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Biomedical subjects

Finn Gottrup

Publications and source records attributed to Finn Gottrup.

36 records · Page 2Linked to original sources
PubMed2004

Hydrocapillary dressing to manage exudate in venous leg ulcers.

This study evaluated the safety and clinical performance of Alione hydrocapillary adhesive dressing, Coloplast A/S, a newly developed moist wound healing dressing designed for exudate management of heavily to lightly exuding ulcers. Twelve patients with heavily to moderately exuding chronic venous leg ulcers were assessed during a 4-week observation period. Assessments included healing progress, pain, odour, peri-ulcer skin condition, ease of use, patient comfort and suitability of the dressing for managing exudate. The median ulcer area was reduced by 71% (P<0.05) and the wound bed tissue improved markedly. No leakages of exudate were reported and the overall impression of the dressing was good. The amount of exudate assessed subjectively (P<0.05). Pain and odour were reduced effectively. No dressing-related adverse events were observed. This study has demonstrated that Alione is safe and easy to use, and exhibits convincing clinical performance and exudate-handling properties in the treatment of chronic venous leg ulcers.

Aged↗
PubMed2004

Venous leg ulcer patient priorities and quality of care: results of a survey.

A comprehensive patient evaluation of quality of care encompasses assessment and patient-rated prioritization of the various provisions of care. One hundred consecutive venous leg ulcer patients treated in a multidisciplinary wound healing center were invited to participate in a cross-sectional study to assess the quality of and assign priority to 28 aspects of medical technical, interpersonal, and organizational care. The response rate to the mailed questionnaire and follow-up telephone survey was 80%. Almost half (46%) of patients (median age 76 years, range 30 to 92) had an ulcer history of >5 years. Seventy-three patients (91%) were satisfied with the overall quality of care. A linear relationship was observed between average assessment score and the relative importance of the quality aspects studied. The quality of medical technical care and empathy aspects of interpersonal care received the most positive assessments and were given highest priority. Next in importance were the quality and coherence of information provided and cooperation between different healthcare sectors. Organizational aspects of care were less positively assessed and received lower priority ratings. Venous leg ulcer care, as provided in a multidisciplinary wound healing center, was assessed as satisfactory by patients, but areas for improvement - notably, cooperation between healthcare sectors and continuity of care - were observed.

Adult↗
PubMed2003

Decrease of collagen deposition in wound repair in type 1 diabetes independent of glycemic control.

HYPOTHESIS: Type 1 and type 2 diabetes mellitus and glycemic control influence wound healing in humans. DESIGN: Experimental study using a human wound-healing model. SETTING: Collaboration among a multidisciplinary wound-healing department, department of medicine, and research laboratories. PATIENTS, CONTROL SUBJECTS, AND METHODS: In 34 patients with type 1 (insulin-dependent) and 25 with type 2 (non-insulin-dependent) diabetes and 5 nondiabetic control subjects matched with the type 2 diabetic patients, wound-healing capacity was determined as subcutaneous accumulation of collagen measured as hydroxyproline. Two expanded polytetrafluoroethylene tubes were implanted and removed 10 days later. The hydroxyproline level was determined by means of high-performance liquid chromatography; the collagenase activity, by using a radiolabeled collagen substrate. Proliferation of fibroblasts cultured from the wounds was studied in patient groups. RESULTS: The deposition of hydroxyproline decreased by 40% (P =.03) in type 1 compared with type 2 diabetes (median, 0.70 vs 1.16 nmol/mg; interquartile range, 0.48-1.04 vs 0.56-1.63 nmol/mg), which in turn did not differ significantly from that of controls (median, 1.35 nmol/mg; interquartile range, 0.72-1.88 nmol/mg). The decreased collagen deposition in type 1 diabetes was not caused by increased collagenase activity. The deposition of hydroxyproline did not correlate significantly (r(s) = 0.07; P =.63) with glycosylated hemoglobin levels in either diabetic group. Fibroblast growth was also decreased in type 1 compared with type 2 diabetic patients and controls. CONCLUSIONS: Collagen deposition in acute wounds is impaired in type 1 diabetes, possibly due to a decreased fibroblast proliferation. In type 2 diabetes, collagen deposition is normal. Glycemic control does not influence collagen deposition in acute wound repair in type 1 or in type 2 diabetes mellitus.

Adult↗
PubMed2003

Monochromatic phototherapy in elderly patients: a new way of treating chronic pressure ulcers?

BACKGROUND AND AIMS: Monochromatic pulsating light may have effects of importance for wound healing, and promising results were obtained in an open study on the healing of pressure ulcers, which motivated the present study. METHODS: One hundred and sixty-four in- and outpatients with grade II and III ulcers were treated with monochromatic pulsating light or placebo over the ulcerated area, according to a specific therapeutic program. RESULTS: No significant effects were observed in the total material. In a subanalysis of grade II ulcers, there was a tendency toward better healing in the monochromatic light group (p = 0.06). A significantly larger reduction in pressure ulcer size was noted among patients in the treatment group with low body weight (BMI < 20). CONCLUSIONS: Monochromatic pulsating light may have effects on pressure ulcer healing, and a new study focusing only on grade II ulcers is under way.

Aged↗
PubMed2003

Abstinence from smoking reduces incisional wound infection: a randomized controlled trial.

OBJECTIVE: Clinical studies show that the incidence of postoperative wound complications is higher in smokers than nonsmokers. In this study, we evaluated the effect of abstinence from smoking on incisional wound infection. METHODS: Seventy-eight healthy subjects (48 smokers and 30 never-smokers) were included in the study and followed for 15 weeks. In the first week of the study, the smokers smoked 20 cigarettes per day. Subsequently, they were randomized to continuous smoking, abstinence with transdermal nicotine patch (25 mg per day), or abstinence with placebo patch. At the end of the first week and 4, 8, and 12 weeks after randomization, incisional wounds were made lateral to the sacrum to excise punch biopsy wounds. At the same time identical wounds were made in 6 never-smokers. In 24 never-smokers a wound was made once. All wounds were followed for 2 weeks for development of wound complications. RESULTS: A total of 228 wounds were evaluated. In smokers the wound infection rate was 12% (11 of 93 wounds) compared with 2% (1 of 48 wounds) in never-smokers (P <0.05). Wound infections were significantly fewer in abstinent smokers compared with continuous smokers after 4, 8, and 12 weeks after randomization. No difference between transdermal nicotine patch and placebo was found. CONCLUSIONS: Smokers have a higher wound infection rate than never-smokers and 4 weeks of abstinence from smoking reduces the incidence of wound infections.

Adult↗
PubMed2002

Oxygen, wound healing and the development of infection. Present status.

Wounds do not heal in tissue that does not bleed and almost always heal in tissue that bleeds extensively. A continuous supply of oxygen to the tissue is vital for the healing process and to resist infection. External factors may decrease the peripheral oxygen supply, but supplementary perioperative oxygen reduces the surgical wound infection rate to half in patients having colorectal resections. Hyperbaric oxygen may be beneficial when the flow and oxygen supply to the healing tissue are compromised by local injury and particularly if anaerobic infection is present. Assessment of perfusion and oxygenation is essential during and after surgery.

Humans↗
PubMed2002

Premenopausal women deposit more collagen than men during healing of an experimental wound.

BACKGROUND: From a post hoc analysis a hypothesis was generated that women deposit more collagen in a surrogate test wound than men. The purpose of this study has been to verify this hypothesis prospectively in a controlled study. METHODS: Post hoc analyses were done on 37 volunteers (study A). The prospective trial included 47 smoking volunteers (study B). Outcome measures were deposition levels of collagen (hydroxyproline) and protein during a period of 10 days in subcutaneously implanted tubes of expanded polytetrafluoroethylene. RESULTS: The mean increments of collagen deposition levels in women as compared with men were 56% (P <.01) in study A and 74% (P <.001) in study B. The mean increase in the ratio collagen/total protein was 74% (P <.001) and 69% (P <.001), indicating that the increase was specific for collagen. CONCLUSIONS: The studies show that deposition in a miniature subcutaneous test wound of collagen, but not noncollagenous protein, is promoted in women as compared to men. These findings may relate to the observation in some reports indicating higher rates of compromised postoperative wound healing in men.

Adult↗
PubMed2002

Dose-dependent impairment of collagen deposition by topical granulocyte-macrophage colony-stimulating factor in human experimental wounds.

OBJECTIVE: The authors studied the dose-dependent effect of topically administered granulocyte-macrophage colony-stimulating factor (GM-CSF) on the connective tissue response using an experimental repair model in surgical patients. SUMMARY BACKGROUND DATA: GM-CSF is primarily indicated in the treatment of immunosuppressed states. The effect of GM-CSF on the tissue repair response in humans is unclear. METHODS: Expanded polytetrafluoroethylene tubes were implanted subcutaneously and GM-CSF was applied locally at concentrations of 0.1 micro g/mL (total dose 0.4 micro g), 1.0 micro g/mL (4.0 micro g), 10 micro g/mL (40 micro g), or 75 micro g/mL (300 micro g) in one arm and saline alone (control) in the contralateral arm of 56 surgical patients. The content of collagen and total protein in the tubes was quantified as hydroxyproline and proline by high-performance liquid chromatography 10 days after implantation. Cellularity and the number of procollagen I-positive fibroblasts were determined by histology and immunohistochemistry. The direct effects of GM-CSF on collagen production by and proliferation of wound fibroblasts cultured from granulation tissue were also measured. RESULTS: Local application of GM-CSF stimulated the inflammatory cell infiltration but reduced the number of fibroblasts in the granulation tissue. GM-CSF treatment suppressed specifically and dose-dependently collagen deposition by up to 81%. A reduced collagen accumulation was also found in the control-treated arm at GM-CSF doses of 4 micro g or more, indicating a systemic depressive effect of GM-CSF on tissue repair. The selective downregulation of collagen production by GM-CSF was also found in wound fibroblasts in vitro. CONCLUSIONS: Inhibition of fibrogenesis with GM-CSF intervention may impair tissue repair processes during surgery.

Adult↗
PubMedDate not supplied

Leg ulcers: uncommon presentations.

Uncommon presentations like vasculitis or other immunologic causes and malignancy account for about 1% to 2% of patients suffering from leg ulcers. We focus on such uncommon leg ulcers including: cutaneous vasculitis causing cutaneous ulceration, other immunologic or metabolic cutaneous lesions such as pyoderma gangrenosum and necrobiosis lipoidica, and ulcers based on neoplastic etiology. A short description on leg ulcers in the tropics is also included. The described uncommon presentations of leg ulcers are typically difficult to diagnose and treat; it is a specialist's job to take care of patients with these types of ulcers. Multidisciplinary specialized wound healing concepts integrated in the national health care system, as an accepted expert function, is the ideal way to organize the wound healing area. Such a system would result in an earlier diagnosis and more sufficient treatment for patients with uncommon presentations of leg ulcers.

Adult↗
PubMedDate not supplied

Organization of wound healing services: the Danish experience and the importance of surgery.

Thomas K. Hunt is a general surgeon. Through his basic wound healing research and clinical work with wound patients he has been a great inspiration for my work in wound healing. In order to fulfill Dr. Hunt's vision, the clinical wound healing arena must be organized in an optimal way, and this article focuses on different options. Multidisciplinary wound care teams or centers focusing on all types of problem wounds have proved to be most effective at providing treatment and care for patients with problem wounds. The ultimate model is an outpatient clinic and an inpatient ward joined within a departmental structure, which represents an integrated part of an accepted national expert program on wound healing. Different types of center models can be established with different advantages and disadvantages. Currently, the wound care arena is being organized in Denmark and the model is described in this article. Of all specialties involved in treatment of wounds, surgery is of vital importance. "Wound healing is the keystone on which surgery is founded" (Thomas K. Hunt). This has long been understood in relation to acute wounds, while the importance of surgery in the treatment of chronic wounds has been less widely recognized. Surgical procedures directly related to the wound consist of debridement of all types of problem wounds and, in more specialized procedures such as skin transplantation, different types of flap constructions, bone surgery, and tendo-Achilles lengthening. Arterial reconstruction is a type of surgery that indirectly, through improved tissue perfusion, improves healing of problem wounds. This study concludes that multidisciplinary specialized wound healing concepts integrated into the national health care system as accepted expert functions would be the ideal way to organize wound healing to best benefit patients and society. Emphasis is on the importance of surgical procedures in wound healing and care. The models described can be applied with minor adjustments to both industrialized and developing countries.

Denmark↗
PubMedDate not supplied

Optimizing wound treatment through health care structuring and professional education.

Considerable developments have occurred in wound healing and care over the last few decades. Innovative technologies such as use of growth factors, bioengineered skin, topical negative pressure, heat, oxygen, and others have entered the clinic. These techniques have been advantageous, but even the most advanced and sophisticated product requires proper wound care and wound bed preparation in order to function optimally. It has been shown that the organization of a wound team, not the change in products, increases the healing of problem wounds (MTV Report, Denmark, 2003). Efficacy studies are generally performed in a few centers with investigators already experienced in the field. This probably leads to an optimal efficacy of the product. Problems arise when the product is marketed and is used by clinicians not specially educated in wound care. If no treatment plan and education is performed, product efficacy and cost-effectiveness decrease dramatically. This is clearly a major problem for patients, but also for communities and, in the end, for companies' sale of the product. Structuring of treatment and education is for these reasons the largest present challenge in the area of wound healing. The optimal way to treat nonhealing wounds is based on a multidisciplinary concept that has been implemented in a national health care system as a recognized expert function. It should consist of a specific treatment plan including modern wound care products and well-educated personnel. This structure is similar to other areas of the medical profession, but has to a lesser degree been established in the treatment of problem wounds. A growing understanding of the importance of this area is, however, shown by the increasing number of working groups focusing on organization and education in wound care. Presently the European Wound Management Association, the World Union of Wound Healing Societies, and The Danish Wound Healing Society have created such types of working groups.

Cooperative Behavior↗
PubMedDate not supplied

Pain and quality of life for patients with venous leg ulcers: proof of concept of the efficacy of Biatain-Ibu, a new pain reducing wound dressing.

Wound pain is a serious problem for elderly patients suffering from chronic leg ulcers, and it may lead to reduced wound healing rates and reduced quality of life. Biatain-Ibu Non-adhesive (Coloplast A/S), a new pain-reducing moist wound healing dressing containing ibuprofen was tested for pain reduction, safety, and efficacy on 10+2 patients in a single-blinded crossover study against Biatain Non-adhesive (Coloplast A/S). Pain was measured with a Numeric Box Scale before, during, and after dressing change. Quality of life was measured using the World Health Organization-5 Well-Being Index. Dressing moist wound healing properties such as absorption capacity and leakage were tested together with assessment of wound exudate and blood plasma content of ibuprofen. Use of the Biatain-Ibu foam dressing correlated with a decrease in pain intensity scores from 7 in the run-in period to approximately 2.5 in the Biatain-Ibu treatment phase. Quality of life measures were improved which together with the reduced pain could contribute to faster wound healing. The moist wound healing properties of Biatain-Ibu were similar to that of the Biatain Non-adhesive and ulcer size was reduced by 24% during the treatment period. Neither side effects nor systemic plasma concentrations of ibuprofen were observed. These data indicate that Biatain-Ibu could reduce persistent and temporary wound pain, increase Quality of life, was found safe to use, and had excellent moist wound healing properties.

Administration, Topical↗
PubMedDate not supplied

Transdermal nicotine patch enhances type I collagen synthesis in abstinent smokers.

Cigarette smokers deposit less collagen, expressed as hydroxyproline, in granulation tissue than nonsmokers. We studied the effect of abstinence from smoking and transdermal nicotine patches on deposition of hydroxyproline, proline, type I procollagen, and total proteins. Fifty-four healthy smokers were studied during 10 days of smoking and again from days 10 to 20 following smoking cessation. After the first 10 days of abstinence they were randomized to double-blind treatment with transdermal nicotine patches of 25 mg/day or placebo for a period of 10 days. During this period and during smoking, an expanded polytetrafluoroethylene tube was implanted into the subcutis. Following removal of the implant, total amino acids and peptides were extracted. Hydroxyproline and proline were analyzed by high-pressure liquid chromatography, type I procollagen was analyzed by enzyme-linked immunoassay, and total proteins were determined colorimetrically. In the 39 subjects who complied with the study protocol, abstinence from smoking did not affect the deposition of hydroxyproline, proline, type I procollagen, or total protein in the implants. During abstinence, the type I procollagen level increased by 18% in the transdermal nicotine patches group and decreased by 10% in the placebo group (p<0.05). We conclude that 20 days of abstinence from smoking does not affect collagen deposition in granulation tissue. However, in abstinent smokers, transdermal nicotine patches appears to increase type I collagen synthesis.

Administration, Cutaneous↗
PubMedDate not supplied

Clinical assessment of infection in nonhealing ulcers analyzed by latent class analysis.

The distinction between bacterial colonization and infection relies on clinical judgement. Determining sensitivity and specificity of this judgement are problematic as no gold standard exists. Six specialists in wound management independently assessed 120 nonhealing chronic wounds. Sixty-five (54.2%) patients had venous ulcer, 18 (15%) arterial ulcers, 15 (12.5%) ulcerative pyoderma gangraenosum, 12 (10%) neuropathic or pressure ulcers, six (5%) vasculitis ulcers, and four patients had ulcers caused by a primary or metastatic cancer disease. Unrestricted latent class analysis was used for determining sensitivity and specificity in the observer's assessment of hypergranulation, redness, and overall impression of infection. Interrater agreement among observers was determined by restricted latent class analysis. The observers used the diagnoses (redness, hypergranulation, and overall impression of infection with different frequencies (p<0.001, Cochrane's Q test). A two latent class model fitted data. Sensitivity for hypergranulation ranged from 3 to 82%, for redness from 34 to 91% and for overall impression of infection from 37 to 90%. None of the observers were interchangeable. These results indicate that clinical assessment of chronic wounds for the presence of infection are difficult tasks accompanied by great variability and low reliability.

Humans↗
PubMedDate not supplied

Antibacterial properties of EMLA and lidocaine in wound tissue biopsies for culturing.

If a tissue biopsy from a chronic wound is sampled for culture, the antibacterial properties of local anesthetics may pose a problem in producing false-negative results. The purpose of this study was to investigate the effects of EMLA (AstraZeneca) and lidocaine on common wound pathogenic bacteria. An in vitro study of a total of 25 clinical isolates and ATCC reference strains of Staphylococcus aureus (including methicillin-resistant S. aureus), Escherichia coli, Pseudomonas aeruginosa, and Streptococcus pyogenes was conducted. The isolates were exposed to the local anesthetic drugs (and some of their contents separately) at 35 degrees C over a 24-hour period and time-kill curves were recorded. No culture media were used and saline was used for controls. EMLA was found to have a rapid acting and powerful antibacterial effect and should not be used before culturing tissue samples. Lidocaine 1% was found not to inhibit the bacterial strains when exposure time was held below 2 hours. We conclude that culturing tissue from a wound biopsy is safe within 2 hours when a pure, preservative-free lidocaine 1% solution is used.

Anesthetics, Local↗