Ferdinando Campitiello

Dipeptidyl Peptidase 4 Inhibition May Facilitate Healing of Chronic Foot Ulcers in Patients with Type 2 Diabetes

The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19–35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.

Effects of a new pocket device for negative pressure wound therapy on surgical wounds of patients affected with Crohn's disease: a pilot trial.

Introduction. Surgical site infections (SSIs) affect costs of care and prolong length of stay. Crohn’s disease (CD) represents an independent risk factor for SSI. The risk can be further increased by concomitant administration of immunosuppressive drugs and poor performance status at the time of surgery. Patients suffering from CD often need more than one surgical intervention during life, sometimes requiring fashioning of a stoma. The aim of this pilot study was to compare a portable device for negative pressure wound therapy (PICO, Smith & Nephew, London, UK) to conventional gauze dressings in patients undergoing surgery for stricturing CD. Methods. Between January 2010 and November 2011, this controlled trial enrolled 30 patients, who were assigned to treatment with either PICO (n = 13) or conventional dressings (n = 17). Each patient completed a 3-month follow-up. Results. Patients receiving PICO experienced significantly less postoperative wound complications (P = .001) and SSI (P = .017) compared with those who received conventional dressings. This resulted in shorter hospital stay (P = .0007). No significant differences in cosmetic results were found. Conclusion. These data suggest that PICO allows faster and safe discharge by reducing the incidence of SSI and wound-related complications in selected patients undergoing surgical intervention for stricturing CD. This could be particularly useful in patients receiving steroids.

Preventive NPWT over closed incisions in general surgery: Does age matter?

Surgical site events (SSE), including surgical wound complications and surgical site infections, are a major concern in patients undergoing general surgery operations. These increase the costs of care, and can lead to prolonged hospital stay and need for further treatments, ultimately resulting in poor quality of life. Negative pressure wound therapy (NPWT) has been recently reported as a preventive strategy to avoid SSE, but little is known on the topic, and particularly in geriatric population. Our primary aim was to assess the efficacy of NPWT by means of a pocket device (PICO, Smith & Nephew, London, UK) in preventing SSE compared with conventional dressings in patients undergoing surgery with primary wound closure for breast and for colorectal diseases in our Unit. Our secondary aims were to assess the efficacy and safety of PICO in elderly patients, and to seek for differences between breast and abdominal results. All consecutive patients undergoing breast and colorectal surgery in our Unit between September 2012 and May 2014 were prospectively enrolled in this open label controlled study. Breast patients receiving NPWT were assigned to group B1, those receiving conventional dressings were assigned to group B2. Colorectal patients were assigned to group C1 (NPWT) and C2 (conventional dressings) in similar fashion. Each group included 25 patients, and at least 10 (40%) patients aged over 65 years to allow sub-analyses. NPWT significantly reduced SSE in both breast and colorectal patients compared with controls. No significant differences were observed according to age. Similar benefits were observed in breast and colorectal patients. Our results suggest that PICO is an effective tool to prevent SSE in patients undergoing general surgery, irrespective of age. Its use is recommended in frail, elderly patients at risk of SSE.

Treatment of Leg Chronic Wounds with Dermal Substitutes and Thin Skin Grafts

Tissue repair is a natural process occurring any time the skin is injured. Repair is achieved through different successive phases: inflammation, formation of granulation tissue, forma‐ tion of the extracellular matrix (ECM), and remodeling. ECM plays an important role in tis‐ sue regeneration representing the principal component of the dermal skin layer. The composition of ECM includes proteoglycans, hyaluronic acid, collagen, fibronectin and elas‐ tin. As well as providing a structural support for cells, some components of the ECM bind to growth factors, creating a reservoir of active molecules that can be rapidly mobilized follow‐ ing injury to stimulate cell proliferation and migration [1].

Wound bed preparation with NPWT in diabetic foot ulcers: case report

Background Negative Pressure Wound Therapy (NPWT) is primarily used for very complex chronic wounds. The surgical treatment of the diabetic wounds with loss of soft tissue usually consists of closure using split-thickness skin grafts or transposition flaps. However, the first step consists of standard wound care with moist gauze dressing with the aim to prepare the wound bed for final closure. Clinical and experimental studies reported that negative pressure increases local blood flow and decreases bacterial colonization. Localized negative pressure removes fluids from the wound and promotes the granulation tissue, which is required for wound closure.

The use of negative pressure wound therapy (npwt) and dermal substitutes in the treatment of diabetic foot ulcers

Background The NPWT is becoming an important tool in the treatment of both acute and chronic wounds. The authors describe their initial experience using NPWT to fix a dermal substitute for preserving maximal foot length after surgical debridement in diabetic patients with foot lesions that were assessed for sensory-motor neuropathy and infection. The application of dressings to fix dermal templates can reduce shearing forces, restrict seroma and haematoma formation, simplify wound care and improve patient tolerance.

An evaluation of an ultrasonic debridement system in patients with diabetic foot ulcers: a case series

OBJECTIVE This study evaluated the use of ultrasonic debridement in patients with diabetic foot ulcers (DFU). METHOD In this prospective, single-arm, open-label study, all patients with DFUs underwent wound debridement by ultrasonic debridement system (SonicOne OR Ultrasonic debridement system). Wherever possible, the edges were approximated by means of stitches. In other cases, the surgical breach healed by secondary intention, or a partial thickness skin graft (with or without Integra Dermal Regeneration Template or Integra Flowable Wound Matrix) was applied, and subsequently healed by primary intention. RESULTS We assessed 15 patients with a DFU. The time required for debridement was short (an average 15.06±4.02 minutes). Complete wound healing (defined as 100% re-epithelialisation) was achieved in all 15 cases. Median time to heal was 39.20±16.05 days. The ultrasonic debridement system was found to show adequate debridement while preserving more viable tissue to promote rapid healing. CONCLUSION Our findings show that the device demonstrates advantages in the reduction of debridement times, and efficacy in safely preserving the viable tissue, with a low complication rate in surgery of DFUs. A study that uses a larger cohort is required to fully evaluate the effectiveness, or otherwise, of the ultrasonic debridement system.

The use of a dermal substitute and thin skin graft in the cure of lower limbs wounds from vasculitis: observational study

Background In patients with lower limbs wounds from vasculitis reconstructive surgery with skin grafts can be considered, but this treatment likely fails because of the position, width, and depth of the lesion(s). In these patients a new therapeutic prospect is the use of a dermal matrix that stimulates the production of endogenous collagen before repair with skin graft autografting. Integra® is a semibiological implant consisting of a two-layered membrane that produces a histo-inductive and histo-conductive action on mesenchyme, leading to the formation of normal derma.

The Short Stripping of Saphena and the Corcos’ External Phleboextractor in Our Experience

To evaluate our experience with Corcos’ external phleboextractor in the day case surgery of varicose veins.