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Introduction
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Publications
Publications (313)
Skin necrosis is a result of several local and systemic factors, which have to be explored before indicating local debridement, among them being the local vascularisation.
Multiple debridement technologies are nowadays available and should be adapted to the local availabilities and expertise. Most of the caregivers do not feel comfortable to debrid...
This chapter describes the updated methods and respective indications of recent surgical debridement technologies applied for the management of necrotic tissues.
Since 2009, the law has reinforced the role of the general practitioner in coordinating care in France. Various structures, such as coordination support systems and specific regional systems, have been set up to improve the efficiency of care pathways. Primary care teams and specialized care teams organize care around patients. Multi-professional h...
Intralesional corticosteroid administration (ICA) is a first-line keloid treatment. However, it faces significant variability in current clinical and scientific practice, which hinders comparability of treatment results.
The aim of the study was to reach consensus on different aspects of ICA using hypodermic needles in keloids among an internationa...
Background:
HOCl (eg, pHAp) preserved solutions have antimicrobial properties and are considered safe and effective for wound management. NPWTi-d (or NPWTi) is an established adjunctive wound modality for a variety of wound etiologies in various anatomic locations in which an instillate solution dwells on the surface of the wound to assist in woun...
Scars form a medical problem still considered as a cosmetic issue by most of the societies and fewly covered except for burns and trauma.
A few EBM exists on technologies used in scar management, except for silicone. Most of the treatment options are consensually used and the recommendation are to use them in combination. Scar management is based o...
Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlyin...
Scars form a medical problem still considered as a cosmetic issue by most of the societies and poorly covered except for burns and trauma. The classification established in 2002 (Mustoe et al. 2002) separates 6 classes of scars, from immature scar to large spreading keloidas. POSAS scale is now considered as one of the most valuable tool concerning...
Monolayer graphene directly presented on the wound bed is assessed for its healing properties using both in vitro and in vivo models. For in vivo study, a cutaneous excisional wound is created on the dorsal surface of healthy and type-1 diabetic mice to mimic acute and delayed wound healing, respectively. A pig model is also chosen for its resembla...
The diabetic foot ulcer (DFU) is a major disabling complication of diabetes mellitus. Growing evidence suggests topical erythropoietin (EPO) can promote wound healing. The aim of this study is to clinically assess the efficacy of a proprietary topical EPO-containing hydrogel for treating DFUs. We conducted a randomized, controlled trial in 20 patie...
Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed, thanks to new medical devices based on fluid aspiration capacities and the development of negative pressure wound therapy. Negative-pressure wound therapy was initially designed for a do...
Mechanotherapy of postoperative scarring is considered an effective measure to prevent pathological scars. Tension increases suture line enlargement, opening the way to infection. Several options have been proposed since decades and are currently used in practice, from adhesive sutures to adhesive dressings, reapproximation devices, and postoperati...
Use of telemedicine has expanded rapidly in recent years, yet there are few comparative studies to determine its effectiveness in wound care. To provide experimental data in the field of telemedicine with regard to wound care, a pilot project named “Domoplaies” was publicly funded in France in 2011. A randomized, controlled trial was performed to m...
The use of negative pressure wound therapy with instillation and dwell time (NPWTi‐d) has gained wider adoption and interest due in part to the increasing complexity of wounds and patient conditions. Best practices for the use of NPWTi‐d have shifted in recent years based on a growing body of evidence and expanded worldwide experience with the tech...
Les brûlures sont souvent difficiles à analyser pendant les premiers jours en termes de profondeur. La surface est plus facile à évaluer, en se servant d’outils mnémotechniques simples, comme la règle des 9 de Wallace, ou d’outils plus spécialisés, comme les tables de Lund et Browder. En effet, les proportions de surface sont variables en fonction...
Objective
To evaluate the tolerance and healing rate of a collagen regeneration template in covering full-thickness wounds, including rate of adverse events.
Method
In this prospective, multicentre study, patients with a full-thickness wound underwent two-stage surgery consisting of implantation of a collagen regeneration template followed by a sp...
Background: Various international guidelines and recommendations are available for management of diabetic foot infections. We present a review of the guidelines and recommendations for management of these infections.
Methods: A systematic literature search was conducted through MEDLINE, CENTRAL, EMBASE, LILACS, DARE, and national health bodies. Bas...
Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatme...
Objective: To inform on the interim results of the Remede d'Or study, which is a prospective, multicenter, single-blind, randomised, controlled clinical study on the safety and efficacy of RMD-G1, a topical carbopol-based hydrogel with a fibronectin (FN)-matrix whose active pharmaceutical ingredient (API) is erythropoietin (EPO), for treating diabe...
Objective::
To evaluate the performance of Jelonet Plus (JP) and UrgoTul (UT), assessing pain at dressing removal when managing acute or chronic wounds at granulation and epithelialisation stages.
Methods::
This was a randomised, multicentre, controlled single-blinded study using a cross-over design. Hospitalised and ambulatory patients presenti...
La thérapie par pression négative a permis, depuis son introduction en 1997, une spectaculaire progression des prises en charge chirurgicales des plaies aiguës et chroniques. La technique a pris une place considérable dans les indications de chirurgie reconstructrice. Elle s’est imposée comme un moment chirurgical nécessaire entre la détersion et l...
Background
Chronic wounds are frequent, affect quality of life, and increase care costs. Telemedicine provides potential for effective wound care management, especially for the monitoring of complex wounds at home.
Objectives
The objective of the present study was to determine the clinical effects and costs of telemedicine for the follow-up of com...
Abstract: A new reticulated open-cell foam dressing with through holes (ROCF-CC) has been introduced to assist with wound cleansing by removing thick wound exudate and infectious materials during negative pressure wound therapy with instillation. Due to the limited published evidence supporting use of ROCF-CC dressings with negative pressure wound...
Le dispositif Moleculight i:X™ est un nouvel appareil d’imagerie en temps réel. Le principe de cet appareil d’imagerie repose sur l’autofluorescence des bactéries et des tissus, permettant une interprétation de photographie mettant en avant la présence bactérienne. Le Moleculight i:X™ semble, selon les résultats de cette analyse, être un nouvel out...
Flammacerium is a topical treatment composed of silver sulfadiazine and cerium nitrate initially used in burns. The objective was to assess the effectiveness of silver sulfadiazine and cerium nitrate on ischemic necrosis wounds of the lower limb as an alternative to amputation for a period of 12 weeks. Patients were prospectively randomized to rece...
Introduction: The prevalence of biofilms on chronic wounds is difficult to evaluate and the clinical diagnosis of biofilm remains essentially based on expert opinions. While all previous studies converge towards the proof that biofilm presence on non-healing chronic wounds is the general case, no study reports its occurrence on cared wounds after i...
Introduction: To better understand pressure ulcer etiology, research model used either long (>3h) or intense pressure (>250 mmHg) compression which does not represent the clinical challenge of hospital acquired pressure ulcer. Moreover, a lot of the data available are focused on skin whereas the muscle is known to be the first tissue damaged.
Aims:...
A new reticulated open-cell foam dressing with through holes (ROCF-CC) has been introduced to assist with wound cleansing by removing thick wound exudate and infectious materials during neg- ative pressure wound therapy with instillation. Due to the limited published evidence supporting use of ROCF-CC dressings with negative pressure wound therapy...
Removing sloughy tissue in wounds can
be challenging for many clinicians. Clinical assessment of wound depth and undermining is a skill that is poorly acquired, owing to a lack of understanding of the pathophysiological determination of wound infection. Surgical wound debridement can be tedious and
sometimes considered a “second class” surgery that...
Aucun consensus n’existe sur la stratégie thérapeutique des ostéites sur escarres pelviennes. Les objectifs de notre étude étaient d’évaluer l’impact d’un algorithme de prise en charge optimisée (figure) sur la guérison des escarres pelviennes compliquées d’une ostéite.
Les expérimentations de l’article 36 de la loi de financement de la Sécurité sociale pour 2014 (LFSS 2014), visent à définir les modèles de rémunération qui pourraient être mis en place dans le cadre de la télémédecine. Initialement prévue dans neuf régions, cette expérimentation est étendue depuis la LFSS 2017 à l’ensemble du territoire national....
Le projet Domoplaies a été réalisé en partenariat de deux régions, Languedoc-Roussillon et Basse-Normandie. Accordé en 2011 par l’ASIP Santé, il a pu être analysé à partir de 2016. Plus de 4 500 patients porteurs de plaies complexes ont pu être inclus. Les coûts de fonctionnement tenant compte des coûts médicaux, de structure et de logistique sont...
La prévention et le traitement des escarres passe par l’utilisation de supports de redistribution des pressions pour décharger ou augmenter la surface d’appui et diminuer l’intensité des pressions. Le choix du support dépend de la mobilité et du risque d’escarre du patient. Des recommandations existent pour aider au choix de la catégorie de support...
Diabetic foot ulcer (DFU) is a frequent complication in diabetic patients, occurring in up to 25% of those affected. Among the treatments available to clinicians, the use of bioengineered skin substitutes is an attractive alternative. Artificial dermis functions as a matrix, covering the wound and supporting healing and reconstruction of the lost t...
We have previously reported that the topical application of erythropoietin (EPO) to cutaneous wounds in rats and mice with experimentally-induced diabetes mellitus (DM) accelerates their healing by stimulating angiogenesis, reepithelialization, and collagen deposition, and suppressing the inflammatory response and apoptosis. Aquaporins (AQP) are in...
L’apport de l’instillation dans la thérapie par pression négative concerne la possibilité de réduire la charge bactérienne locale en instillant et retirant périodiquement un liquide de trempage. Les recommandations récentes proposent l’utilisation de sérum salé plutôt que des solutions contenant un antiseptique ou un antibactérien. Le développement...
We describe our experience with a novel foam dressing architecture in tandem with
negative pressure wound therapy and instillation (NPWTi-d) for removing viscous
wound exudate and infectious materials. A retrospective review was conducted of the
outcomes of 21 patients who received NPWTi-d using a reticulated open cell foam
instillation dressing wi...
This study aimed to determine the effect of low-level laser therapy (LLLT) on chronic venous leg ulcers (VLUs). A double-blinded prospective randomized controlled trial was conducted to compare incidence of complete wound closure, ulcer size and pain reduction in patients randomized to 24 treatments of placebo or LLLT (635 nm) over 12 weeks. Patien...
La mecanotherapie des cicatrices postoperatoires est consideree comme le traitement le plus efficace pour prevenir les cicatrices pathologiques hypertrophiques et cheloides. Plusieurs options sont ainsi utilisees en pratique courante. La technologie permettant a la fois de terminer la suture et de maintenir les berges cutanees au contact pendant pl...
Les greffes de peau représentent un acquis ancien dont l’actualité reste adaptée à de nombreuses situations en chirurgie reconstructrice des plaies aiguës et chroniques. La simplicité apparente de la technique cache l’impérative maîtrise de gestes fondamentaux. De nombreuses complications laissant persister des séquelles cosmétiques sont inacceptab...
Background:
Telemedicine in wound care is an evolving method of information technology and telecommunication designed to provide health care at a distance. Given the visual nature of wound care, telemedicine has many potential applications within this field. The authors will review the current status of wound care and telemedicine.
Methods:
A co...
Innovations in technology are used in managing chronic wounds. Despite the wide range of technologies available, healing of chronic wounds remains variable. In this paper, the authors offer an evidence based approach to the use of technology for diagnosis and management based on the concept of standardised care.
Nurses are often on the frontline regarding the choice of dressing for chronic wounds. In this age of connected health, numerous tools are available to help them or guide them in their choices. A study was carried out in 2015 to assess the perceptions and practices of private practice nurses with regard to the use of smartphone applications to help...
Negative pressure wound therapy with instillation (NPWTi) and dwell time is an adjunctive treatment modality for selected complex wounds. Because of the greater amount of research now available, a multidisciplinary expert panel comprising the fields of podiatry, plastic and general surgery, burn treatment, infectious diseases, and orthopedics was c...
There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (M...
Skin necrosis is a result of several factors.
Tendon necrosis may be observed in several types of wounds, traumas or chronic wounds like pressure ulcers, diabetic foot ulcers or arterial leg ulcers, as a consequence of skin necrosis. The origin is multifactorial, exposure to air and desiccation of poorly vascularised structures being the most frequently encountered situation and infection and...
Surgery, normally considered inappropriate for patients receiving palliative care, can nevertheless be an option in the case of infection. Some procedures are carried out in these situations, such as emergency debridement or the amputation of the foot or lower limb. These techniques also aim to improve the comfort of the patient at the end of life....
Effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy (NPWT) is a well-established advance...
This chapter describes the updated methods and respective indications of recent surgical debridement technologies applied for the management of necrotic tissues.
In recent years, wound care has gained increasing recognition as a distinct medical specialty. An understanding of the complex mechanisms involved in wound healing facilitates efficient assessment and treatment of patients with wounds, and skin necrosis can be considered the starting point in the entire healing process. This book is the first to di...
Necrosis in burns has a major impact on dermal regeneration, functional, and esthetic results. Thus patient’s satisfaction and quality of life is determined by the timely regeneration process of all dermal layers. Pathophysiological changes after burn trauma lead to different perfusion patterns (“zones”). Inflammation has been described having a ke...
Developing a new drug is expensive: the cost of going from bench to bedside is about $US1 billion. Therefore, the repurposing of an approved drug is potentially rewarding because it expands the drug's existing therapeutic profile and preempts additional development costs. As the safety profile of a repurposed drug is already well known, any new inv...
Hypertrophic scars and keloids can be aesthetically displeasing and lead to severe psychosocial impairment. Many invasive and non-invasive options are available for the plastic (and any other) surgeon both to prevent and to treat abnormal scar formation. Recently, an updated set of practical evidence-based guidelines for the management of hypertrop...
Negative‐pressure wound therapy ( NPWT ) was developed in the early 1990s and reported in 1997 by Argenta and Morykwas. Ignored at first, this technique progressively came to be considered as an outstanding advancement in reconstructive surgery. Several randomized controlled studies produced evidence for the effect of NPWT on promotion of granulati...
The PANSaBIO project aims to evaluate the prevalence of biofilms on a large panel of chronic wounds (more than 100 samples) and relate its presence to the type and history of the wound and its microbiology. A large file computing all the data is under construction. Moreover, several strategies to prepare an innovative anti-biofilm dressing have bee...
New developments in wound management may either come from remarkable progress in science and enhanced understanding of the intimate pathophysiology of wounds, or from improvements in organisation of health care.
Negative pressure therapy enables significant progress to be made in wound treatment by favouring tissue development. The indications depend on the shape of the wound and the exposed tissues. Specific training, as well as the respect of the recommendations set out by the French National Authority for Health, help to favour cicatrisation and limit c...
There is no consensus regarding the diagnostic and therapeutic strategy for pubic osteomyelitis secondary to pelvic pressure sores. Diagnosis is often difficult and bone biopsies with microbiological and anatomical-pathological examination remain the gold standard. The rate of cicatrisation of pressure sores is low. Cleansing and negative pressure...
Lower T-junction wound dehiscence following breast reduction surgery or mastopexy constitutes a vexing and grievous complication both to the surgeon and the patient. Treatment modalities that can expedite wound healing and reepithelialization rates are highly craved. The objective of this study was to assess wound healing and epithelialization rate...
Negative pressure wound therapy combined with timed, cyclical instillation (NPWTi) of topical wound solutions has been recently presented as a new adjunctive modality for treating wounds with signs of infection. Normal saline, antiseptics and antimicrobials all have been proposed in scientific and clinical studies as potentially effective when used...
Contexte. La prise en charge des plaies, en particulier chroniques est un problème majeur en soins primaires, responsable d'un sur-coût important dans les systèmes de soins occidentaux. La formation des soignants dans le domaine des plaies et de la cicatrisation est globalement insuffisante: l'enseignement initial est faible et la formation continu...
Contexte :
En 2009, l’étude VULNUS estimait à 2 millions le nombre de patients porteurs de plaies aiguës ou chroniques en France. Ce nombre est en constante augmentation, du fait de l’allongement de la durée de vie et de l’explosion des pathologies chroniques. Or, les professionnels de santé en soins primaires sont peu formés à cette discipline et...
Between 5% and 10% of cancer patients develop malignant wounds. Cancer wounds can occur as a clinical entity, especially over the breast, with the development of painful, spreading cancer invasions of the skin. Marjolin's ulcers develop in open wounds after a long period, and form rare malignancies arising from previously traumatised, chronically i...
The treatment of chronic wounds is slow and difficult and the presence of an infection can further delay the healing. Diagnosis of this infection is clinical. It must be accompanied by targeted sampling carried out in accordance with a specific technique in order to adapt the treatment as best as possible.
Copyright © 2013 Elsevier Masson SAS. All...
To investigate use of negative pressure wound therapy (NPWT) combined with instillation for patients either presenting with a complex wound or after failure of classic NPWT.
A retrospective case series study conducted on patients treated using an NPWT instillation system (V.A.C. Instill; KCI Inc.) from January to December 2012. The instillation mac...
Scars can be functionally or socially disabling. Many patients affected therefore request corrective surgery. The list of surgical techniques is long and the most frequently-used solutions are well-known.
Copyright © 2013. Published by Elsevier Masson SAS.
