Advanced therapies for chronic wounds: NPWT, engineered skin, growth factors, extracellular matrices

Shankaran, Vidya; Brooks, Megan; Mostow, Eliot N.

doi:10.1111/dth.12050

Cited by 34 publications

(22 citation statements)

References 39 publications

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“…4 The care of chronic wounds has become its own specialty, with providers often using advanced therapies, including growth factors, extracellular matrices (ECMs), engineered skin, and negative pressure wound therapy (NPWT). 5 Care for such conditions has been reported to cost 2% to 3% of the healthcare budgets in developed countries. 2,3 Chronic wounds can be classified as vascular ulcers (e.g., venous and arterial ulcers), diabetic ulcers, and pressure ulcers (PUs).…”

Section: Scope and Significancementioning

confidence: 99%

Challenges in the Treatment of Chronic Wounds

Frykberg

Banks

2015

Advances in Wound Care

1,823

1,429

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Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients.Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing.Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based.Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.

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Section: Scope and Significancementioning

confidence: 99%

Challenges in the Treatment of Chronic Wounds

Frykberg

Banks

2015

Advances in Wound Care

1,823

1,429

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“…It has been widely used in treating chronic or acute wounds in recent years 2–4,6,7,16. NPWT is a new strategy used in burn treatments 5,6…”

Section: Discussionmentioning

confidence: 99%

Severe complications after negative pressure wound therapy in burned wounds: two case reports

Ren

2014

TCRM

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We present two typical cases of severe complications (sepsis and hemorrhage) after negative pressure wound therapy (NPWT) in burned patients. Necrotic tissues in some deep burn wounds are difficult to judge correctly and remove thoroughly. An electrically burned blood vessel looks “intact” but can easily break. Necrotic tissue or injured blood vessels when using NPWT are dangerous, both for causing sepsis and hemorrhage. This is the first article that reports the severe complications of NPWT in burned patients. It is imperative to heed indications and avoid contraindications. Proper preparation of wound beds, close observation, and sufficient irrigation are also crucial to avoid these severe complications, and there is an urgent need to substitute the central vacuum system with the low-pressure system.

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“…Exsudate can be removed and the wound cleaning can be promoted. NPWT is indicated for leg ulcers, deep pressure ulcers, traumatic wounds and to support post-surgical supply of skin grafts (35,36). While randomized controlled-trials for NPWT are missing a number of positive case series are proving the effect of this therapy.…”

Section: Debridement and Antimicrobial Effectsmentioning

confidence: 99%