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BACKGROUND: Chronic non-healing wounds present a substantial economic burden to healthcare system; significant reductions in quality of life for those affected, and precede often serious events such as limp amputations or even premature deaths. This burden is also likely to increase with a larger proportion of elderly and increasing prevalence of life-style diseases such as obesity and diabetes. Reviews of the evidence on the burden of illness associated with chronic wounds have not been comprehensive in scope and have not provided an assessment of the distribution of the health care costs across categories of resource use. METHODS/DESIGN: This study is a systematic review of multiple databases for studies on adult patients with chronic wounds and with the primary objective to assess the impact on health-related quality of life by category of ulcers, and associated direct and indirect costs. Eligible studies will primary be empirical studies evaluating, describing or comparing measurement of quality of life and economic impact. Two reviewers will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form. Differences in applied methodologies and uncertainties will clearly be accounted for. Conservative valuations of costs and impact on health-related quality of life will be prioritised. Variations that may depend on age distribution, the categorisation of ulcer, healthcare system etc. will be described clearly. DISCUSSION: The proposed systematic review will yield a comprehensive assessment of the humanistic and economic burden of chronic wounds in an adult population. A better understanding of the humanistic and economic burden of chronic wounds is essential for policy and planning purposes, to monitor trends in disease burden and not at least in order to estimate the real-world cost-effectiveness of new treatments and therapies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016037496.

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BACKGROUND: Chronic wounds impose a significant and often underappreciated burden to the individual, the healthcare system and the society as a whole. Preliminary literature search suggests that there are at present no reliable estimates on the total prevalence of chronic wounds for different settings and categories of chronic wounds. Such information is essential for policy and planning purposes as the increasing number of elderly and the prevalence of lifestyle diseases point in the direction of an increased burden. Knowledge about the prevalence and incidence of chronic wounds in relation to population characteristics is important for informing healthcare planning and resource allocation. The objective is to present a transparent process for how to review the existing literature on the prevalence and incidence rates of chronic wounds and resulting implications. METHODS/DESIGN: We will search electronic bibliographic databases (MEDLINE, EMBASE, the EBM Reviews and Cochrane, Cumulative Index to Nursing and allied Health Literature (CINAHL), PsycINFO, Global Health) and reference lists of included articles. Two investigators will independently screen titles and abstracts and select studies involving adults with chronic wounds. These investigators will also independently extract data using a pre-designed data extraction form that will cover information on demographics, diagnostics including disease prevalence, medical history, hospital and community-based management and outcomes. Subgroup analysis and sensitivity analysis will be performed to address the heterogeneity across studies. Meta-analysis will also be performed if homogeneous group of studies will be found. The collective evidence will be further stratified according to the important background variables if allowed. DISCUSSION: This study will describe the available epidemiological evidence and summarise prevalence and incidence rates of chronic wounds and related complications. A better understanding of the relationship between population profile and the prevalence of chronic wounds and related complications will be helpful in the development of guidelines for patient management. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016037355.

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Debridement is essential in wound treatment to remove necrotic tissue and wound bacteria but may lead to bacteria spread by aerosolization. This study investigated the wound bacterial reduction and bacterial transmission induced by debridement using curette, plasma-mediated bipolar radiofrequency ablation (Coblation®) or hydrodebridement (Versajet®). Full thickness dermal wounds in porcine joint specimens inoculated with S. aureus were debrided with curette, Coblation, Versajet, or were left untreated. During and after debridement, aerosolized bacteria were measured and to assess wound bacterial load, quantitative swab samples were taken from each wound. Only Coblation was able to reduce the bacterial load of the wound significantly. Versajet debridement resulted in a significant bacterial aerosolization, but this was not the case with Coblation and curette debridement. This study shows that Coblation is a promising wound debridement method, which effectively reduces the wound bed bacterial load without the risk of bacterial aerosolization.

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PURPOSE: The aim of the study was to determine the in vitro effects of plasma-mediated bipolar radiofrequency ablation on human chondrocyte compensatory proliferation and inflammatory mediator expression. METHODS: Human articular cartilage biopsy specimens, from total knee replacement, and human chondrocytes in alginate culture, from patients undergoing autologous chondrocyte implantation, were exposed to plasma ablation with a Paragon T2 probe (ArthroCare, Austin, TX). Instantaneous chondrocyte death was investigated with live/dead assays of biopsy specimens and cell cultures. Chondrocyte proliferation was determined by Hoechst staining of DNA on days 3 and 6. Messenger RNA expression of IL-1ß, IL-6, IL-8, tumor necrosis factor α, high-mobility group protein B1, matrix metalloproteinase 13, type IIA collagen, and versican was determined on days 3 and 6. RESULTS: Live/dead imaging showed a well-defined local margin of cell death ranging from 150 to 200 µm deep, both in the alginate gel and in the biopsy specimens exposed to plasma ablation. The ablation-exposed group showed a significant proliferation increase compared with control on day 3 (P < .043). There were significant increases compared with control in IL-6 expression on day 3 (P < .020) and day 6 (P < .045) and in IL-8 expression on day 3 (P < .048). No differences were seen for IL-1ß, tumor necrosis factor α, high-mobility group protein B1, matrix metalloproteinase 13, type II collagen, or versican. CONCLUSIONS: This study has shown that exposure to plasma-mediated ablation induces a well-defined area of immediate cell death and a short-term increase in proliferation with human articular chondrocytes in vitro. The exposure also alters cytokine expression for the same period, causing upregulation of IL-6 and IL-8. CLINICAL RELEVANCE: The results show the potential of plasma-mediated ablation to cause the onset of a tissue regeneration response with human articular cartilage.

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Infection constitutes an important part of wound pathology and impedes wound healing. Plasma-mediated bipolar radiofrequency ablation (Coblation(®)) is a tissue-removal technique suggested for use in wound treatment. The aims of this study were to determine the antimicrobial effect of ablation exposure on bacteria and fungi relevant to wound infection, and how exposure time, temperature and aerobic/anaerobic growth influence the effect. Suspensions of 10(6) colony-forming units/ml of Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Escherichia coli and Candida albicans were exposed to ablation or thermal control for 500, 1000 or 2000 ms, or left untreated, and incubated aerobically. E. coli was also incubated anaerobically. Ablation was significantly (p < 0.0001) microbicidal on all strains compared with untreated and thermal control. The reductions compared with untreated control were 99.87-99.99% for all strains. In conclusion, plasma-mediated bipolar radio-frequency ablation has a general microbicidal effect in vitro on microbes relevant to wound infection independent of aerobic/anaerobic growth and thermal effect.

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