This article reviews the scientific basis for the certain factors that delay wound repair in the clinical setting. A brief history of wound healing is given, followed by a discussion of endogenous local factors (bacterial infection, hypoxia, foreign body, and desiccation) and endogenous systemic factors (nutritional deficiencies, aging, coagulation disorders, and the Ehlers-Danlos syndromes) associated with poor wound repair. Also reviewed are the mechanisms by which exogenously administered agents (glucocorticoids, antineoplastic agents, and anticoagulants) may delay healing. Commonly used topical antimicrobials, their spectrum of activity, and evidence of effects on wound healing are examined. Finally, properties of commercially available wound coverings and wound care in the future are discussed.

https://www.jaad.org/article/S0190-9622(85)70242-3/pdf

Cutaneous tissue repair: practical implications of current knowledge. II.

Accurate evaluation of bacterial colonization as a predictive index for wound sepsis has relied on a quantitative culture technique that provides exact colony counts per gram of tissue by culture of five serial dilutions of biopsy tissue homogenate. The method, while useful to the physician, is both labor intensive and expensive. In this study 78 eschar biopsies were cultured by a semiquantitative technique that involved the use of 0.1- and 0.01-ml samples of inocula and by the serial dilution method. Exact colony counts from the semiquantitative culture method were available only from cultures containing 10(4) to 10(6) CFU/g of tissue. Other colony counts were reported as less than 10(4) or greater than 10(6) CFU/g. Agreement by category of colony counts between the two methods was 96%. For prediction of wound sepsis, the semiquantitative procedure had a positive predictive value of 100% and a negative predictive value of 93.7%. This method also resulted in an approximately 30% reduction of work units (as defined by the College of American Pathologists) and a 60% reduction in the amount of media for specimen processing. Therefore, this semiquantitative culture technique provides accurate information to the physician while saving both time and materials.

Comparison of quantitative and semiquantitative culture techniques for burn biopsy.

The response of Streptococcus pyogenes to amoxicillin or amoxicillin-clavulanic acid (Augmentin; Beecham Group) therapy of a mixed streptococcal-staphylococcal infection was studied in a surgical wound in mice. A superficial wound was produced on the backs of anesthetized mice, and a suture infected with S. pyogenes, Staphylococcus aureus, or a mixed inoculum of both organisms was inserted. Oral therapy was started 4 h after infection and continued for 3 days. Both amoxicillin and amoxicillin-clavulanic acid were effective in eliminating the streptococci from the pure wound infection. In contrast, amoxicillin failed to eliminate the streptococci from a mixed infection in which a beta-lactamase-producing strain of S. aureus was also present, wound counts reaching 10(7) streptococci per wound by 80 h, whereas amoxicillin-clavulanic acid reduced the count to less than 33 streptococci per wound by 24 h. Numbers of S. aureus were also reduced by amoxicillin-clavulanic acid therapy, controlling the infection, whereas amoxicillin was ineffective. Also of significance was the fact that successful therapy was achieved with blood and tissue concentrations of amoxicillin and clavulanic acid of the same order as those measured in humans. These results show that amoxicillin therapy failed to eliminate S. pyogenes from a wound infection in the presence of a beta-lactamase-producing strain of S. aureus and suggest the potential of amoxicillin-clavulanic acid in the treatment of mixed bacterial skin infections involving beta-lactamase-producing organisms.

Response of Streptococcus pyogenes to therapy with amoxicillin or amoxicillin-clavulanic acid in a mouse model of mixed infection caused by Staphylococcus aureus and Streptococcus pyogenes.

Povidone-iodine ointment: no effect of split skin graft healing time.

The objective of this study was to compare the antibacterial effects of selective laser treatments on contaminated wounds. Comparisons were made using the diode (808 nm) laser with and without an accompanying chromophore, Nd:YAG (1064 nm), and KTP (532 nm) lasers. A known quantity (mean concentration of 7.9 +/- 1.9 CFU/ml X 10 8 ) of bacterial organisms (Staphylococcus intermedius) was inoculated into skin incisions aseptically made on the backs of experimental rabbits. The bacteria were allowed to adhere/colonize for one hour, and each site was then treated with various laser modalities. Tissue samples were taken at one and forty-eight hours after treatment. The number of viable bacteria was then quantitated (CFU/ml) by a spot-plate counting technique. Initial results illustrated the fact that selective photothermolysis of superficial cellular layers of targeted tissue occurred with an accompanying decrease of bacterial numbers that virtually created a `clean' (organisms numbers less than 10 5 per gram of tissue) wound. This effect was especially noticeable using the diode laser (808 nm) and an accompanying chromophore, indocyanine green.

Use of diode laser energy (808 nm) for selective photothermolysis of contaminated wounds

Quantitative bacteriology in the management of wound sepsis provides an objective way to monitor the success or failure of wound care. The clinical appearance of a wound requiring skin grafting may be misleading. Grafting wounds that appeared clinically ready was unsuccessful when analysis showed bacteriological counts of 10(5) or greater organisms per gram of tissue. A rapid and simple method for quantitative tissue culture is described. Three cases are described illustrating the value of the results of the method.

Quantitative bacteriology in wound care.

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Quantitative bacteriology in wound care.