Biography:

Caroline Schober-Flores RN, BSN, CWS works at the Children's Hosptial Colorado which is a regional Epidermolysis Center. She works within a multidisciplinary team that addresses the complex care that these individuals require. She has been a clinical wound specialist since 2005 which is her primary role in caring for these patients. Caroline educates patients, families and other healthcare providers on the complex care that these individuals require, both locally and nationally. She has published 7 articles with her most recent publication done in 2014, entitled Epidermolysis-The Challenges of a Chronic Wound in the JDNA journal.

Abstract:

Epidermolysis Bullosa (EB) is a genetic skin disorder characterized by skin fragility resulting in blisters and erosions. Wound care for individuals diagnosed with EB is aimed at wound healing and injury prevention. Although some of these individuals’ wounds heal and progress through the phases of healing in a timely manner, others become chronic and remain in a non-healing state. Those chronic wounds often have multiple bacterial complications including a high bacterial bio-burden, infections, multi-organism resistance to antibiotics, and the eventual development of a bio-film covering the wound. It is those chronic wounds that are covered with a bio-film that are the most challenging to deal with this patient population. Many of the wound products currently available only minimally affect an adherent bio-film; therefore, an alternative method of bio-film reduction was researched. This lecture will discuss a wound product called Plurogel which has been shown to be an effective method to painlessly reduce biofilm adherence for this patient population. In addition, the use of an advanced wound called Hyalomatrix will also be presented as method re-stimulate wound healing in a chronic wound, stalled in healing. The results with the use of these products have been very promising in re-stimulating wound healing in a chronic wound for a patient diagnosed with Epidermolysis Bullosa.

Biography:

Arup K Indra has done his PhD in 2001 from Jadavpur University, Kolkata, India and did his postdoctoral training on Nuclear receptor signaling in Institut Génétique Biologie Moléculaire Cellulaire (IGBMC), ILLKIRCH, France under the guidance of Prof Pierre Chambon. He is currently an Associate Professor in the OSU/OHSU College of Pharmacy and co-director of the OHSU-OSU Cancer Prevention and Control Initiative. He has published more than 43 papers in reputed journals and has been serving as an editorial board member in many journals. He regularly serves on the grant review panel for NIH, DOD and Welcome Trust, UK.

Abstract:

Surgical site infections constitute nearly 25% of all healthcare-associated infections (HAIs) and are the most common cause of infections in patients undergoing surgery. Current treatment plan utilizes wound dressings that deliver antibiotics, but their use can lead to selection and survival of drug-resistant microorganisms. The increasing frequency of multidrug-resistant bacterial species highlights the need for new approaches with distinct modes of action in order to boost the antimicrobial treatment modules used for prevention of surgical site infections. In collaboration, we and others have demonstrated that 1,25-dihydroxy vitamin D₃[(1,25(OH)₂D₃); an active and more potent form of vitamin D] induces expression of cathelicidin antimicrobial peptide (CAMP) gene, the encoded hCAP18 protein and secretion of the antimicrobial peptide LL-37 that is cleaved from the C-terminal end of hCAP18 in human immune cells, epithelial cells and skin keratinocytes. We recently demonstrated that local sustained delivery of 1,25(OH)₂D₃ by biocompatible and biodegradable, nanofibrous dressings can induce expression of endogenous antimicrobial peptide hCAP18/LL-37 in vitro in keratinocytes and immune cells, in vivo in skin wounds from a humanized transgenic mouse that expresses a human hCAMP gene, and in ex vivo human skin wounds. We also showed that nanofibers loaded with Calcipotriol, a low calcemic analog of 1,25(OH)₂D₃ can accelerate cutaneous wound healing and promote efficient wound closure in vivo in the humanized mouse model expressing the human CAMP gene (hCAMP) in place of the mouse counterpart.  The cellular and the molecular mechanisms underlying efficient wound healing following treatment with Vitamin D3 loaded nanofibers is currently being investigated.

Biography:

Gitali Ganguli-Indra has done her PhD in 2001 from “Institut Génétique Biologie Moléculaire Cellulaire (IGBMC), Université Louis Pasteur, ILLKIRCH, France and did her postdoctoral studies at the same place. She is an Associate Professor in the College of Pharmacy at Oregon State University and member of Knight Cancer Institute, OHSU. She holds a patent on a biomarker for head and neck cancer. She has published more than 33 papers in reputed journals and has been serving as an editorial board member for many journals. She also serves as a reviewer on NIH study section for skin research.

Abstract:

Wound healing is a major health concern and hair follicle stem cells (HFSC) play an important role in the repair process. We have characterized the function of transcriptional regulator COUP-TF interacting protein 2 [(Ctip2)/Bcl11b in a mouse model of cutaneous wound healing. We have shown that loss of Ctip2 in epidermis affects wound healing by directly or indirectly regulating gene expression involved in keratinocyte proliferation/differentiation, migration, and cell adhesion and remodeling of extracellular matrix. To understand the role of hair follicle bulge cells expressing Ctip2 during wound repair, we have now generated and characterized a ligand (RU486) inducible mouse line by selectively deleting Ctip2 in the bulge area of the hair follicles. Deletion of Ctip2 in the hair follicle bulge stem cells demonstrated reduced expression of PCNA and HF-specific transcription factors such as NFATC1 in HF bulge region. Preliminary studies indicate that similar to our previous report, selective loss of Ctip2 in HF bulge delays wound healing in mice by affecting the re-epithelialization process. Additional mechanisms of action are currently being investigated. We have also identified Ctip2-regulated novel genes and signaling pathways during cutaneous wound healing on wounded and unwounded skin from control and mutant mice lacking Ctip2 in the entire epidermis. Specifically, expression of Igf1, Egf and Cxcl11 were found to be significantly altered in the mutant skin, compared to the controls. The genes/pathways identified in our study will serve as potential therapeutic targets for pharmacological manipulation to promote efficient wound repair and tissue remodeling.

Biography:

Saman mohammadipour is a colorectal surgeon with a decade experience in wound management .He used all the method for wound care and has experiences in vacuum therapy. In this article he presents a case with a deadly wound which is managed in multidisciplinary team.

Abstract:

The idea of a multidisciplinary team approach has been accepted as the best way to deliver wound care. A major challenge is the lack of united services aimed at addressing the complex  needs of individuals with wounds. The concept of multidisciplinary suggests the use of different disciplines to answer  a particular clinical problem. In the small wound, management wound care by wocn (wound ostomy continent nurse) sometimes is enough and the wound be come better in the short time .but in complex wound or more life threatening form beside wound care other factors such as nutrition ,calories ,psychology  ,family  training ,endocrine and electrolyte balance ,heart evaluation ,etc… must be consider. Use of all modern wound dressings without accepting these factors is useless. This article reviews the case of 20 years old boy with a lateral skin and abdominal wall traumatic degloving injury. Due to lack of viable tissue, we had to manage wound with openly. After initial resuscitation and hemostasis we began to care and dressing the wound in hospital for about 4 month with multidisciplinary team includes all special which we had needed for example nutritionist , colorectal and plastic surgeon , psychiatrist , nephrologist .etc..

Calories consumption is one of the most important factor in these cases. You have to balance all protein, vitamins and nutritional element for better healing.  oral feeding in the best way beside parental helping for wound management. Daily irrigation and debridement for early stage by surgeon in second factor till we remove all necrotic tissue.

Family support and psychological consulting must be done as soon as possible for reassuring patient and families. We checked and balanced all electrolyte every day. Mobilization of patient in early phase prevents thromboembolic event with anticoagulant drug. Multistage plastic surgery should be done for covering the internal organs. In this case, after 4-month patient discharged and the wound covered totally after one year.

In summary, we believe that effective management of wounds as a team requires the   elements such as  using all specialty for improvement , making a good and healthy psychological environment and supporting by  hospital and patient insurance .

Biography:

Mitra Shahriari, Saman Mohammadi Pour, and Amir Arzhangian

Islamic Azad University,

Iran

Abstract:

Non-healing ulcers are a major health problem worldwide and have a great impact at personal, professional and social levels. They affect patient health, emotional state, and quality of life, causing considerable morbidity and mortality in addition to contributing to significant health care costs from lengthy hospitalizations to advanced home care and surgical care costs. The conventional treatment of these wounds can be slow due to their chronic inflammatory state and the senescence of local reparative cells. Application of autologous Platelet Rich Plasma (PRP) has been a major breakthrough for the treatment alternative for non-healing ulcers, as it is an easy and cost-effective method, and provides the necessary growth factors that enhance tissue healing. PRP is a conglomeration of thrombocytes, cytokines and various growth factors which are secreted by α-granules of platelets that augment the rate of the natural healing process with a decrease in time. In this study, we used PRP injection and PRP gel at the same time for healing a 6-year old chronic pressure wound on left buttock site of a 76-year-old man with 18-year history of c4 SCI, paraplegia impairment, 10-year history of diabetes with end-colostomy. Initially, he was admitted to hospital where he underwent surgical debridement and was started  IV antibiotics for suspected osteomyelitis for 2 weeks. At the time of transfer to hospital, the pressure ulcer on the left buttock was noted to be stage IV with a fibrous and necrotic base measuring 10×7.5×5cm³. at the beginning  there was improvement in ulcer healing during 8 month management by vacuum therapy and using different kinds of products like collagen, alginate and hyaluronic acid  base dressing, in addition, modifying nutritional status, with wound  measurements decreasing to 8×5.5×3.5cm³, but over time the healing process slowed prompting  applying PRP treatment as a last resort. The patient underwent a total of 3 PRP treatments over a span of 6 weeks (performed bi-weekly). The wound improved without using further products and dressing. We found that PRP therapy (injection at the bed and the margins of wound and gel PRP in combination) stimulate acceleration of healing installed pressure ulcers in SCI patients.