Review on use of platelet- rich plasma for wound care in medicare population

      Wound care management has continued to evolve and considering the Medicare population (ages 65 and above), the implications of management are significant. In the Medicare population, chronic wounds rank among the topmost reasons for seeking care. One sixth of Medicare patients are affected by chronic wounds which takes a major toll economically and medically (Nussbaum et al, 2018). Platelet rich plasma (PRP) is an important aspect of management due to its regenerative properties and its ability to accelerate healing. Some researchers have opined that PRP has the unique ability to completely heal wounds, however, research findings are conflicting with regards to the outcomes based on the types of wounds such as pressure ulcers and venous ulcers. PRP is a combination of thrombocytes, cytokines and multiple growth factors which include, but are not limited to, Platelet-Derived Growth Factor, Fibroblast Growth Factor, Insulin Growth Factor, Vascular Endothelial Growth Factor, Transforming Growth Factor-β, and Hepatocyte Growth Factor. Owing to the growing need and concern for PRP, especially in the area of regulation and consistency of outcomes of treatment, the authors have presented an overview of this modality of wound care in the older population.

Veronica C Nwagwu is Clinical Assistant Professor, Division of Geriatric and Palliative Medicine, University of Michigan Medical School; Certified Wound Care Specialist Physician, Cochair Wound Prevention and Management SIG- American Geriatrics Society (AGS); Theodore Suh is Professor of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Health System, Professor, GRECC Ann Arbor Veterans Affairs Hospital, US; Jerome Okudo is Researcher, Department of Public Health, University of Texas, Houston, Texas, US

Mupirocin ointment in the treatment of chronic non-healing wounds: a case series

Abstact: Mupirocin ointment (Supirocin ointment) is a topical antimicrobial that contains an active substance called mupirocin. It is used in adults, adolescents, children and infants aged ≥4 weeks to treat infections on the skin such as infected hair follicles that form pimples containing pus (folliculitis), skin infection with blistering and crusting (impetigo) or recurring boils (furunculosis). Mupirocin (pseudomonic acid A), derived from the common Gram-neagtive bacteria, Pseudomonas fluorescens, inhibits bacterial protein and RNA synthesis by binding to bacterial isoleucyl-tRNA synthetase. Once the formation of the isoleucyl-tRNA synthetase is blocked, the cellular levels of the isoleucine charged transfer RNA are depleted, stopping protein and RNA synthesis in bacteria. It is a potent inhibitor against Gram-positive skin flora such as coagulase-negative Staphylococci and Staphylococcus aureus. Its rapid systemic metabolism means it can only be used topically which, combined with its novel chemical structure, should make cross-resistance less likely to occur than with other currently available antibiotics. It is available as topical preparations only and has no oral derivative, providing a lower risk of resistance and, therefore, may be beneficial in wound care management.

Harikrishna KR Nair is a Professor and Head of Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur;

Wan Sakinah is a Medical Officer, Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur

Alina Md Isa is a Registered Staff Nurse, Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur

Key words: ■ Chronic wounds ■ Mupirocin ointment ■ Non-healing ■ Wound bed preparation ■ Wound care management

Efficacy of topical mupirocin versus 2% mupirocin in novel Cogen-S base in chronic skin ulcers: a pilot study

Aim: To compare the efficacy and safety of topical Mupimet (2% mupirocin in a novel Cogen-S base) against mupirocin alone in the management of skin ulcers. Methods: We conducted a randomised controlled trial (RCT) with patients suffering from skin ulcers of Wagner grading 1 or 2 for over 4 weeks. Both the medications were applied topically twice daily for 12 weeks. Ulcer area, wound size and wound infection score were assessed on a five-point scale. During this study period, treatment-emergent adverse reactions were not observed either by the investigators or by the patients. The results were expressed as mean± standard deviation values to imply the wound size of the foot ulcer from the baseline to the week 12.

Results: We recruited 50 patients, with 21 patients treated with mupirocin 2% and 24 patients treated with Mupimet ointment (five were lost to follow-up). We observed that the ulcer area was significantly reduced in the test groups (2% mupirocin in novel Cogen-S base) at 10 weeks, whereas the control group demonstrated a decrease in the wound size of over a period of 12 weeks. Statisical comparison using a t-test between two groups was conducted and showed statistical significance between the two groups in the study. When compared with the control value after 12 weeks, the test value is highly significant (p≤0.05 control and p≤0.05 test).

Conclusion: The wound healing effect of topical Mupimet (in Cogen-S base) with the antimicrobial effect of mupirocin toward the overall management of skin ulcers. The acceleration of wound healing is higher in combined form than mupirocin alone.

Key words: Chronic skin ulcer . Cogen-S .  Collagen .  Efficacy 2% Mupirocin .  Wound healing

Cavity wounds: a juicy topic

      Cavity wounds are deep, highly exuding wounds that can occur in most wound aetiologies and locations. They can present a challenge in clinical practice due to high exudate levels that can increase the risk of infection and maceration. Cavity wounds should be ‘loosely filled’ with a highly absorbent dressing. Exufiber® and Exufiber® Ag+ have properties that are well-suited to managing cavity wounds. At the Wounds UK Annual Conference 2021, delegates attended an interactive Made Easy session with the opportunity to use Exufiber in a simulated cavity wound and reflect on how they teach the management of cavity wound.

KEY WORDS Cavity wound Exudate Exufiber® Filling

Assessment of adherent silicone foam dressing with technology lipidocolloid: a case series from China

Abstract: Wound healing is a complex process that may be affected by various factors. An appropriate microenvironment is necessary to attain accelerated healing. Modern dressings are designed to facilitate healing by providing the moist wound environment needed, but also to provide an atraumatic experience for the patients. This article discusses three cases where a silicone border adhesive foam dressing containing technology lipidocolloid (TLC) healing matrix technology was applied. The case results emulate those achieved in previous, in mostly European studies, demonstrating that the evaluated dressing is effective in promotion of wound healing while also being acceptable to both health professionals and patients in China.

Key words: ■ Acute wounds ■ Chronic wounds ■ Silver antimicrobial ■ UrgoTul Ag ■ Wound infection

Wang Chunli, RN. Wound and Ostomy Centre, Shenzhen Hospital of Nanfang Medical University, Shenzhen (China); Liu Zeyun, RN. Head of Pressure Injury Clinic, Aerospace Central Hospital, Beijing (China); Liu Yang, RN, Head Nurse of wound Care Clinic, the First Affiliated Hospital of Harbin Medical University, Harbin (China); Emilio Galea, International Medical Director, Urgo Education & Training Alliance, Singapore; Helen Wang, Medical Manager, URGO Medical, Shanghai (China)

Antibacterial activity of silver sulfadiazine against Streptococcus pyogenes

Beta-haemolytic Streptococcus is a Gram-positive microorganism that is found in burn wounds and provokes graft failure. Streptococcus pyogenes toxins increase the depth and severity of burn wounds. Topical antimicrobial agents can be used to treat burn wounds and improve results after burn infection. However, there are few studies exploring the antimicrobial action of silver sulfadiazine against S pyogenes. This study aimed to evaluate 1% silver sulfadiazine antimicrobial activity against S pyogenes. We isolated eight S pyogenes samples from adult patients at the Hospital Provincial de Rosario, Rosario, Argentina. Six samples were from burn wounds and two from blood culture. The outcomes were compared with the topical antimicrobial agents 2% mupirocin and 1% fusidic acid cream. We tested and compared the susceptibility of S pyogenes with these topical antimicrobial agents using agar well diffusion assays and minimum bactericidal concentration tests. The results show that the 1% silver sulfadiazine cream has an inhibitory effect on S pyogenes similar to that of 2% mupirocin and 1% fusidic acid cream. Considering its greater antimicrobial spectrum, silver sulfadiazine is a valid alternative to control many infections associated with wounds and burns, including those caused by S pyogenes.

Authors (clockwise from top left): Cecilia Casabonne, Agustina González, Virginia Aquili and Claudia Balagué