Sex Hormones and Wound Healing
Abstract: Delayed wound healing often occurs in the elderly, imposing significant medical, financial, and social burdens upon the patient and society. Post-menopausal decline in estrogens may negatively impact wound healing in the geriatric population. This article presents an overview of animal and human data on androgens and estrogens and their potential role in wound healing in the elderly.
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Wound Bed Preparation: The Science Behind the Removal of Barriers to Healing [PART 2]
Abstract: Wound healing involves a well-orchestrated, complex process leading to repair of injured tissues. However, chronic wounds do not follow the normal pattern of repair. This is due to underlying physiological problems associated with their development, which unless corrected would continue to cause wound deterioration. The key to effective wound care lies in a combination of three approaches: treatment of underlying medical problems, assessment and treatment of local wound bed, and effective management of any patient-centered concerns. An essential component of this recommended approach is restoration of healthy granulation tissue in the wound bed. Wound bed preparation brings a number of existing procedures, including debridement, treatment of infection, and management of exudate levels, together into a systematic approach to help restore the chronic wound bed environment. The aim of wound bed preparation is to remove the barriers to healing and initiate the repair process. This review explores the scientific rationale behind this concept and examines how wound bed preparation offers healthcare professionals an improved paradigm for the treatment of chronic wounds. By implementing wound bed preparation, the formation of healthy granulation tissue will be optimized and the efficiency of biotechnological therapies improved, which would ultimately reduce the time to wound closure.
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Evidence Corner
Evidence Corner Evidence Corner: Evidence Corner - Laura L. Bolton, PhD, FPWCA Dear Readers: Wound healing is delayed in response to chronic1 and acute2 psychological stressors. Conclusion: These results clarify a mechanism by which everyday psychosocial stressors delay wound healing. Social Interaction Reduces Stress-Induced Wound Healing Delay Reference: Detillion ...
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Antiseptics on Wounds: An Area of Controversy (PART ONE)
Abstract: Antiseptics have long and commonly been used on wounds to prevent or treat infection. However, citing cytotoxicity data, many authors have advised against their use on open wounds. This article discusses antiseptics and their use on open wounds, as well reviews relevant animal studies and clinical trials examining the effects of commonly used antiseptics, including iodine compounds (povidone iodine and cadexomer iodine), chlorhexidine, hydrogen peroxide, acetic acid, and silver compounds. This article examines their effects on wound healing and reepithelization and their efficacy on reducing bacterial number in wounds and incidence of wound infections. The authors found despite cytotoxicty data, most antiseptics have not been shown to clearly impede healing, especially newer formulations like cadexomer iodine (which speeds healing) and novel silver delivery systems. These compounds appear to be relatively safe and efficient in preventing infection in human wounds. Given this review, the role of antiseptics on wounds and their role in wound care management should be reconsidered.
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Cutaneous Biofilms: Friend or Foe?
Abstract: This paper reviews the potential role of bacteria living in an adhered matrix made of extracellular polysaccharide, a biofilm, in wound healing. Communication between bacterial cells or quorum sensing via transcription of certain genes within the biofilm will be discussed as it relates to the biofilm environment. Bacteria that live in the biofilm environment have been shown to be more resistant to antiseptics and antimicrobial agents. This knowledge may be important to healthcare providers who care for infected chronic wounds that are unresponsive to antimicrobial therapy. Several potential new ideas for controlling the formation of biofilm will be discussed, since enhancing lactoferrin, a component of innate immunity, may disrupt biofilms. The use of enzymes for the removal of biofilms has been successful on surfaces, such as soft contact lenses, and may have a role in removal of biofilms from a wound bed. Additional work is needed to substantiate our hypothesis that biofilms play a significant role in delayed wound healing and to investigate possible removal of bacteria living in this protected environment.
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Composition of Wound Fluid from Pressure Ulcers Treated with Negative Pressure Wound Therapy Using V.A.C.® Therapy in Home Health or Extended Care Patients: A Pilot Study
Abstract: The purpose of this pilot study was to characterize changes in concentrations of tumor necrosis factor (TNF)-a, interleukin (IL)-1b, matrix metalloproteinase (MMP)-3, MMP-9, and tissue inhibitor of metalloproteinase (TIMP)-1 in wound fluid collected from pressure ulcers in adults treated with negative pressure wound therapy (NPWT; V.A.C.® Therapy, KCI, San Antonio, Tex). Wound fluids were collected from 8 patients with Stage III or IV pressure ulcers in home care and extended care settings. Concentrations of analytes were measured immediately prior to initiation of NPWT (Day 0) and at Days 1, 3, and 7 continuous NPWT. There were statistically significant (P < 0.05) decreases from baseline in the levels of MMP-3 (Day 0 > [Day 1 ~ Day 3 ~ Day 7]), MMP-9 (Day 0 > [Day 1 ~ Day 3]), and MMP-3:TIMP-1 ratios (Day 0 > [Day 1 ~ Day 3 ~ Day 7]). No other significant differences were detected. Previous studies have shown a consistent decrease in protease levels to have prognostic value for healing. Thus, the change in composition of fluids from pressure ulcers treated with NPWT may be beneficial to wound healing.
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Hormonal Influences on Wound Healing: A Review of Current Experimental Data
Abstract: Skin, the largest organ in the body, undergoes numerous age-related structural and functional changes, including a delayed wound healing response. Delayed or nonhealing wounds pose an immense problem, leading to increased morbidity and mortality and an estimated cost to the United States health system in excess of $20 billion. In recent years, the important role of hormones in age-related delayed healing has become apparent, and the skin has emerged as a clear target of hormonal action. Reduced estrogen levels post-menopause have major effects on cutaneous healing, altering cytokine profiles to induce a pro-inflammatory state, modulating the balance between matrix synthesis and degradation, and attenuating keratinocyte migration. Exogenous estrogen treatment, via a systemic or topical route, can reverse many of these age-associated changes in both mouse and human models. In contrast, the effects of androgens on healing appear to be detrimental. This review will outline current understanding of hormonal influences on cutaneous healing, focusing on in-vivo and in-vitro data.
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Is Antimicrobial Efficacy Sufficient? A Question Concerning the Benefits of New Dressings
Abstract: Clinical research and general experience is accentuating the importance of minimizing the bacterial load in both chronic and acute wounds. This understanding, combined with the increasing prevalence of antibiotic-resistant bacteria in both hospital and community settings, is driving the development of new types of antimicrobial dressings. Various products tout their antimicrobial efficacy, but little is described relative to their impact on wound healing. Two new antimicrobial dressing products were examined, a nanocrystalline silver-coated dressing (SCD) and a gauze dressing impregnated with polyhexamethylene biguanide (PHMB), in in-vitro tests and an animal model of delayed wound healing. Both dressings were demonstrated to have potent in-vitro bactericidal effects. However, the PHMB dressing did not have any activity beyond its own borders, whereas the SCD demonstrated antimicrobial activity that diffused into the surrounding environment, as shown in zone of inhibition assays. In wound healing experiments, wounds dressed with the SCD dressing developed a full granulation bed much faster than those dressed with the PHMB dressing and also demonstrated a lower wound bioburden than those dressed with the PHMB dressing. These results suggest that in clinical use, simply being an effective antimicrobial is not sufficient to make a product the best choice to promote wound healing. This is consistent with results obtained with other topical antimicrobial products that may be effective against contaminating organisms but that may impede wound healing.
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Involuntary Weight Loss and its Effects on the Body?s Ability to Heal
s Ability to Heal Supplement: Involuntary Weight Loss and its Effects on the Body? s Ability to Heal - Questions and Answer and Evaluation Form Involuntary Weight Loss and Its Effects on the Body's Ability to Heal? YES NO 3. Be familiar with the use of adjunctive nutrition support for involuntary weight loss in LTAC and COPD patients and patients with wounds?
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Novel Stabilization and Sterilization Method for Collagen-based Biologic Wound Dressings
Abstract: Biologic extracellular matrix (ECM)-based wound dressings offer promise in the treatment of chronic wounds. A variety of animal and human tissue derived dressings are currently available. These products are processed and/or sterilized by a range of chemical and mechanical processes, which will impact the final quality of the matrices?ultimately affecting the overall wound healing process. A novel method is described to prepare a sterile and biocompatible biological wound dressing. The advantages and the clinical implications of this wound dressing preparation are also discussed.
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