March, 2006

Dear Readers,

       In Letters to the Editor, a critique of the article by Parsons et al [Parsons D, Bowler PG, Myles V, Jones S. Silver antimicrobial dressings in wound management: a comparison of antibacterial, physical, and chemical characteristics. WOUNDS. 2005;17(8):222–232.] was received from Andersen and Dolmer. In the authors’ responses, Parsons et al reiterate and discuss the objectives of the work and the areas of agreement and disagreement with the critique. (Companies continue to develop meaningful laboratory testing methods to assess active dressings, and most recognize the value and shortcomings of the tests. Nonetheless, useful information can be forthcoming. Ultimately, one would like to see large, controlled clinical trials documenting the effects of various products. Until those are available, I suspect that we will continue to see a variety of laboratory test methods devised in order to understand and present the effects of wound products.)
       In this month’s Evidence Corner, Dr. Laura Bolton reviews 2 articles addressing the broadly held view that physical exercise is an important variable for healing chronic and acute wounds. The first article by Shamley et al, Delayed versus immediate exercises following surgery for breast cancer: a systematic review [Breast Cancer Res Treat. 2005;90(3):263–271.], supports the delay of arm exercises in order to reduce seroma formation following breast cancer surgery. The second article by Emery et al, Exercise accelerates wound healing among healthy older adults: a preliminary investigation [J Gerontol A Biol Sci Med Sci. 2005;60(11):1432–1436.], revealed that regular exercise enhanced wound healing of punch biopsy excisions in volunteers between the ages of 55 and 77. Bolton points out the growing evidence supporting the value of exercise in acute and chronic wound care and prevention protocols. Her “…take-home message is to apply therapeutic regimens, like exercise, with evidence of efficacy but apply them wisely with appropriate consideration of postoperative issues, such as circulatory disruption.”
       With the Symposium on Advanced Wound Care scheduled to begin next month (April 30–May 3, 2006), we have published the 31 abstracts selected for oral presentation at the meeting. The abstracts cover a broad range of topics, from basic science, clinical challenges and techniques, product assessments, measurement methods, biologically active treatments, chronic wound prevention, infection treatments, pain control and reduction, to dressing effects. You will also find a listing of some of the industrial exhibits. We hope to see our Readers at the Henry B. Gonzalez Convention Center in San Antonio.
       Kaimal et al (How much pressure does a pressure dressing press? A pilot study quantifying the effects of a pressure dressing on the post-cesarean section incision) report the methods used to measure forces exerted on the tissues by a standard pressure dressing and the results obtained in treating surgical incisions in a small cohort of patients (n = 5). The authors found that pressure was significantly increased under the dressing; however, they believe it is not clear as to any clinical significance. The rise in pressure was not adequate to overcome capillary venous pressure in the tissues, so there may be no positive effect on decreasing hematoma formation. Using these reported methods, a larger trial of various pressure dressing techniques for preventing hematomas “…would be appropriate.”
       Gu et al (PDGF-BB, TGF-b1, and FGF-2 proteins elevate scar formation in a rabbit ear excessive scar model) describe the development of an animal wound model showing excessive scar tissue. Although the result does not exactly simulate the human scar, the “… model might still provide a useful tool for evaluation of newly produced anti-scarring agents.” [Perhaps the authors’ selection of the rabbit for these studies was important, as the rabbit ear has some unique capabilities to “regenerate” tissue in ear hole-punches. These punch wounds in rabbit ears form a blastema-like structure characteristic of regenerating tissues (eg, in some amphibians or reptiles). See Goss RJ, Grimes LN. Epidermal downgrowths in regenerating rabbit ear holes. J Morphol. 1975;146(4):533–542.]
       Menendez and Warriner (Marjolin’s ulcer: report of two cases) describe chronic wounds following burn injury that developed Marjolin’s ulcers (epidermoid carcinomas arising in chronic wounds). Although this condition is more commonly seen post burn scar formation, it can be found in other chronic wounds of long duration. The authors describe the condition and its relevance to pressure ulcers, venous stasis ulcers, and other chronic wounds. Because the malignant transformation in the chronic wound, though rare, is aggressive, the authors “… encourage the liberal use of biopsies in long standing chronic ulcers and repeated biopsies if necessary.”
       Saydam et al (The effects of topically applied nitrofurazone and rifamycin on wound healing) present their findings on the effects of 2 antibacterial agents commonly used in Turkey on the course of healing in experimental excisions in rat skin. Nitrofurazone is an inexpensive, broad-spectrum antibiotic; however, it is ineffective against Pseudomonas aeruginosa. Added to this, its use has been largely abandoned due to a negative influence on healing and hypersensitivity reactions in patients with surgical or traumatic wounds. The authors have found that combining nitrofurazone with rifamycin resulted in several advantages: “The antibacterial spectrum increases [effective against Pseudomonas], the risk of drug resistance development decreases, and…the risk of wound healing delay decreases.” They believe the findings merit further research and consideration.

David T. Rovee, PhD
Editor, WOUNDS