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.  A female patient developed a heel ulcer after hip surgery.  It was covered with eschar tissue and described as an unstageable pressure injury (photo A).  The eschar tissue was removed by sharp debridement.  After a few days, the wound was re-assessed with evidence of some pink and yellow tissues (photo B).  What is the yellow tissue? What treatment should be considered for the management of yellow tissue?

 9-6-16 CSI photos.jpg


A. In general, necrotic tissues have been described in the form of eschar and slough.  Although eschar is often depicted as the dark, desiccated, hard, and leathery tissue, it could also appear wet, soft, and spongy; this depends on the amount of fluid intake and hydration. Slough, on the other hand, tends to be yellow in color and takes on a stringy, mucinous, and slimy consistency.  Slough is a devitalized tissue that may contain proteinaceous tissue, biofilm/bacterial, and fibrin.  During the wound healing process, soluble fibrinogen is converted into strands of fibrin monomers that are organized into insoluble fibrin polymers and a network of fibrin fibers. These scaffolds of fibrin provide stability to the fibrin clot and provide a provisional matrix that allows keratinocytes and other cells to adhere, proliferate, organize, and perform specialized functions required for the inflammatory response and for tissue repair at the site of damage.

The fibrinous matrix of a wound contains other plasma proteins, including fibronectin and vitronectin, which anchor cells to the extracellular matrix components, such as collagen and proteoglycans. Hyaluronic acid is another critical component of the wound extracellular matrix and may have a regulatory role in the control of fibrin degradation and polymerization, thus altering the structure of the fibrin matrix. There is evidence that outcomes of wound healing can be affected by the fibrin structure in terms of its thickness of the fibers, the number of branch points, the porosity, and the permeability.  A buildup of fibrinous material in a wound may trigger and perpetuate an excessive and prolonged inflammatory response.  The fibrin matrix may also harbor bacterial and biofilm.  Vigorous cleansing and debridement is an important step in wound management to remove excessive yellow fibrin.  However, other structures or materials could assume a similar yellow appearance on a wound bed, including tendon, bony structure, adipose or fatty tissue, thick viscous pus, dried up exudate or crust, and even wound dressing fabrics.  Careful evaluation is prudent to correctly identify yellow-colored tissue.







In the News

Impaired Insulin Metabolism in Periwound Skin Can Affect Healing

Wound healing is impaired in people with diabetes because high levels of glucose in the blood can affect blood vessels, nerves, and the immune system. In Cologne, Germany, researchers demonstrated in a study, using the skin of larvae of the fruit fly Drosophila melanogaster, that slowed insulin metabolism at the wound site can directly affect neighboring cells involved in wound healing. After a skin injury, the periwound cells respond by forming an actomyosin cable around the wound. The ring gradually contracts to seal off the gap until complete healing is achieved. When insulin metabolism is impaired, the formation of actomyosin cable ring is delayed and weak. This results in incomplete or slow wound healing.

Wireless Electroceutical Dressing to Promote Wound Healing

A team of researchers at Ohio State University has created a portable adhesive patch that delivers a continuous, small electrical current. The wireless electroceutical dressing mimics the natural physiological process and harnesses the body's innate response to injury to help wounds heal and destroy biofilm. The new prototype is made of a combination of silk and silver and includes a flexible, portable, and self-contained battery that delivers a continuous, safe, low-level electrical current to the injury. Preliminary data indicated that infected wounds covered by the experimental bioelectric dressing healed better and more quickly than those covered with a plain dressing that is commonly used in the care of wounds. Researchers hypothesize that the electrical currents may disrupt bacteria in 2 ways: by interrupting the production of chemical messages that instruct bacteria to develop biofilms and by weakening the molecular structure of existing biofilms, potentially making them more susceptible to antibiotics or the body's natural immune response.

Fungus Promote Biofilm Formation

Researchers in Pennsylvania and Iowa have discovered that fungal communities found in chronic wounds can form mixed bacterial-fungal biofilms leading to poor healing outcomes. The team followed 100 patients with diabetic foot ulcers over 26 weeks. Eighty percent of the wounds harbored fungi including Cladosporium herbarum that was found in 41% of the samples and Candida albicans found more than one-fifth of the samples. High levels of ascomycetes, or sac fungi, were associated with wounds that took longer than 8 weeks to heal. Although no single species of fungi was associated with poor outcomes, mixed communities were associated with slow healing or complications, such as bone infection and amputation.

Development of Atmospheric Plasma Wound Treatment Device

Advanced Plasma Products and its partners from the Montana State University and the University Of Tennessee are working on the development and testing of the Atmospheric Plasma Wound Applicator device to treat chronic wounds that are difficult to treat. Plasma forms when certain amounts of energy, like heat or more commonly some kind of electricity, passes through a gas.

The collection of free electrons and ionized gas, called plasma, can support wound healing by its antiseptic effects, by stimulation of proliferation and migration of wound relating skin cells, by activation or inhibition of integrin receptors on the cell surface or by its proangiogenic effect.

















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The Official Journal of the APWCA


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
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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!