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: 1.5

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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. This is a young patient with a history of spina bifida resulting in paralysis of both legs.  He spends most of his time in a powered wheelchair and continues to enjoy a very busy social life. The wound care team was asked to examine this wound that developed on the ankle area.  What is the cause of this wound?

What is your diagnosis? 

  

A. The wound is linear in shape with smooth, even edges, which suggests this is most likely caused by external trauma, such as an abrasion or laceration. He was recently prescribed with compression bandages to control pedal edema due to the loss of calf muscle pump function and the extended time he spent in a chair with his legs in a dependent position. A short-stretch compression bandaging system was applied daily with a figure 8 wrap-style around the ankle. After investigating, the wound care team concluded that the wound was caused by the compression bandage. The following recommendations were made:

1.   Provide education and training to staff to ensure safe application of compression.

2.     Document a plan of care and application method to ensure consistency and discourage “personal” modification.

3. Use appropriate tension to apply the short-stretch bandage: Snug, no tug, to avoid the excessive pressure to the area.

4.   Ensure dorsiflexion of the foot while the bandages are applied to prevent slippage.

5. Use an ankle-foot orthosis to keep his feet in a normal position and prevent excessive passive movements due to weakness of the feet.

6. Apply an atraumatic dressing to cover the open lesion.

7.  Customize a piece of foam to the ankle area to reduce friction.

8.  Pad the ankle to reduce the angle of flexion between the leg and the foot. This will help distribute pressure evenly to minimize trauma to the skinfold and the Achilles tendon.

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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

Mark your calendars now for the 30th annual Clinical Symposium on Advances in Skin & Wound Care! Next year's conference will be held September 18-21, 2015, at the Hyatt Regency in New Orleans, Louisiana. Watch here and in the journal for more information in the coming months.

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: 12/4/2014 What is a systematic review?

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

Latest Entry: 9/16/2014 HBO Nugget 13

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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 Impact Factor
Advances in Skin & Wound Care has received an Impact Factor Ranking of 1.6 in the current Journal Citation Report.  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

Application of Ionic Liquids for Wound Care

The presence of biofilm triggers a sustained inflammatory response in chronic wounds that is purported to be the primary reason for slow healing. Skin infections account for approximately 10% of all hospital visits; the prevalence and healthcare costs have been gradually increasing over the last 3 decades. Wounds infections could lead to serious complications such as prolonged hospital stay, sepsis, limb amputation, and death. To help address this problem, the Los Alamos National Laboratory research team in New Mexico has identified a new class of material called ionic liquids that consist of choline-geranate. Ionic liquids have a unique property to disrupt biofilm and facilitate delivery of antibiotic to deactivate hard-to-reach wound pathogens that are inside the core of biofilm. Researchers claimed that ionic liquids could penetrate through the skin allowing antibiotics to reach below the dermis. It has been documented that choline-geranate increased delivery of cefadroxil, an antibiotic, by >16-fold into the deep tissue layers of the skin without inducing skin irritation. Topical application of ionic liquids to an open wound could potentially reduce the risk of serious infection, especially in battlefield, before proper treatment is available. These liquids can be developed from inexpensive starting materials that are FDA approved and are extremely stable to high temperatures and pressures, making them ideal for real-world applications.

Targeted Therapy Using Fibroblast Growth Factors

Angiogenesis or the growth of new blood vessels is crucial to wound healing. The research team at Washington University School of Medicine in St. Louis, Missouri, evaluated a group of proteins known as fibroblast growth factors (FGF) and their role in wound healing. The FGF proteins interact with specific receptor molecules, known as FGFRs, located on the surface of many types of cells in the body including the interior of blood vessels and blood cells. Using a murine model, the researchers experimentally inhibited the expression of the FGFR1 and FGFR2 proteins, 2 major mediators of the FGF signal that are present in the cells that line blood vessels. They noticed delayed healing from a skin injury and a significant decrease in the density of blood vessels surrounding the injury site. Human FGF2 is already in clinical use as a topical spray in Japan for foot ulcers to promote wound healing with some success. There are conditions when new blood vessels growth is undesirable, such as vision loss related to age-related macular degeneration and diabetic retinopathy. Excessive blood vessels in the eye are fragile and they tend to break easily causing bleeding, tissue damage, and scar formation. Targeted inhibition of FGF signaling in the eye to inhibit the growth of blood vessels may help prevent vision loss.

Nanosheets for Burn Wounds

Burn wounds are vulnerable to infection and keeping them sealed off from bacteria is essential for a successful recovery. A researcher group from Japan’s Tokai University developed novel nanosheets that are made of a biodegradable polyester called poly(L-lactic acid), or PLLA. These nanosheets are extremely flexible, giving them the ability to coat small and irregular contours on the body. Without any adhesive, the nanosheet patchwork effectively covered even the smallest bumps and wrinkles on the mouse's digits. This material is ideal as a burn wound dressing because of its ability to conform to the curvature of the body and protect the injured areas against bacterial contamination. The dressing protected wounds from infection for 3 continuous days. With an additional coating, the nanosheets kept bacteria out for a total of 6 days, reducing the number of times dressings have to be changed.

Short-term Stress May Be Beneficial for Healing

Researchers at the San Francisco VA Medical Center (SFVAMC) found that under chronic stress, steroid hormones produced by the adrenal glands can have a harmful effect on the protective functions of normal skin and inhibit wound healing. However, under shorter intervals of stress, the researchers found that the stressed mice showed significantly reduced inflammation and faster healing from experimentally induced dermatitis. Short-term psychological stress has a potential role in promoting healing. Results challenge the notion of treatment that involved high doses and prolonged use of steroid therapy.

Human Amniotic Membrane/Umbilical Cord Matrix for the Treatment of Diabetic Foot Ulcers

Amniox Medical announced the initiation of a multicenter, randomized, parallel, crossover design study of nonhealing diabetic foot ulcers compares Cryopreserved, Umbilical Cord Allograft (NEOX® CORD 1K) versus standard of care. Amniox is a human amniotic membrane/umbilical cord matrix comprises key proteins, cytokines, and growth factors that have been shown to modulate inflammation and promote regeneration of normal tissue. The anti-inflammatory properties of these placental tissues may also decrease scar tissue formation.

NIH Awards Grant to Imbed Bio to Develop Advanced Wound Dressing

Imbed Biosciences, Inc, Madison, Wisconsin, has been awarded a $1.5 million competitive Small Business Innovation Research Phase II grant from National Institute for Arthritis and Musculoskeletal and Skin Diseases, a division of the National Institutes of Health. Imbed Biosciences aims to develop unique polymeric nanofilm dressings containing silver nanoparticles. The nanofilm dressing dissolves in the wound over time, thus minimizing painful dressing changes.