• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.173-178
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• 2002

Wound healing is the result of interaction of normal cellular and biochemical responses that restore the interrupted anatomical structure in limited period. When any response of them is impaired, it results in chronic wound. The factors that influence the wound healing process is not only limited to the fundamental disease of the individual but also the local factors, especially various growth factors secreted from the various cells involved in tissue regeneration have important role. Recent reports that the chronic wounds are depleted of these growth factors have led active studies on the alteration of local wound environment with manipulation of the growth factors and the its application in management of chronic wounds. We investigated the effect on the chronic wounds in 10 patients with various pathologic conditions to suggest the appropriate application and guideline of the indication. The chronic wounds resulting from various causes in 10 patients were treated with rhPDGF gel and good wound care. All the chronic wounds were located on the lower extremity and the average diameter was 2.5 cm. 7 patients were completely cured within 8 weeks, however the patient who received previous radiation therapy the healing was delayed to 14 weeks. Two patients with vascular ulcer were not cured with rhPDGF alone. Local application of rhPDGF has yielded complete cure of the chronic wound in 70% of the patients within 2 months. The author suggests that it would be an effective alternative treatment modality of chronic wound when it is applied with good wound care and appropriate indication.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.116-119
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• 2006

Management of chronic wound has been a great problem to many surgeons because the wound is usually associated with an underlying disease of the patient. Without accurate diagnosis and treatment of the disease, the wound can not be healed. Systemic vasculitis is a rare systemic disease which causes inflammation and obstruction of the vessels. This autoimmune disease involves multiple organs and may inflict skin wound spontaneously without traumas. It would improve or aggravate the wound in proportion to the activities of the disease. Our experience is a case of 28-year-old female who has had chronic ulcers on her right foot, especially on the great toe for 1 year. Although she had several operations of sympathectomy, debridement and artificial dermal graft, her wound was not improved. She has been diagnosed as systemic vasculitis during the evaluation for histopathology and cause of fever and pancytopenia. After medical treatments, she had the operation of adipofascial turnover flap coverage and skin graft, and the wound was improved without any complication or relapse. The diagnosis and treatment of the underlying disease should be ahead of the management of chronic wound.

• Journal of Animal Science and Technology
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• v.64 no.5
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• pp.997-1007
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• 2022

Delayed healing associated with distal limb wounds is highly challenging in equine clinical practice. This study aimed to evaluate healing rates between chronic non-granulating wounds of horse distal limbs that were treated with maltodextrin/ascorbic acid gel alone or in combination with povidone-iodine 1% solution and those treated with povidone-iodine 1% only throughout the study period (35 days) in clinical settings. The study was conducted on 18 adult horses (3-15 years old). Based on the treatment regimen utilized, the horses were divided into three groups (n = 6), with each group having a similar mean wound area. The percentages of wound contraction, epithelialization, and overall wound healing were determined weekly for each wound. By the end of the study, the total wound healing percentage was significantly increased between the study groups (p < 0.05). The use of maltodextrin/ascorbic acid gel resulted in considerable wound contraction, rapid epithelialization, and complication-free wound healing. Based on the findings of this study, maltodextrin/ascorbic acid gel, independently or in combination with a 1% povidone-iodine solution, might be applied as a safe and effective wound healing promoting agent in horses with chronic non-granulating wounds.

• Journal of Korean Foot and Ankle Society
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• v.26 no.2
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• pp.78-83
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• 2022

Purpose: The purpose of this study was to evaluate the surgical outcome of split-thickness skin graft (STSG) for chronic diabetic wounds of the foot and ankle. Materials and Methods: The medical records of 20 patients who underwent surgery for chronic diabetic wounds of the foot and ankle between October 2013 and May 2018 were reviewed. Surgical management consisted of consecutive debridement, followed by negative-pressure wound therapy and STSG. We used an acellular dermal matrix between the wound and the overlying STSG in some patients with wide or uneven wounds. Patient satisfaction, comorbidities, wound size and location, length of hospital stay, wound healing time, and complications were investigated. Results: Of 20 patients, 17 (85.0%) were satisfied with the surgical outcome. Eight patients had diabetic wounds associated with peripheral vascular disease (PVD), 7 patients had diabetic wounds without PVD, and 5 patients had acute infection superimposed with necrotizing abscesses. The mean size of the wound was 49.6 cm². The mean length of hospital stay was 33.3 days. The mean time to wound healing was 7.9 weeks. The mean follow-up period was 25.9 months. Complications included delayed wound healing (4 cases) and recurrence of the diabetic wounds (2 cases), which were resolved by meticulous wound dressing. Conclusion: STSG remains a good treatment strategy for chronic diabetic wounds of the foot and ankle.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.393-399
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• 2008

Purpose: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. Methods: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. Results: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. Conclusion: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

• Archives of Plastic Surgery
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• v.33 no.5
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• pp.606-611
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• 2006

Purpose: Animal models of a chronic wound are yet to be fully developed, and animal studies on this subject has yet to take place. The purpose of this study is to create the foundation for research on chronic wound healing based on a swine model, the most similar to that of a human. Methods: Three female 2-3 month old 'yolkshires' were used. Total of eight full thickness skin defects, $6{\times}3cm$ sized, were created on the back of each pigs. Three groups were created for comparison; Group I (n=4) was left as they were after full skin thickness excision, while the excised tissues of Group II (n=3) were turned inside out and sutured so that the epidermis would come in contact with the fascia. Group III (n=3) were excised full skin thickness in depth and silicone blocks were implanted in them. Dressing was not practised so that the wounds would be vulnerable to infection. Results: In Group III, the skin contraction rate was the least among the three groups for each three weeks of observation respectively. Also during the three weeks, bacteral colonization was at the highest among the comparison. On the third week, inflammatory cells were still active, but the generations of epidermis and collagen synthesis were detected minimally. Conclusion: The Group III was relatively the most similar model of chronic wounds. and modification of the silicone blocks, could provide us with a very effective chronic skin wound model similar to human.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.305-313
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• 2007

Purpose: Wound healing is a result of complex processes whose components, such as cells, extracellular matrix, proteolytic enzymes, and their inhibitors receive effects from immune compartments, cytokines, chemokines, and growth factors. Impairment of normal physiologic response to wounding makes nonhealing chronic wounds. Wound infection and exacerbated proteolytic process may induce uncontrolled tissue degradation or exudates formation, which may result in the development of a nonhealing chronic wound. Thus proper management of wound infection and exudates is critical to prevent and treat nonhealing wound. The aim of this study is to evaluate effects of Aquacel AG, silver-containing carboxymethylcellulose dressing on treatment for exudative infected wound. Methods: The study included 31 patients with nonhealing wound. Wound was dressed with Aquacel AG. The effect of dressing was investigated by serial bacterial culture and wound exudates assessment. Each infection and exudates control time was determined and statistically analyzed. Results: Wound infection and exudates were effectively managed using Aquacel AG dressing. Mean infection and exudates control time were $3.4{\pm}1.2$ and $5.7{\pm}1.4$ weeks, respectively. Statistical analysis of the data indicated that infection control time correlated positively to age and exudates control time (p<0.05). Conclusion: There is as yet no ideal dressing for the topical treatment of chronic nonhealing wound. But silver-containing carboxymethylcellulose dressing can be used effectively for exudative, infected nonhealing wound.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.355-359
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• 2008

Purpose: Oncostatin M(OSM) has been known as a role in fibrosis and anti-inflammatory effects of various organs and tissues. Although there have been a number of studies which are focused on the roles and mechanisms of OSM, there are few reports on its effects in chronic wound healing. The purpose of this study is to evaluate the effects of OSM in wound healing activities of dermal fibroblasts of chronic wound in vitro. In particular, this study is focused on cell proliferation and synthesis of collagen and glycosaminoglycan(GAG), which are the major components of the extracellular matrices, of diabetic fibroblasts. Methods: Fibroblasts were isolated from excess skin that was obtained from diabetic foot ulcer patients who underwent debridement. The isolated fibroblasts were cultivated in presence of OSM(100 ng/mL). Cell proliferation, collagen synthesis and GAG levels were compared. Results: All the components tested in this study increased in OSM treatment group. In particular, collagen and GAG synthesis demonstrated statistically significant increases(p<0.05 in the Mann-Whitney U-test). Conclusion: These results indicate that OSM increases wound healing activities of dermal fibroblasts of chronic wound in vitro.

• Archives of Plastic Surgery
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• v.45 no.6
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• pp.564-571
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• 2018

Background Chronic wounds occur due to failure of the normal healing process, associated with a lack of deposition of cellular components and a suitable microenvironment such as the extracellular matrix (ECM). Acellular dermal matrix (ADM) is viewed as an ECM substitute, and a paste-type ADM has recently been introduced. We hypothesized that CGPaste, an injectable paste-type ADM, could serve as a scaffold and promote wound healing. Methods We retrospectively studied seven patients in whom CGPaste was applied between 2017 and 2018, who had pressure ulcers, necrotizing fasciitis, diabetic foot ulcers, traumatic defects, and osteomyelitis. The goal of applying CGPaste was to achieve complete wound healing with re-epithelialization or growth of granulation tissue, depending upon the wound bed status. CGPaste was injected based on the wound size along with the application of a dressing. Results Four of the seven patients showed granulation tissue on their wound bed, while the other three patients had a bony wound bed. The mean wound area was $453.57mm^2$ and the depth was 10.71 mm. Wound healing occurred in five of the seven patients (71.43%). The mean duration of complete healing was 2.4 weeks. Two patients showed failure due to paste absorption (29.57%); these patients had wound beds comprising bone with relatively large and deep wounds ($40{\times}30$ and $30{\times}20mm^2$ in area and 15 and 10 mm in depth). Conclusions CGPaste is an effective option for coverage of small and deep chronic wounds for which a flap operation or skin grafting is unfeasible.

• Journal of Medicine and Life Science
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• v.15 no.2
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• pp.56-61
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• 2018

Advances in medical technology has enabled better management of complicated and chronic wounds. Negative-pressure wound therapy (NPWT) is a novel dressing technique that uses negative pressure to drain exudates and blood from wounds. NPWT increases local blood flow and promotes reduction of edema and wound healing and is suitable for a variety of wounds. It is associated with few adverse effects and shows excellent efficacy and cost-effectiveness. NPWT promotes rapid growth of granulation tissue and wound contraction; thus, it is more advantageous than general dressings as it reduces the size skin of grafts or flaps required for repair, and patients with chronic wounds can be treated as outpatients. We investigated the general usage and mechanism of NPWT, its clinical applications and adverse effects.