The efficacy of NPWT in promoting wound healing has been largely accepted by clinicians, yet the number of high-level clinical studies demonstrating its effectiveness is small and much more can be ...learned about the mechanisms of action. In the future, hopefully we will have the data to assist clinicians in selecting optimal parameters for specific wounds including interface material, waveform of suction application, and the amount of suction to be applied. Further investigation into specific interface coatings and instillation therapy are also needed. We believe that advances in mechanobiology, the science of wound healing, the understanding of biofilms, and advances in cell therapy will lead to better care for our patients.
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When adipose tissue (AT) is impaired by trauma or disease, AT engineering could provide a shelf-ready structural and functional restoration as alternative to current clinical ...treatments, which mainly aim at aesthetic replacement. Yet, the lack of an efficient vascular network within the scaffolds represents a major limitation to their translation application in patients. Here, we propose the use of microstructured crosslinked gelatin hydrogels with an embedded prevascular channel as scaffolding materials for AT engineering. The scaffolds are fabricated using – simultaneously – alginate-based microbeads and 3D printed filaments as sacrificial material encapsulated in gelatin at the point of material fabrication and removed post-crosslinking. This method yields the formation of microstructures that resemble the micro-architecture of physiological human fat tissue and of microvessels that can facilitate vascularization through anastomosis with patients’ own blood vessels. The cytocompatible method used to prepare the gelatin scaffolds showed structural stability over time while allowing for cell infiltration and protease-based remodeling/degradation. Scaffolds’ mechanical properties were also designed to mimic the one of natural breast adipose tissue, a key parameter for AT regeneration. Scaffold’s embedded channel (∅ = 300–400 µm) allowed for cell infiltration and enabled blood flow in vitro when an anastomosis with a rat blood artery was performed using surgical glue. In vitro tests with human mesenchymal stem cells (hMSC) showed colonization of the porous structure of the gelatin hydrogels, differentiation into adipocytes and accumulation of lipid droplets, as shown by Oil Red O staining.
The potential clinical use of scaffolds for adipose tissue (AT) regeneration is currently limited by an unmet simultaneous achievement of adequate structural/morphological properties together with a promoted scaffold vascularization. Sacrificial materials, currently used either to obtain a tissue-mimicking structure or hollow channels to promote scaffold’ vascularization, are powerful versatile tools for the fabrication of scaffolds with desired features. However, an integrated approach by means of sacrificial templates aiming at simultaneously achieving an adequate AT-mimicking structure and hollow channels for vascularization is missing. Here, we prove the suitability of crosslinked gelatin scaffolds obtained by using sacrificial alginate microbeads and 3D printed strands to achieve proper features and hollow channels useful for scaffolds vascularization.
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Chronic wounds do not heal in an orderly fashion in part due to the lack of timely release of biological factors essential for healing. Topical administration of various therapeutic factors at ...different stages is shown to enhance the healing rate of chronic wounds. Developing a wound dressing that can deliver biomolecules with a predetermined spatial and temporal pattern would be beneficial for effective treatment of chronic wounds. Here, an actively controlled wound dressing is fabricated using composite fibers with a core electrical heater covered by a layer of hydrogel containing thermoresponsive drug carriers. The fibers are loaded with different drugs and biological factors and are then assembled using textile processes to create a flexible and wearable wound dressing. These fibers can be individually addressed to enable on‐demand release of different drugs with a controlled temporal profile. Here, the effectiveness of the engineered dressing for on‐demand release of antibiotics and vascular endothelial growth factor (VEGF) is demonstrated for eliminating bacterial infection and inducing angiogenesis in vitro. The effectiveness of the VEGF release on improving healing rate is also demonstrated in a murine model of diabetic wounds.
A smart textile dressing is fabricated using composite fibers with a core electrical heater covered by a layer of hydrogel containing thermoresponsive drug carriers. The fibers are assembled into fabrics using textile processes, in which each thread operates as an independent functional unit that can be individually triggered to allow the on‐demand release of a specific drug.
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A 45-year-old man presents with extensive burns after a house fire. Excision and grafting are recommended for management of his burns. Depending on the depth and extent of the burn, early excision ...and grafting promote wound healing, reduce the risk of infection, and shorten hospitalization but increase the need for blood transfusion, as compared with conservative management.
Depending on the depth and extent of the burn, early excision and grafting promote wound healing, reduce the risk of infection, and shorten hospitalization but increase the need for blood transfusion, as compared with conservative management.
Foreword
This
Journal
feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations.
Stage
A 45-year-old man was rescued from his burning house. Firefighters removed his smoldering clothes and initiated intravenous access, pulse oximetry, and electrocardiographic monitoring. An endotracheal tube was inserted, and ventilation with 100% oxygen was initiated for presumed airway instability and inhalation injury. He was taken to a local emergency department with both superficial and deep dermal burns involving his torso and arms; the burns covered 42% of his total body-surface area. Intravenous fluid resuscitation was initiated. He was then transferred to a burn center for definitive treatment. Tube feeding was initiated through a nasogastric tube. The burns were cleansed . . .
Medical device-related pressure injuries (MDRPIs) account for more than 30% of all hospital-acquired pressure injuries. The COVID-19 pandemic introduced a large population of patients at risk for ...MDRPIs due to prolonged intubation and prone positioning. We reviewed our experience with MDRPIs during the 2020 COVID-19 pandemic at an Academic Medical Center.
We evaluated 30 cases of MDRPIs acquired during the peak of our pandemic, April 1 to May 31, 2020, and compared these to injuries seen over a similar time period prior to the pandemic.
Our experiences with MDRPIs during this time has led the WOC team to begin development of a quality improvement project aimed at improving management of high-risk respiratory illness patients requiring intubation and prone positioning.
Challenges and Management of Surgical Site Occurrences Gabriel, Allen; Gupta, Subhas; Orgill, Dennis P
Plastic and reconstructive surgery (1963),
01/2019, Volume:
143, Issue:
1S Management of Surgical Incisions Utilizing Closed-Incision Negative-Pressure Therapy
Journal Article
Peer reviewed
Postoperative complications such as surgical site infections, dehiscence, seromas, and hematomas prolong wound care and impose significant cost increases to patients and healthcare providers. ...Clinicians aiming to reduce the incidence of these complications should be aware of risk factors associated with surgical type, procedures used, patient characteristics, and postoperative care. Today, improved guidelines and general practices for managing surgical incisions have reduced the incidence of complications to historic lows. In addition to these standard care options, advanced wound care approaches have been extensively studied and exist as options for clinicians to provide adjunctive postoperative support and facilitate wound healing. These systems include advanced wound dressings and closed-incision negative-pressure therapy. Advanced wound care is not appropriate in all settings, and healthcare providers must assess each case for specific needs to be addressed by the available incision management plans. Emerging therapies that are intended to improve the continuum of postoperative care should continue to be evaluated in controlled clinical trials to determine their effectiveness under different circumstances and to support the creation of more robust guidelines for their use.
Cutaneous wound healing is a complex process with many types of mechanical forces regulating the quality and speed of healing. The role of mechanical forces in regulating tissue growth, repair and ...remodelling was recognised more than a century ago. Such forces influence gene expression, the synthesis of growth factors and inflammatory mediators and cellular processes like proliferation of many load-sensitive cells. However, the exact mechanisms by which these forces interact with cells and ways to use them to stimulate tissues are still active research fronts. This article sets to review the literature on mechanical forces and their role in cutaneous wound healing.
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Negative pressure wound therapy (NPWT), which was introduced as a commercial product (V.A.C.® Therapy, KCI USA, Inc., San Antonio, TX) less than 20 years ago, has revolutionised the treatment of ...complex wounds. Indicated for wide variety of wound types, NPWT is an adjunctive therapy that can be used safely in a range of care settings. Current research indicates that there are four primary NPWT mechanisms of action: macrodeformation, microdeformation, fluid removal and environmental control of the wound. The interaction of the primary mechanisms results in secondary effects through cell signalling (e.g. granulation tissue formation, cell proliferation and modulation of inflammation). Better understanding of the mechanisms of action also provides insight into future directions for NPWT research that could create better solutions for patients with complex wounds.
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