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Cutaneous ectopic bowel mucosa after the clousure of an ileostomy
P3610
P3701
Novel phase controlled, multisource radiofrequency system for simultanous fractional microablation and volumetric dermal heating Yoram Harth, MD, Medical OR, Herzlya, Israel; Daniel Lischinsky, EndyMed, Cesarea, Israel; Monica Elman, MD, Beit Harofim Medical Center, Holon, Israel; Roi Ram, EndyMed, Cesarea, Israel; Varda Gottfried, PhD, EndyMed, Cesarea, Israel
Silver impregnated dressings: Do they help chronic venous ulcers heal? David Judy, DO, Largo Medical Center/Sun Coast Hospital, Largo, FL, United States; Claude Burton, MD, Duke University Medical Center, Durham, NC, United States; Jan Johnson, MSN, CNP, Duke University Medical Center, Durham, NC, United States; Stephanie Yates, MSN, CNP, Duke University Medical Center, Durham, NC, United States
Background: Optimal skin rejuvenation requires therapy of epidermal and dermal changes. Most existing fractional laser based can deliver ablative or deep dermal heating. Treatments with CO2 lasers that deliver both are usually associated with significant pain and patient downtime. The objective of this study was to assess the effectiveness of a novel phase controlled RF system for skin rejuvenation on face and body areas. This device uses the interaction between multiple phase controlled radiofrequency (RF) sources to ablate epidermis in 112, 300-m wide contact points, simultaneously with the delivery of a nonablative deep dermal heat to a depth of more than 800m. Methods: Twenty subjects with medium to moderate signs of skin aging were enrolled in the study. Patients were photographed using standard methods. Each patient received between one and two treatment passes.
In venous ulcer treatment, the standard of care is compression bandaging with a dressing that maintains a moist healing environment. Dressings are placed against the wound bed and under the compression wrap for many of the following reasons: to add moisture to the wound, to absorb drainage, to control odor, or to facilitate healing. The wound repair process is complex and involves steps that include inflammation around the site of injury, angiogenesis and the development of granulation tissue, repair of the connective tissue and epithelium, and ultimately remodeling that leads to a healed wound. Recently, silver has been incorporated into dressings to exert its antimicrobial effect, hoping to improve the healing process. Some of the first reported uses as silver as an antimicrobial dates back to 550 BC when Cyrus the Great, King of Persia, established a board of health and a medical dispensary for his citizens for which he used silver vessels to store water after being boiled. In the posteWorld War II era, the use of silver declined because of the explosive growth of fast-acting antibiotic therapy. With the emergence of MRSA and other multidrug-resistant microorganisms, silver has become much more popular. Today, silver has been shown to be antimicrobial and is now being used in a wide variety of applications. There are many different dressings on the market containing silver. Every company has its own product, with a varying concentration of silver or proclaiming a different delivery system. Although company research has shown through case studies that chronic wounds heal with the use of silver impregnated dressings, there are few randomized, controlled trials that examine the efficiency of healing venous ulcers using silver dressings. We performed a prospective randomized study comparing silver impregnated dressings to placebo. Among the 22 patients treated with silver, 14 (63%) were classified as treatment successes in comparison to 20 (90.9%) of the 22 patients who received placebo. A 2-sided Fisher exact test was performed and resulted in a P value of .07. KaplaneMeier plots and a log-rank test comparing the cumulative rates of success over the 8-week study period revealed that the overall performance of the placebo (foam alone) exceeded that of the silver treatment. Using the log-rank test in the time to event analysis resulted in a significant P value of .04. We feel that silver is not the perfect solution to chronic nonhealing ulcers and that its use on every ulcer should be questioned. With the current findings of our study, we feel one should first start out by using standards of care that include a primary dressing that maintains proper moisture control and inelastic Unna boot for edema, to treat venous ulcers.
Results: All subjects experienced mild edema and mild erythema as an immediate response to treatment. Edema resolved after up to 1hour posttreatment and erythema lasted up to 2 days. Microablative crusts lasted up to 4 days on facial areas and up to 7 days on body areas. Patients photographs before and 2, 4, and 8 weeks posttreatment were graded according to the Fitzpatrick wrinkle and elastosis scale by two blinded dermatologists. Conclusions: The presented results describe, for the first time, a treatment that offers a combination of RF microablation and volumetric deep dermal heating for the simultaneous and fast epidermal and dermal skin rejuvenation effect. Commercial support: EndyMed, Cesarea, Israel.
Commercial support: None identified.
WOUND HEALING AND ULCERS P3700 A new wound measurement and documentation system Valentina Dini, MD, PhD, Department of Dermatology, University of Pisa, Pisa, Italy; Alberto Piaggesi, MD, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy; Marco Romanelli, MD, PhD, Department of Dermatology, University of Pisa, Pisa, Italy; Maria Stefania Bertone, RN, Department of Dermatology, University of Pisa, Pisa, Italy; Paolo Barachini, MD, Department of Dermatology, University of Pisa, Pisa, Italy Aim: Wound measurement is essential in assessing the progress of wound healing. The most commonly used tools include wound tracing, width and length measurements, and digital photography. The authors present a new wound measurement and documentation system. This innovative device combines a digital camera and structured lighting in the form of two laser beams to automatically correct for image scale and skin curvature, allowing rapid and accurate measurements of the wound surface area and depth. Methods: We collected wound planimetry in 30 patients affected by venous leg ulcers (15) and diabetic foot ulcers (15). To estimate the repeatability and the reproducibility of wound assessment, two female nurses participated in this study. The intra- and interrater reliability of the measurements were observed using intraclass correlation coefficient (ICC) and the BlandeAltman test.
P3702
Results: No statistically significant differences were found between scans evaluated by two investigators about wound area and depth. The ICC values were excellent either for intra- or interrater reproducibility with a very low relative error value. The intra- and interrater measurements were shown to be reliable as indicated by high ICC values ([0.80). The mean 6 SD time for a full scan acquisition on the wound area and depth was 2.6 6 1.2 minutes. Conclusions: The scanner was found to be accurate and reliable, easy to learn and use, portable, and compact. The results presented suggest that this device may be a viable choice in the management of different types of chronic wounds.
Cutaneous ectopic bowel mucosa after the clousure of an ileostomy Altea Esteve Martı´nez, MD, Hospital General Universitario de Valencia, Valencia, Spain; Amparo Perez Ferriols, MD, Hospital General Universitario de Valencia, Valencia, Spain; Ana Esther Garcı´a Rabasco, MD, Hospital General Universitario de Valencia, Valencia, Spain; Pablo Hernandez Bel, MD, Hospital General Universitario de Valencia, Valencia, Spain; Victor Alegre De Miquel, MD, Hospital General Universitario de Valencia, Valencia, Spain We present a 56-year-old woman with a 3-year persistent skin lesion in the site of a prior ileostomy, following clousure and healing of the ileostomy site. Six years earlier, she underwent to a total colectomy because of an ulcerative colitis. By the time she arrived to our dermatology department, she presented asyntomatic erosions with erythematous velvety tissue on the scar of the sutured ilestomy which persisted despite local wound care during those 3 years. Histologic examination of the tissue was made, showing villi of intestinal mucosa among portions of nonaltered skin. Ectopic gastrointestinal tissue is not infrequent; however, cutaneous ectopic bowel mucosa is extremely rare. Implantation could develope when seeding the ostomy the suture passes along bowel mucosa and then the skin, or it could develop if intestinal mucosa persists following the ostomy clousure. A review of the literature shows only two cases that are similar to ours.
Commercial support: None identified.
Commercial support: None identified.
AB150
J AM ACAD DERMATOL
MARCH 2010
P3701
Novel phase controlled, multisource radiofrequency system for simultanous fractional microablation and volumetric dermal heating Yoram Harth, MD, Medical OR, Herzlya, Israel; Daniel Lischinsky, EndyMed, Cesarea, Israel; Monica Elman, MD, Beit Harofim Medical Center, Holon, Israel; Roi Ram, EndyMed, Cesarea, Israel; Varda Gottfried, PhD, EndyMed, Cesarea, Israel
Silver impregnated dressings: Do they help chronic venous ulcers heal? David Judy, DO, Largo Medical Center/Sun Coast Hospital, Largo, FL, United States; Claude Burton, MD, Duke University Medical Center, Durham, NC, United States; Jan Johnson, MSN, CNP, Duke University Medical Center, Durham, NC, United States; Stephanie Yates, MSN, CNP, Duke University Medical Center, Durham, NC, United States
Background: Optimal skin rejuvenation requires therapy of epidermal and dermal changes. Most existing fractional laser based can deliver ablative or deep dermal heating. Treatments with CO2 lasers that deliver both are usually associated with significant pain and patient downtime. The objective of this study was to assess the effectiveness of a novel phase controlled RF system for skin rejuvenation on face and body areas. This device uses the interaction between multiple phase controlled radiofrequency (RF) sources to ablate epidermis in 112, 300-m wide contact points, simultaneously with the delivery of a nonablative deep dermal heat to a depth of more than 800m. Methods: Twenty subjects with medium to moderate signs of skin aging were enrolled in the study. Patients were photographed using standard methods. Each patient received between one and two treatment passes.
In venous ulcer treatment, the standard of care is compression bandaging with a dressing that maintains a moist healing environment. Dressings are placed against the wound bed and under the compression wrap for many of the following reasons: to add moisture to the wound, to absorb drainage, to control odor, or to facilitate healing. The wound repair process is complex and involves steps that include inflammation around the site of injury, angiogenesis and the development of granulation tissue, repair of the connective tissue and epithelium, and ultimately remodeling that leads to a healed wound. Recently, silver has been incorporated into dressings to exert its antimicrobial effect, hoping to improve the healing process. Some of the first reported uses as silver as an antimicrobial dates back to 550 BC when Cyrus the Great, King of Persia, established a board of health and a medical dispensary for his citizens for which he used silver vessels to store water after being boiled. In the posteWorld War II era, the use of silver declined because of the explosive growth of fast-acting antibiotic therapy. With the emergence of MRSA and other multidrug-resistant microorganisms, silver has become much more popular. Today, silver has been shown to be antimicrobial and is now being used in a wide variety of applications. There are many different dressings on the market containing silver. Every company has its own product, with a varying concentration of silver or proclaiming a different delivery system. Although company research has shown through case studies that chronic wounds heal with the use of silver impregnated dressings, there are few randomized, controlled trials that examine the efficiency of healing venous ulcers using silver dressings. We performed a prospective randomized study comparing silver impregnated dressings to placebo. Among the 22 patients treated with silver, 14 (63%) were classified as treatment successes in comparison to 20 (90.9%) of the 22 patients who received placebo. A 2-sided Fisher exact test was performed and resulted in a P value of .07. KaplaneMeier plots and a log-rank test comparing the cumulative rates of success over the 8-week study period revealed that the overall performance of the placebo (foam alone) exceeded that of the silver treatment. Using the log-rank test in the time to event analysis resulted in a significant P value of .04. We feel that silver is not the perfect solution to chronic nonhealing ulcers and that its use on every ulcer should be questioned. With the current findings of our study, we feel one should first start out by using standards of care that include a primary dressing that maintains proper moisture control and inelastic Unna boot for edema, to treat venous ulcers.
Results: All subjects experienced mild edema and mild erythema as an immediate response to treatment. Edema resolved after up to 1hour posttreatment and erythema lasted up to 2 days. Microablative crusts lasted up to 4 days on facial areas and up to 7 days on body areas. Patients photographs before and 2, 4, and 8 weeks posttreatment were graded according to the Fitzpatrick wrinkle and elastosis scale by two blinded dermatologists. Conclusions: The presented results describe, for the first time, a treatment that offers a combination of RF microablation and volumetric deep dermal heating for the simultaneous and fast epidermal and dermal skin rejuvenation effect. Commercial support: EndyMed, Cesarea, Israel.
Commercial support: None identified.
WOUND HEALING AND ULCERS P3700 A new wound measurement and documentation system Valentina Dini, MD, PhD, Department of Dermatology, University of Pisa, Pisa, Italy; Alberto Piaggesi, MD, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy; Marco Romanelli, MD, PhD, Department of Dermatology, University of Pisa, Pisa, Italy; Maria Stefania Bertone, RN, Department of Dermatology, University of Pisa, Pisa, Italy; Paolo Barachini, MD, Department of Dermatology, University of Pisa, Pisa, Italy Aim: Wound measurement is essential in assessing the progress of wound healing. The most commonly used tools include wound tracing, width and length measurements, and digital photography. The authors present a new wound measurement and documentation system. This innovative device combines a digital camera and structured lighting in the form of two laser beams to automatically correct for image scale and skin curvature, allowing rapid and accurate measurements of the wound surface area and depth. Methods: We collected wound planimetry in 30 patients affected by venous leg ulcers (15) and diabetic foot ulcers (15). To estimate the repeatability and the reproducibility of wound assessment, two female nurses participated in this study. The intra- and interrater reliability of the measurements were observed using intraclass correlation coefficient (ICC) and the BlandeAltman test.
P3702
Results: No statistically significant differences were found between scans evaluated by two investigators about wound area and depth. The ICC values were excellent either for intra- or interrater reproducibility with a very low relative error value. The intra- and interrater measurements were shown to be reliable as indicated by high ICC values ([0.80). The mean 6 SD time for a full scan acquisition on the wound area and depth was 2.6 6 1.2 minutes. Conclusions: The scanner was found to be accurate and reliable, easy to learn and use, portable, and compact. The results presented suggest that this device may be a viable choice in the management of different types of chronic wounds.
Cutaneous ectopic bowel mucosa after the clousure of an ileostomy Altea Esteve Martı´nez, MD, Hospital General Universitario de Valencia, Valencia, Spain; Amparo Perez Ferriols, MD, Hospital General Universitario de Valencia, Valencia, Spain; Ana Esther Garcı´a Rabasco, MD, Hospital General Universitario de Valencia, Valencia, Spain; Pablo Hernandez Bel, MD, Hospital General Universitario de Valencia, Valencia, Spain; Victor Alegre De Miquel, MD, Hospital General Universitario de Valencia, Valencia, Spain We present a 56-year-old woman with a 3-year persistent skin lesion in the site of a prior ileostomy, following clousure and healing of the ileostomy site. Six years earlier, she underwent to a total colectomy because of an ulcerative colitis. By the time she arrived to our dermatology department, she presented asyntomatic erosions with erythematous velvety tissue on the scar of the sutured ilestomy which persisted despite local wound care during those 3 years. Histologic examination of the tissue was made, showing villi of intestinal mucosa among portions of nonaltered skin. Ectopic gastrointestinal tissue is not infrequent; however, cutaneous ectopic bowel mucosa is extremely rare. Implantation could develope when seeding the ostomy the suture passes along bowel mucosa and then the skin, or it could develop if intestinal mucosa persists following the ostomy clousure. A review of the literature shows only two cases that are similar to ours.
Commercial support: None identified.
Commercial support: None identified.
AB150
J AM ACAD DERMATOL
MARCH 2010