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The role of carbon dioxide therapy in the treatment of chronic wounds.

 

Abstract

A wound is defined as chronic when it does not heal according to the normal repair times and mechanisms. This particular condition may be principally due to local hypoxia.

Carbon dioxide (CO2) therapy refers to the transcutaneous or subcutaneous administration of CO2 for therapeutic effects on both microcirculation and tissue oxygenation. In this study, we report the clinical and instrumental results of the application of CO2 in the therapy of chronic wounds. The study included 70 patients affected by chronic ulcers. The patients were selected by etiology and wound extension and equally divided into two homogeneous groups.

In group A, CO2 therapy was used in addition to the routine methods of treatment for such lesions (surgical and/or chemical debridement, advanced dressings according to the features of each lesion). In group B, patients were treated using routine methods alone. Both groups underwent instrumental (laser Doppler flow, measurement of TcPO2, clinical and photographic evaluation.

In the group that underwent subcutaneous treatment with CO2 therapy, the results highlighted a significant increase in tissue oxygenation values, which was confirmed by greater progress of the lesions both in terms of healing and reduction of the injured area. Considering the safety, efficacy and reliability of this method, even if further studies are necessary, we believe that it is useful to include subcutaneous carbon dioxide therapy in the treatment of wounds involving hypoxia-related damage.

Reference: https://www.ncbi.nlm.nih.gov/pubmed/20363999

 

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Smart bandage can monitor chronic wounds and dispense drugs

Researchers are hoping that this new technology might reduce amputations.

Chronic or slow-healing wounds are an increasing problem around the world. That’s why a team of researchers at Tufts University is working on a smart bandage that can keep track of what is going on with a wound and release treatments as necessary.

According to a recent article in the journal Small, researchers led by Pooria Mostafalu sought to increase the healing rate of chronic wounds by creating a smart bandage. “The wound environment is dynamic, but their healing rate can be enhanced by administration of therapies at the right time,” the article says.

The smart bandage can monitor the temperature and pH of the wound. If it detects a change, it can diagnose the problem and dispense drugs as necessary, thanks to a central processor, which a doctor can program to administer treatment if certain conditions are detected. “A stimuli‐responsive drug releasing system comprising of a hydrogel loaded with thermo‐responsive drug carriers and an electronically controlled flexible heater is also integrated into the wound dressing to release the drugs on‐demand,” the paper says. The bandage will also monitor treatment to determine if further steps are necessary. It can also provide real-time status updates via Bluetooth.

smart

“Chronic wounds are one of the leading causes of amputations outside of war settings,” author Sameer Sonkusale told Digital Trends. Flexible and responsive bandages that can monitor a wound and deliver real-time treatment could be key in reducing the number of these amputations because they can treat a chronic wound quickly to prevent infection and promote healing.

Introducing technology into bandages isn’t a new concept; there are quite a few of these smart wound dressings floating around. This idea does have a lot of promise, though, especially because the bandage itself can dispense treatment rather than waiting for a doctor’s response. It will be awhile before it is available for real-world application (and it’s quite possible that it never will be). According to the article, the next step for the smart bandage is to test the technology on chronic wounds in animals to see if it is as effective as it was in the researchers’ experiments.

Reference: https://goo.gl/ppc4tg

 

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The contribution of depth, infection, and ischemia to risk of amputation

Abstract

OBJECTIVE To validate a wound classification instrument that includes assessment of depth, infection, and ischemia based on the eventual outcome of the wound.

 

RESEARCH DESIGN AND METHODS We evaluated the medical records of 360 diabetic patients presenting for care of foot wounds at a multidisciplinary tertiary care foot clinic. As per protocol, all patients had a standardized evaluation to assess wound depth, sensory neuropathy, vascular insufficiency, and infection. Patients were assessed at 6 months after their initial evaluation to see whether an amputation had been performed.

 

RESULTS There was a significant overall trend toward increased prevalence of amputations as wounds increased in both depth (χ2trend = 143.1, P < 0.001) and stage (χ2trend = 91.0, P < 0.001). This was true for every subcategory as well with the exception of noninfected, nonischemic ulcers. There were no amputations performed within this stage during the follow-up period. Patients were more than 11 times more likely to receive a midfoot or higher level amputation if their wound probed to bone (18.3 vs. 2.0%, P < 0.001, χ2 = 31.5, odds ratio (OR) = 11.1, CI = 4.0–30.3). Patients with infection and ischemia were nearly 90 times more likely to receive a midfoot or higher amputation compared with patients in less advanced wound stages (76.5 vs. 3.5%, P < 0.001, χ2 = 133.5, OR = 89.6, CI = 25–316).

 

CONCLUSIONS Outcomes deteriorated with increasing grade and stage of wounds when measured using the University of Texas Wound Classification System.

  • Received November 20, 1997.
  • Accepted January 15, 1998.

Reference: http://care.diabetesjournals.org/content/21/5/855