Martin C Robson

• M.D.
• Professor at University of South Florida

Background: Intracavitary irrigation is a routine component of many surgical procedures, especially in those involving a contaminated field. Normal saline remains the irrigant of choice for most surgeons. Hypochlorous acid is a weak acid that produces hypochlorite ions with antimicrobial properties. Reducing microbial concentration during intracav...

Topical antiseptics are widely used for wound treatment, with the goal of disrupting biofilm capacity. We analysed the effectiveness of a variety of antiseptics to inhibit various stages of biofilm formation and to remove biofilms in vitro as well as the agents' cytotoxic effects on fibroblasts. We found that the chlorine-releasing agents exhibited...

The various fibroproliferative disorders affecting humans have in common excess fibroblast activity and persistent overexpression or dysregulated activity of transforming growth factor beta (TGF-β). Cancer has many similar characteristics. Antineoplastic drugs can downregulate fibroblast activity and cytokine growth factors. This study evaluates th...

Drawtex's ability to remove pathogens and associated virulence factors has been demonstrated in vitro. A model of burn wound infection was used to characterize the in vivo impact of this dressing on infection and wound healing. Paired burn wounds were created on the dorsum of Sprague Dawley rats and were inoculated with methicillin-resistant Staphy...

Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity,...

COMPLEX, OPEN MAXILLOFACIAL FRACTURES ARE OFTEN ACCOMPANIED BY EXTENSIVE CONTAMINATION, CRUSH, OR AVULSION OF THE OVERLYING SOFT TISSUE, THERE HAVE BEEN TWO ALTERNATIVES TO TREATMENT: either radical debridement of all contaminated tissue, fixation of the underlying fractures, and soft tissue closure by pedicle flap or graft is done; or more conserv...

Objectives: Edema in partial-thickness burn wounds can decrease tissue perfusion, increase tissue ischemia, and deepen the burn injury. We report the results of a clinical trial comparing the effectiveness of a hydro-conductive dressing to our standard burn dressing at removing edema fluid from partial-thickness burns and present the proposed mecha...

Wound infections can have devastating effects on healing as well as the health of the patient. Complications increase when the pathogens are capable of producing virulence factors and/or are drug resistant. Novel methods are needed to take on the challenges of treating such wounds. Drawtex ® dressing is purported to have hydroconductive properties...

The rising costs of caring for chronic cutaneous ulcers (CCUs) and recent appreciation of the mortality of CCUs have led to consideration of the reasons for the failure to have new drug therapies. No new chemical entities to heal CCUs have been approved by the Food and Drug Administration (FDA) in over a decade, in part due to an inability to reach...

Transforming growth factor beta (TGF-B) has been implicated in the pathobiology of progressive fibrotic disorders. Modern laboratory models can demonstrate the role of TGF-B in Dupuytren’s Disease and allow molecular mechanistic treatments to be proposed. Data are reviewed from an in vitro model, the fibroblast-populated collagen lattice (FPCL), an...

Purpose: Neoplasms are the result of abnormal cell proliferation. Dupuytren’s contracture and keloid scar are characterized by fibroblast hyperproliferation and collagen deposition resulting in abnormal scar tissue. This similarity has lead to investigation of antiproliferative/antimetabolite agents used in the treatment of neoplasms to control/all...

Objectives: To compare the in vitro and in vivo effects of silver products on wound healing. Methods: Eight silver products were compared to determine: fibroblast function using fibroblast-populated collagen lattices (FPCLs), fibroblast viability using the Trypan Blue exclusion test, and fibroblast mitochondrial activity using the MTT [yellow te...

Introduction and objective: Traumatic avulsive injuries present complex therapeutic decisions. Radical and repeated debridement of all foreign material, necrotic tissue, bacteria, and deleterious chemicals followed by control of the bacterial bioburden and wound closure has been the gold standard. However, when such injuries occur in the face, the...

Objective: Certain cytokines, especially those known as growth factors, have been demonstrated to mediate or modulate burn wound healing. Experimental and clinical evidence suggests that there are therapeutic advantages to the wound healing process when these agents are utilized. Positive effects have been reported for 4 types of wounds seen in th...

During oxidative burst, neutrophils selectively generate HOCl to destroy invading microbial pathogens. Excess HOCl reacts with taurine, a semi-essential amino acid, resulting in the formation of the longer-lived biogenerated broad-spectrum antimicrobial agent, N-chlorotaurine (NCT). In the presence of an excess of HOCl or under moderately acidic co...

Activated macrophages play a significant role in wound healing and infected tissue repair. In this study, we investigate the recruitment of macrophages into the wound, and the effects on the bactericidal/phagocyte activity after exposure to amnion-derived cellular cytokine solution (ACCS). To evaluate the influence of ACCS on the migratory behavior...

Kaposi's sarcoma (KS) typically presents as multiple bilateral cutaneous patches or plaques of the lower extremities. This malignancy, however, can evolve with atypical presentation masquerading as a chronic wound. Lesions can mimic venous stasis ulcers, arterial insufficiency, vascular ulcers or chronic-infected wounds. With acquired immune defici...

Obesity increases the risk of laparotomy dehiscence and incisional hernia. The aim of this study was to measure the biological effect of obesity on laparotomy wound healing and the formation of incisional hernias. Normal-weight Sprague-Dawley (SD) and obese Zucker rats were used in an established laparotomy wound healing and incisional ventral hern...

Background: Wound healing trajectories (percent healing vs time) provide a dynamic picture of the decrease in wound burden over the entire continuum of the healing process. Trajectories can be robustly compared using survival statistics methodology. Improvement in healing can be determined by shifting the curve from "impaired" healing toward "ideal...

The use of biologic markers to aid in individualizing wound treatment may help improve outcomes. A biologic marker that has been demonstrated to be predictive of healing in both chronic and acute wounds is wound tissue bacterial level. The objective of this study was to determine whether tissue bacterial level can be used to individualize wound tre...

The microbiology of war wounds has changed as medicine and warfare have evolved. This study was designed to determine the microbial flora and bacterial quantification of present-day war wounds in US troops from Iraq and Afghanistan upon arrival at the National Naval Medical Center (NNMC). Patients with extremity combat wounds treated with a vacuum-...

Amnion-derived multipotent progenitor (AMP) cells, unlike most stem cells, have been demonstrated to be nontumorigenic and nonimmunogenic. Amnion-derived cellular cytokine solution (ACCS), a secreted product of AMP cells, is a cocktail of cytokines existing at physiological levels and has been used to accelerate epithelialization of experimental pa...

Amnion-derived Multipotent Progenitor cells appear to be useful as adjuvants in wound healing. Amnion-derived multipotent progenitor cells secrete a unique combination of cytokines and growth factors, known as amnion-derived cellular cytokine solution (ACCS). In the skin, a cytokine communication network between mesenchymal and epithelial cells tig...

The purpose of this study was to determine whether amnion-derived cellular cytokine solution (ACCS) could improve the quality of epithelialization and accelerate closure of dermatome-created partial-thickness wounds in normal and streptozotocin-induced diabetic pigs. Dermatome-created partial-thickness wounds were sealed with wound chambers in heal...

Meshed, split-thickness skin grafts, especially when required to be widely spread, do not obtain immediate biologic closure. In patients with burns that cover a large percentage of the body surface area, this leaves the patient at risk for metabolic problems and life-threatening infection. The purpose of this study was to determine whether amnion-d...

Objective: Wound repair is a complex integration of dynamic processes mediated by humeral messages controlling the levels of cytokines, growth factors, and matrix metalloproteinases in the wound space. Isolated growth factors and growth factor combinations have been used to accelerate wound healing with limited success. A cellular cytokine solution...

Animal bite injuries to humans are relatively common, however, bite injuries to the lower extremity and more specifically the foot are relatively uncommon. Foot injuries, once infected, may lead to further complications, such as soft tissue loss, bone loss, and the need for amputation. Patients with preexisting medical conditions, such as periphera...

The Wound Healing Society (WHS) is a professional society of physicians, nurses, physical therapists, podiatrists, and other wound care specialists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound heal...

The Wound Healing Society is a professional organization of physicians, nurses, physical therapists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound healing. To that end, the following comprehensive, e...

The Wound Healing Society (WHS) is a professional society of physicians, nurses, physical therapists, podiatrists, and other wound care specialists, basic scientists, clinical researchers, and industrial researchers dedicated to assuring that every patient receives optimal wound care. Its mission is to advance the science and practice of wound heal...

Brown recluse spider bites cause significant trauma via their tissue toxic venom. Diagnosis of these injuries and envenomation is difficult and many times presumptive. Treatment is varied and dependent upon presentation and course of injury. We present a case of a previously unreported incidence of osteomyelitis of the mandible as a result of a bro...

Growth factors demonstrate mixed results improving wound healing. Amnion-derived multipotent cells release physiologic levels of growth factors and tissue inhibitors of metalloproteinases. This solution was tested in models of acute and chronic wound healing. Acute model: Sprague-Dawley rats underwent laparotomy incisions. The midline fascia was pr...

Debridement is essential for successful wound management. Enzymatic debridement is commonly utilized in wound care but has been reported to be unsafe in wounds with significant bacterial bioburden, unless used in conjunction with topical antimicrobials. We examine this hypothesis with 2 commercially available, commonly used preparations of enzymati...

Wound repair is a complex integration of dynamic processes mediated by humeral messages controlling the levels of cytokines, growth factors, and matrix metalloproteinases in the wound space. Isolated growth factors and growth factor combinations have been used to accelerate wound healing with limited success. A cellular cytokine solution can be col...

The treatment of patients with cancer has advanced into a complex, multimodal approach incorporating surgery, radiation, and chemotherapy. Managing wounds in this population is complicated by tumor biology, the patient's disease state, and additional comorbidities, some of which may be iatrogenic. Radiation therapy, frequently employed for local-re...

Acute wounds will always be an important source of morbidity and mortality in the United States and around the world. Traumatic injuries and surgical procedures alike will increase in volume, presenting surgeons will challenging wounds and their complications. A rich history of clinical wound management makes it clear that a firm understanding of t...

Wound dressings containing silver as antimicrobial agents are available in various forms and formulations; however, little is understood concerning their comparative efficacy as antimicrobial agents. Eight commercially available silver-containing dressings, Acticoat 7, Acticoat Moisture Control, Acticoat Absorbent, Silvercel, Aquacel Ag, Contreet F...

Background: A topical antimicrobial that can decrease the bacterial bioburden of chronic wounds without impairing the wound's ability to heal is a therapeutic imperative. A stabilized form of hypochlorous acid (NVC-101) has been demonstrated in vitro and in standard toxicity testing to possess properties that could fulfill these criteria. Materials...

Objective: Hypochlorous acid (HOCl), a major inorganic bactericidal compound of innate immunity, is effective against a broad range of microorganisms. Owing to its chemical nature, HOCl has never been used as a pharmaceutical drug for treating infection. In this article, we describe the chemical production, stabilization, and biological activity of...

Acute wound failure is a common complication following surgical procedures and trauma. Laparotomy wound failure leads to abdominal dehiscence and incisional hernia formation. Delayed recovery of wound-breaking strength is one mechanism for laparotomy wound failure. Early fascial wounds are relatively acellular, and there is a delay in the appearanc...

Hypochlorous acid (HOCl), a major inorganic bactericidal compound of innate immunity, is effective against a broad range of microorganisms. Owing to its chemical nature, HOCl has never been used as a pharmaceutical drug for treating infection. In this article, we describe the chemical production, stabilization, and biological activity of a pharmace...

Background: A topical antimicrobial that can decrease the bacterial bioburden of chronic wounds without impairing the wound's ability to heal is a therapeutic imperative. A stabilized form of hypochlorous acid (NVC-101) has been demonstrated in vitro and in standard toxicity testing to possess properties that could fulfill these criteria. Materials...

Uniformity of quality of the care rendered to patients with wounds has been a paramount desire of clinicians, govern- ment regulators, and third-party payers. Whether it was for the best patient care, minimum standards to be met, or reimbursable therapies, guidelines for treatment have been sought. One of the goals of the founders of the Wound Heal...

There were major differences between our approach to evidence citations and past approaches to evidence-based guidelines. Most past approaches relied only on publications regarding clinical human studies. Laboratory or animal studies were not cited. We have used well-controlled animal studies that present proof of principle, especially when a clini...

Principle: Infection will cause wound-healing failure, often with progressive deterioration of the wound. Systemically administered antibiotics do not effectively decrease bacterial levels in granulating wounds. Other methods that may be suitable include enhancing host defense mechanisms, debridement, wound cleaning, and topical antimicrobials. For...

There exists a quantitative relationship between bacterial contamination and clinical infection. Because of this relationship, delayed wound closure can be performed based on the number of viable bacteria present in the incision at the time of closure. This principle was applied to 95 delayed wound closures in a prospective series. Ninety-three cas...

Introduction: A practical method for diagnosing wound infection in venous leg ulcerations is problematic. The majority of physicians still rely on the classic signs and symptoms of infection. However, in a recent study, these physical findings were found to be unreliable or absent altogether. The gold standard for the diagnosis of infection is havi...

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Outcome measures of venous ulcer healing are not uniformly accepted. Stringent criteria of 100% closure fail to provide information of healing over the entire span of repair. Wound-healing trajectories (plot of percentage of wound closure versus time of wound treatment) were constructed for 232 patients treated in eight clinical trials at two indep...

Fibrosis and proliferative scarring are prominent features of the severe forms of rhinophyma. Up-regulation of growth and fibroblast kinetics are hallmarks of fibrosis. Persistent overexpression or dysregulated activation of the fibrogenic isoforms of transforming growth factor beta (TGF-beta) is associated with the increased fibroblast function le...

In a 16-patient study, cultured fibroblast populations from normal skin were able to replicate an average of 14.8 +/- 2.2 times before becoming senescent, while fibroblast populations from the ulcer bed reached the end of their replicative life span after 7.2 +/- 1.9 population doublings (p= 0.001). Fibroblast populations from 10 of 16 pressure ulc...

Background:Platelet-derived growth factor (PDGF) has been demonstrated in pre-clinical studies to promote granu- lation tissue and stimulate cutaneous ulcer healing.Becaplermin gel 100 µg/g is the commercial preparation of the PDGF-BB homodimer and has been

Abdominal wall fascial wound healing failure is a common clinical problem for general surgeons, manifesting in early postoperative fascial dehiscence as well as delayed development of incisional hernias. We previously reported that abdominal wall fascial incisions normally recover breaking strength faster than simultaneous dermal incisions in a rod...

Clinical trials that follow venous ulcers to complete healing can be costly because of the prolonged healing time involved. Initial healing rates in venous ulcers are calculated by 2 methods, which are based on a metric using wound area and perimeter. It has been proposed that these rates allow the prediction of complete healing and that they may b...

We sought to reduce the high incidence of abdominal wall incisional hernias using sustained release growth factor therapy. Incisional hernias complicate 11% of abdominal wall closures, resulting in 200,000 incisional hernia repairs in the United States each year. Mechanical improvements alone in mesh, suture material, and surgical technique have fa...

Background: It is estimated that 2.5 million people in the United States have chronic venous ulcers. Standard care for these ulcers includes compression, debridement of necrotic tissue, treatment of edema, and control of infection. There has been a search for additional therapeutic compounds and/or devices to enhance ulcer healing beyond that provi...

Cytokine growth factor treatment of chronic wounds has met with mixed results. The chronic wound presents a hostile environment to peptides such as growth factors. Cytokine growth factors have not been studied extensively in acute wounds. However, incisional hernias are a major example of acute wound failure that has not been solved by various mech...

Reconstruction procedures of soft tissue defects created after tumor excision in the ilioinguinal region which have received prior radiation therapy are associated with serious morbidities. Despite the availability of muscle or myocutaneous flaps, wound infection, wound breakdown, and necrosis occur with relative frequency. Changes in tissues secon...

Oxygen is a necessary component of norm a l wound healing and is required for multiple cell functions, including the killing of bacte- ria by leuko cytes. A new ox y g e n - g e n e r a t i n g dressing has been developed that prov i d e s i n t e rmittent periods of hy p e r oxia inter- spersed with periods in which the wo u n d oxygen tension is...

Wounds that contain a significant number of fibroblasts that are arrested because of senescence, damaged DNA, or enduring quiescence do not heal. As the arrested population of cells decreases and more cells that divide and contribute to wound repair populate the wound, the wound is more likely to achieve closure. Having an understanding of the regu...

Proliferative scarring in all organ systems is an enigma. Treatment has been difficult to impossible because the pathobiology of exuberant scarring and fibrosis was unclear. With the concept that proliferative scarring can be viewed on the healing trajectory and dissected into variations of the normal wound healing cellular processes mediated by so...

Infection complicating a plastic-surgery procedure can be a catastrophic event, both for the patient and the surgeon. Surveys published in 1975 and 1985 demonstrated the "usual and customary" practices of plastic surgeons with regard to the use of prophylactic antibiotics. The objective of this study was to determine plastic surgeons' current use o...

There is a continual need for new products for wound care, as well as a desire by scientists and clinicians to translate information into wound healing improvements for patients. Pharmaceutical and biotechnology companies devote immense resources to fulfilling these needs and desires. However, there are many impediments to drug development that are...

Most individuals expect that healing is an inevitable outcome; wound healing is taken for granted. Although wound healing is perceived as inevitable, it can be fraught with problems and altered at many points. In the past, optimization of wound healing focused on minimizing contamination, accurate tissue approximation, and providing protection. Wit...

During the past 5 years, progress in the treatment of pressure ulcers appears to have reached a plateau. Several factors in the design of recent clinical studies may have contributed to this situation. These factors include the criteria chosen for patient selection, small sample size, and lack of a concisely defined final clinical outcome. Hunt not...

Mycobacterium kansasii is an uncommon cause of infection of the hand. Other atypical mycobacteria that cause hand infections are M marinium, M avium, M intracellularis, and M chelonei. Such infections usually occur around aquatic areas, though sometimes the source of infection is elusive. Inoculation of the atypical mycobacterium into the host occu...

The lower-extremity amputation rate in people with diabetes mellitus is high, and the wound failure rate at the time of amputation is as high as 28%. Even with successful healing of the primary amputation site, amputation of part of the contralateral limb occurs in 50% of patients within 2 to 5 years. The purpose of this study was to provide valid...

Mycobacterium kansasii is an uncommon cause of infection of the hand. Other atypical mycobacteria that cause hand infections are M marinium, M avium, M intracellularis, and M. chelonei. Such infections usually occur around aquatic areas, though sometimes the source of infection is elusive. Inoculation of the atypical mycobacterium into the host occ...

Background: Chronic wounds represent a worldwide problem. For laboratory and clinical research to adequately address this problem, a common language needs to exist. Observation: This language should include a system of wound classification, a lexicon of wound descriptors, and a description of the processes that are likely to affect wound healing...

Recent evidence suggests that fibrosis may play an important role in the pathobiology of rhinophyma. The fibrogenic cytokine transforming growth factor (TGF)-beta2 has been reported to be up-regulated in rhinophyma tissue. Of the three common isoforms of TGF-beta, TGF-beta1 and TGF-beta2 are considered fibrogenic, whereas TGF-beta3 has antiscarring...

Dupuytren's contracture is a fibroproliferative disorder that is associated with increased collagen deposition. Isoforms of transforming growth factor beta (TGF(beta)), normally TGF(beta1) and TGF(beta2), are involved in the progressive fibrosis of Dupuytren's disease. It has been suggested that downregulation of TGF(beta) may be useful in the trea...

Pressure ulcers are associated with significant rates of morbidity and mortality, particularly in the geriatric and spinal cord–injured populations. Newer pharmacologically active therapies include the use of topically applied recombinant human platelet-derived growth factor-BB (becaplermin), the active ingredient in REGRANEX® (becaplermin) Gel 0.0...

New treatments for chronic wounds require carefully performed clinical trials with significant endpoints. Total wound closure is the only endpoint currently accepted by the Food and Drug Administration. This study describes a scale that measures ease of wound closure and applies it to a four-arm prospectively randomized, blinded pressure ulcer tria...

Previous analyses of fluids collected from chronic, nonhealing wounds found elevated levels of inflammatory cytokines, elevated levels of proteinases, and low levels of growth factor activity compared with fluids collected from acute, healing wounds. This led to the general hypothesis that chronic inflammation in acute wounds produces elevated leve...

This randomized, double blinded, placebo- controlled, multi-center trial was undertaken to establish the safety and effective dose level of transforming growth factor β2 (TGF-β2) required to improve the healing of chronic foot ulcers in diabetic patients. Patients with chronic diabetic foot ulcers were randomized into five groups: standardized care...

Pressure ulcers were treated with (A) granulocyte macrophage colony stimulating factor (GM-CSF), (B) basic fibroblast growth factor (bFGF), (C) sequential GM-CSF and bFGF, or (D) placebo for 36 days. Each treatment was investigated to determine its ability to modulate changes in ulcer fibroblast populations that were capable of cell division and th...

About 600,000 people in the United States are estimated to be affected by venous ulcers. The cornerstone of care of chronic venous ulcers involves the application of compression bandages. Other therapies include treatment of associated infection, treatment for edema and inflammation, and debridement when necessary. Repifermin, a recombinant human K...

Approximately 200,000 incisional hernias are repaired annually in the United States. The high incidence (11-20%) and recurrence rate (24-54%) for incisional hernias have not changed appreciably in 75 years. Mechanical advances in suture material, incision orientation, and closure technique have failed to eliminate this common surgical complication....

Wounds have been with mankind since the beginning. The evolution of wound healing and tissue repair may not have kept pace with modern technology. It has been postulated that, in evolution, the characteristics of speed of healing in compromised situations with overwhelming contamination and foreign bodies have been selected at the expense of qualit...