Carelyn Fylling - Academia.edu (original) (raw)

Papers by Carelyn Fylling

PubMed, Oct 1, 1989

This study included patients who presented with at least one chronic nonhealing ulcer and had bee... more This study included patients who presented with at least one chronic nonhealing ulcer and had been told by their referring physician that they would require amputation at the transmetatarsal level or higher. Hospital records of all patients seen in a comprehensive wound-healing clinic from August 1984 through January 1986 were reviewed. Twenty-four patients with 27 lower extremity ulcers were identified. An aggressive clinical wound care protocol, including arterial revascularization, control of infection, wound debridement, protective orthotics, and use of topically applied autologous Platelet-Derived Wound Healing Formula, was used to heal these chronic ulcers. With follow-up time ranging from 12 to 22 months, complete wound healing was obtained in 18 of 24 patients (75%), and limb salvage was obtained in 20 of 24 patients (83%). Of the 24 patients, 18 (75%) achieved wound healing and a functional limb; 16 of the 18 (67%) were ambulatory, and two (8%) had a functional limb for transfers, but were not ambulatory due to preexisting stroke. We conclude that an aggressive, comprehensive amputation intervention program can prevent the emotional, functional, and economic costs of limb loss in most high-risk patients.

PubMed, 1997

This multicenter, retrospective study evaluated the wound healing and limb salvage outcomes over ... more This multicenter, retrospective study evaluated the wound healing and limb salvage outcomes over a 4-year period in 3,830 patients in 39 hospital-affiliated Wound Care Centers. These centers provide comprehensive outpatient wound care for chronic, nonhealing wounds. Two distinct outcomes were identified: (1) wound healing with comprehensive wound care (CWC) alone, and (2) wound healing with comprehensive wound care plus platelet releasate (CWC+PR). Data were analyzed with respect to healing and limb salvage in two groups: 1,019 patients who received CWC and 2,811 patients who received CWC+PR. Analysis of the standardized, customized database showed that overall healing rates were higher (p < .00001) and amputation rates were lower (p = .00005) in the CWC+PR group than in the CWC group. In addition, when healing rates were analyzed according to underlying condition, patients with all underlying conditions except autoimmune disorders showed higher healing rates in the CWC+PR group than in the CWC group. This study showed that patients treated with comprehensive wound care plus topical use of autologous platelet releasate had significantly higher rates of wound healing and increased limb salvage for most wounds than those treated with comprehensive wound care alone.

PubMed, Jun 1, 2006

Nonhealing diabetic foot ulcers are a common cause of amputation. Emerging cellular therapies suc... more Nonhealing diabetic foot ulcers are a common cause of amputation. Emerging cellular therapies such as platelet-rich plasma gel provide ulcer management options to avoid loss of limb. The purpose of this prospective, randomized, controlled, blinded, multicenter clinical study was to evaluate the safety and efficacy of autologous platelet-rich plasma gel for the treatment of nonhealing diabetic foot ulcers. One hundred, twenty-nine (129) patients were screened; 72 completed a 7-day screening period and met the study inclusion criteria. Patients were randomized into two groups - the standard care with platelet-rich plasma gel or control (saline gel) dressing group - and evaluated biweekly for 12 weeks or until healing. Healing was confirmed 1 week following closure and monitored for another 11 weeks. An independent audit led to the exclusion of 32 patients from the final per-protocol analysis because of protocol violations and failure to complete treatment. In this group, 13 out of 19 (68.4%) of the platelet-rich plasma gel and nine out of 21 (42.9%) of the control wounds healed. After adjusting for wound size outliers (n = 5), significantly more platelet-rich plasma gel (13 out of 16, 81.3%) than control gel (eight out of 19, 42.1%) treated wounds healed (P = 0.036, Fisher's exact test). Kaplan-Meier time-to-healing also was significantly different between groups (log-rank, P = 0.0177). No treatment-related serious adverse events were reported and bovine thrombin used in the preparation of PRP did not cause Factor V inhibition. When used with good standards of care, the majority of nonhealing diabetic foot ulcers treated with autologous platelet-rich plasma gel can be expected to heal.

and treatment data in a wound outcomes registry: clinical impact of topical platelet-rich plasma ... more and treatment data in a wound outcomes registry: clinical impact of topical platelet-rich plasma gel on healing trajectory

The American Journal of Surgery, 1990

An independent review panel composed of an orthopedic surgeon, a vascular surgeon, and an endocri... more An independent review panel composed of an orthopedic surgeon, a vascular surgeon, and an endocrinologist was convened to conduct a case history review. The 71 patients reviewed had 124 wounds on 81 limbs and participated in the comprehensive wound management program of the University of Minnesota. Based on their expertise, the review panel classified the wounds by severity and identified the limb's risk for amputation. The resulting scores were then compared with the patient's actual outcome. The review panel predicted 65 (80%) of the limbs would be salvaged and 16 (20%) would be amputated. The actual outcome was that 75 (93%) of the limbs were salvaged and 6 (7%) were amputated (p less than 0.005). The university's wound management program was highly successful, compared with the predictions of the reviewers.

Ostomy/Wound Management, 2010

Chronic wounds are characterized by a long inflammatory phase that hinders regenerative wound hea... more Chronic wounds are characterized by a long inflammatory phase that hinders regenerative wound healing. The purpose of this prospective case series was to evaluate how a physiologically relevant concentration of an autologous platelet-rich plasma (PRP) gel affects initial wound healing trajectories of chronic, nonhealing wounds of various etiologies and in different care settings. Using convenience sampling methods, 49 patients (average age: 60.6 years, SD 14.7) with 65 nonhealing wounds (mean duration 47.8 weeks, range 3 to 260) at eight long-term acute care (LTAC) hospitals and three outpatient foot or wound clinics who were prescribed PRP gel for their nonhealing wound were enrolled. The majority of patients had low albumin, hematocrit, and/or hemoglobin levels. After wound assessments and measurements were obtained and the gel prepared, a skin barrier was applied to the periwound skin and the gel applied and protected with cover dressings. The most common wounds were pressure ulc...

Objective: Autologous platelet rich plasma is an advanced wound therapy used in hardto-heal acute... more Objective: Autologous platelet rich plasma is an advanced wound therapy used in hardto-heal acute and chronic wounds. To better understand the use and clinical outcomes of the therapy, a systematic review of the published literature in cutaneous wounds was performed. Methods: Electronic and hand searches for randomized controlled trials and comparative group studies using platelet rich plasma therapy in cutaneous wounds and published over the last 10 years was conducted. Eligible studies compared the treatment to standard care or other interventions. All citations were screened and eligible studies were assessed for validity, quality, and bias using accepted scoring methods. The primary outcomes were effect of platelet rich plasma and control wound care on wound healing and related healing measurements. Secondary outcomes related to healing such as infection, pain, exudate, adverse events, and quality of life were also considered. The meta-analysis utilized appropriate statistical m...

Objective: Autologous platelet rich plasma is an advanced wound therapy used in hard-to-heal acut... more Objective: Autologous platelet rich plasma is an advanced wound therapy used in hard-to-heal acute and chronic wounds. To better understand the use and clinical outcomes of the therapy, a systematic review of the published literature in cutaneous wounds was performed. Methods: Electronic and hand searches for randomized controlled trials and comparative group studies using platelet rich plasma therapy in cutaneous wounds and published over the last 10 years was conducted. Eligible studies compared the treatment to standard care or other interventions. All citations were screened and eligible studies were assessed for validity, quality, and bias using accepted scoring methods. The primary outcomes were effect of platelet rich plasma and control wound care on wound healing and related healing measurements. Secondary outcomes related to healing such as infection, pain, exudate, adverse events, and quality of life were also considered. The meta-analysis utilized appropriate statistical ...

Ostomy Wound Management, Jul 1, 2006

Advances in wound care: the journal for prevention and healing

ABSTRACT

The Diabetes educator, 1984

Journal of enterostomal therapy

Amputation is a complex problem for a patient, the health care system, and the country. Every end... more Amputation is a complex problem for a patient, the health care system, and the country. Every endeavor should be made to try to reduce the incidence of amputation. The only way this can be done is by identifying the causative problems and designing interventions to solve those problems. The new era of amputation prevention for the patient with diabetes includes the development of comprehensive wound or foot care programs that use state-of-the-art noninvasive vascular testing, quality angiography, distal vascular reconstruction procedures, aggressive infection control, total contact casting as appropriate, use of growth factors to enhance wound healing, use of orthotic shoes to prevent recurrence, and extensive patient education. By implementing these new systems into the health care system, data for amputation incidence hopefully will be reduced in the future.

Ostomy/wound management, 1989

Journal of Wound, Ostomy and Continence Nursing, 1989

Purpose: Long term acute care (LTAC) hospitals have patients with non-healing wounds and signific... more Purpose: Long term acute care (LTAC) hospitals have patients with non-healing wounds and significant co-morbidities which complicate the wound repair process. A patient’s wound must progress adequately in 25 days of hospitalization to support timely discharge or the patient may become a cost burden for the hospital. This study was to determine whether using autologous platelet rich plasma gel* (PRP Gel) to treat the wounds would accomplish this goal. Methodology: Patient age, albumin, hemoglobin, previous wound duration, and objective wound measurements were prospectively gathered to determine wound area, volume, amount of undermining, sinus tracts & tunneling (ST/T). PRP Gel contains the patient’s growth factors, cytokines, and chemokines for cell growth and migration, plasma-derived proteins to produce a fibrin matrix scaffold and anti-inflammatory properties to progress the natural healing process. Results: Twenty two patients with 31 wounds were treated in 8 LTAC sites. Wound et...