Remo Papini

Negative-pressure wound therapy: a snapshot of the evidence

Topical negative pressure (TNP) is a mode of therapy used to encourage wound healing. It can be used as a primary treatment for chronic/complex wounds or as an adjunct to surgery. Based on the evidence to date, the clinical effectiveness of negative‐pressure therapy is still unclear. Although case reports and retrospective studies have demonstrated enhanced wound healing in acute/traumatic wounds, chronic wounds, infected wounds, wounds secondary to diabetes mellitus, sternal wounds and lower limb wounds, there are very few randomised controlled trials, with unclear results. The evidence is lacking for the use of TNP therapy for other indications to enhance wound healing such as patients with decubitus ulcers, diabetes and peripheral vascular disease and to improve skin graft take. There have been, as yet, no quality‐of‐life studies available for negative‐pressure therapy. Despite this, the usage of TNP has increased. This review provides an overview of clinical studies using TNP and proposes avenues for further research to elucidate the exact mechanism of TNP, in addition to large randomised controlled clinical trials of patients undergoing this therapy.

Cultured autologous keratinocytes in suspension accelerate epithelial maturation in an in vivo wound model as measured by surface electrical capacitance.

Background: Human epidermis serves as a protective covering against loss of endogenous fluids and exogenous microbial invasion. Cultured epithelial autograft suspensions have been used to enhance epithelialization to improve mortality, morbidity, and the overall quality of the scar. The measurement of surface electrical capacitance as an indicator of transepidermal water loss has been used in neonatology and dermatology to determine epidermal maturation. This tool has been used in a double-blind, randomized, controlled trial to compare the effects of cultured epithelial autograft in suspension on epidermal healing and maturation compared with a control in an in vivo partial thickness wound model. Methods: In this double-blind, randomized, controlled trial (n = 8), the authors assessed the effect of cultured epithelial autograft on epidermal healing and maturation in standardized partial thickness wounds. Surface electrical capacitance was compared on 16 split-thickness skin graft donor sites treated with cultured epithelial autograft (n = 8) against controls treated with Dulbecco’s Modified Eagle’s Medium (n = 8) using a NOVA Dermaphase Meter at 4, 5, 6, and 7 days postoperatively. Results: A statistically significant difference on continuous readings at days 5 (p = 0.012) and 7 (p = 0.036) and instantaneously on days 5 (p = 0.025) and 6 (p = 0.036) in surface electrical capacitance was observed in the cultured epithelial autograft over the Dulbecco’s Modified Eagle’s Medium–treated wounds. Conclusions: Measuring surface electrical capacitance provides an objective and repeatable method of assessing epidermal maturation. This study indicates that the rate of epithelialization and epidermal maturation is more rapid in partial thickness epidermal skin wounds treated with cultured epithelial autograft.

Partial growth plate fusion caused by burn

Growth plate fusion is a rare but important complication of burn injury in childhood. Reported cases are all of complete fusion. We present a case of partial fusion of the growth plates secondary to a burn injury, which to our knowledge has not been reported in the literature before. Partial fusion of the growth plate behaves differently as compared with complete fusion, and if treated at an early stage by appropriate surgery limb deformity and long-term disability may be prevented. The importance of early recognition and treatment cannot be overemphasized.