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Best in Class: Scottsdale Wound Management Guide

Comprehensive pocket handbook offers differential diagnosis and treatment options at your fingertips

Malvern, PA (June 8, 2009) – Proper wound care management has become one of the top concerns for many clinicians across various medical specialties. Treatment is specific to the wound type, the patient and the long-term care plan and requires ongoing assessment. Read More

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Feature

Skin Substitutes in Burn Care

VOLUME: 20 PUBLICATION DATE: Jul 01 2008
Issue: 
7

Large surface area burns continue to be one of the most difficult and deadly problems the medical community faces today. Although major strides have been made in burn care throughout the years, many difficulties remain. Historically, some rather bizarre and egregious concoctions, at least by modern standards, have been applied to burns to promote healing. Barbara Ravage, author of Burn Unit, records and describes fascinating unguents and emollients that include using calf dung and black mud as topical burn treatments, as recorded in the Ebers Papyrus from the 1500s BC.1

Successful Treatment of Recalcitrant, Diabetic Heel Ulcers with Topical Becaplermin (rhPDGF-BB) Gel





Figure 1. Examples of heel ulcers in two patients before (A and C) and after (B and D) treatment with topical becaplermin (rhPDGF-BB).
VOLUME: 14 PUBLICATION DATE: Apr 10 2002
Issue: 
3

Introduction

Diabetic foot ulceration is a major complication of diabetes mellitus.1–5 Among the 10 to 15 million diabetic patients, two to three percent will develop foot ulcers each year, and approximately 15 percent will develop foot ulcers during their lifetimes.4,6–8 The four percent of the US population with diagnosed diabetes mellitus constitute 46 percent of the approximately 162,500 annual hospitalizations for foot ulcers.4,7 Foot ulcers precede 85 percent of all nontraumatic, lower-limb amputations, and half of all nontraumatic, lower-limb amputations in

Peripheral Arterial Perfusion: Is it Adequate for Wound Healing?

VOLUME: 20 PUBLICATION DATE: Aug 01 2008
Issue: 
8

     More than 8 million Americans are affected by peripheral arterial occlusive disease (PAOD).1 The presence of PAOD can seriously inhibit the ability of a lower extremity ulceration to heal. Many wounds will not heal unless adequate arterial perfusion is reestablished. Traditionally, revascularization was achieved by open surgical bypass,2 but recent advances in percutaneous angioplasty and stenting techniques have provided new options. These innovations offer promising new treatment alternatives for those patients who were previously considered unsuitab

Coumadin-Induced Skin Necrosis

VOLUME: 14 PUBLICATION DATE: Aug 15 2002
Issue: 
6

Introduction

Coumadin-induced skin necrosis (CISN) is a rare, unusual, and unpredictable integumentary complication of anticoagulant therapy. Also known as warfarin-induced skin necrosis (WISN), the dermatologic complication occurs in 0.01 to 0.1 percent of warfarin-treated patients. As anticoagulation is a component of therapy for many major chronic illnesses, recognition of the condition is crucial for prompt intervention in clinical practice. The syndrome also can result in substantial morbidity and possible fatality. This article addresses the historical background, pathogenesis, clinic

Evaluation of Platelet-Derived Growth Factor in a Rat Model of Ischemic Skin Wound Healing

Measurement of wound areas in ischemic wounds treated with vehicle or PDGF. Ischemic wounds were treated with a daily topical application of placebo (n = 18) or PDGF (n = 18). The wound areas were then measured on day 1, 3, 5, 7, 9, and 13 after surgery.
Time course of TNF-alpha expression measured in ischemic wounds treated with vehicle or PDGF. Tissue homogenates obtained on day 1, 3, 5, 7, 9, and 13 after surgery were assayed for TNF-alpha protein levels using the sandwich antibody capture ELISA techniTime course of active MMP-9 levels measured in ischemic wounds treated with vehicle or PDGF. Active MMP-9 levels in ischemic wounds treated with placebo or PDGF were determined by gelatin zymography on day 1, 3, 5, 7, 9, and 13 after surgery.
Measurement of wound areas in ischemic wounds treated with Ad-PDGF, saline, and Ad-LacZ controls. After a single application of Ad-PDGF (n = 6), saline (n = 6), or Ad LacZ (n = 6) in ischemic wounds, serial measurements of wound area were obtained on day
VOLUME: 14 PUBLICATION DATE: Jun 10 2002
Issue: 
5

Introduction

Chronic wounds affect an estimated two million people in the United States and are a major socioeconomic burden to the patient and the healthcare system, resulting in an estimated yearly expenditure of upwards of $3 billion.[1] The basic foundation for good wound care involves eliminating exacerbating factors, such as localized pressure in pressure ulcers and diabetic foot wounds and edema in chronic venous stasis ulcers. Standard wound care procedures include wound debridement, the use of dressings to maintain a moist environment, and topical antimicrobial agents when needed t

A Brief Historical Review of Flaps and Burn Reconstruction

VOLUME: 20 PUBLICATION DATE: Jul 01 2008
Issue: 
7

We are like dwarfs sitting on the shoulders of giants. We see more, and things that are more distant, than they did, not because our sight is superior or because we are taller than they, but because they raise us up, and by their great stature add to ours.”

                         —John of Salisbury, 1159 AD

Classic Examples of Flap and Burn Reconstruction

Perhaps one of the earliest and most notable fla

A Cost Analysis of a Living Skin Equivalent in the Treatment of Diabetic Foot Ulcers

VOLUME: 14 PUBLICATION DATE: May 10 2002
Issue: 
4

Introduction

It is estimated that 15 percent of patients with diabetes will develop foot ulcers and that 15 to 20 percent of those will progress to lower-extremity amputation.1,2 Indeed, it has been reported that foot ulcers precede 85 percent of all nontraumatic, lower-extremity amputations.3 The cost of treating diabetic foot ulcers (DFUs) is reported to range between $4,000.00 to $8,000.00 per ulcer episode and almost $28,000.00 over the first two years after diagnosis.1,3 The attributable cost of amputations is estimated at between $20,000.00 to $60,000.00.2,3

History of Metabolic Treatments in Burn Care

Pharmacological and nonpharmacological modulators of hypermetabolism
VOLUME: 20 PUBLICATION DATE: Jul 01 2008
Issue: 
7

Throughout the latter portion of the 20th century, major developments and advances within the specialty of burn care have been made. Several interventions and developments in reducing energy demands following burns have played a role in attenuating the metabolic response and reducing energy requirements. As a result, long-term function and prognosis have greatly improved. These interventions include early burn excision and wound closure with skin grafts or substitutes, early and aggressive enteral feeding, elevating environmental temperature to thermal neutrality, and pharmacological therapie

Closure of Partial-Thickness Facial Burns with a Bioactive Skin Substitute in the Major Burn Population Decreases the Cost of Ca

Figure 1. Admission photo after initial debridement of partial-thickness burn and placement of bilayered skin substitute, initially anchored with a soft gauze dressing.Figure 2. Day 2 post burn: Bilayered skin substitute well adhered to facial burn, including eyelids. Minimal exudate is evident.
VOLUME: 14 PUBLICATION DATE: Aug 15 2002
Issue: 
6

Introduction

Management of partial-thickness burns of the face requires extensive healthcare resources, especially in the endotracheal-intubated patient, to control pain, avoid infection, and minimize scarring.1-4

Standard care for partial-thickness burns is the frequent application of antibiotic ointments and cleansing to avoid exudate buildup and infection.3,4 This process is not only time consuming but requires considerable analgesia and involves the potential for endotracheal tube dislodgement with patient movement.

Immediate wound closure of the partial-thickness facial burn can

Assessment of a Wound Cleansing Solution in the Treatment of Problem Wounds

VOLUME: 20 PUBLICATION DATE: Jun 01 2008
Issue: 
6

Problem wounds are rarely affected by a single factor.1 Delay in closure of a wound can result from problems such as poor perfusion, infection, pressure, and chronic venous hypertension.

To support wound healing, systemic factors and local factors should be addressed.1–4 Local barriers to healing must be removed before attempting wound closure.

Sometimes a wound may present as healthy and granulating and yet does not heal. This could be due to the wound bed containing nonviable (senescent) cells or cells of the wrong phenotype. In either cas



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