Wound management

Along with the front hospitals (HOE), the action of sorting out the injured was one of the most important innovations of the Great War. Progressively, it was implemented and codified on each level of the evacuating chain, with variations due to the different phases of the conflict, such as in Verdun or in the Somme. From 1917 onwards, specific sorting centers, managed by experimented soldiers, were set up in the evacuating hospitals.
Avec les “hôpitaux de l’avant”, le triage des blessés est l’une des principales innovations de
la Grande Guerre. Il est progressivement réalisé et codifié à tous les échelons de la chaîne des
évacuations avec des variantes selon les phases de combat, comme à Verdun ou dans la Somme.
À partir de 1917, des centres de triage spécifiques, animés par des personnels expérimentés, sont
mis sur pied dans les hôpitaux d’évacuation.
Along with the front hospitals (HoE), the action
of sorting out the injured was one of the most important innovations of the Great War. Progressively, it was implemented and codified on each level of the evacuating chain, with variations due to the different phases of the conflict, such as in Verdun or in the Somme. From 1917 onwards, specific sorting centers, managed by experimented soldiers, were set up in the evacuating hospitals.

Les gelures sont des lésions locales des extrémités liées à une exposition à des températures en dessous de 0°C. Le risque, en l’absence de prise en charge, est l’amputation des zones gelées qui évoluent vers la gangrène. Le traitement et l’évacuation des patients victimes de gelures constituent une urgence. Les infirmiers sont particulièrement associés aux soins secondaires qui peuvent être longs. Frostbites are cold-freezing injuries of the extremities due to the exposure to temperatures below 0°C. The risk, in the absence of treatment, is the amputation of frostbitten areas which become gangrenous. Victims of frostbite must be treated and evacuated urgently. Nurses play an active role in the secondary long-term treatment.

The current economic downturn in the UK and other countries has caused healthcare organisations to justify the costs of more advanced technologies. This is seen especially within the wound care discipline. The costs of healthcare account for a third of all UK government spend and with the prevalence of chronic wounds increasing, the cost of modern wound care is becoming more strained and open to scrutiny. Healthcare decision makers should not base their decisions on cost of dressings alone, but take into account the costs mitigated by using an advanced wound therapy. A clinical-economic assessment should be performed on a number of advanced therapies to assess if these are indeed more cost-effective long-term.

Virtual Patients (VPs) are an interactive computer-based clinical patient scenario used in medical education. To determine how VPs are used in medical education, a literature search and review was completed. Methods: A literature search was completed using Google Scholar. Keywords used were “Virtual Patient”, “Case-based learning” and “Medical Education”. Conclusion: VPs are a teaching tool used throughout medical education, using clinical cases to bridge the gap between knowledge and clinical practice. The impact of VPs has been equally as effective for medical students as traditional non-computer based methods. However, the role of VPs in specialities such as wound care is less clear and requires more evidence. This is part one of two articles. In part two, the author describes the development and application of a wound healing VP integrated into the medical curriculum at Cardiff University Medical School.

Les vagues d’attentats en France depuis les années 1980 ont apporté à la pratique civile l’expérience du polymorphisme des mécanismes vulnérants physiques et psychiques du terrorisme. Les enseignements tirés des confl its militaires de la prise en charge de nombreuses victimes dans les premières minutes sont à diffuser à tous les professionnels de santé et largement à la population. Les objectifs des “gestes qui sauvent” sont simples, clairs, et leurs applications permettent de limiter le nombre de morts évitables (sauver) et les conséquences des blessures (mieux sauver). Dans ces situations, l’hémorragie est la première cause de mortalité, à stopper idéalement dans les dix premières minutes dites de “platine” ou dans la “demi-heure hémorragique” faisant le pronostic vital.

Aim: The wound is the consequence of an acute skin aggression either limited or spreading, sometimes iatrogenic, which may be worsened by a delay in care in peculiar circumstances. The aim of this study is to present the benefits and give potential indications of a waterproof dressing. This dressing guarantees the protection during the healing process and increases the patient’s compliance to the treatment of his wounds, even in difficult situations.
Methods: We used various dressings or means (primary adherent dressings, polyurethane film, cling film) to protect wounds in isolated or precarious care situations, but also in a more conventional context. Results: Secuderm® is the only dressing that is waterproof, reliable for acute and chronic protection for repeated exposures to water: excessive sweating, friction of clothing, projection or complete immersion under water. We report the use of Secuderm® in different exemption situations: in Guyana during French military missions by the Navy divers, in Cameroon for the treatment of Buruli ulcers, after arthroscopy, to protect medical devices (catheters, etc.) on acute wounds, or even during patient exposure to a nuclear, radiological, biological or chemical risk (NRBC). Discussion: To effectively protect a wound is difficult when the human resources and materials are limited. An efficient protection of the healing wound allows the resumption of professional, social and private activities in a certain comfort. Probably the only solution that is currently available, Secuderm® is a cunning waterproof protection for several days. Its indications are multiple whether in the treatment of acute, chronic or iatrogenic wounds, at the hospital, at home, in degraded situation or even when exposed to nuclear, radiological, biological or chemical risk. Prospective comparative studies are required.
But : La plaie est la conséquence d’une agression cutanée aiguë plus ou moins étendue, parfois iatrogène, pouvant être aggravée par un retard de prise en charge quand le contexte devient particulier. Le but de ce travail est de présenter les intérêts et les indications potentielles d’un pansement étanche. Ce pansement permet de garantir la protection du processus cicatriciel et d’augmenter l’adhésion du patient à ses soins, plus encore en situation difficile. Méthode : Nous avons utilisé divers pansements ou moyens (pansements primaire adhérents, film de polyuréthane, film alimentaire) pour protéger les plaies dans des situations de prises en charge isolées ou précaires, mais aussi dans un contexte plus conventionnel. Résultats : Le Secuderm® est une solution de protection étanche fiable en aigue et dans le temps lors d’expositions répétées à l’eau : transpiration importante, friction des vêtements, projection ou immersion complète sous l’eau. Nous rapportons l’utilisation du Secuderm® dans différentes situations d’exceptions : en Guyane chez des militaires en mission, des plongeurs de la marine nationale, au Cameroun dans le traitement de l’ulcère de Buruli, après arthroscopie, en protection de dispositifs médicaux (cathéters, etc.) sur des plaies aiguës, ou encore lors de l’exposition d’un patient à un risque nucléaire, radiologique, biologique ou chimique (NRBC).
Discussion : La protection efficace d’une plaie est d’autant plus difficile que les moyens humains et matériels sont limités. Une protection efficace d’une plaie autorise la poursuite d’une activité professionnelle, sociale et privée avec la garantie d’un certain confort. Probablement seule solution actuellement disponible, le Secuderm® assure une protection étanche astucieuse plusieurs jours. Ses indications sont multiples qu’il s’agisse des plaies aiguës, chroniques ou iatrogènes, à l’hôpital, à domicile, en situation dégradée voire même lors d’une exposition au risque NRBC. Des études prospectives comparatives sont nécessaires.

Virtual patients (VPs) are an interactive computer-based clinical patient scenario used in medical education. Part one of this article, published in the last issue, discussed a literature search carried out to determine how VPs are used in medical education. Here, in part two, the author describes the development and application of a wound healing VP that has been integrated into the medical curriculum at Cardiff University Medical School. The e-module, which was designed based on learning outcomes, balances core content and interacitvity with questions engage the reader and promote the application of conceptualised ideas. There is scope to distribute the module to other healthcare students and professionals.

A degloving wound is a minimal to extensive loss of skin with variable amounts of deep tissues loss through trauma. The occurrence of degloving injuries has been reported to affect different body parts. This article presents a left forelimb degloving wound that was successfully managed via second intention following a failed first intention management in a 2year-old German shepherd bitch.

Points essentiels
■ Les plaies traumatiques et chroniques imposent des soins et des démarches de soins différentes.
■ La plaie doit être lavée abondamment à l’eau ou au sérum physiologique avant l’évaluation.
■ Le nettoyage avec une solution aqueuse et la détersion mécanique sont les deux actes fondamentaux de la prise en charge initiale d’une plaie aiguë aux urgences.
■ Les antiseptiques doivent être utilisés de façon raisonnée. Pour cela, le praticien doit comprendre l’écologie microbienne et le bactériocycle naturel au sein de la plaie aiguë ou chronique.
■ En cas d’attente ou en préhospitalier, les lésions sont couvertes d’un pansement légèrement humide ou permettant un retrait non traumatique.
■ En présence d’un patient porteur d’escarre ou à risque d’escarre, des supports associés à des mobilisations régulières.
■ Les plaies tumorales compliquées d’un événement aigu (hémorragie, infection) nécessitent une prise de contact rapide avec le service d’oncologie en charge du malade.

Millionen Menschen leiden unter schlecht oder gar nicht heilenden Wunden - besonders bekannt ist etwa der häufig bei älteren Menschen auftretende Dekubitus - mit denen nicht nur enorme gesellschaftliche Kosten, sondern auch erhebliche soziale Belastungen durch den Verlust von Lebensqualität und Arbeitsfähigkeit verbunden sind. Die Heilungschancen der Betroffenen hängen verständlicherweise stark von der medizinischen Qualität der Wundbehandlung und Wundpflege ab, die selbst wiederum von der Qualität der Wunddokumentation abhängig ist - den schriftlichen und fotografischen Aufzeichnungen über die Wundentwicklung sowie die durchgeführten Pflegemaßnahmen, die von den Pflegekräften für den behandelnden Arzt angefertigt werden. In Vorbereitung eines F&E-Projekts zur Entwicklung eines digitalen Wunddokumentationssystems (DigiWund) wurde an der Hochschule Harz in Wernigerode eine umfangreiche Literaturstudie zur schriftlichen und fotografischen Dokumentation insbesondere chronischer Wunden durchgeführt. Ein Ergebnis dieser Recherchen ist die vorliegende Einführung in die Grundlagen der Wunddokumentation - eine leicht zu lesende und praxisrelevante Übersicht. Nach einer allgemeinen Einführung in die volkswirtschaftlichen und medizinischen Grundlagen im ersten und einer Definition wesentlicher Grundbegriffe im zweiten Kapitel, werden im dritten Kapitel die drei bedeutendsten chronischen Wunderkrankungen - der Dekubitus, der diabetische Fuß und der Ulcus cruris - betrachtet. Das vierte Kapitel widmet sich der Frage, zu welchem Zweck chronische Wunden dokumentiert werden und beleuchtet häufig verwendete Skalensysteme zur Einschätzung der Schwere chronischer Wunden sowie wesentliche rechtliche Anforderungen an eine hochwertige Wunddokumentation. Das fünfte und umfangreichste Kapitel listet alle wesentlichen Wundeigenschaften - von der Größe der Wunde über ihre Lokalisation und Tiefe bis hin zum Geruch eventuell austretenden Exsudats - auf, wobei für jedes dieser Merkmale die medizinische und pflegerische Bedeutung sowie gängige Methoden zur Erfassung und schriftlichen Dokumentation aufgezeigt werden. Im nachfolgenden sechsten Kapitel stehen dagegen die fotografische Wunddokumentation und die Frage im Vordergrund, welche Qualitätsmerkmale für Wundfotos existieren. Im siebten und letzten Kapitel werden abschließend noch einige der über das Buch hinausgehenden Themen wie etwa die Bedeutung der Ernährung für die Wundheilung oder die Wundprophylaxe aufgegriffen.

The direct application of bone marrow (BM) can accelerate the healing of chronic wounds. We hypothesized that this effect is due to the presence of stromal progenitor cells (SPCs) found within whole BM preparations. To test this hypothesis, we isolated adult murine SPCs from whole BM and examined their ability to enhance impaired wound healing compared with ficoll separated BM cells in the diabetic (db/db) mouse model. SPCs significantly enhanced reepithelialization, granulation tissue formation, and neovascularization compared with control wounds treated with BM or PBS alone. Higher frequencies of donor SPC cells compared with donor BM cells were observed in treated wounds at 7 days. Transdifferentiation into GFP-positive mature endothelial cells was not observed. These observations suggest that SPCs improve wound healing through indirect mechanisms which lead to enhanced vascularization rather than through direct participation and incorporation into tissue. We conclude that topical application of BM-derived SPCs may represent an effective strategy for the treatment of chronic diabetic wounds.

Objective: Wound management recommendations usually group dressings by base substrate material or reimbursement codes, even when functional differences are vast (e.g., honey-containing alginates, super-absorbent hydrogels). Polymeric membrane dressings (PMDs) diverge dramatically from conventional foam dressings in functional attributes, indications, and patient results, providing an opportunity to demonstrate the evidence for categorizing dressings based upon functional differences. Approach: A search of ALL published literature describing the use of PMDs, with no date or language limits, was conducted. Documents simply listing a PMD brand name (e.g., PolyMem) as one of many ''foam'' dressings were eliminated. The subset of evidence evaluating PMDs for tissue damage resulting from pressure (pressure ulcers, pressure injuries, henceforth: PUs) was summarized. Results: Studies of PMDs, primarily from independent clinician-researchers, have accumulated into a significant evidence base over the past 30 years. PMDs actively cleanse and debride wounds, balance moisture, relieve pain, and limit inflammation: all functions not shared by conventional foams. Innovation: This article supports a paradigm shift for wound management guidance materials to embrace a more evidence-based, patient-centered method of classifying products. The results presented here, using PMDs for PUs as an example , show that functional attributes, indications, and patient results are not always dictated by dressing substrates. Rather than being comparable with conventional foam dressings, PMDs have substantially enhanced functions and results. Conclusion: These results strongly support the author's assertion that evidence-based wound management requires guidelines and recommendations that categorize advanced dressings based upon how they function in real-life settings, rather than upon their base substrate.

Extracorporeal shock wave therapy has been reported as an effective treatment for lower limb ulceration. The aim of this systematic review was to investigate the effectiveness of extracorporeal shock wave therapy for the treatment of lower limb ulceration.

Introduction. Pilonidal sinus (PNS) disease affects the skin and subcutaneous tissue of the natal cleft of the buttocks. The treatment is
variable and depends on presentation and the extent of disease. The mainstay of surgical management for PNS disease is to excise all
sinus tracts and pits. There are numerous surgical techniques and none of them are considered optimal. Residual dead space is
responsible for the majority of complications in PNS surgery. Objective. In this study, the authors describe a modified technique of the
Karydakis procedure and investigate the effects of this new method. Materials and Methods. In this trial, 80 patients were included
between January 2014 and January 2015. A new technique in PNS surgery, which can be described as a modified Karydakis procedure,
was performed. In this technique, following total sinus excision, the excised defect was closed with the standard Karydakis method, but
in order to reduce the dead space under the standard Karydakis flap, an advancement tissue flap with additional skin excision was
performed. During a mean follow-up period of 20 months, some complications occurred, including wound dehiscence, the formation
of a seroma, the formation of a hematoma, and infection. These complications were monitored. Results. There were 19 female and 61
male patients with a mean age of 24 years (range, 18–49 years). The mean volume of the sinus was 26 cc (range, 8–80 cc). A total of 10
patients (12.5%) experienced complications. All complications were managed successfully with follow-up treatment and appropriate
wound care. Conclusions. The results of this pilot study suggest this technique may be considered as an alternative surgical method in
PNS surgery, provided the results are corroborated by further randomized controlled trials.

La société française de médecine d’urgence (SFMU) a publié en septembre dernier des recommandations formalisées d’experts (RFE) sur la prise en charge des plaies aiguës en structure d’urgence. Elaboré via une revue de la littérature internationale exhaustive, et avec des experts de différentes sociétés savantes françaises, ce référentiel donne aux soignants, et à la population, des éléments clairs, simplifiant les soins de la plaie aiguë en urgence.

Introduction : La main est le principal outil de l’homme. En cas de traumatisme aigu, toute la filière de soin doit être mobilisée pour optimiser une récupération fonctionnelle hypothétique. Les acteurs sont nombreux à intervenir dans ce processus cicatriciel parfois long. Nous rapportons un exemple de prise en charge multidisciplinaire ayant autorisée une réhabilitation socio-professionnelle optimale au regard des lésions initiales. Cas clinique : Observation d’un militaire de 26 ans, maçon de spécialité, victime au travail d’un écrasement de sa main dominante dans une bétonnière. Le parcours de soin du patient est rapporté aidé d’une iconographie : conditionnement initial, prise en charge préhospitalière et hospitalière puis évolution des soins au retour à domicile. L’urgence fonctionnelle a été reconnue immédiatement comme urgence absolue, imposant une prise en charge dans les six heures. Sa médicalisation précoce préhospitalière a permis une régulation sur un plateau chirurgical fondamental à la stabilisation et à la reconstruction ostéo-tendineuse, articulaire et cutanée de la main. Ces résultats ont été consolidés en deux mois par une coopération pluridisciplinaire dynamique entre chirurgien, médecin traitant, infirmiers et kinésithérapeutes. Discussion : Le déploiement d’une véritable ‘chaîne de survie fonctionnelle d’une main’ a autorisé une reprise du travail rapide grâce à des résultats esthétiques et fonctionnels très satisfaisants. Ces synergies professionnelles parfois nouvelles ont été jugées comme gratifiantes et constructives par l’ensemble des acteurs. Par ailleurs le coût global de la prise en charge a été diminué tout en augmentant la qualité du vécu cicatriciel du patient.
Introduction : The hand is the primary work tool of mankinf. In acute trauma, the entire chain of care must be mobilized to optimize a hypothetical functional recovery. Many actors are involved in this sometimes long healing process. We report an example of multidisciplinary care has allowed an optimal socio-professional rehabilitation in terms of the initial lesions. Clinical case: Observation of a 26 years old military mason, victim of a workplace accident, who crushed his dominant hand in a concrete mixer. The course of patient care is reported with iconography : initial conditioning, prehospital and hospital care and care developments after return home. Results : The functional emergency was immediately recognized as an "absolute emergency." His early prehospital medicalization has a fundamental control on a stabilization and reconstruction tendon bone, joint and skin of the hand surgical tray. These results have been consolidated in two months by a dynamic multidisciplinary cooperation between surgeon, doctor, nurses and physiotherapists. Discussion : The deployment of a real 'chain of survival functional hand has allowed a rapid recovery work with very satisfactory aesthetic and functional results. These new business synergies were sometimes deemed rewarding and constructive by all actors. Moreover, the overall cost of care was reduced while increasing the quality of patient experience scar.

Pack mules are often subject to tethering injuries and saddle sores. Prevention is the best approach to these injuries and action should be taken to ensure that the mule’s welfare is protected. Where wounds do occur, a wound management plan is required that addresses the underlying causes of any wounds and promotes wound healing.

To report the use and describe the interest of hemostatic dressings in a civilian setting, we provided medical prehospital teams with QuikClot Combat Gauze (QCG) and asked physicians to complete a specific questionnaire after each use. Thirty uses were prospectively reported. The wounds were mostly caused by cold steel (n=15) and were primarily cervicocephalic (n=16), with 19/30 active arterial bleedings. For 26/30 uses, hemostatic dressing was justified by the inefficiency of other hemostasis techniques. Those 30 applications were associated with 22 complete cessations of bleeding, six decreases of bleeding, and ineffectiveness in two cases. The application of QCG permitted the removal of an effective tourniquet that was applied initially for three patients. No side-effects were reported. The provision of hemostatic dressings in civilian resuscitation ambulances was useful by providing an additional tool to limit bleeding while rapidly transporting the injured patient to a surgical facility.

Le bilan initial et les premiers soins conditionnent la qualité du traitement chirurgical secondaire des plaies complexes de la main. Le soignant primo-intervenant en est l’acteur principal. L’analyse de la gestion de ces traumatismes “en situation dégradée” permet de dégager les étapes essentielles de prise en charge initiale : contrôle du  saignement, prévention de l’infection et bilan lésionnel précis. Le transfert secondaire vers un centre spécialisé est ainsi optimisé.
[The initial assessment and care determine the quality of the secondary surgical treatment of complex hand wounds. The caregiver providing this initial care plays a critical role. The analysis of the management of these traumas in exceptional situations enables the key stages of the initial treatment to be identifi ed: bleeding control, infection prevention and an accurate assessment of the injury. These measures thereby help to optimise the patient’s transfer towards a specialised unit.]

ITV réalisée par Isabelle Fromantin, vice-présidente de la SFFPC:

- Quelle conduite à tenir immédiate adoptez vous face à une plaie traumatique sur la voie publique ? Vous contentez vous de « couvrir » pendant le transport ou assurez vous des premiers soins ?
- Utilisez-vous des produits particuliers en cas d’hémorragie ? lesquels ?
- Quelle est votre attitude devant une plaie par balle ?
- Et face à un patient brûlé dans un incendie ?
- Le nombre de patient porteur de plaie est-il fréquent par rapport au nombre d’appel que vous recevez ?
- Si vous pouviez changer immédiatement une chose dans la prise en charge des plaies en pré-hospitalier, qu’est ce que ce serait ?
- Auriez vous quelques références et lectures à nous proposer sur ce sujet ?

A tropical forest is a hostile environment for humans. The military physician supporting these immersion activities must cope with varied clinical situations with limited resources to reduce operational unavailability. This article reports a prospective cross-sectional epidemiologic study conducted from January to May 2012, observing the daily activity at sick call during the rainy season at the tropical forest training center (CEFE) advanced jungle commando training, located in French Guyana. The aim was to observe the distribution of traumatic injuries and specific diseases in this tropical environment. In all, 9,221 army staff members participated in the training (mean age: 30.8 years) during the 120-day study period. There were 486 medical visits, for a mean daily incidence of 5.3% (trainees: 83.8%, trainers: 16.5%). Skin lesions were most frequent (39%), principally irritative dermatitis and skin maceration (moisture/dressing associated dermatitis). A third (34%) of these conditions were due to trauma, mainly limb contusions and ligament injuries. Tropical diseases accounted for 3% of the reasons for consultation, with rare problems related to equatorial fauna or flora. The remaining conditions (24%) were not specific to the environment or activity. Operational attrition averaged five days. Removal from the training course was necessary in 13.8% of the cases. In an isolated area with a demanding environment , edical practice in a tropical forest requires health prevention actions and close medical follow-up. The permanent presence of a physician provides both care and expertise and is an important asset for both trainees and trainers.
La forêt équatoriale est un environnement hostile pour l’homme. Le médecin militaire soutenant des activités en immersion doit faire face à des situations cliniques variées avec des moyens limités pour réduire l’indisponibilité opérationnelle. Etude épidémiologique prospective transversale de janvier à mai 2012 observant, en saison des pluies, l’activité quotidienne de consultation médicale du Centre d’entrainement en forêt équatoriale (CEFE), pôle d’excellence dans l’aguerrissement commando en jungle situé en Guyane. Le but était d’observer la répartition des affections traumatiques et les pathologies spécifiques de l’environnement équatorial. Durant 120 jours, 9221 personnels ont été inclus (âge moyen de 30,8 ans ). Pour 486 consultations l’incidence moyenne des consultations était de 5,3% par jour (stagiaires : 83,8%, encadrement : 16,5%). Les lésions cutanées étaient majoritaires (39%), principalement des dermites irritatives et de macération. Un tiers (34%) des affections étaient traumatiques, en majorité des contusions et lésions ligamentaires des membres. Les maladies tropicales représentaient 3% des motifs de consultations avec de rares problèmes liées à la faune ou à la flore équatoriale. Le reste des affections (24%) étaient non spécifiques du milieu ou de l’activité. L’attrition opérationnelle était de 5 jours en moyenne . Un arrêt définitif de l’entrainement a été nécessaire dans 13,8% des cas. En milieu isolé, dans un environnement exigeant, l’exercice médical en forêt équatoriale impose des actions de prévention sanitaire et un suivi médical au plus près. Entre soins et expertise, la présence permanente du médecin est un véritable atout pour les stagiaires et l’encadrement.

L’eau du robinet est une alternative possible et sûre à une solution de chlorure de sodium stérile pour le nettoyage des plaies aigues avant suture : étude prospective, en double-aveugle, randomisée et contrôlée.
Weiss EA, Oldham G, Lin M, Foster T et al. (2013). Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. BMJ Open; 3:e001504. Clinicaltrials.gov : NCT01564342.

Les plaies représente le second motif d’admission aux urgences (13% des motifs de recours). Les recommandations sur la prise en charge initiale des plaies aigues sont principalement fondées sur des avis d’experts, les niveaux de preuves scientifiques étant limitées. L’utilité – ou l’inutilité – des antiseptiques initialement n’a pas été prouvée, l’attitude actuelle est d’insister sur le nettoyage généreux à l’aide d’une solution neutre et la détersion initiale.
Objectif primaire : Evaluer s’il existait une différence significative du taux d’infection des plaies suturées aux urgences, préalablement nettoyée avec une solution stérile de chlorure de sodium (SS) versus de l’eau du robinet (TW). Secondaire : Valider l’hypothèse que l’usage d’une solution aqueuse exclusive (SS ou TW) était sûr et efficace dans ce contexte.
Type d’études et pertinence : Etude prospective monocentrique, randomisée, contrôlée en double aveugle (Stanford, Angleterre) rapportant et comparant le taux d’infection après usage strict de SS ou TW pour le nettoyage des plaies aiguës.
Critère de jugement principal : Signe d’infection à H48 et J30 dans les deux groupes. Seule étude avec sur le sujet avec une telle méthodologie.

Burns is a global public health problem in the developed world and expensive burn dressings are not universally available. Most burns patients suffer from a deep second degree burn that can be treated conservatively. However, the ideal dressing for the burn wound has not been identified. This study is performed in animal experiment to compare the healing of deep second degree burns treated with silver sulfadiazine (SSD) and a Mixture of Honey, Beeswax and olive oil (MHBO). A standard deep second-degree burn wound was produced, in five dogs, each dog has three groups; MHBO, SSD 1% cream and control group (no topical therapy at all). The efficacy of treatment was assessed based on the healing percentage of the wound, time to complete wound healing and the degree of inflammation and exudation. Wound contraction was higher in MHBO group than both SSD and the control group. It was significantly higher in MHBO group than the control group on days 18, 21, 24 and 27 while significantly high...

Background: Dressing materials are known to influence post-operative surgical wound healing
and scar formation (SF). A particular dressing that could promote wound hydration is
essential to ensure quick epithelialization and reduce SF. This study examined the effective-
ness of a novel Continuous Diffusion of Oxygen (CDO) dressing to reduce scar length post
cervicotomy.
Methods: A randomized controlled trial was performed in patients undergoing cervicotomy,
either for thyroid or parathyroid disease. Patients were randomized to either control (CG) or
intervention (IG) groups. The IG received a portable CDO system (TransCu O2, EO2 Concepts
Inc., TX, USA), whereas the CG received a standard dressing for a 4-week period. The primary
outcome was > 10% of scar length reduction and %change in scar length.
Results: 21 patients were recruited (Age: 53 ± 16 years; 90% female; CG = 9, IG = 12). 5 patients
were lost to follow-up. At 4 weeks, 88.8% of the IG significantly achieved > 10% of scar
reduction (versus CG = 28.5%, d = 0.48, P = 0.049), showing a 40.4% smaller scar (15.7% versus
11.2%, d = 0.13, P = 0.72) compared to the CG. However, the difference was not significant. A
sub-sample of patients undergoing thyroidectomy showed a significant scar reduction using
CDO (IG = 11.6% versus CG = 5.1%, d = 2.96, P = 0.009).
Conclusions: This is the first study to assess scar reduction using CDO adjunct therapy after cervicotomy. Advanced CDO dressings may assist wound healing showing improved outcomes for scar visualization in patients undergoing thyroidectomy. A larger sample is required to validate this observation.

Necrotizing fasciitis of the lower extremities results in large tissue defects, and most cases require reconstruction using skin grafts or flaps. We describe a 61-year-old man who developed necrotizing fasciitis of the right lower leg and septic shock, following a traumatic injury to his leg. Wound culture yielded methicillin-resistant Staphylococcus aureus. Extensive debridement was performed four times along with the use of appropriate antibiotics. After 2 weeks, physical examination showed an open wound (approximately 30×20 cm in size) with partial tibial bone exposure. Subsequently, the patient underwent successful reconstruction using a tibialis anterior musculofascial flap and split-thickness skin grafting. The tibialis anterior muscle was bihalved and pivoted to cover the exposed bone surface. The patient was without pain and was able to successfully perform daily activities at the 15-month follow-up. This case report highlights the utility of a bihalved tibialis anterior mus...

Novel findings on fabrication techniques for bioactive materials, discovering further basic knowledge
about wound healing process, and availability of stem cells as alternative candidate for differentiated cells
have highly encouraged scientists for developing new bioengineered skin substitutes (BSS) that offer an
effective remedy for a specific wound type. However, technical, clinical, legislative and economic reasons
hamper wide-spread commercialization and clinical translation of BSS. Among the various types of
strategies that target skin repair and regeneration, tissue engineering with stem cells is most promising
route. Tissue engineering by cooperation of several disciplines forms a context on which the commercial
development of BSS is possible to provide benefits for patients who currently have limited or no cure
options. The principles of tissue engineering are to initiate cell cultures in vitro, grow them in monolayer
or on porous scaffolds and transplant the composite into a patient with a specific wound indication in vivo.
The potential for creating of custom-designed biomaterials and availability of stem cells from either
autologous or allogenic sources have helped to produce novel innovative BSS. Currently, wide range of
skin substitutes are already being fabricated for clinical use in different wound indications but not yet
definitively established. Therefore, many novel engineered constructs might be fabricated in the future.
In this review, we describe the progress that has been made to date in the field of skin substitutes and the
critical issues that are still hindering successful production and bench to bedside translation of BSS and
restricting the availability of these innovative therapeutic constructs. Integrity of the science and
technology, interdisciplinary expertise collaborations, and early interaction with regulatory entities such
as Food and Drug Administration (FDA) and European Medicines Agency (EMA), together with other
critical determinants, is vital to the successful commercialization of tissue engineering products into the
marketplace/clinic.

The direct application of bone marrow (BM) can accelerate the healing of chronic wounds. We hypothesized that this effect is due to the presence of stromal progenitor cells (SPCs) found within whole BM preparations. To test this hypothesis, we isolated adult murine SPCs from whole BM and examined their ability to enhance impaired wound healing compared with ficoll separated BM cells in the diabetic (db/db) mouse model. SPCs significantly enhanced reepithelialization, granulation tissue formation, and neovascularization compared with control wounds treated with BM or PBS alone. Higher frequencies of donor SPC cells compared with donor BM cells were observed in treated wounds at 7 days. Transdifferentiation into GFP-positive mature endothelial cells was not observed. These observations suggest that SPCs improve wound healing through indirect mechanisms which lead to enhanced vascularization rather than through direct participation and incorporation into tissue. We conclude that topical application of BM-derived SPCs may represent an effective strategy for the treatment of chronic diabetic wounds.