 |
|
Healing of Diabetic Foot Ulcers and Pressure Ulcers With Human Skin Equivalent
A New Paradigm in Wound Healing
Harold Brem, MD;
Jeroen Balledux, MD;
Tamir Bloom, BA;
Morris D. Kerstein, MD;
Larry Hollier, MD
Arch Surg. 2000;135:627-634.
Hypothesis In patients with diabetic foot and pressure ulcers, early intervention with biological therapy will either halt progression or result in rapid healing of these chronic wounds.
Design In a prospective nonrandomized case series, 23 consecutive patients were treated with human skin equivalent (HSE) after excisional debridement of their wounds.
Setting A single university teaching hospital and tertiary care center.
Patients and Methods Twenty-three consecutive patients with a total of 41 wounds (1.0-7.5 cm in diameter) were treated with placement of HSE after sharp excisional debridement. All patients with pressure ulcers received alternating air therapy with zero-pressure alternating air mattresses.
Main Outcome Measure Time to 100% healing, as defined by full epithelialization of the wound and by no drainage from the site.
Results Seven of 10 patients with diabetic foot ulcers had complete healing of all wounds. In these patients 17 of 20 wounds healed in an average of 42 days. Seven of 13 patients with pressure ulcers had complete healing of all wounds. In patients with pressure ulcers, 13 of 21 wounds healed in an average of 29 days. All wounds that did not heal in this series occurred in patients who had an additional stage IV ulcer or a wound with exposed bone. Twenty-nine of 30 wounds that healed did so after a single application of the HSE.
Conclusions In diabetic ulcers and pressure ulcers of various durations, the application of HSE with the surgical principles used in a traditional skin graft is successful in producing healing. The high success rate with complete closure in these various types of wounds suggests that HSE may function as a reservoir of growth factors that also stimulate wound contraction and epithelialization. If a wound has not fully healed after 6 weeks, a second application of HSE should be used. If the wound is not healing, an occult infection is the likely cause. All nonischemic diabetic foot and pressure ulcers that are identified and treated early with aggressive therapy (including antibiotics, off-loading of pressure, and biological therapy) will not progress.
From the Department of Surgery, The Mount Sinai Medical Center, New York, NY.
This study was supported in part by a research grant from Pegasus Airwave Inc, Boca Raton, Fla (Dr Brem).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Cutaneous tissue engineering and lower extremity wounds (part 2).
Dini et al.
INT J LOW EXTREM WOUNDS 2006;5:27-34.
ABSTRACT
What is the future of diabetic wound care?
Sweitzer et al.
The Diabetes Educator 2006;32:197-210.
ABSTRACT
| FULL TEXT
Molecular Pathogenesis of Chronic Wounds: The Role of {beta}-Catenin and c-myc in the Inhibition of Epithelialization and Wound Healing
Stojadinovic et al.
Am. J. Pathol. 2005;167:59-69.
ABSTRACT
| FULL TEXT
Engraftment of a vascularized human skin equivalent
SCHECHNER et al.
FASEB J. 2003;17:2250-2256.
ABSTRACT
| FULL TEXT
Adverse Effects of Dietary Glycotoxins on Wound Healing in Genetically Diabetic Mice
Peppa et al.
Diabetes 2003;52:2805-2813.
ABSTRACT
| FULL TEXT
A Clinical Investigation on the Characteristics and Outcomes of Treating Chronic Lower Extremity Wounds using the TissueTech Autograft System
Uccioli
INT J LOW EXTREM WOUNDS 2003;2:140-151.
ABSTRACT
The Use of Cells in Reparative Medicine
PARENTEAU and YOUNG
Ann. N. Y. Acad. Sci. 2002;961:27-39.
ABSTRACT
| FULL TEXT
Wound Treatment with Human Skin Equivalent
De et al.
J. Am. Podiatr. Med. Assoc. 2002;92:19-23.
ABSTRACT
| FULL TEXT
Inflammation in Nonhealing Diabetic Wounds : The Space-Time Continuum Does Matter
Pierce
Am. J. Pathol. 2001;159:399-403.
FULL TEXT
|
