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Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa: a retrospective study.

Høgsberg T, Bjarnsholt T, Thomsen JS, Kirketerp-Møller K - PLoS ONE (2011)

Bottom Line: The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks.Smoking also significantly suppressed the outcome at the 12-week follow-up.Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p = 0.001).

View Article: PubMed Central - PubMed

Affiliation: Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.

ABSTRACT
The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous leg ulcers on 91 extremities, from the 1(st) of March 2005 until the 31(st) of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P. aeruginosa, isolated at least once from 12 weeks prior, to or during surgery, were healed (98% or more) by week 12 follow-up, while 73,1% of ulcers without P. aeruginosa were so by the same time (p = 0.001). Smoking also significantly suppressed the outcome at the 12-week follow-up. Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p = 0.001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts.

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A venous leg ulcer at time of operation.Standard state-of-the-art treatment failed to heal the ulcer and according to our protocol the patient was offered a revision and split-skin transplant.
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pone-0020492-g001: A venous leg ulcer at time of operation.Standard state-of-the-art treatment failed to heal the ulcer and according to our protocol the patient was offered a revision and split-skin transplant.

Mentions: It is our clinical experience during our daily work with chronic venous leg ulcers and STSGs that once the ulcers are colonized by P. aeruginosa, even weeks or months preoperatively, the success rate of skin grafting deteriorates. This, in spite of an aggressive treatment, in our clinic, of P. aeruginosa, in the form of extensive debridement of the wound bed before grafting often combined with systemic antibiotic therapy. Our focus on P. aeruginosa has increased over time due to increasing evidence of this bacterium to impair healing of chronic wounds. From our recent studies we have elucidated P. aeruginosa as being present in the wounds as biofilms in many of our patients, see Figure 1[18]–[20]. The ability of colonizing bacteria to establish themselves and proliferate in a biofilm could be the cause of the lack of successful antibiotic treatment. Currently we are changing our antibiotic regime to accommodate the eradication of bacteria in biofilms. In order to evaluate the impact of P. aeruginosa on graft take in our present antibiotic regimen we chose to make a retrospective study to establish the relevance of the subject prior to further investigation. Our aim of this study was to determine whether graft take and survival of the graft, in the first 3 months, was dependent on wound bed bacteriology from 12 weeks prior, to or during surgery, with particular attention to P. aeruginosa.


Success rate of split-thickness skin grafting of chronic venous leg ulcers depends on the presence of Pseudomonas aeruginosa: a retrospective study.

Høgsberg T, Bjarnsholt T, Thomsen JS, Kirketerp-Møller K - PLoS ONE (2011)

A venous leg ulcer at time of operation.Standard state-of-the-art treatment failed to heal the ulcer and according to our protocol the patient was offered a revision and split-skin transplant.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3105064&req=5

pone-0020492-g001: A venous leg ulcer at time of operation.Standard state-of-the-art treatment failed to heal the ulcer and according to our protocol the patient was offered a revision and split-skin transplant.
Mentions: It is our clinical experience during our daily work with chronic venous leg ulcers and STSGs that once the ulcers are colonized by P. aeruginosa, even weeks or months preoperatively, the success rate of skin grafting deteriorates. This, in spite of an aggressive treatment, in our clinic, of P. aeruginosa, in the form of extensive debridement of the wound bed before grafting often combined with systemic antibiotic therapy. Our focus on P. aeruginosa has increased over time due to increasing evidence of this bacterium to impair healing of chronic wounds. From our recent studies we have elucidated P. aeruginosa as being present in the wounds as biofilms in many of our patients, see Figure 1[18]–[20]. The ability of colonizing bacteria to establish themselves and proliferate in a biofilm could be the cause of the lack of successful antibiotic treatment. Currently we are changing our antibiotic regime to accommodate the eradication of bacteria in biofilms. In order to evaluate the impact of P. aeruginosa on graft take in our present antibiotic regimen we chose to make a retrospective study to establish the relevance of the subject prior to further investigation. Our aim of this study was to determine whether graft take and survival of the graft, in the first 3 months, was dependent on wound bed bacteriology from 12 weeks prior, to or during surgery, with particular attention to P. aeruginosa.

Bottom Line: The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks.Smoking also significantly suppressed the outcome at the 12-week follow-up.Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p = 0.001).

View Article: PubMed Central - PubMed

Affiliation: Copenhagen Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.

ABSTRACT
The last years of research have proposed that bacteria might be involved in and contribute to the lack of healing of chronic wounds. Especially it seems that Pseudomonas aeruginosa play a crucial role in the healing. At Copenhagen Wound Healing Centre it was for many years clinical suspected that once chronic venous leg ulcers were colonized (weeks or months preoperatively) by P. aeruginosa, the success rate of skin grafting deteriorated despite aggressive treatment. To investigate this, a retrospective study was performed on the clinical outcome of 82 consecutive patients with chronic venous leg ulcers on 91 extremities, from the 1(st) of March 2005 until the 31(st) of August 2006. This was achieved by analysing the microbiology, demographic data, smoking and drinking habits, diabetes, renal impairment, co-morbidities, approximated size and age of the wounds, immunosuppressive treatment and complicating factors on the clinical outcome of each patient. The results were evaluated using a Student T-test for continuous parameters, chi-square test for categorical parameters and a logistic regression analysis to predict healing after 12 weeks. The analysis revealed that only 33,3% of ulcers with P. aeruginosa, isolated at least once from 12 weeks prior, to or during surgery, were healed (98% or more) by week 12 follow-up, while 73,1% of ulcers without P. aeruginosa were so by the same time (p = 0.001). Smoking also significantly suppressed the outcome at the 12-week follow-up. Subsequently, a logistic regression analysis was carried out leaving P. aeruginosa as the only predictor left in the model (p = 0.001). This study supports our hypothesis that P. aeruginosa in chronic venous leg ulcers, despite treatment, has considerable impact on partial take or rejection of split-thickness skin grafts.

Show MeSH
Related in: MedlinePlus