I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
Five Millennia of Wound Care Products — What is New? A Literature Review
- Wed, 3/25/09 - 10:16am
- 0 Comments
- 9233 reads
Start Page:
16
End Page:
32 Abstract: The first wound and wound treatments were described five millennia ago. Since then, various principles of wound care have been passed on from generation to generation. In contrast to large numbers of general technological inventions over the last 100 years, progress beyond ancient wound care practices is a recent phenomenon. It is essential to know the historical aspects of wound treatment (both successes and failures) in order to continue this progress and provide future direction. A survey of the literature shows that concepts such as “laudable pus” persisted for hundreds of years and that lasting discoveries and meaningful progress did not occur until grand-scale manufacturing and marketing started. Landmarks such as understanding the principles of asepsis/antisepsis, fundamental cellular research findings, knowledge about antibiotics/antimicrobials, moist wound healing, and the chemical and physical processes of wound healing have provided the foundation to guide major developments in wound management, including available evidence-based guidelines. Although research regarding interaction of basic wound management principles remains limited, the combined efforts of global research and clinical groups predict a bright future for improved wound management.
An Ancient Background
Knowledge of the biology of wounds and wound healing, together with inventions and innovations of new wound care products, has proliferated throughout time. The earliest civilizations of Mesopotamia, Arabia, Egypt, and Greece left fascinating records of their medical practice — ie, the clay tablets, Sanskrit documents (2000 BC), Smith papyrus (1650 BC), Eber’s papyrus (1550 BC) and Homer’s writings (800 BC) (see Figure 1). Medical practices of those eras were founded predominantly on empirical beliefs and magic; physicians made decisions based on observation, judgment, and experience. However, wound management during the early Egyptian civilization resembles current approaches. Treatments consisted primarily of wound closure through suturing or open wound therapy in diseased wounds with debridement followed by (though probably not intentionally) antibacterial 
therapies.1 Ulcerating lesions were bound with figs containing papain.2 Only recently have these agents been found to remove the fibrous slough present on wounds. Wine, vinegar, and hot water were used to cleanse the wounds. After cleansing, dry powders consisting of a mixture of metals (mercury, zinc, silver, and copper) were used to prevent inflammation1 (see Table 1). Copper was found on the island of Cyprus in great amounts and because of its bright blue color, it was used to “paint” ugly wounds.1,3 Interestingly, the reaction of copper with wine and vinegar results in the formation of a strong antibacterial compound (copper acetate).4 Silver was used as an ingredient in plasters to cover open wounds, as well as to purify the drinking water of monarchs of ancient dynasties.5 Strips of linen soaked in grease, honey, oil, and lint were used to cover the wound surface.1 A literature review by Aldini et al6 notes that it is now known that using lint to pack and fill the wound space might create an oxygen-poor environment that could stimulate angiogenesis; combining the aforementioned products not only prevented the linen from sticking to the wound base (ie, creating a nonadherent dressing), but also was a potential practical solution to diluting the strong osmolytic honey.
References:
1. Majno G. The Healing Hand. Man and Wound in the Ancient World. Cambridge, MA: Harvard University Press;1975.
2. Bibbings J. Honey, lizard dung and pigeons' blood. Nurs Times. 1984;80(48):36–38.
3. Dollwet HH, Sorenson JR. Roles of copper in bone maintenance and healing. Biol Trace Elem Res. 1988;18(1):39–48.
4. Caldwell MD. Topical wound therapy — an historical perspective. J Trauma. 1990;30(12 suppl):S116–S22.
5. Lansdown AB. A review of the use of silver in wound care: facts and fallacies. Br J Nurs. 2004;13(6 suppl):S6–S19.
6. Aldini N, Fini M, Giardino R. From Hippocrates to tissue engineering: surgical strategies in wound treatment. World J Surg. 2008;32(9):2114–2121.
7. Bolton LL. Moist wound healing from past to present. In: Rovee DT, Maibach HI (eds). The Epidermis in Wound Healing. London, UK: CRC Press;2004:89–101.
8. Lee YL, Cesario T, Wang Y, Shanbrom E, Thrupp L. Antibacterial activity of vegetables and juices. Nutrition. 2003;19(11-12):994–996.
9. Giner-Larza EM, Manez S, Giner RM, et al. Anti-inflammatory triterpenes from Pistacia terebinthus galls. Planta Med. 2002;68(4):311–315.
10. Selvaggi G, Monstrey S, Van Landuyt K, Hamdi M, Blondeel P. The role of iodine in antisepsis and wound management: a reappraisal. Acta Chir Belg. 2003;103(3):241–247.
11. Gamgee S. The treatment of wounds. Lancet. 1876;108(1282):885–887.
12. Haller JS Jr. Treatment of infected wounds during the Great War, 1914 to 1918. South Med J. 1992;85(3):303–315.
13. Forrest RD. Early history of wound treatment. J R Soc Med. 1982;75(3):198–205.
14. Saadia R, Schein M. Debridement of gunshot wounds: semantics and surgery. World J Surg. 2000;24(9):1146–1149.
15. Coppi C. I dressed your wounds, God healed you. A wounded person's psychology according to Ambroise Pare. Ostomy Wound Manage. 2005;51(8):62–64.
16. Klasen HJ. Historical review of the use of silver in the treatment of burns. I. Early uses. Burns. 2000;26(2):117–130.
17. Carrel A, Burrows M. Cultivation of adult tissues and organs outside the body. JAMA. 1910;55:1379–1381.
18. Reverdin J. Greffe epidermique. Bull Soc Imperiale Chir Paris. 1869;10:511–515.
19. Chick LR: Brief history and biology of skin grafting. Ann Plast Surg. 1988;21(4):358–365.
20. Freshwater MF, Krizek TJ. George David Pollock and the development of skin grafting. Ann Plast Surg. 1978;1(1):96–102.
21. Kramer-Schultheiss KS, Schultheiss D. From wound healing to modern tissue engineering of the skin. A historical review on early techniques of cell and tissue culture. Hautarzt. 2002;53(11):751–760.
22. Moulin de D. A History of Surgery: with Emphasis on the Netherlands. Dordrecht: Martinus Nijhoff Publishers;1988.
23. Illingworth C. The Lister Lecture, 1964: Wound Sepsis — from Carbolic Acid to Hyperbaric Oxygen. Can Med Assoc J. 1964;91(20):1041–1045.
24. Drosou A, Falabella A, Kirsner RS. Antiseptics on wounds: an area of controversy. WOUNDS. 2003;15(5):149–166.
25. Flynn J. Povidone-iodine as a topical antiseptic for treating and preventing wound infection: a literature review. Br J Community Nurs. 2003;8(6 suppl):S36–S42.
26. Klasen HJ. A historical review of the use of silver in the treatment of burns. II. Renewed interest for silver. Burns. 2000;26(2):131–138.
27. Moyer CA, Brentano L, Gravens DL, Margraf HW, Monafo WW Jr. Treatment of large human burns with 0.5 per cent silver nitrate solution. Arch Surg. 1965;90(6):812–867.
28. Russell A. Introduction of biocides into clinical practice and the impact on antibiotic-resistant bacteria. J Appl Microbiol. 2002;92(suppl):121S–35S.
29. Lineaweaver W, McMorris S, Soucy D, Howard R. Cellular and bacterial toxicities of topical antimicrobials. Plast Reconstr Surg. 1985;75(3):394–396.
30. Lineaweaver W, Howard R, Soucy D, et al. Topical antimicrobial toxicity. Arch Surg. 1985;120(3):267–270.
31. Cooper ML, Laxer JA, Hansbrough JF. The cytotoxic effects of commonly used topical antimicrobial agents on human fibroblasts and keratinocytes. J Trauma. 1991;31(6):775–782; discussion 782–784.
32. Larson EL, McGinley KJ, Foglia AR, Talbot GH, Leyden JJ. Composition and antimicrobic resistance of skin flora in hospitalized and healthy adults. J Clin Microbiol. 1986;23(3):604–608.
33. Lawrence JC. The use of iodine as an antiseptic agent. J Wound Care. 1998;7(8):421–425.
34. Fox CL Jr. Topical therapy and the development of silver sulfadiazine. Surg Gynecol Obstet. 1983;157(1):82–88.
35. Bang LM, Buntting C, Molan P. The effect of dilution on the rate of hydrogen peroxide production in honey and its implications for wound healing. J Altern Complement Med. 2003;9(2):267–273.
36. Cooper RA, Molan PC, Harding KG. The sensitivity to honey of Gram-positive cocci of clinical significance isolated from wounds. J Appl Microbiol. 2002;93(5):857–863.
37. Cooper RA, Halas E, Molan PC. The efficacy of honey in inhibiting strains of Pseudomonas aeruginosa from infected burns. J Burn Care Rehabil. 2002;23(6):366–370.
38. Efem SE, Udoh KT, Iwara CI. The antimicrobial spectrum of honey and its clinical significance. Infection. 1992;20(4):227–229.
39. Lusby PE, Coombes A, Wilkinson JM. Honey: a potent agent for wound healing? J WOCN. 2002;29(6):295–300.
40. White JW Jr, Subers MH, Schepartz AI. The identification of inhibine, the antibacterial factor in honey, as hydrogen peroxide and its origin in a honey glucose-oxidase system. Biochim Biophys Acta. 1963;73(5):57–70.
41. Willix DJ, Molan PC, Harfoot CG. A comparison of the sensitivity of wound-infecting species of bacteria to the antibacterial activity of Manuka honey and other honey. J Appl Bacteriol. 1992;73(5):388–394.
42. Molan PC. The role of honey in the management of wounds. J Wound Care. 1999;8(8):415–418.
43. Pieper B, Caliri MH. Nontraditional wound care: a review of the evidence for the use of sugar, papaya/papain, and fatty acids. J WOCN. 2003;30(4):175–183.
44. Dawson JS. Preiskel Elective Prize. The role of sugar in wound healing. A comparative trial of the healing of infected wounds using traditional gauze/antiseptic packing, and granulated sugar, undertaken during an elective period at Kagando Hospital, Uganda. Ann R Coll Surg Engl. 1996;78(2 suppl):82–85.
45. Goldstein H. Maggots in the treatment of wound and bone infections. J Bone Joint Surg. 1931;13(3):476–478.
46. Bear W. The treatment of chronic osteomyelitis with the maggot (larva of the blowfly). J Bone Joint Surg. 1931;13:438–475.
47. Lerch K, Linde HJ, Lehn N, Grifka J. Bacteria ingestion by blowfly larvae: an in vitro study. Dermatology. 2003;207(4):362–366.
48. Horobin AJ, Shakesheff KM, Woodrow S, Robinson C, Pritchard DI. Maggots and wound healing: an investigation of the effects of secretions from Lucilia sericata larvae upon interactions between human dermal fibroblasts and extracellular matrix components. Br J Dermatol. 2003;148(5):923–933.
49. Sherman RA, Hall MJ, Thomas S. Medicinal maggots: an ancient remedy for some contemporary afflictions. Annu Rev Entomol. 2000;45(1):55–81.
50. Steenvoorde P, Jukema GN. The antimicrobial activity of maggots: in vivo results. J Tissue Viabil. 2004;14(3):97–101.
51. Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962;193:293–294.
52. Hinman CD, Maibach H. Effect of air exposure and occlusion on experimental human skin wounds. Nature. 1963;200(10):377–378.
53. Garb J. Nevus verrucosus unilateris cured with podophyllin ointment. Ointment applied as occlusive dressings: report of a case. Arch Dermatol. 1960;81(4):606–609.
54. Jonkman MF. Occlusive dressings. Ned Tijdschr Geneeskd. 1991;135(41):1905–1908.
55. Kester J, Fennema O. Edible films and coatings: a review. Food Technology. 1986;12(40):47–59.
56. Morgan D. Alginate dressings. J Tissue Viabil. 1996;7(1):4–14.
57. Chaby G, Senet P, Vaneau M, et al. Dressings for acute and chronic wounds: a systematic review. Arch Dermatol. 2007;143(10):1297–1304.
58. Vaneau M, Chaby G, Guillot B, et al. Consensus panel recommendations for chronic and acute wound dressings. Arch Dermatol. 2007;143(10):1291–1294.
59. Falanga V, Grinnell F, Gilchrest B, Maddox YT, Moshell A. Workshop on the pathogenesis of chronic wounds. J Invest Dermatol. 1994;102(1):125–127.
60. Bakker K, Schaper NC: New developments in the treatment of diabetic foot ulcers. Ned Tijdschr Geneeskd. 2000;144(9):409–412.
61. Knighton DR, Ciresi KF, Fiegel VD, Austin LL, Butler EL. Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF). Ann Surg. 1986;204(3):322–330.
62. Robson MC, Phillips LG, Thomason A, Robson LE, Pierce GF. Platelet-derived growth factor BB for the treatment of chronic pressure ulcers. Lancet. 1992;339(8784):23–25.
63. Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A phase III randomized placebo-controlled double-blind study. Diabetes Care. 1998;21(5):822–827.
64. Steed DL. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity diabetic ulcers. Diabetic Ulcer Study Group. J Vasc Surg. 1995;21(1):71–78; discussion 79–81.
65. Smiell JM. Clinical safety of becaplermin (rhPDGF-BB) gel. Becaplermin Studies Group. Am J Surg. 1998;176(2A suppl): 68S–73S.
66. US Food and Drug Administration. rhPDGF. Available at: www.fda.gov/cder/drug. Accessed February 21, 2009.
67. Badiavas E, Mehta PP, Falanga V. Retrovirally mediated gene transfer in a skin equivalent model of chronic wounds. J Dermatol Sci. 1996;13(1):56–62.
68. Robson MC, Cooper DM, Aslam R, et al. Guidelines for the treatment of venous ulcers. Wound Repair Regen. 2006;14(6):649–662.
69. Vin F, Teot L, Meaume S. The healing properties of Promogran in venous leg ulcers. J Wound Care. 2002;11(9):335–341.
70. Eaglstein WH, Falanga V. Tissue engineering for skin: an update. J Am Acad Dermatol. 1998;39(6):1007–1010.
71. Eaglstein WH, Falanga V. Tissue engineering and the development of Apligraf a human skin equivalent. Adv Wound Care. 1998;11(4 suppl):1–8.
72. Steed DL, Attinger C, Colaizzi T, et al. Guidelines for the treatment of diabetic ulcers. Wound Repair Regen. 2006;14(6):680–692.
73. Blakytny R, Jude EB, Martin Gibson J, Boulton AJ, Ferguson MW. Lack of insulin-like growth factor 1 (IGF1) in the basal keratinocyte layer of diabetic skin and diabetic foot ulcers. J Pathol. 2000;190(5):589–594.
74. Andreadis ST. Gene transfer to epidermal stem cells: implications for tissue engineering. Expert Opin Biol Ther. 2004;4(6):783–800.
75. Badiavas EV, Falanga V. Treatment of chronic wounds with bone marrow-derived cells. Arch Dermatol. 2003;139(4):510–516.
76. Cherry GW, Harding K, Ryan TJ. Wound Bed Preparation. International Congress and Symposium Series 250. London, UK: Roy Soc Med Press Ltd;2001.
77. Schultz GS, Sibbald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11(1 suppl):S1–S28.
78. Attinger CE, Bulan EJ. Debridement. The key initial first step in wound healing. Foot Ankle Clin. 2001;6(4):627–660.
79. Mouës CM, van den Bemd GJCM, Hovious SER. Debridement of chronic wounds temporarily induces an acute-like environment that stimulates fibroblasts. Wound Repair Regen. 2004;11(5):A30.
80. Cook H, Davies KJ, Harding KG, Thomas DW. Defective extracellular matrix reorganization by chronic wound fibroblasts is associated with alterations in TIMP-1, TIMP-2, and MMP-2 activity. J Invest Dermatol. 2000;115(2):225–233.
81. Mouës CM, Vos MC, van den Bemd GJ, Stijnen T, Hovius SE. Bacterial load in relation to vacuum-assisted closure wound therapy: a prospective randomized trial. Wound Repair Regen. 2004;12(1):11–17.
82. Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553–562.
83. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563–576; discussion 577.
84. Redon H. Closing of large wounds by suppression. Presse Med. 1955;63(49):1034.
85. Kostiuchenok BM, Kolker, II, Karlov VA, Ignatenko SN, Muzykant LI. Vacuum treatment in the surgical management of suppurative wounds. Vestn Khir Im I I Grek. 1986;137(9):18–21.
86. Usupov Y, Yepifanov M. Active wound drainage. Vestnik Khirugii. 1987;4:42–45.
87. Chariker M, Jeter K, Tintle T. Effective management of incisional and cutaneous fistulae with closed suction wound drainage. Contemp Surg. 1989;34:59–63.
88. Fleischmann W, Lang E, Russ M. Treatment of infection by vacuum sealing. Unfallchirurg. 1997;100(4):301–304.
89. Fleischmann W, Russ M, Westhauser A, Stampehl M. Vacuum sealing as carrier system for controlled local drug administration in wound infection. Unfallchirurg. 1998;101(8):649–654.
90. Fleischmann W, Strecker W, Bombelli M, Kinzl L. Vacuum sealing as treatment of soft tissue damage in open fractures. Unfallchirurg. 1993;96(9):488–492.
91. Armstrong DG, Lavery LA. Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial. Lancet. 2005;366(9498):1704–1710.
92. Vuerstaek JD, Vainas T, Wuite J, Nelemans P, Neumann MH, Veraart JC. State-of-the-art treatment of chronic leg ulcers: a randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings. J Vasc Surg. 2006;44(5):1029–1037; discussion 1038.
93. Saxena V, Hwang CW, Huang S, Eichbaum Q, Ingber D, Orgill DP. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg. 2004;114(5):1086-96; discussion 1097–1098.
94. Timmers MS, Le Cessie S, Banwell P, Jukema GN. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg. 2005;55(6): 665–671.
95. World Union of Wound Healing Societies (WUWHS). Principles of best practice: vacuum assisted closure: recommendations for use. A consensus document. Available at: www.WUWHS.org. Accessed February 22, 2009.
96. Berendt AR. Counterpoint: hyperbaric oxygen for diabetic foot wounds is not effective. Clin Infect Dis. 2006;43(2):193–198.
97. Barnes RC. Point: hyperbaric oxygen is beneficial for diabetic foot wounds. Clin Infect Dis. 2006;43(2):188–192.
98. Sheridan RL, Shank ES. Hyperbaric oxygen treatment: a brief overview9of a controversial topic. J Trauma. 1999;47(2):426–435.
99. Roeckl-Wiedmann I, Bennett M, Kranke P. Systematic review of hyperbaric oxygen in the management of chronic wounds. Br J Surg. 2005;92(1):24–32.
100. Weiss DS, Kirsner R, Eaglstein WH. Electrical stimulation and wound healing. Arch Dermatol. 1990;126(2):222–225.
101. Hampton S, King L. Healing an intractable wound using bio-electrical stimulation therapy. Br J Nurs. 2005;14(15):S30–S32.
102. Gordon GA. Designed electromagnetic pulsed therapy: clinical applications. J Cell Physiol. 2007;212(3):579–582.
103. Ennis WJ, Meneses P, Borhani M. Push-pull theory: using mechanotransduction to achieve tissue perfusion and wound healing in complex cases. Gynecol Oncol. 2008;111(2 suppl): S81–S86.
Post new comment