7 research outputs found
Success Rate of Split-Thickness Skin Grafting of Chronic Venous Leg Ulcers Depends on the Presence of Pseudomonas aeruginosa: A Retrospective Study
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 1st of March 2005 until the 31st 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
Healing data of ulcers 12 weeks postoperative from ulcers with or without <i>P. aeruginosa.</i>
<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0020492#pone-0020492-t002" target="_blank">Table 2</a> is transferred into <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0020492#pone-0020492-t001" target="_blank">table 1</a> by merging categories.</p><p>P = 0,001, N = 91, Chi = 11,96, Chi-square test.</p
Detailed healing categories at 12 weeks follow-up divided by presence of <i>Pseudomonas aeruginosa</i> pre- and/or peri-operative or not.
<p>P = 0,011, Mann Whitney test.</p
The same ulcer as <b>Figure 1</b> five weeks post operative.
<p>The spit-skin transplant is well attached and almost completely healed.</p
A venous leg ulcer at time of operation.
<p>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.</p
CLSM three-dimensional image of a large <i>P. aeruginosa</i> biofilm in the wound bed of a chronic wound (identified by a specific PNA FISH probe (red)).
<p>CLSM three-dimensional image of a large <i>P. aeruginosa</i> biofilm in the wound bed of a chronic wound (identified by a specific PNA FISH probe (red)).</p