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INTRODUCTION: Chronic wounds are a significant healthcare problem in the United States. Their costs approach 25 billion dollars in the United States. Current wound-care treatments of local wound care, moist dressings, and source control, while necessary for wound healing, are frequently not enough to ensure complete wound closure. The current surgical technique of split-thickness skin grafting is an operative procedure, painful, time-consuming, and leaves significant donor site wounds. A recently developed and marketed epidermal autograft harvester was tested at our university hospital wound center on 13 patients with wounds of various etiologies. Their clinical outcomes were evaluated, as were the costs associated with its usage compared with the potential costs of continued wound care without autograft placement. METHODS: Thirteen patients whose wounds appeared to have "stalled" or reached a plateau in healing by measurement data and visual evidence were chosen to receive an epidermal autograft to accelerate wound closure. Wound-types included diabetic ulcers, venous or lymphedema-related ulcers, surgical site wounds, and traumatic wounds. Time-to-healing in days, when applicable, was captured. Wound center billing and charges were available and evaluated for nine of the 13 patients. Costs of standard care continuation compared with the cost of epidermal autograft technology usage were compared. RESULTS: Healing rates were 62%; eight of the 13 patients had healed within four months, two were lost to follow-up, and three have wounds that remain open. Four of the patients healed in less than one month. The comparatively rapid closure of the open wound(s) post-epidermal autograft placement potentially reduced healthcare costs based on charges at an average of $1,153 per patient and yielded an average of $650 to the wound center, not applying the routine costs of dressings applied in the center. Conclusion: The epidermal autograft harvester accelerated healing in eight of the 13 of the patients (62%) we treated at the time of the writing of this article. By accelerating wound healing in our patient population, costs associated with subsequent wound care seem to have decreased to a dramatic degree and wound center finances have improved. No wound recurrence has been noted once the wounds had healed in our year-long experience with the technology. In addition, the procedure has been well-tolerated and easy to perform. Given the improved outcomes, cost-savings, and a better financial outlook for the wound center, utilization of the novel epidermal autograft harvester is proving itself to be in the "win-win" category of wound care treatments.
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Riansuwan et al. at Cleveland Clinic developed a scoring system to quantify the risk of Hartmann's nonreversal based on age, preoperative transfusion, pulmonary comorbidity, American Society of Anesthesiologists score, perforation, and anticoagulation. Our study validates the scoring system in a community hospital setting. Patients undergoing Hartmann's procedure for diverticulitis (2006 to June 2009) were identified from our hospital's database. Two groups were formed based on Hartmann's reversal within 1 year and those with nonreversal. An independent-sample t test and logistic regression using score and nine other variables as predictors of Hartmann's nonreversal were run. Sixty-three of 93 patients (67.7%) had a Hartmann's reversal. Higher scores and higher mean age were seen in the nonreversal group (15.5 ± 3.0 vs 12.1 ± 2.5 and 73 ± 15 vs 63 ± 14 years, respectively). Patients with scores 18 or above were not reversed; 43 of 49 patients (88%) with scores of 13 or less were reversed. Logistic regression confirmed that the only predictive variable for nonreversal is a higher score. The scoring system is predictive of nonreversibility of Hartmann's procedure for acute diverticulitis. This will be useful in allowing surgeons to strategize accurately and to counsel patients realistically. Higher scores may allow both the surgeon and patient to have a low threshold for exploring alternatives to Hartmann's procedure.
