Index: WOUNDS 2011;23(11):322–327

  Abstract: Sinus tract formation is common in a wide variety of wounds and can be difficult to manage. Nonsurgical techniques for treating sinus tracts have generally been disappointing, though many nonsurgical options have been explored including dermal matrix injection, platelet-derived growth factors, fibrin sealant, and phenytoin. This case series explores the treatment of nonhealing chronic wound-related sinus tracts with autologous platelet-rich plasma (PRP) in a series of patients in a single center, hospital-based, chronic wound care center. Methods. PRP was prepared using the Harvest SmartPRep procedure. During processing, the blood was separated into two distinct chambers: one containing packed red blood cells, and the other with autologous platelet concentrate and plasma supernatant. The plasma was injected into the entire sinus tract beginning from the base of the tract. Results. Nine of 12 patients healed, and three did not heal and required other interventions (excision and flap repair). All patients, except one, received only one PRP injection. One case of infection that could be directly attributed to the PRP injection was reported. All other patients experienced no pain, discomfort, or signs or symptoms of infection. Conclusion. PRP injection can be a useful technique in cases of straight, relatively short, persistent sinus tracts.

Index: WOUNDS 2011;23(10):301–308

  Abstract: The role of negative pressure wound therapy (NPWT) in below knee amputation (BKA) stump closure is not well described. The purpose of this series was to analyze morbidity outcomes, particularly related to dehiscence, of BKAs treated with postoperative NPWT prior to definitive closure. Methods. Medical records were retrospectively reviewed from 6 patients with large diameter legs due to chronic venous insufficiency of Charcot disease, who underwent a BKA and received postoperative NPWT between April 2006 and December 2008. NPWT was applied as a postsurgical dressing over closed fascia to help condition the open stump for successful closure. Mean patient age was 56 years. The average hospital stay after BKA was 10 days (range, 6–15 days). Average duration of NPWT was 7 days (range, 4–9 days). Results. All patients survived to discharge. Complete reepithelialization and healing of the stump averaged 84 days (range, 39–182 days) following initial placement of NPWT. Patients were casted for prosthesis in an average of 90 days (range, 42–187 days). The average follow-up time was 311 days (range, 210–440 days). None of the wounds dehisced or required repeat procedures during follow up. Complete wound closure was achieved in all cases, and no local or systemic complications were recorded for any of the patients. Conclusion. This experience suggests that early, short-term application of NPWT may be a valuable adjunct in BKA stump closure.

  Outpatient wound care centers are encountering patients with more complex wounds and an increased incidence of concomitant complicating comorbidities. As the population ages, patients with chronic wounds are presenting with multiple active disease processes that cause initiation of the wounds, impede wound healing, and preclude safely proceeding with surgical procedures, under anesthesia, to treat those wounds.

Index: WOUNDS 2011;23(8):243–251

Abstract: The presence of a chronic ulcer presents a challenge to clinicians in long-term care while being both a physical and psychological burden to the residents and their families. Dressings play an important adjunctive role in concert with overall efforts to manage the underlying causes of chronic, non-healing wounds. With more than 2000 dressings and a variety of treatment protocols available, chronic wound management is as much an art as it is science. Each wound requires a unique combination of dressings that is matched to the needs of the patient and the clinical presentation of the wound. Treatment often depends on the skill level of the clinician and the ability to develop appropriate interventions and plan of care. This retrospective series of four case studies serves to demonstrate the improved potential for healing outcomes when collagen dressings are used appropriately.

Abstract: The following case series includes a surgical excision, a burn wound, and a chronic venous ulcer that were successfully treated with Sepaderm®, a new wound management system. Sepaderm was chosen for its ease of use and its ability to remove excess exudate from the wound bed. The system also limits exudate leakage onto periwound tissue and protects against direct contact with the wound bed. These cases provide initial evidence that the Sepaderm system performed well and facilitated healing of different wound types, including a previously nonhealing venous leg ulcer.

Abstract: Chronic wounds are a frequent problem in developing countries, are often difficult to heal because they lack the necessary growth factors to maintain the healing process, and are frequently complicated by superinfection. Conventional therapies such as dressings, surgical debridement, and even skin grafting cannot provide satisfactory healing since these treatments are not able to provide enough necessary growth factors to modulate the healing process. Platelet-rich plasma (PRP), as a concentrate of platelets, releases a high concentration of multiple growth factors that can modulate