Guidelines to aid healing of acute wounds by decreasing impediments of healing (original) (raw)

2008, Wound Repair and Regeneration

Abstract

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Achieving uniformity in wound care has been a long-standing goal among clinicians. The Wound Healing Society (WHS) undertook the development of treatment guidelines but faced challenges due to inconsistencies in definitions related to wounds and their healing processes. This paper presents guidelines aimed at facilitating the healing of acute wounds by understanding the impediments to recovery, highlighting the significance of leukocyte levels and the effects of blood transfusions on healing outcomes.

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  129. Raitio A, Tuomas H, Kokkonen N, Salo T, Sorsa T, Hanemaaijer R, Oikarinen A. Levels of matrix metal- loproteinase-2, -9 and -8 in the skin, serum and saliva of smokers and non-smokers. Arch Dermatol Res 2005; 197: 242-8. (EXP)
  130. Reus WF 3rd, Colen LB, Straker DJ. Tobacco smok- ing and complications in elective microsurgery. Plast Reconstr Surg 1992; 89: 490-4. (RETRO S)
  131. Siana JE, Rex S, Gottrup F. The effect of cigarette smoking on wound healing. Scand J Plast Reconstr Surg Hand Surg 1989; 23: 207-9. (CLIN S)
  132. Lind J, Kramhoft M, Bedtker S. The influence of smoking on complications after primary amputations of the lower extremity. Clin Orthop Relat Res 1991; 267: 211-7. (RETRO S)
  133. Rogliani M, Labardi L, Silvi E, Maggiulli F, Grimaldi M, Cervelli V. Smokers: risks and complications in abdominal dermolipectomy. Aesthet Plast Surg 2006; 30: 422-4. (RETRO S)
  134. Lindstro¨m D, Wladis A, Linder S, Na˚sell H, Adami J. Preoperative cessation of smoking seems to reduce the frequency of complications. Lakartidningen 2004; 101: 1920-2. (LIT REV)
  135. Guideline #10.2: Chronic corticosteroid usage should be minimized whenever possible before surgical procedures and until the acute wound is healed. When this is not pos- sible, various agents may be useful in decreasing the detri- mental effects of corticosteroids on healing. Level of evidence: II Principle: The humoral and cellular inflammatory re- sponse is a fundamental part of the mechanism of acute wound healing. Corticosteroids can adversely affect sev- eral wound healing processes. Agents that can abrogate or ameliorate some of the effects of corticosteroids should benefit healing. Evidence:
  136. Hunt TK. Disorders of wound healing. World J Surg 1980; 4: 271-7. (LIT REV)
  137. Stephens FO, Dunphy JE, Hunt TK. Effect of delayed administration of corticosteroids on wound contrac- tion. Ann Surg 1971; 173: 214-8. (EXP)
  138. Gupta A, Jain GK, Raghubir R. A time course study for the development for an immunocompromised wound model using hydrocortisone. J Pharmacol Tox- icol Meth 1999; 4: 183-7. (EXP)
  139. Hunt TK, Ehrlich HP, Garcia JA, Dunphy JE. Effect of vitamin A on reversing the inhibitory effect of cor- tisone on healing of open wounds in animals and man. Ann Surg 1969; 170: 633-41. (EXP)
  140. Ehrlich HP, Tarver H, Hunt TK. Effects of vitamin A and glucocorticoids upon inflammation and collagen synthesis. Ann Surg 1973; 177: 222-7. (EXP)
  141. Smith KP, Zardiakas LD, Didlake RH. Cortisone, vi- tamin A, and wound healing: the importance of mea- suring wound surface area. J Surg Res 1986; 40: 120-5. (EXP)
  142. Ehrlich HP, Hunt TK. Effects of cortisone and vita- min A on wound healing. Ann Surg 1968; 167: 324-8. (LIT REV)
  143. Ehrlich HP, Hunt TK. The effects of corticosteroid and anabolic steroids on the tensile strength of healing wounds. Ann Surg 1969; 170: 203-6. (EXP)
  144. Demling RH. Oxandrolone, an anabolic steroid, en- hances the healing of a cutaneous wound in a rat. Wound Rep Regen 2000; 8: 97-102. (EXP)
  145. Kim CS, Buchmiller TL, Fonkalsrud EW, Phillips JD. The effect of anabolic steroids on ameliorating the ad- verse effects of chronic corticosteroids on intestinal anastomotic healing in rabbits. Surg Gynecol Obstet 1993; 176: 73-9. (EXP)
  146. Kelley SF, Felix AM, Ehrlich HP. The antagonism of glucocorticoid inhibition of wound healing in rats by growth hormone-releasing factor. Proc Soc Exp Biol Med 1990; 194: 320-6. (EXP)
  147. Garrel DR, Gaudreau P, Zhang LM, Reeves I, Braz- eau P. Chronic administration of growth hormone-re- leasing factor increases wound strength and collagen maturation in granulation tissue. J Surg Res 1991; 51: 297-302. (EXP)
  148. Dinc S, Durmus E, Gulcelik MA, Kuru B, Ustun H, Renda N, Alagol H. Effects of beta-D-glucan on ste- roid-induced impairment of colonic anastomotic heal- ing. Acta Chir Beig 2006; 106: 63-7. (EXP)
  149. Guideline #10.3: Zinc therapy improves healing in zinc- deficient patients. Its benefit in patients without zinc defi- ciency has not been substantiated. Wound Rep Reg (2008) 16 723-748 c 2008 by the Wound Healing Society
  150. Lansdown AB, Mirastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: theoretical, experi- mental, and clinical aspects. Wound Rep Regen 2007; 15: 2-16. (LIT REV)
  151. Agren MS. Studies on zinc in wound healing. Acta Derm Venereol 1990; 154 (Suppl.): 1-36. (EXP)
  152. Faure H, Peyrin JC, Richard MJ, Favier A. Parental supplementation with zinc in surgical patients corrects postoperative serum-zinc drop. Biol Trace Elem Res 1991; 30: 27-45. (RCT)
  153. Agren MS, Ostenfeld U, Kallehave F, Gong Y, Raffn K, Crawford ME, Kiss K, Friis-Mller A, Gluud C, Jorgensen LN. A randomized, double-blind, placebo- controlled multicenter trial evaluating topical zinc ox- ide for acute open wounds following pilonidal disease excision. Wound Rep Regen 2006; 14: 526-35. (RCT)
  154. Greenway SE, Filler LE, Greenway FL. Topical insulin in wound healing: a randomized, double-blind, placebo- controlled trial. J Wound Care 1999; 8: 526-8. (RCT) Guideline #10.4: There is insufficient evidence to recom- mend specific exogenous nutrients such as vitamins to im- prove acute wound healing in patients who are not deficient in those nutrients. Level of evidence: II Principle: Although specific actions of many individual nutrients could benefit acute wound healing, data are not available for definitive recommendations. Evidence:
  155. Silverstein RJ, Landsman AS. The effects of a moderate and high dose of vitamin C on wound healing in a con- trolled guinea pig model. J Foot Ankle Surg 1999; 38: 333-8. (EXP)
  156. Vaxman F, Olender S, Lambert A, Nisand G, Grenier JF. Can the wound healing process be improved by vi- tamin supplementation? Experimental study on hu- mans. Eur Surg Res 1996; 28: 306-14. (RCT)
  157. Baumann LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg 1999; 25: 311-5. (RCT)
  158. Barbul A, Fishel RS, Shimazu S, Wasserkrug HL, Yoshimura NN, Tao RC, Efron G. Intravenous hype- ralimentation with high arginine levels improves wound healing and immune function. J Surg Res 1985; 38: 328-34. (EXP)
  159. Barbul A, Lazarou SA, Efron DT, Wasserkrug HL, Ef- ron G. Arginine enhances wound healing and lympho- cyte immune responses in humans. Surgery 1990; 108: 336-7. (RCT)
  160. Kirk SJ, Hurson M, Regan MC, Holt DR, Wasserkrug HL, Barbul A. Arginine stimulates wound healing and immune function in elderly human beings. Surgery 1993; 114: 155-9. (RCT)
  161. Shi HP, Most D, Efron DT, Witte MB, Barbul A. Sup- plemental L-arginine enhances wound healing in diabetic rats. Wound Rep Regen 2003; 11: 198-203. (EXP)
  162. Shi HP, Wang SM, Zhang GX, Zhang YJ, Barbul A. Supplemental L-arginine enhances wound healing fol- lowing trauma/hemorrhagic shock. Wound Rep Regen 2007; 15: 66-70. (EXP) (The effects of hyperbaric oxygen on acute wound healing are discussed in Guideline #1.3. The effects of anticoagu- lants on acute wound healing are discussed in Guideline #3.1. The effects of chemotherapeutic drugs on acute wound healing are discussed in Guideline #7.1.)
  163. #11: GUIDELINES TO DECREASE THE IMPEDIMENT TO ACUTE WOUND HEALING CAUSED BY EXCESSIVE SCAR FORMATION Preamble: In excessive healing or proliferative scarring, it is as if the equilibrium point between collagen deposition and collagen lysis is never reached. It is unclear why some wounds seem to continue in the repair processes without an apparent turnoff switch. Because of these unknowns, there is no universally accepted treatment regimen. In a recent meta- analysis of excessive scarring treatments, the mean amount of improvement to be expected was only 60%. Guideline #11.1: Pressure garments or compression dressings are effective in decreasing scarring in burn inju- ries that require > 21 days to heal. Level of evidence: I Principle: Excessive or hypertrophic scarring is rare in burn injuries that heal within 21 days. The exact mecha- nism by which pressure is effective is unknown. Evidence:
  164. Van den Kerckhove E, Stappaerts K, Fieuws S, Laperre J, Massage P, Flour M, Boeckx W. The assessment of erythema and thickness on burn related scars during pressure garment therapy as a preventive measure for hypertrophic scarring. Burns 2005; 31: 696-702. (RCT)
  165. Klopp R, Niemer W, Frankel M, von der Weth A. Effect of four treatment variants on the functional and cosmetic state of mature scars. J Wound Care 2000; 9: 319-24. (RCT)
  166. Chang P, Laubenthal KN, Lewis RW II, Rosenquist MD, Lindley-Smith P, Kealey GP. Prospective, ran- domized study of the efficacy of pressure garment ther- apy in patients with burns. J Burn Care Rehabil 1995; 16: 473-5. (RCT)
  167. Huang TT, Blackwell SJ, Lewis SR. Ten years of expe- rience in managing patients with burn contractures of axilla, elbow, wrist, and knee joints. Plast Reconstr Surg 1978; 61: 70-6. (RETRO S)
  168. Van den Kerckhove E, Fieuws S, Massage´P, Hierner R, Boeckx W, Deleuze JP, Laperre J, Anthonissen M. Reproducibility of repeated measurements with the Kikuhime pressure sensor under pressure garments in burn scar treatment. Burns 2007; 33: 572-8. (CLIN S)
  169. Cheng JC, Evans JH, Leung KS, Clark JA, Choy TT, Leung PC. Pressure therapy in the treatment of post- burn hypertrophic scar-a critical look into its Wound Rep Reg (2008) 16 723-748 c 2008 by the Wound Healing Society usefulness and fallacies by pressure monitoring. Burns Incl Therm Inj 1984; 10: 154-63. (CLIN S)
  170. Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cot- ter J. Hypertrophic burn scars: analysis of variables. J Trauma 1983; 23: 895-8. (CLIN S)
  171. Cubison TC, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hy- pertrophic scars (HTS) in paediatric burns due to scald injury. Burns 2006; 32: 992-9. (CLIN S) Guideline #11.2: Silicone sheeting is useful in prevention and treatment of proliferative scars. Level of evidence: I Principle: Although the exact mechanism by which sili- cone sheeting is effective is not agreed upon, it does de- crease fibroblast activity and downregulates the fibrogenic isoforms of transforming growth factor-b (TGF-b). Evidence:
  172. O'Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2006; 1: CD003826. (STAT)
  173. Ziegler UE. International clinical recommendations on scar management. Zentralbl Chir 2004; 129: 296-306. (STAT)
  174. Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the lit- erature. Arch Facial Plast Surg 2006; 8: 362-8. (STAT)
  175. Li-Tsang CW, Lau JC, Choi J, Chan CC, Jianan L. A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-trau- matic hypertrophic scar among the Chinese population. Burns 2006; 32: 678-83. (RCT)
  176. Gold MH, Foster TD, Adair MA, Burlison K, Lewis T. Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg 2001; 27: 641-4. (RCT)
  177. Ahn ST, Monafo WW, Mustoe TA. Topical silicone gel: a new treatment for hypertrophic scars. Surgery 1989; 106: 781-6. (RCT)
  178. Ahn ST, Monafo WW, Mustoe TA. Topical silicone gel for the prevention and treatment of hypertrophic scar. Arch Surg 1991; 126: 499-504. (CLIN S)
  179. Kuhn MA, Moffit MR, Smith PD, Lyle WG, Ko F, Meltzer DD, Robson MC. Silicone sheeting decreases fi- broblast activity and downregulates TGF-B2 in hypertro- phic scar model. Int J Surg Investig 2001; 2: 467-74. (EXP)
  180. Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, Zell D, Li Q. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and manage- ment. Dermatol Surg 2007; 33: 1291-302. (LIT REV)
  181. Guideline #11.3: Intralesional corticosteroids, especially triamcinolone acetonide (Kenalog), can be a useful treat- ment of proliferative scars. Level of evidence: I Principle: Intralesional corticosteroid injections have been successful in treating hypertrophic scars and keloids, but the mechanism of action has not been defined despite a great deal of investigation. Evidence:
  182. Ziegler UE. International clinical recommendations on scar management. Zentralbl Chir 2004; 129: 296-306. (STAT)
  183. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: compari- son among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treat- ments. Arch Dermatol 2002; 138: 1149-55. (RCT)
  184. Kiil J. Keloids treated with topical injections of triamcinolone acetonide (Kenalog). Immediate and long- term results. Plast Reconstr Surg 1977; 11: 169-72. (RCT)
  185. Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Derma- tol Surg 2006; 32: 907-15. (RCT)
  186. Layton AM, Yip J, Cunliffe WJ. A comparison of intr- alesional triamcinolone and cryosurgery in the treatment of acne keloids. Br J Dermatol 1994; 130: 498-501. (RCT)
  187. Sclafani AP, Gordon L, Chadha M, Romo T III. Pre- vention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the litera- ture. Dermatol Surg 1996; 22: 569-74. (RCT)
  188. Ketchum LD, Smith J, Robinson DW, Masters FW. Treatment of hypertrophic scars, keloid, and scar con- tracture by triamcinolone acetonide. Plast Reconstr Surg 1966; 38: 209-18. (CLIN S)
  189. Guideline #11.4: Agents that neutralize or abrogate the action of the fibrogenic isoforms of TGF-b (TGF-b1, TGF-b2) may be useful in preventing or treating prolifer- ative scars. Level of evidence: II Principle: It has been demonstrated that persistent over- expression or dysregulated activation of TGF-b1 and TGF-b2 can lead to fibrosis and scar formation, while TGF-b3 tends to decrease fibrosis and scarring. Evidence:
  190. Shah M, Foreman DM, Ferguson MW. Neutralization of TGF-beta1 and TGF-beta2 or exogenous adminis- tration of TGF-beta3 to cutaneous rat wounds reduces scarring. J Cell Sci 1995; 108: 985-1002. (EXP)
  191. Tredget EE, Wang R, Shen Q, Scott PG, Ghahary A. Transforming growth factor-beta mRNA and protein in hypertrophic scar tissues and fibroblasts: antagonism by IFN-alpha and IFN-gamma in vitro and in vivo. J Interferon Cytokine Res 2000; 20: 143-51. (EXP)
  192. Granstein RD, Rook A, Flotte TJ, Haas A, Gallo RL, Jaffe HS, Amento EP. A controlled trial of intralesional recombinant interferon-gamma in the treatment of keloidal scarring. Clinical and biologic findings. Arch Dermatol 1990; 126: 1295-302. (RCT)
  193. Davison SP, Mess S, Kauffman LC, Al-Attar A. In- effective treatment of keloids with interferon alpha-2b. Plast Reconstr Surg 2006; 117: 247-52. (RCT)
  194. Tredget EE, Shankowsky HA, Pannu R, Nedelec B, Iwa- shina T, Ghahary A, Taerum TV, Scott PG. Transform- ing growth factor-beta in thermally injured patients with hypertrophic scars: effects of interferon alpha-2b. Plast Reconstr Surg 1998; 102: 1317-28. (CLIN S) Wound Rep Reg (2008) 16 723-748 c 2008 by the Wound Healing Society
  195. Ferguson MW, O'Kane S. Scar-free healing: from em- bryonic mechanisms to adult therapeutic intervention. Philo Trans R Soc Lond B Biol Sci 2004; 359: 839-50. (LIT REV)
  196. Robson MC. Proliferative scarring. Surg Clin North Am 2003; 83: 557-69. (LIT REV)
  197. Payne WG, Ko F, Anspaugh S, Wheeler CK, Wright TE, Robson MC. Down-regulating causes of fibrosis with tamoxifen: a possible cellular/molecular approach to treat rhinophyma. Ann Plast Surg 2006; 56: 301-5. (EXP) Guideline #11.5: Postoperative radiotherapy following excision of keloids may be useful in preventing recurrence. However, dosage regimens are not agreed upon, and there remains a theoretical argument against use of radiother- apy for benign conditions. Level of evidence: II Principle: Ionizing radiation can prevent recurrence of scar proliferation. Techniques vary widely, making results difficult to interpret. Evidence:
  198. Ziegler UE. International clinical recommendations on scar management. Zentralbl Chir 2004; 129: 296-306. (STAT)
  199. van de Kar AL, Kreulen M, van Zuijien PP, Olden- burger F. The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: a prospective clinical outcome study. Plast Reconstr Surg 2007; 119: 2248-54. (RCT)
  200. Sclafani AP, Gordon L, Chadha M, Romo T III. Pre- vention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the litera- ture. Dermatol Surg 1996; 22: 569-74. (RCT)
  201. Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Ku- ribayashi S, Tateno A. Postoperative radiation proto- col for keloids and hypertrophic scars: statistical analysis of 370 sites followed for over 18 months. Ann Plast Surg 2007; 59: 688-91. (CLIN S)
  202. Akita S, Akino K, Yakabe A, Imaizumi T, Tanaka K, Anraku K, Yano H, Hirano A. Combined surgical ex- cision and radiation therapy for keloid treatment. J Craniofac Surg 2007; 18: 1164-9. (CLIN S)
  203. Guix B, Henriquez I, Andre´s A, Finestres F, Tello JI, Martı´nez A. Treatment of keloids by high-dose brachy- therapy: a seven year study. Int J Radiat Oncol Biol Phys 2001; 50: 167-72. (CLIN S)
  204. Guideline #11.6: Laser therapy may be useful for the treatment of proliferative scars. Level of evidence: II Principle: Lasers used at nondestructive power levels have been demonstrated to cause inhibition of collagen production by keloid-derived fibroblasts. The almost end- less variety of lasers and dosages prevent compilation of similar studies. Evidence:
  205. Abergel RP, Dwyer RM, Meeker CA, Lask G, Kelly AP, Uitto J. Laser treatment of keloids: a clinical trial and an in vitro study with Nd:Yag laser. Lasers Surg Med 1984; 4: 291-5. (CLIN S)
  206. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: compari- son among intralesional corticosteroids, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treat- ments. Arch Dermatol 2002; 138: 1149-55. (RCT)
  207. Alster T. Laser scar revision: comparison study of 585- nm pulsed-dye laser with and without intralesional cor- ticosteroids. Dermatol Surg 2003; 29: 25-9. (RCT)
  208. Jih MH, Friedman PM, Goldberg LH, Robles M, Glaich AS, Kimyai-Asadi A. The 1450-nm diode laser for facial inflammatory acne vulgaris: dose-response and 12-month follow-up study. J Am Acad Dermatol 2006; 55: 80-7. (RCT)
  209. Weiss RA, Gold M, Bene N, Biron JA, Munavalli G, Weiss M, Beasley K. Prospective clinical evaluation of 1440-nm laser delivered by microarray for treatment of photoaging and scars. J Drugs Dermatol 2006; 8: 740-4. (CLIN S)
  210. Hasegawa T, Matsukura T, Mizuno Y, Suga Y, Ogawa H, Ikeda S. Clinical trial of a laser device called frac- tional photothermolysis system for acne scars. J Der- matol 2006; 55: 80-7. (RCT)
  211. Guideline #11.7: Several treatments to minimize scarring or prevent recurrence of scars are based on biologic prin- ciples but, as yet, lack sufficient data for a recommenda- tion. These include surgical techniques, lathrogens, Imiquimod, and vitamin E. Level of evidence: III Principle: Attacking the collagen deposition-collagen lysis equilibrium by mechanical, molecular, or pharmaco- logic means should lead to advances in treatment of exces- sive scarring. Evidence:
  212. Robson MC, Barnett RA, Leitch IOW, Hayward PG. Prevention and treatment of postburn scars and con- tracture. World J Surg 1992; 16: 87-96. (LIT REV)
  213. Engrav LH, Gottlieb JR, Millard SP, Walkinshaw MD, Heimbach DM, Marvin JA. A comparison of intramar- ginal and extramarginal excision of hypertrophic burn scars. Plast Reconstr Surg 1988; 81: 40-5. (RETRO S)
  214. Peacock EE. Pharmacologic control of surface scarring in human beings. Ann Surg 1981; 193: 592-7. (CLIN S)
  215. Chuangsuwanich A, Gunjitisomram S. The efficacy of 5% Imiquimod cream in the prevention of recurrence of excised keloids. J Med Assoc Thai 2007; 90: 1363-7. (CLIN S)
  216. Stashower ME. Successful treatment of earlobe keloids with Imiquimod after tangential shave excision. Der- matol Surg 2006; 32: 380-6. (CLIN S)
  217. Bauman LS, Spencer J. The effects of topical vitamin E on the cosmetic appearance of scars. Dermatol Surg 1999; 25: 311-5. (RCT)
  218. Ehrlich HP, Tarver H, Hunt TK. The inhibitory effects of vitamin E on collagen synthesis and wound repair. Ann Surg 1972; 175: 235-40. (EXP)
  219. Lawrence WT. In search of the optimal treatment for keloids: report of a series and review of the literature. Ann Plast Surg 1991; 27: 164-78. (LIT REV)