Abstract: The purpose of this study was to determine the histologic effects of retention sutures on wound healing in the rat. Defects measuring 6 and 7 cm wide were closed in 96 rats, either with simple sutures alone or with simple and retention sutures. Wound specimens were studied 2, 4, 7, and 25 days postoperatively, corresponding to different key stages of wound healing. Numbers of neutrophils, macrophages, lymphocytes, and fibroblasts were assessed, collagen density and arrangement patterns were examined, and evidence of wound infection and tissue necrosis was recorded. On Postoperative Day 4, wounds closed with retention sutures had a statistically increased number of inflammatory cells and fibroblasts (neutrophils p < 0.001; macrophages p = 0.001; lymphocytes p = 0.003; fibroblasts p = 0.004) and increased evidence of infection (p = 0.036). Additionally, long-term collagen formation was more likely to be disorderly when retention sutures were used (p = 0.039). Therefore, as rete

Abstract: Interstitial edema can impair wound healing. Compression is a well-documented, effective method to reduce interstitial edema associated with venous leg ulcers. However, there are few reports of its effectiveness in the management of foot wounds. The author presents 2 cases where multilayer compression bandages were instrumental in the treatment of foot wounds.

Abstract: Thirty consecutive patients with diabetes, ischemia, and chronic wounds of the lower leg, ankle, and foot were treated over an 18-month period. Patients had appropriate moist wound care, and their wounds failed to heal for 5 weeks or more (average = 11 weeks, range 5–60 weeks). All patients were considered candidates for limb salvage and were referred for a final effort to avoid amputation. Based on previous experiences in the authors’ wound care program, wounds were treated with debridement, silver-coated cloth dressings, and a dermal substitute. All wounds were colonized with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), or a combination of MRSA and another organism, usually pseudomonas or a streptococcus species. All cultures from the episodes of cellulitis were positive for VRE, MRSA, or both, and these were the suspected infecting organisms. All patients gave informed consent for their procedures and wound care. All patients

Abstract: Negative pressure wound therapy (NPWT) is a topical treatment used to promote healing in acute and chronic wounds by applying negative pressure to the wound bed. The most widely used NPWT product in the United States and Canada is Vacuum-Assisted Closure® (V.A.C.® Therapy™, KCI Inc., San Antonio, Tex). This article briefly reviews the literature on V.A.C. pressure levels, discusses the conventional pressure settings that are commonly used with the V.A.C., and explores new literature that challenges commonly recommended pressure settings associated with use of the V.A.C.