Volume 24 - Issue 1 - January 2012
Adipose Derived Regenerative Cell Therapy for Treating a Diabetic Wound: A Case Report
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Abstract: Background. Recent studies have reported on the use of adipose derived regenerative cells (ADRC) as a therapeutic method in wound healing. The present study introduces the first application of successful ADRC therapy for a diabetic foot wound. Case Report. A 63-year-old woman with diabetes mellitus complaining of an opened necrotic wound in the plantar aspect of the right foot was admitted by another surgeon for debridement surgery. Despite multiple efforts, a Chopart’s amputation was performed to salvage rest of the foot. In the early postoperative period, a 2 cm x 2 cm circular ulcer at the heel region and a 1 cm x 2 cm unhealed wound at the previous incision site had formed. Due to resistant diabetic ulcers, the patient was introduced to ARDC therapy (informed consent was obtained). The Celusion System™ (Cytori Therapeutics, Inc, San Diego, CA) was used for autologous generation of ARDC cells—1 cc of the ARDC was mixed with 40 cc of fat graft. Afterward, the ARDC-enriched fat graft was introduced to the heel and plantar region to restore the deficient glabrous tissue. The remaining 4 cc of ARDC were equally injected in a radial fashion to the wound edges. Results. In the postoperative follow-up, accelerated wound healing was observed and the ulcers were completely healed after 4 weeks of ARDC treatment. Conclusion. ARDC therapy has the potential to be a promising new therapeutic modality for treating diabetic wounds.
Global Wound Outcomes
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Applying recognized outcomes management principles can transform the process of caring for wounds into getting results that matter for patients, providers, practice settings, or nations struggling to meet increasing wound care challenges. Documenting and reviewing outcomes in the context of best available evidence frees wound care professionals to replace protocols that aren’t working with those that propel progress toward wound and patient goals.
Previous WOUNDS issues focused on wound outcomes, defined outcomes research and explored its implementation around the world. In the following pages, authors explore how to document and implement wound outcomes in practice: listing choices of wound outcomes to measure, describing how outcome databases add value to one’s practice, and comparing wound outcomes in one’s practice to relevant published benchmarks.
Producing Precise Outcomes in Randomized, Controlled Trials and Clinical Studies
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Index: WOUNDS 2012;24(1):3–9
Abstract: Evidence-based medicine (EBM) uses the current best evidence to inform decisions about care of individual patients, healthcare procedures, and technologies. The “gold standard” for optimal evidence in the Cochrane system is Level I randomized, controlled trials (RCTs) and meta-analyses of several RCTs. In order to achieve this level of evidence, one of the most important measures is the use of outcomes/endpoints. This article will provide, in short form, recommendations on how to achieve rigorous endpoints or outcomes in studies on wound management. Consistency in measuring endpoints/outcomes improves quality of care. To achieve such consistency it is important to 1) use predefined and robust outcomes; 2) adapt outcomes to the intervention under investigation; and 3) use the best evidence available. Also, it is emphasized that the use of complete wound closure or healing as an outcome measure is not always possible or suitable. Remaining patient-focused clarifies which other endpoints are relevant. Finally, “basic care” must be clearly defined and standardized when used as a comparative intervention in a RCT. In conclusion, the use of correct, clinically relevant outcomes or endpoints is of vital importance when establishing optimal evidence in wound healing and care.
Wound Care Outcomes and Associated Cost Among Patients Treated in US Outpatient Wound Centers: Data From the US Wound Registry
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Index: WOUNDS 2012;24(1):10–17
Abstract: Data from registries can be especially useful in the evaluation of healthcare effectiveness. Thus, the goal of this study was to report on use of the US Wound Registry to investigate the outcomes of a broad population of patients undergoing treatment. Using a 5-year slice of de-identified data from electronic health records originating from 59 hospital-based outpatient wound centers in 18 states, outcomes, patient and wound variables, and costs for facility and physician fees and procedures were analyzed for 5240 patients with 7099 wounds. Mean patient age was 61.7 years with 52.3% being male and the majority Caucasian (73.1%) and Medicare beneficiaries (52.6%). The mean number of serious comorbid conditions per patient was 1.8, with the most common being diabetes (46.8%), obese or overweight (71.3%), and having cardiovascular or peripheral vascular disease (51.3%). More than 1.6% of patients died in service or within 4 weeks of the last visit. Almost two thirds of wounds healed (65.8%) with an average time to heal of 15 weeks and 10% of wounds taking 33 weeks or more to heal. The average wound surface area was 19.5 cm2. Half of wounds that healed did so with only the use of moist wound care (50.8%) and without the need for advanced therapeutics. Mean cost to heal per wound was $3927 with jeopardized flaps and grafts the most expensive ($9358). This Registry would seem ideal for comparative effectiveness research in wound care, as it includes patients often excluded from randomized controlled trials and reflects actual practice.
Benchmarking Chronic Wound Healing Outcomes
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Index: WOUNDS 2012;24(1):18–24
Abstract: Background. Benchmarking chronic wound outcomes (comparing outcomes achieved in practice to those reported elsewhere) begins with documenting and summarizing individual and cohort outcomes of one’s practice, continues with searching for comparable results, and is completed by improving care if benchmark outcomes exceed one’s own. Objective. Literature reviewed illustrated this cycle of document-summarize-search-compare outcomes of a recognized healing measure—percent completely healed within 12 weeks of care. Methods. MEDLINE and Association for the Advancement of Wound Care (AAWC) Venous and Pressure Ulcer Guidelines and Evidence Table searches identified example healing benchmarks from randomized controlled trials (RCTs) with 100 subjects/group with a diabetic foot ulcer (DU), venous leg ulcer (VU), or pressure ulcer (PU). Graphed benchmarks were compared to outcomes reported for same-etiology cohorts to illustrate institutional and patient-level benchmarking. Results. Cohorts in some settings reported results similar to the best RCT results for DU and VU. More adequately powered PU RCTs are needed to provide full- and partial-thickness PU benchmarks. RCTs have strengths and limitations as benchmarking resources. Risk-adjusted analyses would improve benchmarking. Conclusion. Documenting and comparing outcomes to published results can support current interventions, highlight opportunities for improvement, or ensure that interventions applied are working to meet individual patient and wound care goals.
Be an Encourager!
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Dear Readers,
As we look to begin a new year, many think of making resolutions. I have never been a big fan of New Year’s resolutions because I believe that living your life to a standard should be an everyday task, and not something you think about once a year. However, this year I want to encourage all of you to make a resolution with me. I want each of us to consciously make an effort to encourage one another. To encourage means to inspire with confidence; to stimulate by assistance or approval; to aid, help, promote, or advance.1 In these days of cutthroat competition and the attitude of doing anything necessary to get ahead, trying to help others be better is rarely something considered. How much of our conversation involves talking about the negatives of people and emphasizing their shortcomings or failures? We do this as if we have none of our own! I want all of us to change that this year.
Evidence Corner
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Dear Readers:
Split-thickness skin grafts are the most common plastic surgery procedure used to replace injured or missing skin. Split-thickness skin-graft donor sites (SSDS) are often considered a “standard” partial-thickness acute wound that readily reepithelizes with minimal complications. Conversely, large, painful SSDS are often reported as unhealed for 2 to 3 weeks. SSDS typically heal in 6.8 to 9.05 days when dressed with moisture-retentive hydrocolloid or film dressings, or 10.5 to 12.9 days if dressed with impregnated gauze. Patients experience less pain and fewer infections for their SSDS when hydrocolloid or film dressings are used.2 Aside from these recognized benefits of moist wound healing what other aspects of care affect SSDS outcomes? Two recent publications reviewed in this month’s Evidence Corner explore this question.
Quarterly Meetings Calendar
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January–March 2012
New York Podiatric Clinical Conference 2012
Location: New York, NY
Date: January 27–29
This year’s program offers Doctors of Podiatric Medicine, Residents, Students, Assistants, and other healthcare professionals the opportunity to attend a vital educational conference that addresses many topics.
www.nyspma.org/pdf/2012DPMRegBrochure.pdf
The John A. Boswick, MD Burn and Wound Care Symposium
Location: Maui, Hawaii
Date: February 6–10
AAWC News
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Wound Care Glossary Available
AAWC Members: Are you enjoying your advance access to our Wound Care Glossary? Login to our Members-Only area at www.aawconline.org to view this new year’s gift to you. With more than 300 words and terms, this glossary will be sure to keep us all on the same page when talking about wounds and treatment options. Nonmembers will have access in the future.
Limited-time Discount on 2012 Clinician Membership Dues
In celebration of the SAWC’s 25th Anniversary in Atlanta, April 19–22, the AAWC is offering clinician members a 25% discount on membership dues. Join or renew before April 30 to take advantage of the savings. The new dues rate is $108.75 instead of $145.00. This limited-time, clinician price is the lowest in more than 5 years. Then, if you are able, take that savings and join us in Atlanta for an extra 20% discount on your registration fee. Register for the SAWC early to save even more! Or, if it is more convenient, join us at SAWC in the fall in Baltimore, September 12–14! View more information at www.sawc.net. The promotion ends May 1.
New Products and Industry News
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PRODUCT NEWS
FDA Clears Single-Use Negative Pressure Wound Therapy System
Smith & Nephew (London, UK) received US Food and Drug Administration (FDA) clearance of the pocket-sized PICO system, a single-use negative pressure wound therapy (NPWT) system. It is cleared for use both in a hospital and homecare setting, and expands the use of NPWT from the traditional wound care population to include a wider range of patients undergoing orthopedic surgery, plastic surgery, and general surgical procedures. The system has already been launched in Europe, Canada, and Australia.
Visit http://global.smith-nephew.com for more information.
