Robert S Kirsner

University of Miami, كورال غيبلز، فلوريدا, Florida, United States

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Publications (418)1645.29 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The skin has recently been found to be an extra-adrenal site for glucocorticoid (GC) synthesis that likely acts to modulate local inflammation. Psychological, physiological, and physical stress, both acute and chronic, triggers immune-protective or -damaging responses, including increases in systemic GC levels, which, according to Lin et al. (this issue), may be beneficial in inflammatory skin disease. However, little is known about the interplay between local and systemic production of GCs and the effect of stress (local or systemic) in regulating tissue-specific GC synthesis, its impact on skin homeostasis, and its effect of skin disease.
    The Journal of investigative dermatology. 12/2014; 134(12):2869-72.
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    ABSTRACT: PURPOSE:: The purpose of this learning activity is to provide information about the etiology and treatment of atrophie blanche. TARGET AUDIENCE:: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES:: After participating in this educational activity, the participant should be better able to:1. Discuss the pathophysiology of atrophie blanche.2. Explore treatment options for livedoid vasculopathy. ABSTRACT: Atrophie blanche (AB) is a porcelain-white scar that may be seen at the base of a healed ulcer or in association with livedoid vasculopathy (LV). The term AB originally had been used synonymously with LV, whereas LV is a noninflammatory thrombotic condition presenting as either a primary or secondary event (often associated with coagulation).
    Advances in Skin & Wound Care 11/2014; 27(11):518-524. · 1.50 Impact Factor
  • Jose E Ollague, Robert S Kirsner
    The Journal of investigative dermatology. 11/2014; 134(11):e22.
  • JAMA dermatology. 08/2014;
  • Daniel G Federman, Robert S Kirsner, John Concato
    JAMA The Journal of the American Medical Association 07/2014; 312(1):87-88. · 29.98 Impact Factor
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    ABSTRACT: Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care (p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes.
    Wound Repair and Regeneration 07/2014; 22(4). · 2.76 Impact Factor
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    ABSTRACT: Diabetic foot ulcers (DFUs) are extremely debilitating and difficult to treat. Multidisciplinary management, patient education, glucose control, debridement, offloading, infection control, and adequate perfusion are the mainstays of standard care endorsed by most practice guidelines. Adjunctive therapies represent new treatment modalities endorsed in recent years, though many lack significant high-powered studies to support their use as standard of care.
    American Journal of Clinical Dermatology 06/2014; · 2.52 Impact Factor
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    ABSTRACT: Approximately 6.5 million Americans suffer from non-healing wounds. As physicians are increasingly expected to manage chronic wounds, the degree to which formalized wound care education exists as a clinical rotation is unclear. For the first time, the prevalence and characteristics of formal wound electives offered by US medical schools are documented. Online surveys were distributed to 134 US medical schools, and to the 74 medical students who completed the wound healing elective at the University of Miami regarding their experiences. School response rate was 41% (n=55). We found that out of 55 schools, only seven schools offered a formal wound healing elective. The University of Miami was the only school to include a surgical component. Students' response rate was 39% (n=29). After completing the elective, twenty students (69%) felt confident in their knowledge of surgical and medical wound management. A majority of students (76%, n=22) felt that the elective was an important part of the medical school curriculum. In conclusion, we found very few schools offer a formal wound elective and recommend medical schools in formalizing this education through clinical electives. Education should be team-based and multidisciplinary; evidence exists that this is the best approach to managing chronic wounds. Basic tenets of wound care, both medical and surgical, should be emphasized.
    Wound Repair and Regeneration 06/2014; · 2.76 Impact Factor
  • Wound Repair and Regeneration 06/2014; · 2.76 Impact Factor
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    Paulo Ricardo Criado, Afsaneh Alavi, Robert S Kirsner
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    ABSTRACT: Chronic venous disease affects millions of people around the world. Venous valvular incompetencies and venous reflux, often a result of outflow obstruction are important contributors to venous disease. The prevalence of thrombophilia is increased in patients with chronic venous insufficiency (CVI). The recognition of underlying thrombophilia particularly in young patients opens new avenues in the management and prevention plan. We emphasize on the consideration of workup for coagulopathy, especially factor VIII deficiency in young patients with venous disease. We report 3 patients with chronic leg ulcers and high levels of FVIII:C activity in plasma and other associated thrombophilic factors. We highlight the need to get a workup done for thrombophilia in young patients with recurrent and chronic leg ulcers related to venous insufficiency or livedoid vasculopathy. Further studies with larger sample sizes are required to define the definite indications for the thrombophilia workups.
    The International Journal of Lower Extremity Wounds 05/2014; · 1.25 Impact Factor
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    ABSTRACT: Chronic wounds represent a major healthcare burden, costing $25 billion annually, and are associated with high mortality. We previously reported that cutaneous wound healing represented only 0.1% ($29.8 million) of the National Institutes of Health budget. This current study focuses on quantifying the contribution by federal agencies other than the National Institutes of Health for fiscal year 2012. Federal databases including USA Spending, Veterans Affairs, Tracking Accountability in Government Grants Systems, Health Services Research Projects in Progress, and Patient-Centered Outcomes Research Institute, were searched for individual projects addressing wound healing. Twenty-seven projects were identified, totaling funding of $16,588,623 (median: $349,856). Four sponsor institutions accounted for 74% of awarded funds: Department of the Army, National Science Foundation, Department of Veterans Affairs, and Agency for Healthcare Research & Quality. Research projects and cooperative agreements comprised 44% and 37% of awarded grants. New applications and continuing projects represented 52% and 37%. Wound healing represented 0.15% of total medical research funded by the non-National Institutes of Health federal sector. Compared with potential impact on US public health, federal investment in wound research is exiguous. This analysis will draw attention to a disproportionately low investment in wound research and its perils to American public health.
    Wound Repair and Regeneration 05/2014; 22(3). · 2.76 Impact Factor
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    ABSTRACT: Using data from a national wound-specific electronic medical record (WoundExpert, Net Health, Pittsburgh, PA), we compared the effectiveness of a bilayered living cellular construct (BLCC) and an acellular porcine small intestine submucosa collagen dressing (SIS) for the treatment of venous leg ulcer. Data from 1,489 patients with 1,801 refractory venous leg ulcers (as defined by failure to have >40% reduction in size in the 4 weeks prior to treatment) with surface areas between 1 and 150 cm2 in size, treated between July 2009 and July 2012 at 158 wound care facilities across the US were analyzed. Patient baseline demographics and wound characteristics were comparable between groups. Kaplan-Meier–derived estimates of wound closure for BLCC (1,451 wounds) was significantly greater (p = 0.01, log-rank test) by weeks 12 (31% vs. 26%), 24 (50% vs. 41%), and 36 (61% vs. 46%), respectively, compared with SIS (350 wounds). BLCC treatment reduced the median time to wound closure by 44%, achieving healing 19 weeks sooner (24 vs. 43 weeks, p = 0.01, log-rank test). Treatment with BLCC increased the probability of healing by 29% compared with porcine SIS dressing (hazard ratio = 1.29 [95% confidence interval 1.06, 1.56], p = 0.01).
    Wound Repair and Regeneration 04/2014; · 2.76 Impact Factor
  • Annette T Batzer, Clive Marsh, Robert S Kirsner
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    ABSTRACT: Keratin proteins have been shown to play a key role in wound healing. Controlled keratin gene (KRT) expression promotes cell growth, migration and differentiation, and as an example of the importance of keratin proteins, absence of KRT17 has been shown to delay wound closure. In addition, downregulation of KRT6 and KRT16 in non-healing chronic venous ulcers suggests that deregulation of keratin expression contributes to non-healing phenotype. A sample of 45 chronic wounds of mixed aetiologies presenting in 31 patients were treated with keratin-based novel topical wound healing products. Thirty-seven wounds or 82% of wounds were either healed or reduced in size of >50% during treatment, with 29 (64%) healing completely and an additional 8 wounds experiencing 50% wound size reduction or greater. Of the wounds that responded, 15 required antimicrobial treatment during their course of treatment, suggesting that keratin dressing treatment should be interrupted briefly and then restarted when wound infection occur.
    International Wound Journal 02/2014; · 1.60 Impact Factor
  • Journal of the American Academy of Dermatology 01/2014; 70(1):201-3. · 4.91 Impact Factor
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    ABSTRACT: The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality.
    Journal of the American Academy of Dermatology 01/2014; 70(1):21.e1-21.e24. · 4.91 Impact Factor
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    ABSTRACT: Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.
    Journal of the American Academy of Dermatology 01/2014; 70(1):1.e1-1.e18. · 4.91 Impact Factor
  • JAMA dermatology. 12/2013;
  • Evidence-based medicine 12/2013;
  • Robert S Kirsner, David J Margolis
    The Lancet 12/2013; · 39.21 Impact Factor
  • Sonia A. Lamel, Robert S. Kirsner
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    ABSTRACT: Venous leg ulcers are a common complication of venous insufficiency, and result in significant patient morbidity and socioeconomic costs related to care. Patients with venous leg ulcers often fail to achieve complete healing with standard of care treatments even with the addition of the numerous adjuvant therapies available. To gain insight into new treatment directions, we reviewed current clinical trials evaluating the efficacy of novel therapeutics in the treatment of venous ulcers.
    Drug Discovery Today Disease Mechanisms 12/2013; 10(s 3–4):e71–e77.

Publication Stats

5k Citations
1,645.29 Total Impact Points

Institutions

  • 1992–2014
    • University of Miami
      • • Department of Dermatology and Cutaneous Surgery
      • • Miller School of Medicine
      • • Department of Medicine
      كورال غيبلز، فلوريدا, Florida, United States
  • 1991–2014
    • University of Miami Miller School of Medicine
      • Department of Dermatology and Cutaneous Surgery
      Miami, Florida, United States
  • 2013
    • Aurora St. Luke's Medical Center
      Milwaukee, Wisconsin, United States
    • University of Toronto
      Toronto, Ontario, Canada
  • 2012
    • Canterbury District Health Board
      Christchurch, Canterbury Region, New Zealand
  • 2011
    • Virginia Commonwealth University
      Richmond, Virginia, United States
  • 2000–2011
    • Yale-New Haven Hospital
      New Haven, Connecticut, United States
  • 1995–2011
    • Yale University
      • • School of Medicine
      • • Department of Internal Medicine
      New Haven, Connecticut, United States
  • 2010
    • University of Florida
      • College of Medicine
      Gainesville, FL, United States
  • 2007–2010
    • Wayne State University
      • College of Nursing
      Detroit, MI, United States
  • 2004–2010
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
  • 2005
    • University Of Miami Hospital
      Miami, Florida, United States
  • 1994
    • Minneapolis Veterans Affairs Hospital
      Minneapolis, Minnesota, United States