Wound Healing (Basic and Clinical Dermatology)

Front cover......Page 1
Series Introduction......Page 8
Preface......Page 10
Contents......Page 12
Contributors......Page 26
1. ACUTE WOUNDS......Page 32
2. ULCERS 2.1. Venous Ulcer......Page 36
2.3. Pressure Ulcers......Page 37
3. CONCLUSION......Page 38
2. DEVELOPMENT 2.1. Fetal Skin......Page 40
3. SCARLESS FETAL WOUND REPAIR SPECIFICITY 3.1. Scarless Fetal Wound Phenotype......Page 41
4. MECHANISMS OF SCARLESS REPAIR 4.1. Wound Healing and Inflammation......Page 42
4.3. Cytokines......Page 43
5. SUMMARY......Page 44
REFERENCES......Page 45
2. PHASES OF ACUTE WOUND HEALING 2.1. Hemostasis......Page 48
2.2. Inflammation......Page 50
2.3. Proliferative Phase......Page 52
2.4. Remodeling......Page 56
3.2. Biochemical Differences in the Molecular Environments of Healing and Chronic Wounds......Page 57
3.3. Biological Differences in the Response of Chronic Wound Cells to Growth Factors......Page 60
4.2. Molecular Basis of Chronic Nonhealing Wounds......Page 61
4.3. Chronic Venous Stasis Ulcers......Page 62
4.5. Future Concepts for the Treatment of Chronic Wounds......Page 63
REFERENCES......Page 65
1. INTRODUCTION......Page 70
2.1. Type I and Type III Collagens in Dermis......Page 71
2.2. Skin Basement Membrane Collagens......Page 72
3. LAMININ......Page 73
3.2. Dermal Microvascular Laminins......Page 74
6. VITRONECTIN......Page 75
7.2. Tenascins......Page 76
REFERENCES......Page 77
1. PROTEOLYTIC REMODELING OF THE EXTRACELLULAR MATRIX DURING CUTANEOUS WOUND HEALING......Page 80
3. REGULATION OF MMP EXPRESSION AND FUNCTION......Page 81
4. ROLES FOR SPECIFIC MMPs IN CUTANEOUS WOUND HEALING......Page 82
5. IMBALANCES BETWEEN MMPs and TIMPs CONTRIBUTE TO PATHOLOGICAL WOUND HEALING......Page 86
REFERENCES......Page 87
1. INTRODUCTION......Page 90
2. CWATS......Page 91
REFERENCES......Page 97
2. BASIC ASSESSMENT OF THE LOWER EXTREMITY ULCER 2.1. General History: An Aid for Developing a Differential Diagnosis......Page 100
3. COMMON CAUSES OF LEG ULCERS......Page 101
3.2. Arterial Ulcers......Page 102
4.2. Hypercoagulable States......Page 103
4.6. Malignancy......Page 104
5.1. Venous Ulcer Physical Exam......Page 105
5.3. Physical Exam of Neuropathic Ulcers......Page 107
6. OTHER IMPORTANT CONSIDERATIONS 6.1. Infection......Page 109
7. CONCLUSION......Page 110
REFERENCES......Page 111
1. INTRODUCTION......Page 114
2. BIOFILMS AND PLANKTONIC BACTERIA......Page 115
4. MICROBIOLOGY OF WOUNDS......Page 116
5. SAMPLING TECHNIQUES......Page 117
7. MANAGEMENT OF BACTERIA IN WOUNDS......Page 119
8. ANTISEPTICS......Page 120
9.1. Effects of Iodine Compounds on the Bacterial Load of Wounds......Page 121
9.2. Effects of Iodine Compounds on Wound Healing Process......Page 122
10. SILVER COMPOUNDS......Page 123
11. OLD AND EMERGING ANTI-MICROBIALS......Page 124
REFERENCES......Page 125
2. DEFINITION......Page 134
4. NORMAL VENOUS PHYSIOLOGY......Page 135
5.1. Venous Pump......Page 136
5.3. Venous Hypertension......Page 137
6. EPIDEMIOLOGY OF VENOUS ULCERS 6.1. Incidence and Prevalence......Page 138
6.3. Risk Factors......Page 139
REFERENCES......Page 140
2. ETIOLOGY 2.1. Risk Factors......Page 142
3.1. Fibrin Deposition Hypothesis......Page 143
3.3. Growth Factor Trapping Hypothesis......Page 144
4.2. Physical Examination......Page 145
4.5. Late Changes......Page 147
5.2. Neuropathic......Page 148
5.4. Malignancy......Page 151
REFERENCES......Page 152
2. EPIDEMIOLOGY......Page 154
2.2. Diagnosis......Page 155
2.4. Doppler Waveform Analysis, Color Duplex Imaging......Page 156
2.6. Wound Healing and Tissue Loss......Page 157
2.7. Therapy......Page 158
REFERENCES......Page 159
12......Page 162
REFERENCES......Page 167
1.1. Definition......Page 170
2.1. Prevalence......Page 171
2.2. Incidence......Page 173
2.3. Long-Term Care Settings......Page 174
2.5. Costs......Page 175
3.1. Pressure......Page 176
4.1. Poor Nutrition......Page 177
5.1. Infection......Page 178
5.2. Osteomyelitis......Page 179
6. SUMMARY......Page 180
REFERENCES......Page 181
2. THE ELEMENTS OF PREVENTION......Page 184
3.1. Risk Factors......Page 185
3.3. Prevention Strategies......Page 186
3.5. Education and System Concerns......Page 188
4.1. Removing the Cause......Page 189
4.3. Wound Care......Page 190
5. SUMMARY......Page 194
REFERENCES......Page 195
ADDITIONAL READINGS......Page 199
1. INTRODUCTION......Page 202
2. EPIDEMIOLOGY OF THE DIABETIC FOOT......Page 203
4. PATHOGENESIS OF DIABETIC FOOT ULCERATION......Page 205
4.2. Neuropathy—The Major Contributory Factor in Ulceration......Page 206
4.4. Foot Pressure Abnormalities in Diabetic Patients......Page 208
5. THE PATHWAY TO ULCERATION......Page 209
REFERENCES......Page 210
2. PATHWAYS TO ULCERATION: CURRENT CONCEPTS......Page 214
3. OFFLOADING: CURRENT CONCEPTS......Page 215
4. ACTIVITY MONITORING......Page 217
5. CONCLUSION......Page 220
REFERENCES......Page 221
1. INTRODUCTION......Page 224
3. EFFECTS OF RADIATION THERAPY......Page 225
4. TREATMENT OF RADIATION-INDUCED WOUNDS......Page 228
5. EXPERIMENTAL TREATMENT STRATEGIES......Page 231
REFERENCES......Page 233
2. CLINICAL FEATURES......Page 236
4. DIAGNOSIS......Page 237
5. TREATMENT......Page 238
REFERENCES......Page 239
1.1. Historical Background......Page 240
2. CLINICAL FEATURES 2.1. Clinical Presentation......Page 241
2.2. Laboratory Findings......Page 242
2.4. Differential Diagnosis......Page 243
3. PATHOGENESIS......Page 245
4. CLINICAL COURSE=PROGNOSIS......Page 248
5. MANAGEMENT 5.1. Medical Management......Page 249
5.2. Other Approaches......Page 250
7. CONCLUSION......Page 251
REFERENCES......Page 252
1.2. Electrical......Page 256
1.3. Chemical......Page 258
1.4. Radiation......Page 259
2. PATHOPHYSIOLOGY 2.1. Partial vs. Full Thickness......Page 260
2.3. Nature of the Burn Wound......Page 261
2.5. Hypertrophic Scarring......Page 262
3.3. AgNO3......Page 264
4. OPERATIVE MANAGEMENT......Page 265
4.3. Temporary Coverage for the Excised Wound......Page 266
4.4. Permanent Coverage......Page 267
REFERENCES......Page 268
2. EPIDEMIOLOGY......Page 270
3. CUTANEOUS LESIONS OF PYODERMA GANGRENOSUM......Page 271
5. DISEASE ASSOCIATIONS......Page 273
7. ETIOLOGY=PATHOGENESIS......Page 274
8. DIAGNOSIS AND EVALUATION......Page 276
9. MANAGEMENT......Page 277
REFERENCES......Page 279
2. CLASSIFICATION......Page 284
3. PATHOGENESIS......Page 285
4. ILLUSTRATIVE EXAMPLES OF CV 4.1. Livedoid Vasculitis......Page 286
4.2. Henoch–Scho¨nlein Purpura......Page 288
4.3. Urticarial Vasculitis......Page 290
4.5. Granulomatous Vasculitis......Page 292
4.6. Cutaneous Polyarteritis Nodosum......Page 294
5. EVALUATION......Page 296
REFERENCES......Page 298
1. DISSEMINATED INTRAVASCULAR COAGULATION......Page 302
2. PURPURA FULMINANS......Page 304
3. THROMBOTIC THROMBOCYTOPENIC PURPURA......Page 305
4. FACTOR V LEIDEN MUTATION......Page 306
7. COUMADIN NECROSIS......Page 307
8. ANTIPHOSPHOLIPID ANTIBODY SYNDROME......Page 308
9. CRYOGLOBULINEMIA I......Page 311
10. CRYOFIBRINOGENEMIA......Page 314
11. CALCIPHYLAXIS......Page 315
12. CHOLESTEROL EMBOLI SYNDROME......Page 316
13. ATROPHIE BLANCHE......Page 317
REFERENCES......Page 318
2. DEFINITION......Page 324
3. PHYSIOLOGY......Page 325
4. CLINICAL MANIFESTATIONS 4.1. Hematologic......Page 328
4.4. Cutaneous Complications......Page 329
5. PREVALENCE......Page 330
6. DIAGNOSIS......Page 332
7.2. Therapy Post-Thrombosis......Page 333
REFERENCES......Page 334
2. ANATOMY OF THE LYMPHATIC SYSTEM......Page 338
3. PHYSIOLOGY OF THE LYMPHATIC SYSTEM......Page 339
4. LYMPHEDEMA VS. EDEMA......Page 340
6. DIAGNOSES OF LYMPHEDEMA......Page 342
8. NON-OPERATIVE LYMPHEDEMA THERAPY......Page 344
8.1. Comprehensive Decongestive Physiotherapy......Page 345
9. OPERATIVE TREATMENT OF LYMPHEDEMA......Page 347
11. PATHOPHYSIOLOGY OF WOUND-RELATED LYMPHEDEMA......Page 348
12. LYMPHEDEMA THERAPY AND THE OPEN WOUND......Page 349
REFERENCES......Page 350
2. MALIGNANT DEGENERATION OF WOUNDS......Page 352
3. MALIGNANCIES WHICH PRESENT AS CHRONIC WOUNDS......Page 355
4. ULCERS THAT DEVELOP SECONDARY TO TREATMENT OF A MALIGNANCY......Page 356
5. CUTANEOUS METASTASES PRESENTING AS ULCERS......Page 359
6. WOUNDS WITH ETIOLOGIES ASSOCIATED WITH MALIGNANCIES......Page 360
REFERENCES......Page 361
27......Page 366
5. WHAT ARE THE SHAPE AND CHARACTER OF THE ULCERS?......Page 367
10. INFECTIOUS ULCERS......Page 368
10.1. Bacterial Ulcers......Page 369
11. ULCERS DUE TO VASCULAR ABNORMALITIES AND INFLAMMATORY DISEASES......Page 373
11.1. Specific Diagnoses......Page 374
11.2. Erythema Induratum......Page 375
12. ULCERS DUE TO FIBROTIC CONDITIONS 12.1. Lipodermatosclerosis (Venous Ulcer, Sclerosing Panniculitis)......Page 377
12.2. Pressure Ulcers and Neuropathic Ulcers......Page 378
REFERENCES......Page 381
2. EPIDEMIOLOGY......Page 382
4. THE NEUTROPENIC PATIENT......Page 383
6. THE IATROGENICALLY IMMUNOSUPPRESSED PATIENT......Page 384
6.4. Mycophenolate Mofetil (MMF)......Page 385
7. THE CHRONIC WOUNDS......Page 386
8. WOUND INFECTION......Page 387
REFERENCES......Page 388
2. APLASIA CUTIS CONGENITA......Page 392
3. EPIDERMOLYSIS BULLOSA......Page 393
4. STEVENS-JOHNSON SYNDROME=TOXIC EPIDERMAL NECROLYSIS......Page 394
5. ULCERATED HEMANGIOMAS......Page 395
6. TRAUMATIC WOUNDS......Page 396
7. EXTRAVASATION INJURIES......Page 398
9. LEG ULCERS IN SICKLE CELL DISEASE......Page 399
10. KELOIDS AND HYPERTROPHIC SCARS......Page 400
11. TISSUE EXPANSION AS A SURGICAL ALTERNATIVE IN CHILDREN......Page 401
REFERENCES......Page 402
1. BACTERIAL 1.1. Ecthyma......Page 406
1.4. Mycobacterial infections......Page 407
1.6. Spirochetal Infection......Page 409
2.4. Blastomycosis......Page 410
3.2. Amebiasis......Page 411
REFERENCES......Page 412
2. ACRO-OSTEOLYSIS......Page 414
5. CONGENITAL HEMOLYTIC ANEMIAS......Page 417
8. CUTIS MARMORATA TELANGIECTATICA CONGENITA......Page 418
11. FLYNN–AIRD SYNDROME......Page 419
16. KLINEFELTER SYNDROME......Page 421
20. WERNER SYNDROME......Page 422
REFERENCES......Page 424
2. HISTORY......Page 428
3. DEBRIDEMENT......Page 429
3.2. Chemical Debridement......Page 430
3.3. Biological Debridement......Page 432
3.4. Mechanical Debridement......Page 433
4. BACTERIAL WOUND COLONIZATION......Page 434
REFERENCES......Page 436
1. COMPRESSION BANDAGING 1.1. Bandage Features and Function......Page 440
1.2. Rationale for Compression......Page 442
1.3. Compression Bandaging Mechanisms of Action......Page 443
1.4. Bandage Compression Pressures (Sub-bandage and Tissue)......Page 444
2. PNEUMATIC COMPRESSION......Page 446
4. ARTERIAL AND MICROCIRCULATORY BLOOD-FLOW CONSIDERATIONS......Page 447
REFERENCES......Page 449
1. MAKING THE DIAGNOSIS......Page 454
2.1 Tubular Bandages (Figs. 1 and 2)......Page 455
2.2 Paste Bandages (Figs. 3 and 4)......Page 456
2.3 Multilayer Wraps (Figs. 5–8)......Page 457
2.6 Compression Pumps......Page 460
2.7 Stockings......Page 461
4. HYPOTHETICAL SCENARIOS......Page 462
5. WHO SHOULD COMPRESS?......Page 463
8. PATIENT EDUCATION......Page 464
REFERENCES......Page 468
1. INTRODUCTION......Page 470
2.1. Terms and Definitions......Page 471
2.2. Types and Characteristics of Therapeutic Currents......Page 472
3.1. Experimental Research In Vitro and In Vivo......Page 475
3.2. Clinical Research Involving Chronic Wounds......Page 481
3.3. Strength of Evidence of Wound Healing with Electrical Stimulation......Page 499
4.2. Delivery of Current to Wound Tissues......Page 501
5. SUMMARY......Page 504
REFERENCES......Page 505
2. LASER PRINCIPLES......Page 512
3. WOUND HEALING......Page 514
4. PROPOSED MECHANISMS OF ACTION......Page 515
5. LASER IRRADIATION ON THE CELLULAR MEDIATORS IN THE HEALING PROCESS......Page 516
7. CONCLUSION......Page 518
REFERENCES......Page 519
1. RATIONALE FOR THE USE OF GROWTH FACTORS TO MANIPULATE WOUND HEALING TRAJECTORIES......Page 522
2.1. Platelet-Derived Growth Factor......Page 523
2.3. Keratinocyte Growth Factor-2......Page 524
2.5. Transforming Growth Factor Beta......Page 525
2.8. Interleukin-1 Beta......Page 526
2.10. Sequential Applications of Growth Factors......Page 527
3.1. Acute Burns......Page 528
3.2. Surgical Incisions......Page 529
4. EXPLANATION FOR LIMITED SUCCESS OF WOUND MANIPULATION BY GROWTH FACTORS......Page 530
REFERENCES......Page 531
2. ANIMAL STUDIES......Page 534
2.2. Granulation Tissue Formation......Page 535
3. MECHANISMS OF ACTION......Page 536
3.2. Mechanical Stimulation......Page 537
4. CHRONIC WOUNDS......Page 538
5. SUBACUTE WOUNDS......Page 539
6. ACUTE WOUNDS......Page 541
7. SUMMARY......Page 542
REFERENCES......Page 544
1. INTRODUCTION......Page 548
2. MANAGING TISSUE LOADS......Page 549
5. TISSUE LOAD MANAGEMENT SURFACES......Page 550
5.1. Foam Mattress Overlays or Mattress Replacements......Page 551
5.4. Gel and Water Products as Overlays and Mattress Replacements......Page 552
5.7. Total Bed Replacement: Air-Fluidized or High-Air-Loss Therapy......Page 553
6. CONCLUSION......Page 554
REFERENCES......Page 555
40......Page 556
1. STUDY SHOWING DECREASE IN PRESSURE......Page 560
REFERENCES......Page 563
2. HISTORY......Page 566
3. CLASSIFICATION AND INDICATIONS......Page 567
4. MECHANISM OF TAKE......Page 568
5. PROCEDURES 5.1. FTSGs......Page 569
5.2. STSGs......Page 571
5.3. PESGs......Page 572
REFERENCES......Page 573
1. INTRODUCTION......Page 576
2. CULTURED EPIDERMAL GRAFTS......Page 577
3. DERMAL SKIN SUBSTITUTES......Page 581
4. FULL THICKNESS SKIN SUBSTITUTES......Page 583
REFERENCES......Page 585
1. INTRODUCTION......Page 592
2. WOUND INFECTION......Page 593
3. COLLAGEN SYNTHESIS......Page 595
5. EPITHELIZATION......Page 597
6. CLINICAL IMPLICATIONS......Page 598
REFERENCES......Page 600
2. HOW HBO2T INCREASES TISSUE OXYGEN LEVELS......Page 604
3. THE PHYSIOLOGICAL EFFECTS OF OXYGEN IN WOUND HEALING......Page 608
5. HYPERBARIC TREATMENT PROTOCOLS......Page 609
6. PATIENT SELECTION FOR HYPERBARIC OXYGEN THERAPY......Page 610
7. MEDICARE COVERAGE GUIDELINES......Page 615
REFERENCES......Page 616
1. A BRIEF HISTORY OF WOUND DRESSINGS......Page 618
3. PASSIVE DRESSING CATEGORIES......Page 620
3.1. Passive Dressings That Absorb Exudate......Page 621
3.2. Passive Dressings That Maintain Moisture......Page 622
3.3. Passive Dressings That Supply Moisture......Page 623
5. REDUCING PROTEASES IN THE WOUND ENVIRONMENT......Page 624
5.2. Collagen Dressings......Page 625
6. REDUCING BACTERIA AND BACTERIAL CHEMICALS IN THE WOUND ENVIRONMENT......Page 626
7. ACTIVE ANTIMICROBIAL DRESSINGS......Page 627
REFERENCES......Page 628
2. INTRODUCTION......Page 630
3. WOUND BIOBURDEN ASSESSMENT 3.1. Host Resistance......Page 631
3.2. Bioburden Load......Page 632
4. BIOBURDEN MANAGEMENT 4.1. Wound Bed Preparation (Debridement)......Page 634
4.2. Antimicrobials......Page 635
REFERENCES......Page 643
SUGGESTED READING......Page 645
2. PENTOXIFYLLINE......Page 648
4. STANOZOLOL......Page 649
8. ANTIMICROBIALS......Page 650
12. ESTROGEN......Page 651
REFERENCES......Page 652
3. PATHOGENESIS 3.1. Wound Healing and Derailments Leading to Keloid or Hypertrophic Scar Formation......Page 654
3.2. Cells Involved in Wound Healing Processes......Page 655
3.3. Significant Processes and Factors in Abnormal Wound Healing......Page 657
4.2. Other Potential Therapies......Page 658
REFERENCES......Page 663
1. INTRODUCTION......Page 668
3. CLASSIFICATION OF CHRONIC WOUND PAIN......Page 669
4. RESOURCES......Page 671
6. PAIN TOOLS AND SCALES......Page 672
7. MANAGEMENT TACTICS AT THE TIME OF DRESSING CHANGE......Page 673
10. STRATEGIES FOR MANAGING NONPROCEDURAL PAIN......Page 674
REFERENCES......Page 675
1. INTRODUCTION......Page 678
2. NUTRITIONAL ASSESSMENT......Page 679
3. GENERAL NUTRITIONAL SUPPORT......Page 680
4.2. Carbohydrates and Lactate......Page 681
4.4. Vitamin C (Ascorbic Acid)......Page 683
4.6. Vitamin E......Page 684
5.1. Human Growth Hormone (HGH)......Page 685
REFERENCES......Page 686
2.1. Infrared......Page 692
2.2. Ultraviolet......Page 693
3. ULTRASOUND......Page 695
4. INTERMITTENT PNEUMATIC COMPRESSION......Page 697
5. WHIRLPOOL......Page 698
REFERENCES......Page 699
1. INTRODUCTION......Page 702
3. ULTRASONOGRAPHY......Page 703
4.1 Laser Doppler Flowmetry......Page 705
6. pH MEASUREMENT......Page 706
7. CONFOCAL MICROSCOPY......Page 707
8. MAGNETIC RESONANCE IMAGING......Page 708
REFERENCES......Page 709
1. INTRODUCTION......Page 712
2. TISSUE ADHESIVES: GRAFT TAKE......Page 713
3. TISSUE ADHESIVES: LIQUID DRESSINGS......Page 714
4. CONCLUSION......Page 716
REFERENCES......Page 717
54......Page 720
1. MODELS OF NORMAL WOUND HEALING......Page 722
1.1. Bacteria-Challenged Wound Models......Page 726
1.2. No Chronic Wounds/Delayed Healing Models......Page 727
2.1. Evaluation of Epidermal Repair......Page 729
2.2. Evaluation of Dermal Repair......Page 731
2.3. Other Measurements......Page 732
REFERENCES......Page 733
2. PROGNOSTIC MODELS......Page 736
2.1. Explanatory and Prognostic Models......Page 737
2.3. Evaluation......Page 738
2.4. Generalizability and Validation......Page 739
3. SURROGATE ENDPOINTS......Page 740
REFERENCES......Page 742
Index......Page 744
Back cover......Page 756