Abstract: Synthetic grafts have become a clinical standard for the acute and chronic surgical care of wounds. While these grafts provide basic wound site coverage, the final outcomes of repair are often inadequate in terms of minimizing scar formation, restoring tissue functionality, and maintaining durability of the repaired site. Accordingly, there is a significant unmet need to develop a “next generation” graft matrices that can actively enhance tissue repair, remodeling and regeneration. To this end, the development of molecular tools to better understand the molecular physiology of wound repair is essential. In the experiments described here, we exploited advances in technologies that enable the noninvasive monitoring of endogenous gene expression, to evaluate the long-term persistence of grafted and engrafted progenitor cells in the wound bed. We show how a preclinical model using an actin promoter-driven bioluminescent reporter gene can provide a quantitative and non-invasive image assessment of bone marrow cell persistence in an Integra® (Integra LifeSciences, Plainsboro, NJ) graft for at least 2 weeks. This approach, along with other cell and tissue-specific promoters, can be used to develop wound healing models in which it is possible to better understand the pathophysiological relevance of tissue repair therapies. We suggest that the development of an increasing number of transgenic reporter mice that express bioluminescent genes under the regulation of specific promoters can be used as donors to characterize the molecular physiology of wound healing and evaluate the biological effectiveness of innovative engineered biomaterials.

Abstract: Background. Topical negative pressure (TNP) therapy has been used since 1995 and growing evidence has facilitated its adoption as the standard of care in wound care. Despite its widespread use, literature on the use of TNP therapy in the home care setting is scarce. Methods. A retrospective study of 140 patients treated with TNP therapy in the outpatient department at a single institution between December 2005 and October 2008 was performed. Results. A total of 140 patients with 146 wounds were treated with TNP therapy. There were 74 male and 66 female patients (mean age was 5

Abstract: V.A.C. Instill® Therapy Unit (Kinetic Concepts, Inc. [KCI], San Antonio, TX) incorporates negative pressure wound therapy (NPWT) with intermittent automated wound irrigation. The following case describes a 2-year-old male with right thigh compartment syndrome from an acutely developing hematoma. Devascularization of the overlying skin led to full-thickness skin necrosis of the anterolateral and posterior right thigh. Following emergent evacuation and a lateral fasciotomy, necrotic skin was excised and nonviable subcutaneous fat was debrided. Wound care included NPWT with the V.A.C.

Abstract: A 23-year-old man living in Orange County, California who was involved in a motor vehicle accident suffered a closed both-bone forearm fracture that was treated with open reduction and internal fixation. The patient then developed wound necrosis and abscesses that revealed a pure culture of non-toxigenic Vibrio cholerae. The wound required debridement and excision, which was followed by split-thickness skin grafting. He also received antibiotics and eventually fully recovered.

Address correspondence to:
Garrett A. Wirth, MD, MS, FACS
University of California, Irvine Medic

Abstract: A 36-year-old man presented with pyoderma gangrenosum associated with cocaine abuse. The patient presented to our department with a 2-week history of ulceration on the left forearm at a skin graft donor site following surgical intervention to repair a perforation of the nasal septum and palate due to cocaine abuse of at least 10 years’ duration—an estimated dosage of up to 2 g/day. Standard medications and additional substance abuse were not described in the patient’s medical history.

Address correspondence to:
Joachim Dissemond, MD
Department of Dermatology
U

Abstract: Sarcoidosis, a systemic inflammatory disease of unknown cause(s), is a diagnosis of exclusion. While skin lesions are common, chronically nonhealing wounds caused by this idiopathic disease are rare and often misdiagnosed. Definitive diagnostic tests do not exist. The finding of noncaseating granulomas on biopsy of wounds is useful. Mistreatment or any delay in proper treatment of ulcerative sarcoidosis can be painful to patients. Corticosteroid therapy generally is effective. The authors present the case of a chronic sarcoid ulcer of the leg that posed a significant diagnostic chall