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Case Study
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Bilayered living skin equivalent use in recalcitrant colonized wound healing Kara Couch, NP,CWS, Jaime Schwartz, MD Problem:.What is the next step in patients with chronic wounds culturing methicillin-resistant staphylococcus aureus and/or pseudomonas aeruginosa that have failed previous surgical debridements and biological dressings (eg, xenograft, autograft)?..Solution: .Surgical debridement and application of bilayered living skin equivalent (BLSE) * Data:.Five people with a total of 7 wounds that had each previously failed biological dressings, were followed. The etiologies of the wounds were 1-sickle cell, 2-pressure, 3-SLE/vasculitis, and 1 surgical wound dehiscence. Deep operative cultures were obtained from the wounds and were positive for 2-pseudomonas, 2-MRSA, and 1-both. The location of the wounds were 2-dorsal foot, 4-malleolar, 1-lower leg Treatment:.Surgical debridement to healthy appearing tissue was achieved before application of BLSE. All BLSE were dressed with a non-adherent silicone dressing, antibiotic ointment (mupirocin for MRSA, gentamicin for pseudomonas) and silver impregnated covering. Extremities were then covered with a multi-layer immobilizing dressing. All surgeries were done as an outpatient procedure in the operating room and all patients were followed up in clinic 7Ð10 days after application. The patients also received oral antibiotics post-operatively. None were on intravenous antibiotic therapy Results:.Eight surgical debridements down to healthy appearing tissue and application of BLSE were used to achieve 7 healed wounds. Average time to heal after application of BLSE was 13.6 weeks (range 7Ð20) Discussion:.BLSE have been used in recalcitrant colonized wounds due to potential anti-microbial activity by producing human beta defensin-2 , a small cationic peptide. This has been shown to have natural antibiotic activity against gram-positive (staph aureus), gram-negative (pseudomonas) and yeast species. We have seen clinically in patient follow up that infected appearing wounds (i.e erythema, odor, exudates and pain) after an application of BLSE, still progressed toward accepted wound healing norms at 10%Ð15% per week . *Apligraf, Organogenesis, Canton, MA.. Schmid P. Immunohistologic characterization of Graftskin (Apligraf¨). WOUNDS. 2000;12(5 suppl A):4AÐ11A Robson MC, Hill DP, Woodske ME, et al. Wound healing trajectories as predictors of effectiveness of therapeutic agents. Arch Surg. 2001;135(7):773. |
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