Principles of Best Diagnostic Practice in Tissue Repair and Wound Healing: An Expert Consensus

Abstract

Chronic wound treatment currently relies heavily on visual assessment by clinicians; however, the clinical signs and symptoms of infection and inflammation are unreliable in chronic wounds. The specialty of wound care has witnessed the advent of advanced interventions, such as cellular and/or tissue based products (CTP). The success of advanced therapies relies on preparing the wound bed by reducing bacterial burden and inflammation. The lack of diagnostics in chronic wound care leads to uncertainty in the adequacy of wound bed preparation. Recent research suggests that two novel point-of-care diagnostic tests can assist in the detection of chronic inflammation known as elevated neutrophil derived protease activity (EPA) and bacterial pathogenesis known as bacterial protease activity(BPA) in chronic wounds. Despite the evidence, however, clinicians report that incorporating diagnostics into every day practice is challenging and across the globe, they have requested guidance on their use. Methods and Recommendations: A panel of wound care experts, experienced with these tests, met to develop guidelines on their use in wound care practice. The consensus panel concluded that the clinician should test for BPA first. The panel maintained that the risk of invasive infection resulting from the presence of pathogenic bacteria was the greatest threat to the patient’s health. If the BPA test is negative, the panel recommended testing for EPA. In addition, it was suggested that if the wound failed to progress after the elevated BPA was treated and subsequent testing was negative for BPA, the clinician should consider testing for EPA. Conclusions: In this manuscript, the consensus panel suggests pathways for testing, treating, and retesting for EPA and BPA. The panel expects that following the algorithm has the potential to improve healing outcomes, result in more cost-effective use of advanced therapies, and improve antimicrobial stewardship by guiding antimicrobial use.

The High Impact of Staphylococcus aureus Biofilm Culture Medium on In Vitro Outcomes of Antimicrobial Activity of Wound Antiseptics and Antibiotic

“…Untreated or treated improperly, infected chronic wound is a factor significantly increasing risk of limb amputation or development of systemic, life-threatening inflammatory symptoms. The treatment of chronic wound infection is still considered a challenge for contemporary medicine and includes application of time-consuming algorithms involving actions performed by multidisciplinary medical team [1].…”

Clorpactin: An Alternative Irrigation Method for Total Knee Arthroplasty Joint Infection Revisions

“…23 28 It has broad-spectrum coverage against microbes and an excellent efficacy to destroy biofilms. 24 25 32 33 It also has a comparable cost to chlorhexidine, betadine, and Dakin's solution, but is more cost-effective when compared with the growing popularity of Irrisept (chlorhexidine gluconate 0.05%) use in orthopedics.…”

“…23 However, Clorpactin has broad-spectrum coverage with decreased pain, decreased negative effects on fibroblasts, and less wound healing complications when compared with other antiseptics. 24 25 26 27 For example, full-strength Dakin's solution produces a toxic chlorine ion when exposed to human tissue, 14 28 While the relative neutrality of Clorpactin makes it less irritating to human skin and open wounds. 23 28 Theoretically, Clorpactin has greater germicidal activity than Dakin's solution as chemicals of this subclass exponential increase germicidal activity as the pH is decreased.…”

“…29 30 31 Lastly, of particular importance in total joint arthroplasty is this compounds excellent efficacy to destroy biofilms. 24 32 33 This article evaluates Clorpactin as an alternative irrigation intraoperative technique for the treatment of PJI using both DAIR and 2-stage procedures.…”

Conformable electrochemical devices for closed-loop wound management

“…Light, as a clean energy source, offers high temporal and spatial resolution and remote control for drug release. The choice of treatment methods is closely tied to specific wound conditions, underscoring the importance of closed-loop wound management (Armstrong et al, 2020;Jiang et al, 2022;Pang et al, 2023).…”