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 tetrazolium salt; 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay. In vivo effects of 9 silver products were evaluated utilizing a rat model of contaminated wounds. Serial quantitative bacteriology was performed on tissue biopsies over a 10-day period and serial wound areas were obtained over 12 days.RESULTS:Fibroblast cytotoxicity occurred for all of the silver products evaluated. Remaining viable fibroblasts were insufficient to allow FPCL contraction. Mitochondrial activity of the fibroblasts allowed a separation of the various silver compounds. Actisorb Silver and Silvercel had the greatest viable fibroblast activity, but less than the control. Despite in vitro cytotoxicity, all of the silver products except Contreet Foam and Acticoat Moisture Control accelerated wound healing.CONCLUSIONS:Silver-containing dressings appeared to benefit healing of the wounds. Just as in vitro bacterial analyses do not fully predict the effect of an antimicrobial in the in vivo setting, in vitro cytotoxicity tests do not fully predict the effect of an agent on wound healing trajectories. Because of the varied antimicrobial and wound healing responses among products, a careful consideration of the particular effects of individual silver-containing dressings or drugs is warranted.

Primary breast lymphoma accounts for only 0.05%-1.1% of all breast malignancies, and less than 1% of all cases of non-Hodgkin lymphoma. Although primary breast lymphoma may present clinical similarities to breast carcinoma, the majority of cases lack the typical features of breast malignancy or lymphoma. We describe a case of primary breast lymphoma in a reconstructed breast, 8 years after a mastectomy for breast cancer. To the best of our knowledge, this is the first reported case in the worldwide literature of primary breast lymphoma in a reconstructed breast. We will discuss the diagnostic and treatment strategies involved in the management of primary breast lymphoma, and the effect of breast reconstruction on the detection of recurrent breast cancer.

Background 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 treatment regimens with a stem-like cell-derived product. Methods Amnion-derived cellular cytokine solution (ACCS) was topically applied to rat chronic wounds, and healing rates were measured. Results Experimental wounds treated with ACCS demonstrated accelerated healing regardless of the tissue level of bacteria, compared with saline. As the level of tissue bacteria increased, the frequency of ACCS application required to obtain optimal results increased. Conclusions It appears that the biologic characteristic of tissue bacterial level can serve as a marker to predict the response of open granulating wounds treated with ACCS.

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 tightly controls keratinocyte and fibroblast migration, proliferation and differentiation–key determinants of wound healing. To evaluate the influence of ACCS on the migratory behavior of keratinocytes and fibroblasts, cell migration was assayed quantitatively using a Boyden chamber. Chemotactic migration activity of fibroblasts or keratinocytes through the membrane determined the influence of ACCS. In the presence of ACCS, fibroblasts and keratinocytes demonstrated a statistically significant (P < 0.05) increase in migration when compared with controls. These cell types, critical to normal wound healing, may be influenced to accelerate migration in wounds, thus accelerating wound repair/healing.

UNLABELLED: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.OBJECTIVE:The purpose of this study was to determine whether amnion-derived cellular cytokine solution could improve epithelialization kinetics and accelerate closure of meshed skin graft interstices.METHODS:Human meshed, split-thickness skin grafts were explanted to athymic "nude" rats and treated with 3 different regimens of amnion-derived cellular cytokine solution (groups I, II, and III) or normal saline (group IV) as a control. Serial wound tracings of unepithelialized interstitial wound areas were compared over time. Two different preparations of amnion-derived cellular cytokine solution were also compared with one another, one containing animal components and the other free of animal components.RESULTS:Only 67.03% of interstices in control animals closed by day 9. This compared with 92.2% closure for group I, 83.72% for group II, and 90.64% for group III. Interstices in all 3 groups treated with amnion-derived cellular cytokine solution (with or without animal-derived components) closed faster statistically than in the control animals (P < .05). There were no statistical differences among the 3 amnion-derived cellular cytokine solution-treated groups.CONCLUSIONS:These data suggest that epithelialization kinetics and interstitial closure of meshed skin grafts can be accelerated with the use of amnion-derived cellular cytokine solution, a physiologic cocktail of cytokines, and provide support for a future clinical trial.

BACKGROUND: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 enzymatic debriding agents. MATERIALS AND METHODS:Using a standard rodent model of a chronically infected granulating wound with bacterial levels greater than 1 x 10(5) Colony Forming Units per gram of tissue, commercially available preparations of collagenase and papain-urea were utilized to investigate the response of infected wounds to these preparations, and to evaluate their ability to overcome the inhibition of infection on wound healing. Quantitative bacteriology of tissue biopsies and wound healing trajectories were used to compare the preparations to saline-treated negative controls. RESULTS:Collagenase- and papain-urea-treated wounds demonstrated a reduction in bacterial burden of wounds to < 10(5) colony forming units/gram of tissue (P < .05). This decrease in bacterial bioburden occurred rapidly, allowing wounds to achieve bacterial balance in a short period of time. Wounds treated with enzymatic debriding agents healed significantly faster and to greater extent than saline-treated controls (P < .01); a direct reflection of the decreasing bacterial load of the wound. CONCLUSIONS:Collagenase and papain-urea appear beneficial and safe even in wounds with high bacterial loads, and appear to significantly aid extent and rate of healing, probably by lowering bacterial burden through their positive enzymatic actions on bacteria and necrotic tissue.

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, Urgotol® SSD and Actisorb®, were tested to determine their comparative antimicrobial effectiveness in vitro and compared against three commercially available topical antimicrobial creams, a non treatment control, and a topical silver‐containing antimicrobial gel, Silvasorb®. Zone of inhibition and quantitative testing was performed by standard methods using Escherichia coli, Pseudomonas aeruginosa, Streptococcus faecalis and Staphylococcus aureus. Results showed all silver dressings and topical antimicrobials displayed antimicrobial activity. Silver‐containing dressings with the highest concentrations of silver exhibited the strongest bacterial inhibitive properties. Concreet® F and the Acticoat® dressings tended to have greater antimicrobial activity than did the others. Topical antimicrobial creams, including silver sulfadiazine, Sulfamylon and gentamicin sulfate, and the topical antimicrobial gel Silvasorb® exhibited superior bacterial inhibition and bactericidal properties, essentially eliminating all bacterial growth at 24 hours. Silver‐containing dressings are likely to provide a barrier to and treatment for infection; however, their bactericidal and bacteriostatic properties are inferior to commonly used topical antimicrobial agents.

Objective To compare the proportion of patients with Stage III pressure ulcers with com- plete wound closure at Week 24,when treated with conventional therapy or conventional therapy plus a human fibroblast-derived dermal replacement.

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 allowed to autoreg u l a t e . Materials and Methods:The effects of an oxygen-generating dressing on healing of infected wounds were examined in 2 ex p e r i- ments using a rodent model of a chronically

Introduction: Despite improvement in abdominal wall closure, 200,000 incisional hernia repairs are performed in the U.S. each year. In fact, the greatest risk factor for incisional hernia formation is a previous incisional hernia. A biological intervention at the host:wound level designed to optimize fascial healing may prevent and/or treat incisional hernias. To date, systematic studies have been difficult due to lack of a reproducible animal model.

BACKGROUND:The isoforms of transforming growth factor beta (TGF-beta) have been shown to be deficient in models of impaired wound healing. Exogenous application of the growth factor to enhance healing as been investigated. TGF-beta1 has been shown to enhance incisional wound strength, but to be dependent on the vehicle used to carry the cytokine. Because TGF-beta2 has shown safety in human trials of chronic wound healing, this study evaluates TGF-beta2 in acute incisional healing using a variety of vehicles.METHODS:Using an acute incisional wound model in healthy rats, rhTGF-beta2 was suspended in various vehicles including fibrin sealant (normal commercial concentration), fibrin sealant (dilute concentration), phosphate buffered saline/serum albumin, and a carboxymethycellulose gel. A single dose of the agent was instilled into the incisions at the time of wound closure and breaking strength analyses and histology performed periodically from days 3-14.RESULTS:TGF-beta2 enhanced the gain of incisional strength in all vehicles during the first two weeks of healing. This was most noticeable by day three with the carboxymethycellulose gel, but by day 7 with the other vehicles. Like reports with TGF-beta1, TGF-beta2 accelerated the gain of wound strength by about three days by day 11. Normal density fibrin sealant delayed incisional healing; whereas, the other vehicles without TGF-beta2 had no significant effect.CONCLUSIONS:The use of TGF-beta2 appears to be of value in increasing incisional wound strength in the first 14 days post-wounding in healthy rats and this effect is demonstrated in a variety of vehicles. These data support the hypothesis that the "normal" incisional wound healing curve can he shifted to the left. Shortening the time for gain of incisional wound strength may have potential clinical use.