July, 2004

Dear Readers:

The paper by Stone, et al., (Bolster versus negative pressure wound therapy for securing split-thickness skin grafts in trauma patients) reports the effectiveness of negative pressure wound therapy (NPWT) for the treatment of skin grafts. As NPWT has been a useful approach for the local treatment of many types of wounds, it could be an effective way to secure skin grafts. The authors conducted a retrospective review of 40 patients whose grafts were treated either with a cotton bolster (control) or NPWT. They found that the two treatment approaches appeared to be equally effective. The authors considered the use of a cotton bolster to be appropriate for most routine, small wounds as NPWT costs were much greater. However, they suggest that a prospective, controlled trial of NPWT for the treatment of grafts associated with high failure rates could “…answer questions about the appropriate use of NPWT.”

Alvarez, et al., (Effectiveness of a biocellulose wound dressing for the treatment of chronic venous leg ulcers: Results of a single center randomized study involving 24 patients)* report the results of a trial comparing standard treatment (control) with a new wound dressing (BWD) produced from microbial cellulose, which is synthesized by the bacterium, Acetobacter xylinum. They found that BWD was more effective than the control for autolytic debridement and pain reduction (p<0.05). The BWD-treated wounds also showed greater reduction in wound size; however, these differences did not reach statistical significance. While this study was small (n=24), the data support “…BWD’s effectiveness in the treatment of chronic venous ulcers.”

Percival and Bowler (Biofilms and their potential role in wound healing) review and discuss the significance of biofilms in many human infections. The biofilm presents a challenge to treatment as the biofilm bacteria are less susceptible to the host’s immune defenses and also more resistant to antimicrobial agents. Within the biofilm, there may be an increased opportunity for gene transfer among the bacteria, which could lead to antimicrobial resistance or the conversion to high virulence. The authors hypothesize that the human wound environment is able to support the development of biofilms, although there is little evidence available at the present time. They discuss published work on the “microbial progression” in wounds and propose that this is actually a model of a progressing biofilm. Left uncontrolled, this progression may lead to clinical infection. This is a thought-provoking paper that makes it clear that the characterization and definition of the role of biofilms in wounds are important areas for scientific and clinical research.

Leveriza-Oh, et al., (Diagnostic Dilemmas) present a case report on Kaposi’s sarcoma. They discuss the pathology and treatment options. The local treatments include cryotherapy, surgical excision, laser, and intralesional therapy. While the only FDA-approved topical medication for Kaposi’s sarcoma is alitretinoin gel, other topicals are emerging and show promise (antivirals and immune response modifiers). A very useful table is provided, which describes the types of Kaposi’s sarcoma and information on the populations affected, the male: female ratios, age of onset, clinical features, extracutaneous manifestations, and median survival times.

David T. Rovee, PhD
Editor, WOUNDS

*Managing editor's note: As an independent member of the Xylos Board of Directors, Dr. Rovee recused himself in the review of the Alvarez manuscript. The acceptance of this manuscript was based on a blinded review by members of the WOUNDS Editorial Advisory Board.