Local Wound Care for Dermatologists (eBook)

Preface 6
Acknowledgments 7
Acknowledgments 8
Contents 9
Contributors 11
1: The Basic Principles in Local Wound Care 14
Wound Healing 14
The Wound Bed Preparation 15
Tissue Debridement 16
Infection 16
Moisture Balance 16
Epithelial Edge 16
Summary 16
References 17
2: Skin pH, Epidermal Barrier Function, Cleansers, and Skin Health 18
Environmental pH 18
pH and Water 19
Skin pH Age and Racial Variations 19
Stability of Skin pH 20
Skin pH and Epidermal Barrier Function 20
Filaggrin 20
SC Lipid-Processing Enzymes 21
SC Serine Proteases 21
Skin Microbiome 21
pH and Wound Healing 22
pH and Skin Cleansers 22
Summary 23
References 23
3: Chronic Wounds and Infections 26
Introduction 26
Basic Approach to Wounds 27
Types of Wounds 27
Chronic, Are Commonly Divided into Typical or Classic Wounds and a Less Common Group Known as Atypical Wounds (Table 3.1) 27
Leg Ulcers – Venous, Arterial 30
Atypical Wounds 31
From Contamination to Infection 31
Infections 32
Wound Sampling 34
Conclusion 34
References 34
4: Wound Dressings 37
Attributes of an Ideal Dressing 39
Wound Cleansing 39
Dressing Categories 40
Skin Protectants 40
Gauze and Cover Dressings 41
Contact Layers 41
Transparent Film Dressings 41
Hydrogel Dressings 42
Hydrocolloid Dressings 42
Calcium Alginate Dressings 42
Gelling Fiber Dressings 43
Foam Dressings 43
Collagen Dressings 43
Composite Dressings 44
Superabsorbent Dressings 44
Concentrated Surfactant Gel 44
Summary 44
References 45
5: The Use of Antiseptic and Antibacterial Agents on Wounds and the Skin 47
Introduction 47
Wound Classification for Healability 48
NERDS Criteria for Local Infection 49
Topical Antimicrobial Dressings 49
Polyhexamethylene Biguanide (PHMB) Topical Dressings 50
Ionized Silver-Based Dressings 51
Iodine-Based Dressings 55
Methylene Blue and Gentian Violet Foam Dressings 56
Honey Dressings 56
Surfactants and Biofilms 57
Topical Antiseptic Agents 57
Moisture-Balance Dressings 58
Hydrogels 59
Films 60
Hydrocolloids 60
Hydrofibers 61
Calcium Alginates 61
Foams 61
Superabsorbents 62
Summary 62
References 62
6: Topical Anti-inflammatory Agents in Wound Care 65
Introduction 65
Corticosteroids 67
Retinoids 67
Protease Modulating Matrix 67
References 68
7: Wound Dressing Allergic Contact Dermatitis: Epidemiology and Management 70
Introduction 70
Current Literature 71
Larger Prospective Studies 71
Discussion 73
Additional Suggestions 75
Patch Testing Caution 76
Extracting the Allergen (for the Experimentally Minded Physician) 77
Treatment 77
References 78
8: Vascular Studies for Nonvascular Surgeons 80
Background 80
Arterial Vascular Studies: Macro-vascular Tests 81
The Ankle-Brachial Pressure Index (ABPI), Toe Pressure (TP), and Toe Brachial Index (TBI) 81
Skin Perfusion Pressure 82
Doppler Arterial Waveforms 84
Duplex Ultrasonography 84
Angiography 85
Microvascular Tests (Microcirculation Assessment): Transcutaneous Oxygen Saturation 86
Venous Studies 87
Venous Doppler 87
Color Flow Duplex Ultrasonography 87
Venography 88
Summary 88
References 90
9: Compression Therapy 93
Introduction 93
Compression Therapy: Mechanism of Action 93
Compression Pressure 94
Compression Modalities 94
Compression Stockings 94
Compression Bandages 96
Compression Devices and Garments 98
Pneumatic Pumps 98
Compression Garments 98
Adherence to Compression Therapy 98
Contraindications to Compression 100
Arterial Disease 100
Congestive Heart Failure 100
Allergy 100
Other Indications for Compression Therapy 101
Other Wound Types 101
Lymphedema 101
Superficial Thrombophlebitis 101
Post-thrombotic Syndrome 101
Pregnancy 101
References 101
10: Management of Diabetic Foot Ulcers: Offloading and Debridement 105
Introduction 105
Pathophysiology of Diabetic Foot Ulcer 105
Local Wound Care 106
Wound Assessment 106
Wound Debridement 107
Wound Care 108
Offloading Modalities 108
Total Contact Cast (TCC) 109
Removable Cast Walker (RCW) 109
Instant Total Contact Cast (iTCC) 110
Half Shoes/Forefoot Offloading and Postoperative Shoe 111
Felt Pad 111
Shoe Modification and Therapeutic Shoes 111
Prophylactic Reconstructive Surgery 111
Conclusion 114
References 114
11: Negative Pressure Wound Therapy 117
Introduction 117
Bacterial Burden 117
Negative Pressure Wound Therapy (NPWT) 118
NPWT Ultraportable Devices 119
NPWT Precautions and Contraindications 121
Cost Evaluation of Current Products 121
NPWT with Instillation 121
Conclusion 122
References 122
12: Oxygen Therapy in Wound Healing 123
Introduction 123
Role of Oxygen for Wound Healing 124
Oxygen Treatment Modalities 125
Indirect Oxygen Treatment 125
Hyperbaric Therapy (HBOT) 125
Topical Oxygen Therapy (TOT) 126
Conclusion 127
References 128
13: The Role of Ablative Fractional Lasers in Wound Healing 131
Introduction 131
Background 131
First Report of Ablative Fractional Laser for Wound Healing 132
Ablative Fractional Laser for Lower Extremity Ulcers 132
Other Reports of Ablative Fractional Laser for Wound Healing 134
Mechanisms of Action 135
Mechanical 135
Collagen Remodeling 135
Debridement 135
Changes in Molecular Profile 136
Other Considerations 136
Future Directions 137
References 137
14: Stem Cell Therapy in Wound Care 139
Background 139
Stages of Wound Healing 139
Acute and Chronic Wounds 140
Current Treatments 140
Stem Cell Therapy 141
Stem Cells Derived from Embryos 141
Stem Cells Derived from the Bone Marrow 141
Stem Cells Derived from Adipose Tissue 142
Stem Cells Derived from the Umbilical Cord 142
Stem Cells Derived from the Epidermis 142
Stem Cell Delivery Techniques 143
Delivery by Injection 143
Delivery by Spraying 143
Delivery by Scaffold 143
Delivery by 3D Printing 144
Challenges and Future Directions 144
References 144
15: Cellular- and Acellular-Based Therapies: Skin Substitutes and Matrices 148
Introduction 148
Principles of Selection and Use of Skin Equivalents 149
Cellular Matrices (Table 15.1) 151
Cultured Epidermal Autografts (CEA, Epicel®, Vericel, Cambridge, MA) 151
Bilayered Living Cellular Constructs (BLCC, Apligraf®, Organogenesis, Canton, MA, and OrCel, Ortec International, Atlanta, GA) 152
Collagen Dermal Matrix (CDM, Dermagraft®, Organogenesis, Canton, MA TransCyte, Advanced BioHealing Inc., Westport, CT) 153
Dehydrated Human Amnion/Chorion Membrane (DHACM, Epifix®, MiMedx Group Inc., Marietta, GA) 153
Cryopreserved Placental Membrane (CPM, Grafix®, Osiris Therapeutics, Inc., Columbia, MD) 154
Acellular Matrices (Table 15.2) 154
Porcine Derived (Oasis®, Smith and Nephew, Largo, FL, Biobrane®, UDL Laboratories, Inc., Rockford, Illinois) 154
Dermal Regeneration Template (DRT, Integra®, LifeSciences, Plainsboro, NJ) 155
Cadaveric Allograft (CA, AlloDerm® Regenerative Tissue Matrix, LifeCell, Branchburg, NJ) 156
Future Research 156
Conclusion 156
References 157
16: Local Peristomal Cutaneous Manifestations and Their Management 161
Introduction 161
Assessment of Peristomal Skin 162
Types of Common Peristomal Skin Complications 163
Medical Adhesive-Related Skin Injury 163
Mechanical P-MARSI 163
Dermatitis P-MARSI 164
Irritant Contact Dermatitis 164
Allergic Dermatitis 164
Management of Common Peristomal Skin Complications 165
Infection 166
Folliculitis 166
Fungal Infection 166
Hypergranulation/Granulomas 167
Pseudoverrucous Lesions 167
Pyoderma Gangrenosum 167
Psoriasis 168
Cancer 169
Caput Medusa/Portal Hypertension 169
Conclusion 169
References 170
17: Comprehensive Wound Care for Malignant Wounds 171
Introduction 171
Assessment Tools 172
Dressings 172
Exudate 174
Malodor and Infection 174
Bleeding 176
Pain 176
Pruritus 178
Palliative Therapeutics 179
References 180
18: Wound Healing in Hidradenitis Suppurativa 184
Introduction 184
Wound Types in HS 185
Factors Affecting Wound Care in HS 186
Tissue Debridement 186
Infection and Inflammation 186
Moisture Balance 186
Edge Effect 186
Dressing Options for Use in HS 186
Superabsorbent and Absorbent Dressings 186
Foam Dressings 187
Gelling Fibers 188
Calcium Alginate 188
Non-adherent Dressings 188
Gel-Based Dressings 188
Dressings with Antiseptics 188
Negative Pressure Wound Therapy (NPWT) and Other Advance Therapies 189
Conclusion 190
References 192
19: Wound Healing in Pyoderma Gangrenosum 194
Introduction 194
Treatment Options 194
Topical and Intralesional Immunosuppressants 195
Topical Corticosteroids 195
Topical Calcineurin Inhibitors 195
Intralesional Immunosuppressants 196
Intralesional Corticosteroids 196
Intralesional Methotrexate 196
Intralesional Biologics 196
Immunomodulatory Drugs 197
Topical Imiquimod 197
Topical Phenytoin 197
5-Aminosalicylic Acid 197
Sodium Cromoglycate 197
Benzoyl Peroxide 197
Dressings 198
Other Therapies 198
Compression Therapy 198
Pain Management 198
Negative Pressure Wound Therapy (NPWT) 198
Skin Substitutes 199
In-Person Approach 199
Conclusion 199
References 199
20: Scar Management 202
Introduction 202
Scar Types 202
Scar Prevention and Early Intervention 203
Treatment of Hypertrophic Scars and Keloids 203
Surgery and Radiotherapy 205
References 205
Index 206