David Rovee, PhD Editor, WOUNDS

Dear Readers:

In the Evidence Corner, Dr. Laura L. Bolton reviews two published studies reporting the efficacy of pulsed-dye laser (PDL), intralesional corticosteroid, intralesional corticosteroid plus 5-fluorouracil (5-FU), or 5-FU alone on ameliorating surgical and burn wound scars. All the treatment approaches were effective. Dr. Bolton states “…that the evidence base for scar therapy is gradually growing stronger.”

Arseculeratne, et al., (A comparison of light reflection rheography and Duplex scanning in the diagnosis of chronic venous insufficiency) conducted a retrospective analysis of 42 patients with leg ulcers who had undergone testing with light reflection rheography (LRR) followed by Duplex ultrasonography. Comparison of the results obtained by LRR and Duplex scanning revealed that LRR was effective in predicting which patients may display an abnormal duplex scan (correlated in 41/42 patients). Along with a clinical assessment, LRR may serve as a useful, noninvasive diagnostic test of chronic venous insufficiency in order to determine which patients require duplex ultrasonography for further confirmation of the diagnosis.

Demarest, et al., (Experience with bilaminate bioartificial skin substitute and ultrathin skin grafting in non-burn soft tissue wound defects) report findings on the use of a collagen/glycosaminoglycan matrix and silicone layer bilaminate (Integra®) for treating large, soft-tissue defects in 15 patients. Most of the defects were the result of necrotizing fasciitis but also included some traumatic injuries (gunshot, avulsion, crush, degloving). While the “bilaminate skin substitute” has been widely used in burn treatment, the authors found that it provided a good closure for other tissue defects. Their success rates and cosmesis results were similar to those reported in treating burn wounds.

Topical becaplermin gel (rhPDGF-BB) is indicated for treatment of diabetic neuropathic ulcers; however, there are reports of its use on other types of wounds. Wieman (Efficacy and safety of recombinant human platelet-derived growth factor-BB [becaplermin] in patients with chronic venous ulcers: A pilot study) studied once daily (35 patients) or twice daily (32 patients) applications of the drug versus placebo (36 and 32 patients, respectively) in venous leg ulcers (VLU). He found that either treatment regimen with PDGF appeared safe, well-tolerated, and may be of benefit in the treatment of VLU. The studies were not powered for statistical significance, but the “…encouraging results warrant further clinical investigation…”

Cochrane, et al., (The application of a fibroblast gel contraction model to assess the cytotoxicity of topical antimicrobial agents) report the effects of several iodine-containing antiseptics on fibroblast contraction of collagen gels in vitro. All of the antiseptics tested showed significant reduction of gel contraction compared to controls. While in-vitro findings do not always predict in-vivo toxicity, the authors suggest that these antiseptics are potentially cytotoxic and that their prolonged use might be detrimental to wound healing.

In this month’s Diagnostic Dilemmas (Burning Feet due to Diabetic Neuropathy), Al-Muhairi and Phillips present the case of a patient with severe burning sensations in the soles of both feet. The patient was diagnosed as having diabetic neuropathy, which can result in extremely variable symptoms ranging from burning, shooting or stabbing pain to complete loss of sensation. The authors discuss treatment of this condition with topical doxepin. Twice-daily treatment with doxepin for four weeks eliminated the severe burning sensation without side effects. While it appears that topical doxepin may be an alternative treatment in alleviating neuropathic pain in the diabetic patient, further controlled studies should be conducted to rule out placebo effects.

David T. Rovee, PhD
Editor, WOUNDS