Using advanced wound care and hyperbaric oxygen to manage wound complications following treatment of vulvovaginal carcinoma

Postoperative management of patients with vulvar cancer is associated with a high incidence of poor wound healing and radiation -induced late tissue necrosis. This case series demonstrates the impact on wound healing with the use of hyperbaric oxygen therapy and advanced wound care following radical vulvectomy and/or radiation therapy.A retrospective case series was performed of all patients from 2016 to 2017 with lower genital cancer who underwent radical surgery with or without chemoradiation treatment, experienced wound dehiscence or late tissue radionecrosis, and were treated with advanced wound care, including hyperbaric oxygen therapy (HBO).Five patients were included with a mean age of 63; four had squamous cell carcinoma and one patient had vaginal adenocarcinoma secondary to prior diethylstilbestrol exposure. Three patients underwent radical vulvectomy. All received pelvic radiation therapy, subsequently experienced wound complications, and were managed with advanced wound care and HBO. The mean reduction in wound area at the final wound follow up visit after completion of HBO therapy was found to be 76%, ranging 42–95%, with an average follow up of five months. The mean number of HBO sessions per patient was 58. Complete tissue granulation or significant improvement in tissue radionecrosis was present in all patients.Advanced wound care and hyperbaric oxygen therapy are beneficial in the management of postoperative wound complications. Prospective studies are needed to identify the optimal use of perioperative hyperbaric oxygen and appropriate wound care for patients with gynecologic malignancies. Keywords: Hyperbaric oxygen therapy, Radiation tissue necrosis, Vulvar carcinom

A Wolf in Sheep\u27s Clothing: An Unusual Presentation of Diabetic Myonecrosis

© 2018 Wolters Kluwer Health, Inc. All rights reserved. GENERAL PURPOSE: To provide information about the diagnosis and treatment of diabetic myonecrosis (DMN). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant should be better able to: 1. Cite the incidence and symptomatology of diabetic myonecrosis. 2. Identify the diagnostic tests associated with DMN. 3. Summarize the evidence-based treatments for DMN

Vesicles for transdermal delivery of peptides and proteins

Elastic vesicles have been developed and evaluated as novel topical and transdermal delivery systems. They are similar to conventional liposomes but with the incorporation of an edge activator in the lipid bilayer structure to provide elasticity. Elastic vesicles are applied non-occluded to the skin and have been shown to permeate through the stratum corneum lipid lamellar regions as a result of the hydration or osmotic force in the skin. They have been investigated as drug carriers for a range of small molecules, peptides, proteins and vaccines, both in vitro and in vivo. Following topical application, structural changes in the stratum corneum have been identified and intact elastic vesicles visualised within the stratum corneum lipid lamellar regions, but no intact vesicles have been identified in the deeper viable tissues. Their method of transporting their drug payload into and through the skin has been investigated but remains an area of contention. This chapter provides an overview of the development of elastic vesicles for delivery into and via the skin