Improving the results of treatment of patients with purulent diseases of fingers and hands using laser irradiation and photodynamic therapy

Despite the evolution in modern surgery and in pharmaceutical industry, purulent pathology of the hand is occupying a leading position for many years among all diseases with which patients are admitted to hospitals. Over the years, medical care for such patients has been improving. A high social and economic significance of this problem makes surgeons to continue searches of new directions not only in surgical techniques, but also in postoperative wound management to improve outcomes in patients with purulent diseases of the hand.The purpose of this work is to assess results of care of patients with purulent finger and hand diseases treated with laser light necrectomy and photodynamic therapy. A comparative analysis of wound process dynamics and treatment outcomes in 198 patients with hand purulent diseases who had been admitted to Moscow City Hospital No. 4 was made by the authors. All patients were divided into four groups depending on the curative modality. In Group 1 (n = 53), a wound was sutured after surgery, and a drainage-lavage system (DLS) was installed; in Group 2 (n = 50), a wound was not sutured because of contraindications to suturing; in Group 3 (n = 46), patients had laser necrectomy after which a wound was sutured and DLS was installed; in Group 4 (n = 49), a wound was not sutured because of contraindications like in Group 2, but it was treated with antiseptic dressings and photodynamic therapy at an early postoperative period. Various aspects of the effectiveness of laser techniques have been analyzed: dynamics of wound healing, changes in wound defect size, level of pain syndrome assessed by VAS, changes in clinical blood tests, changes in wound exudate cytological picture as well as changes in wound microflora. Acceleration of wound healing was noted in all patients who were treated with laser light what, consequently, shortened their inpatient stay. Laser light also changed cytological and microbiological patterns of wound exudate, as evidenced by the decrease of wound detritus and by the decrease of microbial content in the wound. In patients, who were treated with laser light, less pain syndrome was registered immediately after laser technique application.The obtained findings demonstrate a positive effect of laser necrectomy with DLS at wound process as well. Photodynamic therapy significantly improved results in patients with open wound management on the hand and fingers. Laser techniques have good perspectives in purulent surgery of the hand.

Synthesis and Characterization of Nonwoven Cotton-Reinforced Cellulose Hydrogel for Wound Dressings

Hydrogels wound dressings have enormous advantages due to their ability to absorb high wound exudate, capacity to load drugs, and provide quick pain relief. The use of hydrogels as wound dressings in their original form is a considerable challenge, as these are difficult to apply on wounds without support. Therefore, the incorporation of polymeric hydrogels with a certain substrate is an emerging field of interest. The present study fabricated cellulose hydrogel using the sol–gel technique and reinforced it with nonwoven cotton for sustainable wound dressing application. The nonwoven cotton was immersed inside the prepared solution of cellulose and heated at 50 °C for 2 h to form cellulose hydrogel–nonwoven cotton composites and characterized for a range of properties. In addition, the prepared hydrogel composite was also loaded with titania particles to attain antibacterial properties. The Fourier transform infrared spectroscopy and scanning electron microscopy confirmed the formation of cellulose hydrogel layers inside the nonwoven cotton structure. The fabricated composite hydrogels showed good moisture management and air permeability, which are essential for comfortable wound healing. The wound exudate testing revealed that the fluid absorptive capacity of cellulose hydrogel nonwoven cotton composite was improved significantly in comparison to pure nonwoven cotton. The results reveal the successful hydrogel formation, having excellent absorbing, antimicrobial, and sustainable properties.

Impact of human wound exudate on the bactericidal efficacy of antiseptic products in quantitative suspension according to the European standard (DIN EN 13727)

By default, antimicrobial efficacy of antiseptics used in wound management is tested in vitro under standardized conditions according to DIN EN 13727, with albumin and sheep erythrocytes used as organic challenge. However, it is not clear whether these testing conditions do adequately reflect the wound bed environment. Therefore, the aim of this study was to compare the efficacy of different antiseptic products based on octenidine dihydrochloride (OCT), polyhexamethylene biguanide (PHX), and povidone-iodine under challenge with human wound exudate instead of standardized organic load in an in vitro setting according to DIN EN 13727. Bactericidal efficacy of the tested products was reduced to different extend when challenged with human wound exudate compared to standardized conditions. Overall, OCT-based products showed the necessary germ count reductions at the shortest exposure times (e.g., 15 seconds for octenisept®). PHX-based products were the least efficient. In addition to the protein content, other components of wound exudates, such as the microflora, seem to influence the efficacy of antiseptics. This study demonstrates that standardized in vitro test conditions only partly reflect actual wound bed conditions. Consequences for an amendment of existing test methods adapting organic load requirements and the feasibility of standardization of wound exudates are to be discussed.

Influence of pH on the dynamics of the wound process in the postoperative period

The wound process is a set of stages that successively replace each other and as a result lead to epithelization of the skin and closure of the wound defect. The development of the wound process is influenced by the pH value of the wound contents, which determines the rate of all biochemical reactions occurring in the wound. In the course of the study, patients were measured for wound exudate in the postoperative period. It was noted that in patients with the initial values of the hydrogen index, which was 7, a more effective healing process of the postoperative wound was observed, while in patients with the initial pH value of 8, the wound process took a protracted character.

C-reactive Protein Levels in Plasma and Chronic Venous Ulcer Exudate of Persons Who Inject Drugs: A Pilot Study

Background. Persons who inject drugs (PWID) in the groin, legs, and/or feet are at high risk for chronic venous ulcers (CVUs). The plasma C-reactive protein (CRP) level is a marker of systemic inflammation. Objective. This pilot study examined CRP levels in plasma and CVU exudate of PWID. The aims were to (1) compare levels of CRP in plasma and exudate; (2) examine if the CRP level in exudate changed over 4 weeks with wound treatment; and (3) examine the relationship of the exudate CRP level with CVU area, CVU age, number of CVUs, and number of comorbidities. Materials and Methods. Persons who inject drugs seeking wound care were enrolled in this Institutional Review Board approved prospective, longitudinal, descriptive study. A blood sample was collected on the first visit (week 1); the plasma was then separated. Wound exudate was collected on swabs during the first visit (week 1) and 4 weeks later (week 4). All samples were stored at -80° C. Samples were eluted from swabs using mass spectrometry grade water then aliquoted for CRP analysis. Results. The participants of the study included 14 PWID (mean age, 62.14 ± 4.52 years; mean number of comorbidities, 5.71 ± 1.90; and mean number of ulcers 2.07 ± 1.07 that were present for a mean of 7.96 ± 11.91 years without healing). C-reactive protein level in plasma was a mean of 6.47 ± 8.56 mg/L, with lower levels found in wound exudate but highly correlated (rho = .925). Exudate CRP levels decreased from week 1 to week 4, and the 2 were highly correlated (rho = .895). Exudate CRP level week 1 was not significantly related to wound area, wound age, number of ulcers, or number of comorbidities. Conclusions. Plasma and exudate CRP levels were highly correlated. Exudate CRP levels decreased across time. Future large-scale wound healing studies should examine CRP levels over a longer duration and as they correlate to wound healing.

AMNIOTIC MEMBRANE-AS AN EFFECTIVE BIOLOGICAL WOUND COVERING

Burns are one of the most widespread traumatic injuries. The number of victims of burns worldwide is steadily increasing. All this determines the search for new highly effective methods of treating burned patients. (1.2.4.5.20.)The main requirements for wound healing are the creation of an optimal microenvironment for wound healing, high absorption capacity for wound exudate, the ability to prevent the ingress of microorganisms, sufficient permeability to gases, water vapor, elasticity, pyrogenicity, lack of antigen, toxic, local irritants and allergic reactions.Keywords:obligate component, amniotic membrane, hematocrit value, burn treatment, amnion

Clinical performance and quality of life impact of an absorbent bacteria-binding foam dressing

The aim of this prospective multicentre observational study was to assess the clinical performance and safety of Cutimed® Siltec® Sorbact® absorbent bacteria-binding foam dressing in wound healing and its impact on patients' quality of life (QoL). The study was conducted under routine clinical conditions in 5 study sites in Germany and Poland. Each patient with a venous leg ulcer (VLU) or a diabetic foot ulcer (DFU) was observed for 28 days (initial visit and close-out visit, as well as 3 control visits). An assessment of QoL of the patient was undertaken before and after the study. Sixty-two patients were included in the statistical analysis. Clinicians rated the following assessment parameters in relation to Cutimed Siltec Sorbact dressings as ‘very good’ to ‘good’: wearing comfort (rated by the patient), application and removal, exudate absorption with or without compression and fluid retention capacity with or without compression and infection management. The use of Cutimed Siltec Sorbact dressing was beneficial in absorbing wound exudate (chi-square=28.45, P value<0.001), reduction of the viscosity of wound exudate (chi-square=25.63, P value<0.001), and there were more intact, less macerated, red and oedematous wound surroundings. There was also a 9% decrease in the number of infected wounds at the close-out visit. Analysis of the Wound-QoL measures demonstrated a reduction in the perception of performance parameters associated with wound infection. It can therefore be deduced that the use of Cutimed Siltec Sorbact was effective in wound management and had positive implications for patients' QoL.

Rapid Detection of Pathogens in Wound Exudate via Nucleic Acid Lateral Flow Immunoassay

The rapid detection of pathogens in infected wounds can significantly improve the clinical outcome. Wound exudate, which can be collected in a non-invasive way, offers an attractive sample material for the detection of pathogens at the point-of-care (POC). Here, we report the development of a nucleic acid lateral flow immunoassay for direct detection of isothermally amplified DNA combined with fast sample preparation. The streamlined protocol was evaluated using human wound exudate spiked with the opportunistic pathogen Pseudomonas aeruginosa that cause severe health issues upon wound colonization. A detection limit of 2.1 × 105 CFU per mL of wound fluid was achieved, and no cross-reaction with other pathogens was observed. Furthermore, we integrated an internal amplification control that excludes false negative results and, in combination with the flow control, ensures the validity of the test result. The paper-based approach with only three simple hands-on steps has a turn-around time of less than 30 min and covers the complete analytical process chain from sample to answer. This newly developed workflow for wound fluid diagnostics has tremendous potential for reliable pathogen POC testing and subsequent target-oriented therapy.

A modern approach to the treatment of burns

Background. Wound healing as soon as possible is an ultimate goal of treating patients with burns. European guidelines of recent years state that a humid environment is optimal for the treatment of burns. Objective. To describe the modern approach to the treatment of burns. Materials and methods. Analysis of literature sources on this topic. Results and discussion. Over the last 15 years, there has been a significant breakthrough in the armamentarium of wound dressings (WD). The main advantages of modern WD include simplification of the dressing procedure, control of infection, removal of secretions from the wound, creating a favorable environment for healing, and accelerating the cleansing or healing of wounds. Such WD include skin substitutes and interactive dressings. Skin substitutes are divided into synthetic, biological and combined, as well as in temporary and permanent. Dressings, in turn, can be super-absorbent, spongy, hydrocolloid, gel, atraumatic mesh, semi-permeable, etc. After treating wounds with an aqueous antiseptic, such as Dekasan (“Yuria-Pharm”), the exfoliated epidermis is removed and an atraumatic dressing is applied. Sometimes a single application is sufficient for epithelialization of superficial wounds. Dermal burns affecting the epidermis and dermis are burns with incomplete injury depth and can heal on their own. After dermabrasion, the lyophilized xenoskin is soaked in saline with the addition of Dekasan and instantly fixed to the wound surface. Subsequently, the wound is healed by primary tension. Dermabrasion of the wound can be performed mechanically (dry napkin, wet napkin with Dekasan, brush or metal sponge) or surgically (scalpel, dermatome, Water Jet device). Nowadays, it is believed that the creation of a moist environment above the surface of the burn allows epithelial cells to spread horizontally on a thin layer of wound exudate, accelerating wound healing. Hydrogel dressings and shape-resistant hydrogel coatings are widely used in the treatment of limited superficial and border burns. In the exudation phase, a wound coating with nanosilicon is used, which actively absorbs the wound exudate. There are also hydrogel face masks, which have a prolonged effect, cool the damaged area in 60 seconds, eliminate pain, prevent blisters, reduce the likelihood of infection and the spread of burns deep into the tissues. The process of tissue repair and wound healing consists of three phases, which are interrelated and may coincide in time: the inflammatory phase, the proliferation phase and the remodeling phase. Wound healing is affected by the pH of the environment, as many processes, namely, activity of matrix metalloproteinases and their tissue inhibitors, activity of fibroblasts, microbial proliferation, depend on this factor. Interactive WD change the pH of the wound. Conclusions. 1. WD, which support wounds in a humid environment, are an effective means of regulating the wound process. 2. Low pH of wounds changes the qualitative and quantitative composition of the microflora, reduces the microbial contamination of wounds in 100 times. 3. Keeping wounds under modern WD does not increase the level of endogenous intoxication, but on the contrary, improves the course of burn disease. 4. Humid environment promotes the penetration of neutrophilic granulocytes with high enzymatic activity.