Index: WOUNDS 2011;23(12):364–368

  Abstract: The pathogenesis of foot ulceration in patients with diabetes involves the interplay of neuropathy, vasculopathy, and immune dysfunction. Autonomic neuropathy results in loss of pain sensation, decreased sweating, and the development of brittle skin, which predisposes these patients to foot trauma. As a result, the traumatized tissue progresses to necrosis and subsequent ulceration. Once an ulcer is present, the vascular supply to the foot plays an integral role in healing. Foot ischemia in patients with diabetes may be attributed to atherosclerotic macrovascular disease and additional microcirculatory dysfunction. The following report will review the role of open bypass surgery addressing macrovascular problems for limb salvage.

Index: WOUNDS 2011;23(12):357–363

  Abstract: Although operative bypass is still considered the “gold standard” for treating peripheral arterial disease, over the last decade endovascular interventions have become more popular and now represent the vast majority of peripheral arterial treatments being performed. Open bypass is associated with an unacceptable morbidity and mortality that is not encountered to the same extent with endovascular techniques. However, outcomes of endovascular intervention are dependent upon the location and nature of the lesion, as well as possibly the technologies available to treat the lesion and the experience of the interventionalist. In correctly selected patients, endovascular techniques should be the primary management employed for critical limb ischemia. The group of patients that would benefit from endovascular techniques continues to expand with new data constantly emerging. This article will review the current endovascular techniques currently being employed, focusing on the indication for specific intervention.

Index: WOUNDS 2011;23(7):192–203

Abstract: Dermatological problems occur with increased frequency in individuals with diabetes mellitus (DM). Cutaneous manifestations may be the first presenting sign of DM or even precede the diagnosis by many years. The main changes in the skin are due to alterations of microcirculation, the nervous system, and collagen. The most common skin problems in DM are acanthosis nigricans, necrobiosis lipoidica, diabetic dermopathy, scleredema, and granuloma anulare. The purpose of this review is to describe the molecular and anatomopathological alterations occurring at the skin during DM, and to illustrate the most important and common clinical skin manifestations in patients with DM.

Index: WOUNDS 2011;23(7):204–215

Abstract:
  Soft tissue wound healing is a complex and well-orchestrated sequence of events on multiple biological levels involving systemic, cellular, and molecular signals. The physiological process of wound healing leads to full tissue repair and regeneration with nearly complete restoration of tissue integrity and functionality.

  Wounds, particularly among the elderly population, can show delayed or disturbed healing; however, delayed or disturbed healing is also evident in patients with comorbidities such as diabetes, atherosclerosis, venous/arterial insufficiency, reduced mobility due to chronic infirmity, and hypercholesterolemia.

  Chronic wounds consist of a wide range of inflammatory and degenerative conditions of the musculoskeletal system. Management of chronic, difficult to heal, or non-healing soft tissue wounds requires a multidisciplinary approach. Often these treatment options have inconsistent and irregular outcomes. Poor response or failure to conservative treatments places a substantial burden on patients, their families, the healthcare system, and society in general. Therefore, the development of a new, effective method of treatment to improve healing of problematic wounds and reduce treatment-related costs is extremely valuable; ne such therapy is Extracorporeal Shockwave Therapy (ESWT).

  ESWT acts through mechanotransduction, which produces therapeutic benefits through complex biological pathways including neovascularization and tissue regeneration in the therapeutic target. Published data thus far suggest that the application of ESWT for soft tissue indications is safe, reliable, cost-effective, and clinically efficacious. The exact biological effects of ESWT on human cells are not completely understood, but are currently undergoing further study.

  The aim of this review is to provide a general overview of shockwave therapy and its role in the treatment of acute and chronic soft tissue wounds.

Index: WOUNDS 2011;23(6):147–159

Abstract: Many healthcare providers may overlook or even be unaware of most drug-to-drug interactions. Recognizing the existence of drug interactions with the use of hyperbaric oxygen can empower a clinician with knowledge to avoid dangerous interactions that may result in hazardous, negative patient outcomes. Hyperbaric oxygen therapy (HBOT) can reduce the efficiency of certain drugs or make drug therapy more unpredictable. Methods. This review offers the physician information regarding prescription drug interactions with hyperbaric oxygen therapy. First, mechanisms found in the medical literature of potential drug interactions with the use of hyperbaric oxygen are presented. Second, the 100 most frequently prescribed medications in 2009 are reviewed regarding hyperbaric oxygen. Lastly, a table of these 100 medications and any reported effects of hyperbaric oxygen on each drug are provided. Results. The total number of different medications in this review was 69. Reported drug interactions resulting from the effects of hyperbaric oxygen occurred with 38 of the 69 drugs that were reviewed (55%). Descriptions of the possible effects of hyperbaric oxygen are presented for each reviewed medication. Thirty-one medications of the 69 review drugs (44.9%) did not have any description of the possible effects of hyperbaric oxygen. A few references recommended avoidance of hyperbaric oxygen because co-administration of these drugs predisposes the patient to oxygen toxicity. Conclusion. Hyperbaric oxygen therapy may interact with medications through pharmacokinetic or pharmacodynamic mechanisms. This review offers the healthcare provider information regarding potential drug interactions. Empowered with this information, clinicians may assist their patients to maximize pharmacologic outcomes by avoiding these reported harmful interactions.

Oxygen is a powerful substrate and signal. The ability to understand and control this vital substance will open new avenues of therapy for multiple diseases. New insights into cutaneous oxygenation suggest that there may be a sound basis for topical oxygen therapy. The indications for systemic oxygen therapy are expanding as well, as research delves into the role of oxygen in pathophysiologic conditions. Previous therapeutic approaches simply relied on providing oxygen as a critical substrate for fundamental metabolic processes. New therapies that also utilize oxygen as a needed signal will further expand the indications for oxygen therapy.

Dr. Group is from the Department of Dermatology, The University of Texas Medical Branch, Galveston; Dr. Lea is from St. Luke’s Center for Wound Care and The University of Texas Medical Branch, Galveston.

Abstract:

Recent evidence suggests that stem cells derived from bone marrow have the potential to treat many disorders given their plasticity and ability to differentiate into various types of tissues, including skin cells. Stem cells are known to participate in cell migration and proliferation, contributing to the repair and regeneration of injured tissue, as observed in chronic wounds.

Abstract:

Bone regeneration and repair via mesenchymal stem cells (MSC) are intriguing and challenging thoughts today.Many have claimed that MSCs are powerful tools for bone regeneration due to their ability to differentiate into osteoblasts. Seeking all three essential bone growth properties for successful bone remodeling and repair—osteoinductive, osteoconductive, and osteogenic—has been a complex task; however, they are essential in difficult surgical situations with poor host bone tissue.

  Abstract: The open nonhealing wound is a persistent challenge to physicians. Infections, foreign bodies, osteomyelitis, and skin coverage of repaired structures remain problems. As the body ages, the elderly are prone to the development of pressure sores and foot ulcers, particularly patients with diabetes. Many elderly patients will have comorbid conditions making closure of these wounds difficult. The authors have more than 100 combined years of experience treating wounds. Throughout their long careers the authors have treated numerous wounds with various types of methods.