Dear Editor:
  In the October 2011 issue, LaRosa and Fanelli “Successful Outpatient Treatment of Full-thickness, Necrotic, Lower-extremity Ulcers Caused by Traumatic Hematomas in Anticoagulated Patients” did a fine job describing their care of the four warfarin hematoma and necrosis patients. The use of layered skin substitute and negative pressure wound therapy (NPWT) has become more and more established for these wounds. It might be of interest to know that there is another use for NPWT in less severe cases of skin necrosis and slough associated with subcutaneous hematomas. In fact, if there is no necrosis at all, we have successfully managed these with aspiration (sometimes repeated) and light compression therapy. If there is necrosis, but it does not extend to the edge of the hematoma, then there is a cave-like space with a flue-like opening in the top where the eschar formed. After removing the eschar and the clot, NPWT has been very effective in closing the wound. Care is taken to put the foam in the opening, but not under the skin flaps. This has the virtue of coaxing the skin flaps to adhere down to the fat and, I believe, serve as a form of tissue expansion as well. The NPWT can draw the flap edges toward each other reducing the size of the wound by stretching the flap tissue centripetally from all directions.

Dear Editor:

  We read with interest the report by Shklyar et al¹ about the efficacy of ertapenem for treatment of diabetic foot infections. While ertapenem is an important part of the therapeutic armamentarium for these infections, the data presented do not justify the statement that “its use should be strongly considered in individuals with non-healing diabetic foot ulcers.”

Dear Editor:

     Dear Editor: In his excellent review of surgical treatment of the diabetic foot (Surgical management of the diabetic foot, WOUNDS, March 2008), Dr. Caputo correctly points out that decreasing pressure in the ulcer area is crucial to healing the foot ulcers. However, there is important information on successful tendon lengthening treatments including results on follow-up not mentioned in the article. I also have referenced some information published after this article. Lin et al¹ reported a study (Level-III) in which ulcers that did not heal with use of a total co

Dear Editor:

     I recently noticed an oversight in the article (Lountzis et al. Percutaneous flexor tenotomy—office procedure for diabetic toe ulcerations. WOUNDS. 2007;19[3]:64–68), which does not contain results on follow-up. The authors stated the procedure was “never described in an instructive fashion in the literature.” This author had previously published the technique and results on follow-up of this procedure in Wounds and elsewhere.^1–3 The editor, authors, and readers may find the excellent results on follow-up of interest.

    &

Dear Editor:

   This letter is in reference to Williams RL. Cadexomer Iodine: An Effective Palliative Dressing in Chronic Critical Limb Ischemia. WOUNDS. 2009;21(1):15–28.

   Studies performed on a limited number of demographically similar patients without a control arm or randomization may still provide useful clinical information when the results are carefully reviewed, scrutinized, and presented in an objective fashion.

   One of the conclusions drawn from this limited number of patients (n = 11) is that “cadexomer iodine is an effe

Dear Editor:

Regarding the article, Healing Rate as a Prognostic Indicator of Complete Healing: A Reappraisal, in the March, 2003, issue of WOUNDS, may I say that a rather simple mathematical approach I published in Dermatologic Surgery [1997;23:1219–25] entails Gilman’s and other workers’ empirical results from a theoretical approach.

Wounds heal by secondary intention from the edges, and so irrespective of the shape of the wound the rate of change in the area of the wound is proprotional to the area, since there are more cells involved in healing in larger wounds. Thus, we may wr

Dear Editor:

I would like to highlight several key aspects of the Alvarez paper entitled, “A Prospective, Randomized, Comparative Study of Collagenase and Papain-Urea for Pressure Ulcer Debridement,” which was published in WOUNDS in October, 2002 [2002;14(8):293-301]. It is my hope to provide the readers with additional information, which may allow them to better understand the study outcomes and conclusions. I also wish to exemplify the importance of following manufacturer’s recommendations for product usage.

Proper product application. Alvarez, et al., assumed both Colla

Editor’s Note: Please see the update for this case by Hall, Goldberg, and Phillips in the March 2004 issue (posted on the website under March 2004 content).

Dear Editor:

I agree that many ulcerated skin cancers are treated as benign wounds at least initially and a high index of suspicion is necessary [Hall G, Goldberg LJ, Phillips TJ. Chronic ulceration in a radiotherapy site (Diagnostic Dilemmas). WOUNDS 2003;15(10):346–50.]. A biopsy should be taken of any chronic wound that occurs in a previously irradiated field. I do not agree with much of the rest of the management in th

Dear Editor:

We would like to echo Dr. Gilman’s comments [Letter to the Editor, WOUNDS 2003;15(7):A16–18] regarding the article, “Healing rate as a prognostic indicator of complete healing: A reaapraisal” [WOUNDS 2003;15(3):71–76]. The equation that Dr. Gilman derived is correct and provides a rate independent of wound size or shape. Dr. Falanga’s equation gives the average radius of a wound between the two time periods. One equation determines the speed of healing; the other resembles the measure the Food and Drug Administration (FDA) requires: time to heal, which is dependent