Innovations and Advances in Wound Healing

Description:

This book presents state of the art knowledge on new techniques and materials that can improve functional and aesthetic results in wound healing while reducing invasiveness, based on the author’s extensive personal experience. The aim is to equip the practitioner with all the information required in order to select a strategy that will accelerate wound healing and minimize both the risk of complications and scar formation after the wound has fully healed. The opening chapters set the stage by providing an overview of wound healing, including brief descriptions of the anatomy of the skin, the wound healing process, and advanced wound dressings. A full description follows of the various methodologies employed in repairing acute wounds with the goal of achieving optimal functional and cosmetic outcomes while utilizing the safest and least invasive method. Treatment protocols that have proven successful in closing nonhealing and/or delayed healing chronic wounds are then presented. In addition, a chapter addresses aesthetic procedures using advanced technology in wound healing. The closing chapter presents author’s experience with the establishment a hospital wound dressing team. The text is supported by 1,411 full color photos. Since the publication of the second edition, there have been many notable advances in wound healing research. The third edition is expanded and updated to reflect the advancements and new information. Key revisions include new chapters and/or sections on recently developed dressings such as a bioelectric dressing, a fluorescence imaging device of bacteria, usefulness of fibrin glue to support wound healing, graft of 3D-printed micronized adipose tissue, significance of skin hydration level for wound healing, novel staged excision technique to reduce scar length, newly developed risk scoring system to predict wound healing outcomes in diabetic patients, expanded coverage of cell therapy, new devices such as extracorporeal shock wave therapy, and automated SVF cell isolation system.

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Preface to the Third Edition

The Innovations and Advances in Wound Healing, Third Edition, is an expanded and revised edition to the original and second texts published in 2013 and 2016. Like the previous editions, this book presents state-of-the-art knowledge on new techniques and materials that can improve functional and aesthetic results in wound healing while reducing invasiveness, based on the author’s fairly extensive personal experience. The aim is to equip the practitioner with all the information required in order to select a strategy that will accelerate wound healing and minimize both the risk of complications and scar formation after the wound has fully healed.

Over the 7 years since the publication of the second edition, there have been many notable advances in wound healing research. This has led to the development of new therapeutic modalities that have improved the quality of wound management. The third edition has been greatly expanded and updated to reflect the advancements and new information, with applicability to an international audience. The new features and expanded scope of the book will be highly beneficial to readers and practitioners. Key revisions to the book include new chapters and/or sections on recently developed dressings such as a bioelectric dressing; a fluorescence imaging device of bacteria; use of fibrin glue to support wound healing; graft of 3D-printed micronized adipose tissue; significance of skin hydration level for wound healing; novel staged excision technique to reduce scar; newly developed risk-scoring system to predict wound healing outcomes in diabetic patients; expanded coverage of cell therapy; new devices such as low-level laser therapy, extracorporeal shock wave therapy, and automated SVF cell isolation system; and developing and establishing a wound dressing team. In addition, this edition provides technical corrections, updates, and clarifications in all 12 chapters of the second edition.

The third edition consists of 15 chapters. Each chapter contains the latest information, resources, and reference materials from the scientific literature. The opening chapters (Chaps. 1 and 2) set the stage by providing an overview of wound healing, including brief descriptions of the anatomy of the skin, the wound healing process, and advanced wound dressings. A full description follows of the various methodologies employed in repairing acute wounds with the goal of achieving optimal functional and cosmetic outcomes while utilizing the safest and least invasive method (Chaps. 3–6). Treatment protocols that have proven successful in closing nonhealing and/or delayed healing chronic wounds are then presented (Chaps. 7–13). Chapter 14 addresses aesthetic procedures using advanced technology in wound healing. The short closing chapter (Chap. 15) presents author’s experience with the establishment a hospital wound dressing team.

The third edition of the book maintains the principles of the previous editions. I would like to emphasize that the common subjects which have already been well dealt with elsewhere are only briefly described in this book. Only those subjects regarding the novel technology for wound healing have been highlighted. Thus, it may be necessary for trainees in the fields of wound healing to discuss these neglected subjects more fully and to collect together those subjects which are of interest. I would also like to point out that the text is supported by 1411 full color photos to assist in a better understanding of the written words.

The contributors to this book are all affiliated with Korea University Medical Center. I am grateful to my patients and colleagues in the Department of Plastic Surgery for their direct and indirect contributions. I would like to particularly express my gratitude toward Professors Sik Namgoong and Kyung-Chul Moon, a Research Scientist Hyup-Woo Lee, a Certified Wound Care Nurse Ji-Won Son, a secretory Seul-Ki Kim, and all Plastic Surgery Residents. I wish to extend my appreciation to my wife, Hee-Yeon, and my parents. Without their support and encouragement, I could not have completed this book.

It is my hope that this book will provide information on better treatment options in wound healing.

Seoul, Republic of Korea Seung-Kyu Ha

Table of contents :

Preface to the Third Edition
Contents
1: Basics of Wound Healing
Clinical Anatomy of Skin
Epidermis
Epidermal Layers
Epidermal Cells
Epidermal Appendages
Functions of the Epidermis
Dermis
Dermal Layers
Dermal Cells
Dermal Components
Functions of the Dermis
Subcutaneous Tissue
Wound Overview
Definition
Classification
Wound Surface
Chronicity
According to Depth
Wound Documentation
Basic Examination
Wound Types
Granulation Tissue
Epithelialization
Necrotic Wound
Eschar
Scab
Crust
Slough
Callus (Callosity)
Scale
Wound Characteristics
Wound Healing Process
Phases of Wound Healing
Inflammatory Phase
Proliferative Phase
Epithelization (Epidermization)
Accumulation of Extracellular Matrices
Wound Contraction
Angiogenesis
Maturation and Remodeling Phase
Conventional Wound Healing Methods
Repair vs. Regeneration
Types of Wound Healing
Primary Intention
Secondary Intention
Tertiary Intention (Delayed Primary Closure or Secondary Suture)
Skin Graft
Flap Coverage
Replantation
Further Reading
2: Interactive Wound Dressings
Overview
Functions of Wound Dressings
Requisite Conditions for Dressing Materials
Interactive Dressings
Classification Based on Material
Gauze and Impregnated Gauze Dressings
Films
Hydrogels
Foams
Clinical Study: Foam Dressing vs. Gauze Dressing
Methods
Results
Clinical Study: Highly vs. Early Hydrophilic Foam Dressings
Methods
Results
Hydrocolloids
Alginates and Hydrofibers
Biologic Dressings
Composite Dressings and Adjunctives
Bioelectric Dressing
Electrical Stimulation and Wound Healing
Mechanism of Action
Clinical Study
Antimicrobial Dressings
Silver Dressings
Mechanism of Action
Cytotoxicity
Precautions
Iodine Dressings
Cytotoxicity
Foam Dressing Impregnated with PVP-I
Dressing Selection
Infected Wound
Uninfected Wound
Granular and Nondraining
Granular and Draining
Necrotic and Nondraining
Necrotic and Draining
Other Considerations
Further Reading
3: Biologic Dermis Graft
Autogenous Dermis Graft
Surgical Technique
Indication
Clinical Study
Coverage of Deep Wound on Face
Advantages and Disadvantages
Allogenic Dermis Graft
Artificial Dermis Graft
Collagen
Hyaluronic Acid
Advantages and Applications
Further Reading
4: Tissue-Engineered Dermis Graft
Artificial Dermis vs. Tissue-Engineered Dermis
Animal Study
Methods
Results
Photometric Study for Wound Healing Rate
Photometric Study for Wound Contraction
Histological Analysis
Immunohistochemistry of α-SMA
Conclusions
Fibroblast-Seeded Artificial Dermis
Application Methods
Clinical Study
Methods
Results
Adipose-Derived SVF Cell-Seeded Artificial Dermis
Fingertip Reconstruction
Application Methods
Clinical Study
Methods
Results
Advantages and Disadvantages
Facial Coverage
Application Methods
Clinical Study
Methods
Results
Conclusions
Advantages and Disadvantages
Matrix Synthesizing Abilities of SVF Cells
Further Reading
5: Use of Fibrin Glue to Support Wound Healing
Fibrin Glue as Cell Delivery Vehicle
Antibiotic-Saturated Fibrin Glue
In Vitro Study
Methods
Antibiotic-Saturated Fibrin Disc Test
Filter Paper Test
Results
Antibiotic-Saturated Fibrin Disc Test
Filter Papers Test
Advantages and Limitations
Fibrin Glue for Microvascular Anastomosis
Animal Study
Clinical Study
Fibrin Glue for Conjunctival Wound Closure
Clinical Study
Methods
Results
Advantages and Disadvantages
Further Reading
6: Unique Reconstructive Surgery
Arterial Island Flap
Surgical Technique
Clinical Study
Venous Island Flap
Surgical Technique
Clinical Study
Graft of 3D-Printed Micronized Adipose Tissue
Mechanism of Action
Technique
Clinical Study
Novel Staged Excision Technique
Surgical Technique
Clinical Study
Methods
Results
Further Reading
7: Management of Chronic Wounds: With Focus on Diabetic Ulcers
Why Is Diabetic Ulcer Focused On?
Why Does Diabetic Ulcer Get into Trouble?
Factors Contributing Delayed Healing
Vascularity
Infection
Pressure
Therapeutic Footwear
Custom Orthotics
Healing Sandals
Walking Casts
Author’s Methods
Source of Healing (Cell Function)
Risk Factors for Major Amputation
Predicting Wound Healing Outcome
Vasculopathy and Infection
Risk Scoring System
Determination of Vasculopathy and Infection
Creating Risk Scoring System
Wound Healing Outcomes
Results
Advantages and Limitations
Management of Ischemia
Diagnosis of Arterial Insufficiency
Capillary Refill
Rubber of Dependency
Venous Filling Time
Pulses
Doppler Ultrasound
Ankle-Brachial Index
Toe Pressure
Segmental Pressure Measurement
Plethysmography and Duplex Scanning
Transcutaneous Oxygen Pressure (TcpO2)
Angiography
Thermography
Macrocirculation vs Tissue Oxygenation
Factors Contributing Differences Between Macrocirculation and Tissue Oxygenation
Structural Changes of Microcirculatory Capillaries in Diabetics
Increase of Nonenzymatic Advanced Glycosylation End Product (AGE)
Hematologic Changes in Red Blood Cell (RBC)
Diabetic Neuropathy
Importance of Tissue Oxygenation Measurement
Treatment of Ischemia
Percutaneous Transluminal Angioplasty (PTA)
Outcome of PTA
Perfusion Changes After PTA According to Severity of Ischemia
Limitation of PTA
Foot Posture to Increase Tissue Oxygenation
Hyperbaric Oxygen (HBO)
Necessity of Collaboration
Present and Future
Further Reading
8: Significance of Skin Hydration
Xerosis in Patients with Diabetes
Factors Associated with Skin Hydration
Influence of Neuropathy and Microangiopathy on Skin Hydration
Clinical Study
Methods
Results
Skin Hydration Level vs. Diabetic Wound Healing
Clinical Study
Methods
Results
Skin Hydration Cutoff Value to Predict Diabetic Wound Healing
Clinical Study
Methods
Results
Significance of Measuring Skin Hydration
Precautions
References
9: Infection, Debridement, and Biofilm
Diagnosis
Signs and Symptoms
Swab Culture
Tissue Biopsy Culture
Fluid Aspiration
Blood Tests
Imaging Tests
Fluorescence Imaging Device
Clinical Study
Advantages and Disadvantages
Necessity of Tissue Culture of Clinically Uninfected Wound
Clinical Study
Methods
Results
Microbiology of Diabetic Foot Infection (DFI)
Risk Factors of MRSA and Pseudomonas
Treatment
Antimicrobial Therapy
Topical Antimicrobial Therapy
Systemic Antimicrobial Therapy
Adverse Reactions
Debridement
NPWT
Hyperbaric Oxygen, Photodynamic Therapy, and Ultraviolet Light
Debridement
Autolytic Debridement
Enzymatic (Chemical) Debridement
Biological Debridement
Mechanical Debridement
Wet-to-Dry Dressing/Hydrophobic Dressing
Scrubbing
Wound Irrigation
Pulsed Lavage
Hydrosurgery (Waterjet)
Whirlpool
Sharp Debridement
Surgical Debridement
Biofilm
Formation of Biofilm
Diagnosis
Treatment Option
Author’s Treatment Method
Surgical Technique
Author’s Clinical Study
Further Reading
10: Negative-Pressure Wound Therapy (NPWT)
Composition of NPWT Device
Mechanism of Action
Wound Shrinkage or Macrodeformation
Microdeformation
Exudate/Fluid Removal
Creation of the Favorable Wound Environment
Secondary Effects
Clinical Application
Application Method
Benefits
Indications
Contraindications
Adverse Effects
Innovation
NPWT in Diabetic Foot Ulcers
Influence of NPWT on Tissue Oxygenation in the Foot
NPWT for Diabetic Foot Ulcers
References
11: Growth Factor Therapy
Background
Overview
Evaluation of Cell Activity
Growth Factors and Wound Healing
Mechanism of Action
Commercial Growth Factors
Platelet-Derived Growth Factor (PDGF)
Indication
Dosage and Administration
Clinical Study
Precautions
Basic Fibroblast Growth Factor (bFGF)
Indication
Dosage and Administration
Clinical Study
Precautions
Epidermal Growth Factor (EGF)
Indication
Dosage and Administration
Clinical Study
Precautions
References
12: Cell Therapy
Fibroblasts
Fibroblast Autograft
Application Method
Clinical Study
Fibroblast Allograft
Application Method
Allogeneic Dermal Fibroblast Culture
Technique
Clinical Study
Keratinocytes
Keratinocyte Autograft
Keratinocyte Allograft
Application Methods
Clinical Study
Adipose-Derived SVF Cells
Autograft of Adipose-Derived SVF Cells
In Vitro Study
Application Method
Isolation of SVF Cells
Technique
Clinical Study
Injection of Adipose-Derived SVF Cells
Application Method
Isolation of SVF Cells
Technique
Clinical Study
Methods
Results
Advantages
Platelet Concentrate
Allograft of Blood Bank Platelet Concentrate
Experimental Study
In Vitro Study
Animal Study
Application Method
Preparation of BBPC
Technique
Clinical Study
Advantages
Micronized Adipose Tissue (MAT) Niche
MAT Niche Using Fibrin Glue
Application Method
Creation of MAT Niche
Technique
Clinical Study
Advantages
Low-Temperature MAT Niche
Application Method
Creation of MAT Niche
Technique
Clinical Study
Mesenchymal Stem Cells (MSCs)
Adipose-Derived MSCS
Application Methods
Allogeneic ASC Sheet Preparation
Techniques
Clinical Study
Advantages
Bone Marrow-Derived MSCs
Experimental Study
Wound Healing Activity of BM-MSCs In Vitro
BM-MSC Treatment for Diabetic Fibroblasts In Vitro
In Vivo Study
Clinical Experience
Umbilical Cord Blood-Derived MSCs
Experimental Study
Advantages
Limitations
Further Reading
13: Adjunctive Therapy
Nutritional Support
Main Nutrients
Vitamins
Minerals
Nutrient Deficits of Chronic Diabetic Ulcer Patients
Electrical Stimulation
Ultrasound
Ultrasonic Surgical Debridement
Oxygen Therapy
Hyperbaric Oxygen (HBO)
Benefits
Method
Indications
Contraindications
Normobaric Oxygen (NBO)
Benefits
Method
Adverse Effect
Low-Level Laser Therapy (LLLT)
Mechanism of Action
In Vitro Study
Method
Results
Ultraviolet (UV) Light
Pain Scrambler Therapy
Mechanism of Action
Precautions
Foot Massager Device
Extracorporeal Shockwave Therapy (ESWT)
Clinical Study
Method
Results
Further Reading
14: Injectable Tissue-Engineered Soft Tissue
Injectable Soft Tissue Using Fibroblasts
Fibroblasts Seeded in Hyaluronic Acid Filler
Basic Research
Feasibility of Injectable Tissue-Engineered Soft Tissue Using HA Filler
Tracking and Increasing Viability of Fibroblasts Suspended in HA Filler After Topical Injection
Optimal Condition of HA Filler as a Carrier for Fibroblasts
Application Method
Clinical Experience
Clinical Study for Long-Term Results
Methods
Results
Advantages and Attention
New Commercial Drug Containing Fibroblasts
Application Method
Fibroblast Preparation
Injection Technique
Clinical Study
Methods
Results
Injectable Soft Tissue Using Adipose-Derived Cells
Stromal Vascular Fraction (SVF) Cells
Basic Study
What Tissues Are Formed by SVF Cells?
Matrix Synthesizing Abilities of SVF Cells
Application Method
SVF Cell Isolation
Injection of SVF Cells
Clinical Experience
In Vitro Differentiated Adipocytes
Application Method
Preparation of Injectable Immature Adipocytes
Injection of Immature Adipocytes
Clinical Study
Further Reading
15: Developing and Establishing Wound Dressing Team
Role of the Wound Dressing Team
Building the Wound Dressing Team
Team Members’ Education
Referral System Process
Key Elements
Clinical Study
Wound Demographics
Outcome of the Survey
Patient Group
Ward Nurse Group
Dressing Team Nurse Group
Resident/Internist Group
Complications
Advantages
Further Reading