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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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The same ulcer as Figure 1 five weeks post operative.The spit-skin transplant is well attached and almost completely healed.
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pone-0020492-g002: The same ulcer as Figure 1 five weeks post operative.The spit-skin transplant is well attached and almost completely healed.

Mentions: Our grafting methods and procedures have been described previously by Bitsch et al[9] but are briefly as follows: tangential excision of their leg ulcers followed by autografting with meshed STSGs (Figure 1 and 2). This entailed mechanical debridement of necrotic tissues, lipodermatosclerotic skin, exposed tendons, subcutaneous calcifications and bone immediately followed by mesh skin grafting. Mesh grafting consists of harvesting a STSG (0,3 mm thick) with a dermatome and expanding this graft with a mesher. Insufficient perforator veins are ligated superficially to the fascia. Donor grafts are obtained from the thigh. In addition, immobilizing devices are used if skin grafts are applied on to mobile surfaces. The vast majority of the patients are discharged after an average period of 7–10 days. Compression therapy is continued after discharge. Early standard postgraft follow-up consists of 3 controls, in the 3rd, 6th and 12th week in the outpatient clinic.


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)

The same ulcer as Figure 1 five weeks post operative.The spit-skin transplant is well attached and almost completely healed.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0020492-g002: The same ulcer as Figure 1 five weeks post operative.The spit-skin transplant is well attached and almost completely healed.
Mentions: Our grafting methods and procedures have been described previously by Bitsch et al[9] but are briefly as follows: tangential excision of their leg ulcers followed by autografting with meshed STSGs (Figure 1 and 2). This entailed mechanical debridement of necrotic tissues, lipodermatosclerotic skin, exposed tendons, subcutaneous calcifications and bone immediately followed by mesh skin grafting. Mesh grafting consists of harvesting a STSG (0,3 mm thick) with a dermatome and expanding this graft with a mesher. Insufficient perforator veins are ligated superficially to the fascia. Donor grafts are obtained from the thigh. In addition, immobilizing devices are used if skin grafts are applied on to mobile surfaces. The vast majority of the patients are discharged after an average period of 7–10 days. Compression therapy is continued after discharge. Early standard postgraft follow-up consists of 3 controls, in the 3rd, 6th and 12th week in the outpatient clinic.

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