• Journal of Pharmaceutical Investigation
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• 제32권2호
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• pp.113-117
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• 2002

Cyto-toxic effect of silver sulfadiazine (Ag-SD) on keratinocytes and its implication on wound healing process were investigated in $2^{nd}$ degree bum hairless mouse model. As a dermal model, HaCat (immortalized keratinocytes) monolayer culture in DMEM with 10% FBS was used. Cyto-toxicity of Ag-SD was estimated by measuring the cell viability using neutral red assay after adding the drug. The $2^{nd}$ degree bum was prepared on hairless mouse back skin (1 cm diameter) and dressings with Ag-SD were applied for 96 hr. The process of re-epithelialization and the presence of inflammatory cells were investigated and histology with Hematoxylin-Eosin staining was performed. Ag-SD displayed highly cyto-toxic effect on cultured HaCat cells in a concentration dependent manner $(1-100\;{\mu}g/mL)$. Topical application of Ag-SD (2%) could control the infection: no inflammatory cells were observed in histology. However the cyto-toxic effect of Ag-SD on skin cells induced the impairment in epidermal regeneration.

• Archives of Plastic Surgery
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• 제36권5호
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• pp.548-554
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• 2009

Purpose: To evaluate clinical efficacy and safety of hyaluronic acid based autologous dermal fibroblasts (Hyalograft 3D) in the treatment of diabetic foot ulcers. Methods: A total of 28 patients with diabetic ulcers were randomized to either the control group with nonadherent foam dressings(n=14) or the treatment group with autologous tissue - engineered grafts(n=14). Weekly assessment contained vital sign checks, ulcer size measurements, and wound photos. At 12th week, percentages of complete wound healing and mean healing times were compared. Safety was also monitored by adverse events. Results: Complete wound healing was achieved in 84.6% of the treatment group and 23.1% of the control group (p<0.005). The mean times of closures for the treatment versus control groups were 6.1 weeks and 10.9 weeks, respectively. No adverse events related to the study treatment occurred. Conclusion: The use of hyaluronic acid based autologous fibroblast grafts was found to be a safe and effective treatment for diabetic foot ulcers.

• Archives of Plastic Surgery
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• 제48권3호
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• pp.338-343
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• 2021

Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.

• Journal of Yeungnam Medical Science
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• 제40권4호
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• pp.343-351
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• 2023

Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient's general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.

• Archives of Plastic Surgery
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• 제41권6호
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• pp.668-672
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• 2014

Background Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by altering wound microvascular blood flow. Although many studies using laser Doppler have found that NPWT increases perfusion, recent work using other modalities has demonstrated that perfusion is reduced. The purpose of this study was to investigate the influence of NPWT on tissue oxygenation of the foot, which is the most sensitive region of the body to ischemia. Methods Transcutaneous partial pressure of oxygen ($TcpO_2$) was used to determine perfusion beneath NPWT dressings of 10 healthy feet. The sensor was placed on the tarso-metatarsal area of the foot and the NPWT dressing was placed above the sensor. $TcpO_2$ was measured until it reached a steady plateau state. The readings obtained at the suction-on period were compared with the initial baseline (pre-suction) readings. Results $TcpO_2$ decreased significantly immediately after applying NPWT, but gradually increased over time until reaching a steady plateau state. The decrease in $TcpO_2$ from baseline to the steady state was 2.9 to 13.9 mm Hg (mean, $9.3{\pm}3.6$ mm Hg; $13.5{\pm}5.8%$; P<0.01). All feet reached a plateau within 20 to 65 minutes after suction was applied. Conclusions NPWT significantly decrease tissue oxygenation of the foot by 2.9 to 13.9 mm Hg. NPWT should be used with caution on feet that do not have adequate tissue oxygenation for wound healing.

• Archives of Plastic Surgery
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• 제42권1호
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• pp.59-67
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• 2015

Background Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. Methods Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. Results Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). Conclusions By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.

• Archives of Plastic Surgery
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• 제40권5호
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• pp.589-596
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• 2013

Background The treatment of pressure ulcers is complicated, given the various wound dressing products available. The cost of different treatments varies and the cost-effectiveness of each product has not been thoroughly evaluated. We compare two wound dressing protocols-alginate silver dressing (AlSD) and silver zinc sulfadiazine cream (AgZnSD) with regard to wound healing and cost-effectiveness Methods Patients with grade III or IV sacral or trochanteric pressure ulcers were eligible for this prospective, randomized controlled trial. The patients were randomized to receive one of the two dressings for an eight-week period. The criteria of efficacy were based on the Pressure Ulcer Scale for Healing (PUSH) scoring tool. The cost of treatment was also assessed. Results Twenty patients (12 women and 8 men) were randomly assigned to receive either AlSD (n=10) or AgZnSD cream (n=10). The demographic data and wound characteristics were comparable in the two groups. The two groups showed no significant difference in the reduction of PUSH score, wound size, or volume of exudate. The tissue type score was significantly lower in the AlSD group ($3.15{\pm}0.68-1.85{\pm}0.68$ vs. $2.73{\pm}0.79-2.2{\pm}0.41$; P=0.015). The cost of treatment was significantly lower in the AlSD group (377.17 vs. 467.74 USD, respectively; P<0.0001). Conclusions Alginate silver dressing could be effectively used in the treatment of grade III and IV pressure ulcers. It can improve wound tissue characteristics and is cost-effective.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.359-368
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• 2011

Purpose: Aquacel Ag$^{(R)}$ is a hydrofiber wound dressing integrated with ionic silver. Sorbact$^{(R)}$ is a hydrophobiccoated dressing that uses the hydrophobic interaction with microbes. In this study, we compared the wound healing effects and the antibacterial effects of Medifoam$^{(R)}$, Betadine soaked, Aquacel Ag$^{(R)}$ and Sorbact$^{(R)}$ dressings against MRSA-infected wounds. Methods: Eighty rats were divided into four groups: Medifoam$^{(R)}$; Betadine soaked; Aquacel Ag$^{(R)}$; and Sorbact$^{(R)}$. A $1.5{\times}1.5cm$ square full-thickness wound was made on the dorsum of each rat and infected with MRSA. Twenty-four hours thereafter, each dressing was applied to the wound and changed every other day. One, 3, 7, 11 and 15 days after the wound infection, swab culture grade, wound bed appearance score, and wound defect size change were evaluated, and 7 and 15 days after, histologic evaluation was compared between the groups. Results: The bacteria load of wounds in the Sorbact$^{(R)}$ group decreased earlier than in the other groups. The wound bed appearance score of the Sorbact$^{(R)}$ group also increased quicker, compared with the other groups. However, the size of wounds of the Aquacel Ag$^{(R)}$ group decreased more rapidly, compared with other groups. From the histologic point of view, there was no significant difference between Betadine soaked, Aquacel Ag$^{(R)}$ and Sorbact groups. Conclusion: The hydrophobic dressing using Sorbact$^{(R)}$ showed a more rapid reduction in the MRSA load and an elevation in the wound bed appearance score, but a slower decrease in wound size change due to detachment of wound bed tissue when the dressing was eliminated in the low exudate wound. The silver-containing hydrofiber dressing using Aquacel Ag$^{(R)}$ was more effective in ultimate wound size reduction, but some debris was trapped in the wound tissue and induced foreign body reaction in the high exudate wound. Thus, ongoing selection process of treatment based on the evaluation of the infectious wound state will be very important.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.407-412
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• 2008

Purpose: Hydrofluoric acid(HF) is one of the most dangerous mineral acids with the dissociated fluoride ions. The initial corrosive burn is caused by free hydrogen ion, and the second and more severe burn is caused by penetration of fluoride ions into subcutaneous tissues. Silver is a cation producing dressing, an effective antimicrobial agent, but older silver-containing formulations are rapidly inactivated by wound environment, requiring frequent replenishment. But, $Acticoat^{(R)}$ is a relatively new form of silver dressing which helps avoid the problems of earlier agents. The aim of this study is to evaluate effects of $Acticoat^{(R)}$, silver-containing dressing on the treatment for HF injury wound. Methods: From september 2006 to september 2007, the study was carried out with 10 patients who had HF partial thickness burns. $Acticoat^{(R)}$ dressing and 10% calcium gluconate wet gauze dressings in 10 cases. As a principle, in the emergency treatment, partial or complete removal of the nail and early bullectomy along with copious washing with normal saline was done, depending on the degree of HF invasion of the wound. Wound was dressed with $Acticoat^{(R)}$ and 10% calcium gluconate solution. The effect of dressing was investgated by serial bacterial culture and wound exudates assessment. Results: We therefore reviewed 10 cases of HF-induced chemical burns and treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae. Conclusion: As the industrial sector develops, the use of HF is increasing more and more, leading to increased incidences of HF-induced chemical burns. The education of patients regarding this subject should be empathized accordingly. In conclusion, $Acticoat^{(R)}$ dressing is a better choice for HF partial thickness burn injuries because of shorter healing time, less pain and more comfortable dressing.

• 구강회복응용과학지
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• 제36권1호
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• pp.21-28
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• 2020

목적: 치주포대는 감염 위험을 줄이고 치유를 증대 시킨다는 연구들이 있다. 본 연구는 치주 수술 후 부착형 창상 피복재의 사용이 치유 및 수술 만족도에 미치는 영향을 평가하고자 하였다. 연구 재료 및 방법: 치주 수술이 필요한 환자 28명을 대상으로 상악 또는 하악의 양측 사분면에 치주 수술을 시행하였다. Visual Analogue Scale (VAS)를 이용해 술 후 동통, 출혈, 식이 불편감, 지각 과민을 평가하고 추가적으로 작열감과 수술 만족도에 관해 평가하였다. 결과: 수술 후 동통, 출혈, 식이 불편감에 관한 VAS 평균 값은 창상 피복재 유무에 따라 각각; 동통: 2.82, 3.96 (P = 0.002), 출혈: 1.61, 2.54 (P = 0.008), 식이 불편감: 2.82, 4.18 (P < 0.001)로 창상 피복재를 적용한 그룹에서 불편감이 적었으며, 통계적으로 유의하였다. 작열감, 지각 과민과 창상 피복재 적용 유무 사이에 유의한 차이는 없었다. 수술 만족도는 75%에서 창상 피복재를 사용한 경우 높았다. 결론: 본 연구의 결과에 따르면, 창상 피복재의 사용유무와 작열감, 지각 과민과의 통계적 유의성은 없었으나 창상 피복재를 사용한 경우 술 후 동통, 출혈, 식이 불편감이 적었다.