time visualization of bacteria in chronic wounds. This device may allow clinicians to better analyze the bacterial condition of chronic wounds, especially for patients with an immunocompromised condition where the signs and symptoms of high bacterial loads or infection are not present. Their studies have shown the MolecuLight i:X can detect wound subsurface heavy bacterial load as well as subclinical local infection alerting clinicians to initiate targeted and precise treatment.