Management of Complex Wounds with Dermal Substitute Assisted by a Negative Pressure System

Introduction: The standard treatment for complex wound care is autografting. The advent of dermal substitutes has provided a novel tool for the preparation of the bed to be grafted. However, most types of dermal matrices require the application of a skin graft a second time. Currently, other strategies have been developed to improve the vascularization process, such as negative pressure wound therapy (NPWT), which has been reported to reduce the time required for vascular growth and dermal matrix integration and thus achieve a shorter waiting period for autologous graft application. The present study aims to evaluate the effectiveness and safety of dermal matrix management associated with NPWT in the treatment of complex wounds. Methods: Seven patients with a diagnosis of complex wounds were enrolled in this study between July 1, 2015, and June 31, 2016. After debridement and having an adequate wound bed, patients who met the criteria for the application of combined therapy were treated with dermal substitutes and a negative pressure system. The percentage of graft integration into the wound bed, complications, length of hospital stay, and duration of therapy were analyzed. Results: The mean age was 42.5 ± 16 (39 - 54) years old;three women and four men were included in the study. The approximate size of skin loss was 120.7 ± 75 cm2 (25 - 250 cm2). The combined therapy of dermal matrix plus NPWT was instituted in all cases for a period of 14 days. There were no complications, with 100% graft integration in 6 of 7 cases. Patients were discharged after a mean hospital stay of 5.4 days. Conclusions: This study demonstrates that the utilization of combined dermal matrix plus NPWT therapy can be performed safely and effectively in patients with complex wounds with low complication rates and a short hospital stay.

Leucocyte-and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities

Background:Generally,advanced wound care resources are applied for complex wounds that pose a challenge to the medical and nursing teams.In this report,the use of leukocyte-and platelet-rich fibrin(L-PRF)is emphasized for complex wounds as an alternative,simple,inexpensive,time-saving process that does not require hospitalization and has a healing potential over that of bare soft tissue,including bone,tendon,and ligaments.The aim of this study is to extend the use of L-PRF in small-to-moderate-sized complex wounds of lower extremities in which L-PRF maintains the sensitive structures viable.Methods:Between January 2016 and December 2017,17 small-to-moderate-sized complex wounds of lower extremities treated with L-PRF were recruited from the plastic and reconstructive surgery clinic in Aydin State Hospital,Turkey.The treatment was administered twice per week in the outpatient clinic.Depending on the size and extension of the complex wound,two to five blood samples were collected into 8.5 ml dry,glass vacuum tubes with no anticoagulant,and samples were immediately centrifuged at 1630×g for 5 min to obtain L-PRF.Complete healing was defined as the day of complete wound epithelialization.Results:The median values of the initial wound size and wound duration were 12 cm^(2)(interquartile range,6 to 23 cm^(2))and 8 months before first admission(interquartile range,4 to 18 months),respectively.All wounds showed significant improvements after L-PRF therapy and full closure after a median of 18months,with an interquartile range of 11 to 34 months of L-PRF applications.There were recurrences of wounds during the first 6 months after therapy.No adverse events were observed.Conclusions:Our results add to the growing evidence that L-PRF treatments protect and maintain bare soft tissue structures viable,facilitate the formation of granulation tissue and epithelization,and remarkably reduce the need for additional soft tissue surgeries in small-to-medium-sized complex wounds.

Magnetic field-mediated Janus particles with sustained driving capability for severe bleeding control in perforating and inflected wounds

Severe bleeding in perforating and inflected wounds with forky cavities or fine voids encountered during prehospital treatments and surgical procedures is a complex challenge.Therefore,we present a novel hemostatic strategy based on magnetic field-mediated guidance.The biphasic Janus magnetic particle(MSS@Fe2O3-T)comprised aggregates ofα-Fe2O3 nanoparticles(Fe_(2)O_(3) NPs)as the motion actuator,negatively modified microporous starch(MSS)as the base hemostatic substrate,and thrombin as the loaded hemostatic drug.Before application,the particles were first wrapped using NaHCO_(3) and then doped with protonated tranexamic acid(TXA-NH_(3)^(+)),which ensured their high self-dispersibility in liquids.During application,the particles promptly self-diffused in blood by bubble propulsion and travelled to deep bleeding sites against reverse rushing blood flow under magnetic guidance.In vivo tests confirmed the superior hemostatic performance of the particles in perforating and inflected wounds(“V”-shaped femoral artery and“J”-shaped liver bleeding models).The present strategy,for the first time,extends the range of magnetically guided drug carriers to address the challenges in the hemorrhage control of perforating and inflected wounds.