May, 2005

Dear Readers,

       In the Veterinary Wounds Section this month, Dr. Sarah Cockbill addresses the challenge of objectively assessing wound healing in a canine study. In both animal and clinical studies, investigators have employed a myriad of approaches to quantify healing, a task that is even more difficult when attempting to detect small differences between experimental and control groups. Dr. Cockbill points out that while area measurements are not without difficulties, measurement of wound volume and its decrease during repair has been the most difficult assessment. As the techniques of ultrasonography have improved, the technology can be used to produce 3-dimensional scans of tissues including wounds in the skin. Dr. Cockbill comments on the advantages and applications of high-resolution ultrasonography (HRU) for wound assessment. She introduces the article by Mantis et al. reporting experiences of using HRU to measure wound healing in skin wounds in dogs (High-resolution ultrasonography of experimentally induced full-thickness canine skin wounds: efficacy in imaging canine skin and comparison of 2 methods of measuring wound size). Even in the eschar-covered wounds, the investigators could demonstrate the dimensions of the defects (depth, volume) as well as the appearance of new granulation tissue filling the wound cavity. They report on 2 methods to analyze the data, both of which were seen to be useful. One approach was judged superior in detecting small differences between treatment groups. The use of HRU to assess chronic wounds in humans has been reported and can be of great value in determining which wounds are healing and which wounds require a different treatment approach.
       Köse et al. (Alpha sepiolite: an old clay mineral—a new dressing material) present their laboratory studies on the fluid absorptive and odor adsorptive properties of a natural clay mineral and compare its activity with activated charcoal and gauze. They also found that the alpha sepiolite did not alter the pH, unlike the activated charcoal dressings. While the data are of interest, the authors point out that future studies need to address the clinical relevance of the findings.
       Laborde in a case series of 34 patients reports on the efficacy of a tendon lengthening surgical procedure on the healing and recurrence of neuropathic plantar forefoot ulcers (Tendon lengthenings for forefoot ulcers). He found that this treatment appears to be effective for healing most of the ulcers and lowering the recurrence rate. A follow-up study with more patients is underway to document and confirm these findings.
       In Diagnostic Dilemmas, Wheeler et al. review a case of cutaneous nocardiosis found in a patient presenting with cellulitis and multiple open wounds of the leg. They discuss the methods of diagnosis and treatment of the condition. The infecting organism was found to be Nocardia brasiliensis. Although this is a rare cause of chronic wounds, the appropriate early treatment is important and should result in recovery rates of 100%. However, if the infection becomes disseminated, the mortality can reach 66%, even with treatment.