ABSTRACT
Objective: Diabetic foot ulcers (DFUs) that fail to heal with standard care should be treated with advanced wound care products. Efficacy of advanced therapies is dependent on many factors. A secondary analysis of pivotal trial data for a bilayered cellular construct used in the treatment of DFU was undertaken to determine if glycemic control and other factors had an effect on time to healing. Approach: We analyzed the effect of age, gender, diabetes type, insulin usage, body mass index, smoking, initial and ending glycohemoglobin (HgbA1c), Charcot deformity, and wound area, duration, and location on likelihood of healing for wounds treated with bilayered cellular construct (BLCC). Results: In those treated with BLCC, initial wound area (cm2), age, and history of Charcot deformity were found to significantly affect healing. Neither initial HgbA1c nor change in HgbA1c was associated with healing. The bilayered product was found to be equally effective regardless of initial or change in HgbA1c levels (p-values 0.94 and 0.44, respectively). In the control group, initial HgbA1c, insulin usage, female gender, and wound location at the toes significantly influenced healing. Innovation: BLCC subgroup analysis to elucidate selection criteria allowing for targeted use of advanced products on those more likely to respond as well as direct further research into prognostic indicators for BLCC-treated patients. Conclusion: The bilayered cellular construct product remains equally effective regardless of initial or change in HgbA1c levels. Further specific research into the effect of glucose control and other factors on the effectiveness of different advanced DFU treatment products is recommended.
ABSTRACT
UNLABELLED: Sinus tract formation is common in a wide variety of wounds and can be difficult to manage. Nonsurgical techniques for treating sinus tracts have generally been disappointing, though many nonsur- gical options have been explored including dermal matrix injection, platelet-derived growth factors, fibrin sealant, and phenytoin. This case series explores the treatment of nonhealing chronic wound-related si- nus tracts with autologous platelet-rich plasma (PRP) in a series of patients in a single center, hospital-based, chronic wound care cen- ter. METHODS: PRP was prepared using the Harvest SmartPRep pro- cedure. During processing, the blood was separated into two distinct chambers: one containing packed red blood cells, and the other with autologous platelet concentrate and plasma supernatant. The plasma was injected into the entire sinus tract beginning from the base of the tract. RESULTS: Nine of 12 patients healed, and three did not heal and required other interventions (excision and flap repair). All patients, ex- cept one, received only one PRP injection. One case of infection that could be directly attributed to the PRP injection was reported. All other patients experienced no pain, discomfort, or signs or symptoms of in- fection. CONCLUSION: PRP injection can be a useful technique in cases of straight, relatively short, persistent sinus tracts.
ABSTRACT
Pressure ulcers with undermined edges are generally hard to treat and may require surgical debridement and flap coverage. A woman with a 5-month history of a non-healing, undermined, sacro-coccygeal pressure ulcer presented for care at the author's wound care center. Because traditional wound care had failed and surgical debridement and repair was contraindicated due to her overall poor general health and malnutrition, an injectable dermal filler was applied inside the wound. The matrix filler was covered with secondary and tertiary dressings and the wound healed after 8 weeks with no adverse effects or infection. The results of this and previously published case studies suggest that injectable dermal matrix may be a viable option for non-surgical treatment of difficult-to-heal pressure ulcers with undermining. Additional safety, efficacy, and cost-effectiveness studies seem warranted.
