Dear Readers:

Last December, a symposium was held in San Francisco to honor Dr. Thomas K. Hunt for his contributions in wound healing research. Dr. Hunt, Professor Emeritus at the University of California School of Medicine, has published important papers on many aspects of wound healing and is best known for his work on the effects of oxygen on repair. In addition to his own research, he has trained many fine clinicians and researchers in our field. It is fitting that Dr. Laura Bolton in the Evidence Corner honors Dr. Hunt by devoting her section to papers on the effects of hyperbaric oxygen (HBO) on wound healing. One paper, a systematic review by Wang, et al., reported findings from several sources on the effects of HBO in the treatment of various hypoxic wounds. A second paper by Kessler, et al., presented results from their randomized, controlled trial of HBO therapy effects on nonischemic diabetic foot ulcers. The two reports presented evidence of a generally positive effect, however not compelling. While the incidence of adverse events was small, it did range from mild to serious. Dr. Bolton provides the reader with a clinical perspective and general conclusions that can be drawn from this literature.

There is ample evidence to minimize the use of gauze dressings in favor of the modern semi-occlusive dressings that maintain tissue hydration. In spite of this information, the most commonly used primary dressing in the United States remains gauze or “wet-to-dry” gauze. Armstrong and Price (Wet-to-dry gauze dressings: Fact and fiction) in a survey of 65 general surgeons using gauze dressings found that there was significant inconsistency in how the technique was being performed and that its use was often being prescribed inappropriately. The authors discuss the reasons for the use of gauze dressings when more appropriate dressing choices are available. Their data suggest a “…multidisciplinary approach to wound care, which is firmly evidence based, needs to be developed.”

Richters, et al., (Effects of a hydrofiber dressing on inflammatory cells in rat partial-thickness wounds) report macroscopic and microscopic findings on the healing of experimental wounds treated with a hydrofiber dressing (Aquacel®) or paraffin gauze. Reepithelization was faster under the hydrofiber dressings; there were fewer neutrophils present in the wound bed as they were absorbed into the material. The authors discuss the possible mechanisms of action for the Aquacel dressing.

Abai, et al., (Scalp reconstruction after resection of malignant fibrous histiocytoma utilizing a dermal regeneration template: A case report) present their experience in closing a large skin defect with a dermal regeneration template (DRT). Three weeks later, the silicone barrier of the DRT was removed, and thin, meshed autografts were applied. The surgical and aesthetic outcomes were good. Originally, the DRT was developed to treat excisions in burn patients, but its use in reconstructive surgery is evolving. In this case study, it would appear to have been a good choice in order to avoid multiple, complex surgical techniques with blood loss and other risks.

In a preliminary study, Simman, et al., (Brief Communication) treated experimental cutaneous autografts in a pig with either a routine bolster dressing or with negative pressure wound therapy (NPWT). Through histological observations, they noted a decrease in edema and also a reduction of the plane of separation between graft and wound bed in the NPWT treated graft compared to the graft treated with the bolster dressing. While the data are from a single animal study, the authors suggest the positive results may prompt clinical evaluation to confirm the findings.

David T. Rovee, PhD
Editor, WOUNDS