February, 2006

Dear Readers,

In the article by Cochrane et al (The effect of several silver-containing wound dressings on fibroblast function in vitro using the collagen lattice contraction model), the effects of selected silver-containing dressings on fibroblast viability and contraction function are reported. This is an excellent report utilizing the in-vitro collagen gel lattice seeded with equine fibroblasts, a variation of the original work of Bell et al in 1979 [Proc Natl Acad Sci USA. 1979;76(3):1274–1278]. Since wound products containing silver are in wide use for managing infected wounds or those at risk of infection, this study addresses the important question of how the cells of the wound might be affected by these products. Using this model system, the authors could determine significant differences among the tested dressings with regard to their effects on rate of collagen contraction by the fibroblasts and also on fibroblast viability. While some of the effects are probably attributable to the silver, the authors present an interesting discussion of other variables that may contribute to the results. They point out that “…dressing selection should not be based on one particular attribute but that dressing choice should be based on the overall characteristics of a dressing, such as its antimicrobial, fluid handling, physical, and chemical properties.” Like many good studies, this report raises many new questions for future research studies on this class of wound treatment products.

Granick et al (Clinical and economic impact of hydrosurgical debridement on chronic wounds) present a retrospective study of 34 patients with chronic wounds who underwent standard surgical debridement (n = 14) or debridement with a new high-powered waterjet surgical debriding tool (n = 20). The analysis of the data suggested that fewer operative debridements were required when using the waterjet method versus the standard surgical approach (averages of 1.14 and 2, respectively). While the patient numbers are small, the findings are encouraging in light of possible cost savings and outcomes reported by the authors.

Hazen et al (Lipomembranous panniculitis with ulceration and secondary calcinosis cutis: successful treatment using carbon dioxide laser excision and marsupialization) report a case study of a patient with an uncommon condition that led to inflammatory destruction of the subcutaneous fat and dermal and subcutaneous fibrosis in the legs. Treatment of this condition can be difficult and results in variable success. The authors report the use of a novel method to remove the sclerotic mass using carbon dioxide laser with marsupialization and healing by secondary intention. The method appeared to be safe and effective in the treatment of this patient and may be considered as a “…means of treating [similar] patients in whom medical management has failed or may not be appropriate.”

Steenvoorde et al (Failure of the topical negative pressure abdominal dressing system in the “fat” open abdomen: report of a case and review of the literature) describe the management approaches for the open abdomen (laparostomy) in an obese patient with many medical complications. The authors describe the problems encountered and concluded that the topical negative pressure (TNP) abdominal dressing system was not effective in this case. They describe modified approaches combining TNP with fascial sutures or the Bogotá bag for closing the open abdomen.