Aesthetic Dermatology

SAN DIEGO — Although fluid intake can be safely increased in nursing home residents who have, or are at risk for, pressure ulcers and do not routinely ingest the prescribed amount of fluid, levels of subcutaneous oxygen may remain low, results from a multicenter study demonstrated.

"In the nursing home population, hydration is a serious issue," Nancy A. Stotts, R.N., Ed.D., said at the annual meeting of the Wound Healing Society. "Some of the estimates are that up to half of all nursing home residents are underhydrated."

The investigators recorded routine fluid intake for 5 days in 64 residents of five nursing homes in Northern California. The residents were then randomized to receive, for 5 days, the target amount of fluid prescribed by their physician or the target amount plus 10 mL/kg of body weight, said Dr. Stotts, professor of nursing at the University of California, San Francisco.

They also evaluated levels of subcutaneous oxygen in all study participants for 3 days during treatment. Hypovolemia was defined as 45 mm Hg or less, or a less-than-20% increase in response to an oxygen challenge.

Patients' mean age was 79 years; most were female (38) and cognitively impaired (51). Mean baseline daily fluid intake was 1,374 cc for the group who received prescribed fluid, and 1,707 cc for those who were randomized to the extra fluid. After treatment, the mean daily fluid intake increased significantly for both groups: to 1,787 cc for the group who received prescribed fluid, and to 2,380 cc for those who received the extra fluid.

The mean level of subcutaneous oxygen, however, was 40 mm Hg for patients in the target prescribed group, and 36 mm Hg for patients in the group that received supplemental fluid. Subcutaneous oxygen levels less than 45 mm Hg indicate tissue hypoxia that may be caused by hypovolemia, Dr. Stotts said at the meeting, which was held in conjunction with a symposium on advanced wound care.

No cases of fluid overload or heart failure were observed.

Increased fluid intake "did not reverse the low subcutaneous oxygen, perhaps because of chronic underhydration and osmoreceptor reset," she said. "Further work needs to address the optimal dose and duration of fluid for older adults and other factors that contribute to the low subcutaneous oxygen."

The study was funded by the National Institutes of Health.

SAN DIEGO — Although fluid intake can be safely increased in nursing home residents who have, or are at risk for, pressure ulcers and do not routinely ingest the prescribed amount of fluid, levels of subcutaneous oxygen may remain low, results from a multicenter study demonstrated.

"In the nursing home population, hydration is a serious issue," Nancy A. Stotts, R.N., Ed.D., said at the annual meeting of the Wound Healing Society. "Some of the estimates are that up to half of all nursing home residents are underhydrated."

The investigators recorded routine fluid intake for 5 days in 64 residents of five nursing homes in Northern California. The residents were then randomized to receive, for 5 days, the target amount of fluid prescribed by their physician or the target amount plus 10 mL/kg of body weight, said Dr. Stotts, professor of nursing at the University of California, San Francisco.

They also evaluated levels of subcutaneous oxygen in all study participants for 3 days during treatment. Hypovolemia was defined as 45 mm Hg or less, or a less-than-20% increase in response to an oxygen challenge.

Patients' mean age was 79 years; most were female (38) and cognitively impaired (51). Mean baseline daily fluid intake was 1,374 cc for the group who received prescribed fluid, and 1,707 cc for those who were randomized to the extra fluid. After treatment, the mean daily fluid intake increased significantly for both groups: to 1,787 cc for the group who received prescribed fluid, and to 2,380 cc for those who received the extra fluid.

The mean level of subcutaneous oxygen, however, was 40 mm Hg for patients in the target prescribed group, and 36 mm Hg for patients in the group that received supplemental fluid. Subcutaneous oxygen levels less than 45 mm Hg indicate tissue hypoxia that may be caused by hypovolemia, Dr. Stotts said at the meeting, which was held in conjunction with a symposium on advanced wound care.

No cases of fluid overload or heart failure were observed.

Increased fluid intake "did not reverse the low subcutaneous oxygen, perhaps because of chronic underhydration and osmoreceptor reset," she said. "Further work needs to address the optimal dose and duration of fluid for older adults and other factors that contribute to the low subcutaneous oxygen."

The study was funded by the National Institutes of Health.

SAN DIEGO — Although fluid intake can be safely increased in nursing home residents who have, or are at risk for, pressure ulcers and do not routinely ingest the prescribed amount of fluid, levels of subcutaneous oxygen may remain low, results from a multicenter study demonstrated.

"In the nursing home population, hydration is a serious issue," Nancy A. Stotts, R.N., Ed.D., said at the annual meeting of the Wound Healing Society. "Some of the estimates are that up to half of all nursing home residents are underhydrated."

The investigators recorded routine fluid intake for 5 days in 64 residents of five nursing homes in Northern California. The residents were then randomized to receive, for 5 days, the target amount of fluid prescribed by their physician or the target amount plus 10 mL/kg of body weight, said Dr. Stotts, professor of nursing at the University of California, San Francisco.

They also evaluated levels of subcutaneous oxygen in all study participants for 3 days during treatment. Hypovolemia was defined as 45 mm Hg or less, or a less-than-20% increase in response to an oxygen challenge.

Patients' mean age was 79 years; most were female (38) and cognitively impaired (51). Mean baseline daily fluid intake was 1,374 cc for the group who received prescribed fluid, and 1,707 cc for those who were randomized to the extra fluid. After treatment, the mean daily fluid intake increased significantly for both groups: to 1,787 cc for the group who received prescribed fluid, and to 2,380 cc for those who received the extra fluid.

The mean level of subcutaneous oxygen, however, was 40 mm Hg for patients in the target prescribed group, and 36 mm Hg for patients in the group that received supplemental fluid. Subcutaneous oxygen levels less than 45 mm Hg indicate tissue hypoxia that may be caused by hypovolemia, Dr. Stotts said at the meeting, which was held in conjunction with a symposium on advanced wound care.

No cases of fluid overload or heart failure were observed.

Increased fluid intake "did not reverse the low subcutaneous oxygen, perhaps because of chronic underhydration and osmoreceptor reset," she said. "Further work needs to address the optimal dose and duration of fluid for older adults and other factors that contribute to the low subcutaneous oxygen."

The study was funded by the National Institutes of Health.

SAN DIEGO — High-voltage, pulsed electrical stimulation is an effective adjunct to multidisciplinary attempts at limb salvage in diabetic patients with complex lower extremity wounds, results from a small study demonstrated.

Of 45 wounds in 30 patients, 78% of the wounds healed in a mean of 14 weeks using the electrical stimulation system, Dr. Jeremy J. Burdge reported at the annual meeting of the Wound Healing Society.

"This is a preliminary study," said Dr. Burdge, a plastic and reconstructive surgeon who practices in Columbus, Ohio. "Further research is warranted."

He and his associates evaluated the efficacy of a high-voltage electrical stimulation system manufactured by MicroVas Technologies Inc. (Tulsa, Okla.) in patients who failed to improve despite multidisciplinary treatment approaches, including vascular evaluation and surgical intervention as indicated, aggressive off loading, bacterial infection control, and wound debridement.

"There is a variety of ways in which people speculate that high-voltage pulsed current has improved wound healing," Dr. Burdge said at the meeting, which was held in conjunction with a symposium on advanced wound care. "They fall into several groups of either increasing blood flow through promoting microcirculation, increasing wound healing through attraction of proliferating different cell types, or bacteria inhibition by this type of pulsed current."

More than half (57%) of the patients in the study were men; their mean age was 66 years. Comorbidities included neuropathy (84%), peripheral vascular disease (77%), cardiac disease (37%), and infection (33%). "This was a fairly high-risk group of patients," Dr. Burdge noted. "The mean hemoglobin A1c level was 8.2% and nine patients had undergone previous amputation."

The mean age of wounds was 25 weeks, and mean surface area was 7.8 cm

Emitter pads were placed over each wound. Stimulation was delivered for 45 minutes 2–3 times per week by a narrow pulsed current with a width of 80–100 microseconds at a frequency of 55 Hz. Pulses were delivered for 1.5 seconds, with a 1.5-second interval between pulses. The amplitude was individualized for each patient to maximize fused tetanic muscular contraction.

Dr. Burdge reported that the mean number of stimulation treatments per wound was 23 and that 35 (78%) of the wounds healed in a mean of 14 weeks.

Wound healing was defined as either complete epithelialization of the wound or closure with supplemental skin grafts.

Wounds in eight patients failed to heal. One required a metatarsal amputation, four had below-the-knee amputations, one had necrotic tissue and was lost to follow-up, and two patients are continuing further therapy.

At a mean follow-up of 40 weeks, 88% of wounds had no evidence of recurrence. "We did have four patients who had recurrent wounds," he said. "Two went on to complete healing. One had osteomyelitis and went on to a below-the-knee amputation."

Treatment is pending for the fourth wound that recurred.

Dr. Burdge had no conflicts to disclose.

A 3-month-old heel wound is seen in a 66-year-old male with diabetes and neuropathy.

After 22 treatments and a supplemental skin graft, the wound was considered healed. Photos courtesy Dr. Jeremy J. Burdge

SAN DIEGO — High-voltage, pulsed electrical stimulation is an effective adjunct to multidisciplinary attempts at limb salvage in diabetic patients with complex lower extremity wounds, results from a small study demonstrated.

Of 45 wounds in 30 patients, 78% of the wounds healed in a mean of 14 weeks using the electrical stimulation system, Dr. Jeremy J. Burdge reported at the annual meeting of the Wound Healing Society.

"This is a preliminary study," said Dr. Burdge, a plastic and reconstructive surgeon who practices in Columbus, Ohio. "Further research is warranted."

He and his associates evaluated the efficacy of a high-voltage electrical stimulation system manufactured by MicroVas Technologies Inc. (Tulsa, Okla.) in patients who failed to improve despite multidisciplinary treatment approaches, including vascular evaluation and surgical intervention as indicated, aggressive off loading, bacterial infection control, and wound debridement.

"There is a variety of ways in which people speculate that high-voltage pulsed current has improved wound healing," Dr. Burdge said at the meeting, which was held in conjunction with a symposium on advanced wound care. "They fall into several groups of either increasing blood flow through promoting microcirculation, increasing wound healing through attraction of proliferating different cell types, or bacteria inhibition by this type of pulsed current."

More than half (57%) of the patients in the study were men; their mean age was 66 years. Comorbidities included neuropathy (84%), peripheral vascular disease (77%), cardiac disease (37%), and infection (33%). "This was a fairly high-risk group of patients," Dr. Burdge noted. "The mean hemoglobin A1c level was 8.2% and nine patients had undergone previous amputation."

The mean age of wounds was 25 weeks, and mean surface area was 7.8 cm

Emitter pads were placed over each wound. Stimulation was delivered for 45 minutes 2–3 times per week by a narrow pulsed current with a width of 80–100 microseconds at a frequency of 55 Hz. Pulses were delivered for 1.5 seconds, with a 1.5-second interval between pulses. The amplitude was individualized for each patient to maximize fused tetanic muscular contraction.

Dr. Burdge reported that the mean number of stimulation treatments per wound was 23 and that 35 (78%) of the wounds healed in a mean of 14 weeks.

Wound healing was defined as either complete epithelialization of the wound or closure with supplemental skin grafts.

Wounds in eight patients failed to heal. One required a metatarsal amputation, four had below-the-knee amputations, one had necrotic tissue and was lost to follow-up, and two patients are continuing further therapy.

At a mean follow-up of 40 weeks, 88% of wounds had no evidence of recurrence. "We did have four patients who had recurrent wounds," he said. "Two went on to complete healing. One had osteomyelitis and went on to a below-the-knee amputation."

Treatment is pending for the fourth wound that recurred.

Dr. Burdge had no conflicts to disclose.

A 3-month-old heel wound is seen in a 66-year-old male with diabetes and neuropathy.

After 22 treatments and a supplemental skin graft, the wound was considered healed. Photos courtesy Dr. Jeremy J. Burdge

SAN DIEGO — High-voltage, pulsed electrical stimulation is an effective adjunct to multidisciplinary attempts at limb salvage in diabetic patients with complex lower extremity wounds, results from a small study demonstrated.

Of 45 wounds in 30 patients, 78% of the wounds healed in a mean of 14 weeks using the electrical stimulation system, Dr. Jeremy J. Burdge reported at the annual meeting of the Wound Healing Society.

"This is a preliminary study," said Dr. Burdge, a plastic and reconstructive surgeon who practices in Columbus, Ohio. "Further research is warranted."

He and his associates evaluated the efficacy of a high-voltage electrical stimulation system manufactured by MicroVas Technologies Inc. (Tulsa, Okla.) in patients who failed to improve despite multidisciplinary treatment approaches, including vascular evaluation and surgical intervention as indicated, aggressive off loading, bacterial infection control, and wound debridement.

"There is a variety of ways in which people speculate that high-voltage pulsed current has improved wound healing," Dr. Burdge said at the meeting, which was held in conjunction with a symposium on advanced wound care. "They fall into several groups of either increasing blood flow through promoting microcirculation, increasing wound healing through attraction of proliferating different cell types, or bacteria inhibition by this type of pulsed current."

More than half (57%) of the patients in the study were men; their mean age was 66 years. Comorbidities included neuropathy (84%), peripheral vascular disease (77%), cardiac disease (37%), and infection (33%). "This was a fairly high-risk group of patients," Dr. Burdge noted. "The mean hemoglobin A1c level was 8.2% and nine patients had undergone previous amputation."

The mean age of wounds was 25 weeks, and mean surface area was 7.8 cm

Emitter pads were placed over each wound. Stimulation was delivered for 45 minutes 2–3 times per week by a narrow pulsed current with a width of 80–100 microseconds at a frequency of 55 Hz. Pulses were delivered for 1.5 seconds, with a 1.5-second interval between pulses. The amplitude was individualized for each patient to maximize fused tetanic muscular contraction.

Dr. Burdge reported that the mean number of stimulation treatments per wound was 23 and that 35 (78%) of the wounds healed in a mean of 14 weeks.

Wound healing was defined as either complete epithelialization of the wound or closure with supplemental skin grafts.

Wounds in eight patients failed to heal. One required a metatarsal amputation, four had below-the-knee amputations, one had necrotic tissue and was lost to follow-up, and two patients are continuing further therapy.

At a mean follow-up of 40 weeks, 88% of wounds had no evidence of recurrence. "We did have four patients who had recurrent wounds," he said. "Two went on to complete healing. One had osteomyelitis and went on to a below-the-knee amputation."

Treatment is pending for the fourth wound that recurred.

Dr. Burdge had no conflicts to disclose.

A 3-month-old heel wound is seen in a 66-year-old male with diabetes and neuropathy.

After 22 treatments and a supplemental skin graft, the wound was considered healed. Photos courtesy Dr. Jeremy J. Burdge

SAN DIEGO — A new absorbent silver barrier dressing may help prevent and manage complications of percutaneous endoscopic gastrostomy sites, according to the results of a small study.

In a poster presented at the annual meeting of the Wound Healing Society, researchers led by Kathy Leak, R.N., described use of Allevyn Ag dressing (Smith & Nephew) on percutaneous endoscopic gastrostomy (PEG) sites in five patients.

Before May 2008, the protocol for patients who required PEG sites was to apply a silver binding dressing to help reduce the risks and complications associated with PEG site management. That product, however, "has limitations with regard to its absorption capability, cannot be cut to shape, and does not have the capability of foam dressings in helping to reduce overgranulation," wrote Ms. Leak and her associates at Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, England.

"Also, it requires daily dressing changes and a secondary foam dressing to absorb exudate, both of which are cost prohibitive," they noted.

The silver from the Allevyn Ag dressing is activated by fluid from the wound and then kills the bacteria. At the same time, excess fluid is managed by the dressing.

For the trial, Ms. Leak and her associates monitored five patients with PEG sites treated with Allevyn Ag for complications including erythema, overgranulation, high levels of exudate, soreness, and odor from the insertion site.

In all five cases, the product effectively managed exudate and odor, prevented excoriation to the surrounding skin, and provided enhanced comfort, compared with the previous treatment protocol, she said at the meeting, held in conjunction with a symposium on advanced wound care.

One study participant had been treated for cancer of the esophagus and presented with high levels of exudate that were starting to cause soreness and maceration of the peristomal area. He required a single application of Allevyn Ag, which he left in place for 4 days without incident.

Another study participant had a long-standing malabsorption problem and often developed abscesses around the stoma. After treatment with Allevyn Ag for 2 weeks with twice-daily dressing changes, the abscesses completely resolved.

"The dressing exceeded all our expectations on its speed of action to lower bacterial colonization and improve periskin conditions," Ms. Leak said in an interview, noting that, as of May 2008, patients at Doncaster and Bassetlaw Hospitals who have problematic PEG sites receive Allevyn Ag instead of the silver binding dressing.

Smith & Nephew supplied the Allevyn Ag used for the study. Ms. Leak has no financial interest in the company and reported no other relevant conflicts.

The new silver barrier dressing 'exceeded all our expectations on its speed of action.' MS. LEAK

High levels of exudate were starting to cause soreness and maceration.

The site is shown after a single 4-day application of the silver barrier dressing. Photos courtesy Kathy Leak, R.N.

SAN DIEGO — A new absorbent silver barrier dressing may help prevent and manage complications of percutaneous endoscopic gastrostomy sites, according to the results of a small study.

In a poster presented at the annual meeting of the Wound Healing Society, researchers led by Kathy Leak, R.N., described use of Allevyn Ag dressing (Smith & Nephew) on percutaneous endoscopic gastrostomy (PEG) sites in five patients.

Before May 2008, the protocol for patients who required PEG sites was to apply a silver binding dressing to help reduce the risks and complications associated with PEG site management. That product, however, "has limitations with regard to its absorption capability, cannot be cut to shape, and does not have the capability of foam dressings in helping to reduce overgranulation," wrote Ms. Leak and her associates at Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, England.

"Also, it requires daily dressing changes and a secondary foam dressing to absorb exudate, both of which are cost prohibitive," they noted.

The silver from the Allevyn Ag dressing is activated by fluid from the wound and then kills the bacteria. At the same time, excess fluid is managed by the dressing.

For the trial, Ms. Leak and her associates monitored five patients with PEG sites treated with Allevyn Ag for complications including erythema, overgranulation, high levels of exudate, soreness, and odor from the insertion site.

In all five cases, the product effectively managed exudate and odor, prevented excoriation to the surrounding skin, and provided enhanced comfort, compared with the previous treatment protocol, she said at the meeting, held in conjunction with a symposium on advanced wound care.

One study participant had been treated for cancer of the esophagus and presented with high levels of exudate that were starting to cause soreness and maceration of the peristomal area. He required a single application of Allevyn Ag, which he left in place for 4 days without incident.

Another study participant had a long-standing malabsorption problem and often developed abscesses around the stoma. After treatment with Allevyn Ag for 2 weeks with twice-daily dressing changes, the abscesses completely resolved.

"The dressing exceeded all our expectations on its speed of action to lower bacterial colonization and improve periskin conditions," Ms. Leak said in an interview, noting that, as of May 2008, patients at Doncaster and Bassetlaw Hospitals who have problematic PEG sites receive Allevyn Ag instead of the silver binding dressing.

Smith & Nephew supplied the Allevyn Ag used for the study. Ms. Leak has no financial interest in the company and reported no other relevant conflicts.

The new silver barrier dressing 'exceeded all our expectations on its speed of action.' MS. LEAK

High levels of exudate were starting to cause soreness and maceration.

The site is shown after a single 4-day application of the silver barrier dressing. Photos courtesy Kathy Leak, R.N.

SAN DIEGO — A new absorbent silver barrier dressing may help prevent and manage complications of percutaneous endoscopic gastrostomy sites, according to the results of a small study.

In a poster presented at the annual meeting of the Wound Healing Society, researchers led by Kathy Leak, R.N., described use of Allevyn Ag dressing (Smith & Nephew) on percutaneous endoscopic gastrostomy (PEG) sites in five patients.

Before May 2008, the protocol for patients who required PEG sites was to apply a silver binding dressing to help reduce the risks and complications associated with PEG site management. That product, however, "has limitations with regard to its absorption capability, cannot be cut to shape, and does not have the capability of foam dressings in helping to reduce overgranulation," wrote Ms. Leak and her associates at Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, England.

"Also, it requires daily dressing changes and a secondary foam dressing to absorb exudate, both of which are cost prohibitive," they noted.

The silver from the Allevyn Ag dressing is activated by fluid from the wound and then kills the bacteria. At the same time, excess fluid is managed by the dressing.

For the trial, Ms. Leak and her associates monitored five patients with PEG sites treated with Allevyn Ag for complications including erythema, overgranulation, high levels of exudate, soreness, and odor from the insertion site.

In all five cases, the product effectively managed exudate and odor, prevented excoriation to the surrounding skin, and provided enhanced comfort, compared with the previous treatment protocol, she said at the meeting, held in conjunction with a symposium on advanced wound care.

One study participant had been treated for cancer of the esophagus and presented with high levels of exudate that were starting to cause soreness and maceration of the peristomal area. He required a single application of Allevyn Ag, which he left in place for 4 days without incident.

Another study participant had a long-standing malabsorption problem and often developed abscesses around the stoma. After treatment with Allevyn Ag for 2 weeks with twice-daily dressing changes, the abscesses completely resolved.

"The dressing exceeded all our expectations on its speed of action to lower bacterial colonization and improve periskin conditions," Ms. Leak said in an interview, noting that, as of May 2008, patients at Doncaster and Bassetlaw Hospitals who have problematic PEG sites receive Allevyn Ag instead of the silver binding dressing.

Smith & Nephew supplied the Allevyn Ag used for the study. Ms. Leak has no financial interest in the company and reported no other relevant conflicts.

The new silver barrier dressing 'exceeded all our expectations on its speed of action.' MS. LEAK

High levels of exudate were starting to cause soreness and maceration.

The site is shown after a single 4-day application of the silver barrier dressing. Photos courtesy Kathy Leak, R.N.

A greater percentage of diabetic foot ulcers achieved complete closure with negative pressure wound therapy than with advanced moist wound therapy in a randomized controlled study of more than 300 patients.

There were also significantly fewer secondary amputations seen in the group undergoing negative pressure therapy, Dr. Peter A. Blume and colleagues reported.

Diabetic foot ulcers lead to nonhealing chronic wounds that are difficult to treat and are a significant risk factor for nontraumatic amputation.

Several diabetic foot ulcer treatments have been reported. All of them require integration of multiple treatment modalities, with debridement being the foundation for these therapies. Success of any particular form of treatment is dependent on the appropriate match of patient and treatment factors, according to Dr. Blume of the North American Center for Limb Preservation, New Haven, Conn., and colleagues.

The study goal was to determine whether negative pressure wound therapy (NPWT) was a better or equivalent treatment to advanced moist wound therapy (AMWT) in concurrence with debridement for treating foot ulcers in diabetic adults with adequate blood circulation.

Patients were randomly assigned to either NPWT, which used vacuum-assisted closure, or AMWT, which primarily used hydrogels and alginates. The study could not be blinded because of the distinct nature of the two therapies, according to the study investigators.

The multicenter study enrolled 342 patients with a mean age of 58 years over the period of August 2002 to August 2005; 79% of the patients were men. All patients were initially debrided as needed within 2 days of randomization and received standard off-loading therapy as needed after treatment was initiated.

Treatment was continued until ulcer closure, sufficient granulation tissue formation for healing, or until day 112. All patients were examined weekly for the first 4 weeks then every other week until day 112 or ulcer closure. Patients achieving ulcer closure were followed at 3 and 9 months (Diabetes Care 2008;31:631–6).

Complete ulcer closure was defined as skin closure (100% reepithelialization) without a draining or dressing requirement. Closure occurred in 73 of 169 (43%) of the NPWT patients, compared with 48 of 166 (29%) of the AMWT patients. In addition, significantly more NPWT patients achieved 75% closure (105 of 169, 62%), than did AMWT patients (85 of 166, 51%).

The incidence of secondary amputations was also significantly less for NPWT (4%) than for AMWT (10%).

"Although the exact mechanism of the decrease in secondary amputations remains unclear, treatment of DFUs [diabetic foot ulcers] with NPWT appears to promote significant healing," the authors concluded.

Dr. John Lantis (Saint Luke's Roosevelt Hospital, New York), a study coauthor, disclosed receiving honoraria from KCI USA, which provided the vacuum therapy system used and whose global biometrics group provided the data analysis.

ELSEVIER GLOBAL MEDICAL NEWS

A greater percentage of diabetic foot ulcers achieved complete closure with negative pressure wound therapy than with advanced moist wound therapy in a randomized controlled study of more than 300 patients.

There were also significantly fewer secondary amputations seen in the group undergoing negative pressure therapy, Dr. Peter A. Blume and colleagues reported.

Diabetic foot ulcers lead to nonhealing chronic wounds that are difficult to treat and are a significant risk factor for nontraumatic amputation.

Several diabetic foot ulcer treatments have been reported. All of them require integration of multiple treatment modalities, with debridement being the foundation for these therapies. Success of any particular form of treatment is dependent on the appropriate match of patient and treatment factors, according to Dr. Blume of the North American Center for Limb Preservation, New Haven, Conn., and colleagues.

The study goal was to determine whether negative pressure wound therapy (NPWT) was a better or equivalent treatment to advanced moist wound therapy (AMWT) in concurrence with debridement for treating foot ulcers in diabetic adults with adequate blood circulation.

Patients were randomly assigned to either NPWT, which used vacuum-assisted closure, or AMWT, which primarily used hydrogels and alginates. The study could not be blinded because of the distinct nature of the two therapies, according to the study investigators.

The multicenter study enrolled 342 patients with a mean age of 58 years over the period of August 2002 to August 2005; 79% of the patients were men. All patients were initially debrided as needed within 2 days of randomization and received standard off-loading therapy as needed after treatment was initiated.

Treatment was continued until ulcer closure, sufficient granulation tissue formation for healing, or until day 112. All patients were examined weekly for the first 4 weeks then every other week until day 112 or ulcer closure. Patients achieving ulcer closure were followed at 3 and 9 months (Diabetes Care 2008;31:631–6).

Complete ulcer closure was defined as skin closure (100% reepithelialization) without a draining or dressing requirement. Closure occurred in 73 of 169 (43%) of the NPWT patients, compared with 48 of 166 (29%) of the AMWT patients. In addition, significantly more NPWT patients achieved 75% closure (105 of 169, 62%), than did AMWT patients (85 of 166, 51%).

The incidence of secondary amputations was also significantly less for NPWT (4%) than for AMWT (10%).

"Although the exact mechanism of the decrease in secondary amputations remains unclear, treatment of DFUs [diabetic foot ulcers] with NPWT appears to promote significant healing," the authors concluded.

Dr. John Lantis (Saint Luke's Roosevelt Hospital, New York), a study coauthor, disclosed receiving honoraria from KCI USA, which provided the vacuum therapy system used and whose global biometrics group provided the data analysis.

ELSEVIER GLOBAL MEDICAL NEWS

A greater percentage of diabetic foot ulcers achieved complete closure with negative pressure wound therapy than with advanced moist wound therapy in a randomized controlled study of more than 300 patients.

There were also significantly fewer secondary amputations seen in the group undergoing negative pressure therapy, Dr. Peter A. Blume and colleagues reported.

Diabetic foot ulcers lead to nonhealing chronic wounds that are difficult to treat and are a significant risk factor for nontraumatic amputation.

Several diabetic foot ulcer treatments have been reported. All of them require integration of multiple treatment modalities, with debridement being the foundation for these therapies. Success of any particular form of treatment is dependent on the appropriate match of patient and treatment factors, according to Dr. Blume of the North American Center for Limb Preservation, New Haven, Conn., and colleagues.

The study goal was to determine whether negative pressure wound therapy (NPWT) was a better or equivalent treatment to advanced moist wound therapy (AMWT) in concurrence with debridement for treating foot ulcers in diabetic adults with adequate blood circulation.

Patients were randomly assigned to either NPWT, which used vacuum-assisted closure, or AMWT, which primarily used hydrogels and alginates. The study could not be blinded because of the distinct nature of the two therapies, according to the study investigators.

The multicenter study enrolled 342 patients with a mean age of 58 years over the period of August 2002 to August 2005; 79% of the patients were men. All patients were initially debrided as needed within 2 days of randomization and received standard off-loading therapy as needed after treatment was initiated.

Treatment was continued until ulcer closure, sufficient granulation tissue formation for healing, or until day 112. All patients were examined weekly for the first 4 weeks then every other week until day 112 or ulcer closure. Patients achieving ulcer closure were followed at 3 and 9 months (Diabetes Care 2008;31:631–6).

Complete ulcer closure was defined as skin closure (100% reepithelialization) without a draining or dressing requirement. Closure occurred in 73 of 169 (43%) of the NPWT patients, compared with 48 of 166 (29%) of the AMWT patients. In addition, significantly more NPWT patients achieved 75% closure (105 of 169, 62%), than did AMWT patients (85 of 166, 51%).

The incidence of secondary amputations was also significantly less for NPWT (4%) than for AMWT (10%).

"Although the exact mechanism of the decrease in secondary amputations remains unclear, treatment of DFUs [diabetic foot ulcers] with NPWT appears to promote significant healing," the authors concluded.

Dr. John Lantis (Saint Luke's Roosevelt Hospital, New York), a study coauthor, disclosed receiving honoraria from KCI USA, which provided the vacuum therapy system used and whose global biometrics group provided the data analysis.

ELSEVIER GLOBAL MEDICAL NEWS

SAN DIEGO — WoundStat, a hemostatic agent approved in August 2007, is superior to other combat hemostatic agents used for combat and civilian trauma, results from a swine study demonstrated.

The product, marketed by TraumaCure Inc., consists of a pure granular smectite composite. In the study, it produced hemostasis in the face of high-pressure arterial bleeding within 3 minutes. WoundStat is currently used as a life-saving tool by the U.S. military in Afghanistan.

"The study protocol was to hold for 3 minutes, but in subsequent studies and observations, 2 minutes was more than sufficient for WoundStat to stop the hemorrhage," Robert F. Diegelmann, Ph.D., said at the annual meeting of the Wound Healing Society. It also would be simple for the victim or medic to apply.

Dr. Diegelmann, professor of biochemistry and molecular biology, anatomy, and emergency medicine at Virginia Commonwealth University, Richmond, led the research team that developed WoundStat at the university's reanimation engineering shock center.

He and his associates compared the performance of WoundStat with Z-Medica Corp.'s QuikClot zeolite granules and QuikClot zeolite Advance Clotting Sponge, HemCon Medical Technologies Inc.'s chitosan bandage, and the U.S. Army field gauze bandage in a lethal vascular injury model developed by the Army (J. Trauma 2007;63:276–84). The protocol involved creating a 6-mm arteriotomy in a vessel of 25 male swine. After 45 seconds of hemorrhage, five animals each were randomized to be treated with the Army field bandage (control group), QuikClot zeolite granules, the QuikClot zeolite Advance Clotting Sponge, the HemCon chitosan bandage, or WoundStat.

The application of WoundStat, a premixed composite available in 5.5-ounce packages, also involved the application of 200 mm Hg pressure over the product in the wound for 3 minutes.

In all swine, fluid resuscitation began at the time each product was applied, with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a mean arterial blood pressure of 65 mm Hg. The study's primary end points were survival, survival time, posttreatment blood loss, and amount of resuscitation fluid required.

All swine in the WoundStat group survived to 180 minutes and required only a single application, Dr. Diegelmann said at the meeting, held in conjunction with a symposium on advanced wound care. One animal in the HemCon chitosan bandage group survived, but none of the animals in the other groups survived.

He reported that survival and survival times for animals in the WoundStat group were significantly greater, compared with those in all other groups. In addition, posttreatment blood loss and lost-resuscitation fluid volume were significantly less for animals in the WoundStat group, compared with all other groups.

Dr. Diegelmann disclosed that he is a paid consultant for TraumaCure Inc.

The interaction of whole blood and WoundStat resulted in the aggregated red cells and formation of fibrin matrix seen in this scanning electron micrograph (3,300X) of a sample fixed during a span of 1 minute after the addition of the blood. Courtesy Dr. Robert F. Diegelmann

SAN DIEGO — WoundStat, a hemostatic agent approved in August 2007, is superior to other combat hemostatic agents used for combat and civilian trauma, results from a swine study demonstrated.

The product, marketed by TraumaCure Inc., consists of a pure granular smectite composite. In the study, it produced hemostasis in the face of high-pressure arterial bleeding within 3 minutes. WoundStat is currently used as a life-saving tool by the U.S. military in Afghanistan.

"The study protocol was to hold for 3 minutes, but in subsequent studies and observations, 2 minutes was more than sufficient for WoundStat to stop the hemorrhage," Robert F. Diegelmann, Ph.D., said at the annual meeting of the Wound Healing Society. It also would be simple for the victim or medic to apply.

Dr. Diegelmann, professor of biochemistry and molecular biology, anatomy, and emergency medicine at Virginia Commonwealth University, Richmond, led the research team that developed WoundStat at the university's reanimation engineering shock center.

He and his associates compared the performance of WoundStat with Z-Medica Corp.'s QuikClot zeolite granules and QuikClot zeolite Advance Clotting Sponge, HemCon Medical Technologies Inc.'s chitosan bandage, and the U.S. Army field gauze bandage in a lethal vascular injury model developed by the Army (J. Trauma 2007;63:276–84). The protocol involved creating a 6-mm arteriotomy in a vessel of 25 male swine. After 45 seconds of hemorrhage, five animals each were randomized to be treated with the Army field bandage (control group), QuikClot zeolite granules, the QuikClot zeolite Advance Clotting Sponge, the HemCon chitosan bandage, or WoundStat.

The application of WoundStat, a premixed composite available in 5.5-ounce packages, also involved the application of 200 mm Hg pressure over the product in the wound for 3 minutes.

In all swine, fluid resuscitation began at the time each product was applied, with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a mean arterial blood pressure of 65 mm Hg. The study's primary end points were survival, survival time, posttreatment blood loss, and amount of resuscitation fluid required.

All swine in the WoundStat group survived to 180 minutes and required only a single application, Dr. Diegelmann said at the meeting, held in conjunction with a symposium on advanced wound care. One animal in the HemCon chitosan bandage group survived, but none of the animals in the other groups survived.

He reported that survival and survival times for animals in the WoundStat group were significantly greater, compared with those in all other groups. In addition, posttreatment blood loss and lost-resuscitation fluid volume were significantly less for animals in the WoundStat group, compared with all other groups.

Dr. Diegelmann disclosed that he is a paid consultant for TraumaCure Inc.

The interaction of whole blood and WoundStat resulted in the aggregated red cells and formation of fibrin matrix seen in this scanning electron micrograph (3,300X) of a sample fixed during a span of 1 minute after the addition of the blood. Courtesy Dr. Robert F. Diegelmann

SAN DIEGO — WoundStat, a hemostatic agent approved in August 2007, is superior to other combat hemostatic agents used for combat and civilian trauma, results from a swine study demonstrated.

The product, marketed by TraumaCure Inc., consists of a pure granular smectite composite. In the study, it produced hemostasis in the face of high-pressure arterial bleeding within 3 minutes. WoundStat is currently used as a life-saving tool by the U.S. military in Afghanistan.

"The study protocol was to hold for 3 minutes, but in subsequent studies and observations, 2 minutes was more than sufficient for WoundStat to stop the hemorrhage," Robert F. Diegelmann, Ph.D., said at the annual meeting of the Wound Healing Society. It also would be simple for the victim or medic to apply.

Dr. Diegelmann, professor of biochemistry and molecular biology, anatomy, and emergency medicine at Virginia Commonwealth University, Richmond, led the research team that developed WoundStat at the university's reanimation engineering shock center.

He and his associates compared the performance of WoundStat with Z-Medica Corp.'s QuikClot zeolite granules and QuikClot zeolite Advance Clotting Sponge, HemCon Medical Technologies Inc.'s chitosan bandage, and the U.S. Army field gauze bandage in a lethal vascular injury model developed by the Army (J. Trauma 2007;63:276–84). The protocol involved creating a 6-mm arteriotomy in a vessel of 25 male swine. After 45 seconds of hemorrhage, five animals each were randomized to be treated with the Army field bandage (control group), QuikClot zeolite granules, the QuikClot zeolite Advance Clotting Sponge, the HemCon chitosan bandage, or WoundStat.

The application of WoundStat, a premixed composite available in 5.5-ounce packages, also involved the application of 200 mm Hg pressure over the product in the wound for 3 minutes.

In all swine, fluid resuscitation began at the time each product was applied, with 500 mL of Hextend, followed by lactated Ringer's solution at 100 mL/min to achieve and maintain a mean arterial blood pressure of 65 mm Hg. The study's primary end points were survival, survival time, posttreatment blood loss, and amount of resuscitation fluid required.

All swine in the WoundStat group survived to 180 minutes and required only a single application, Dr. Diegelmann said at the meeting, held in conjunction with a symposium on advanced wound care. One animal in the HemCon chitosan bandage group survived, but none of the animals in the other groups survived.

He reported that survival and survival times for animals in the WoundStat group were significantly greater, compared with those in all other groups. In addition, posttreatment blood loss and lost-resuscitation fluid volume were significantly less for animals in the WoundStat group, compared with all other groups.

Dr. Diegelmann disclosed that he is a paid consultant for TraumaCure Inc.

The interaction of whole blood and WoundStat resulted in the aggregated red cells and formation of fibrin matrix seen in this scanning electron micrograph (3,300X) of a sample fixed during a span of 1 minute after the addition of the blood. Courtesy Dr. Robert F. Diegelmann

KISSIMMEE, FLA. — A new 2,790-nm yttrium-scandium-gallium-garnet laser provides an option for skin resurfacing that appears to require less downtime than does resurfacing with either CO2 or er:YAG lasers.

This was the finding in two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery. The results suggest that each treatment session with Cutera Inc.'s Pearl system 2,790-nm YSGG laser typically requires a recovery period from erythema and swelling of 3–4 days, unlike the several weeks of healing usually necessary with CO2 laser resurfacing.

A study conducted by Dr. David M. Verebelyi used the 2,790-nm YSGG laser to treat facial rhytids, dyschromia, and texture abnormalities in 19 patients aged 18–63 years with Fitzpatrick Skin types I-IV. One side of the face of each patient was randomly selected for treatment while the other side was left untreated. Dr. Verebelyi used the laser at a fluence of 3–3.5 J/cm

In Dr. Verebelyi's study and the other study, investigators performed two treatments with the laser on each patient, separated by about 4 weeks. A physician who did not know which side received treatment graded photos on a 10-point scale on which 0 equaled no improvement and 10 equaled excellent improvement.

The physician gave the treated side much higher average ratings than the untreated side in 17 patients who completed two treatment sessions, as follows: for fine lines (6.5 vs. 0.2), erythema (3.5 vs. 0.4), skin texture (7.7 vs. 1.5), scar improvement (3.2 vs. 0.2), and overall appearance (6.9 vs. 0.7), reported Dr. Verebelyi, who is in private practice in Highlands Ranch, Colo.

Erythema and swelling lasted for a mean of 4 days (range of 3–7 days); no patients experienced any permanent side effects.

Dr. Kei Negishi of Tokyo Women's Medical University performed a separate study with the laser to treat 23 patients aged 30–74 years with Fitzpatrick skin types III or IV. Each procedure was performed at a fluence of 1.5–2 J/cm

Improvement was graded as excellent or moderate by 91% of patients for skin texture and elasticity, by 52% for fine lines and elasticity, by 86% for irregular or overall pigmentation, and by 18% for mottled solar lentigos.

A total of 78% of patients rated overall satisfaction as excellent or moderate.

The patients had a mean downtime of 3.4 days with erythema, followed by a mean of 6.7 days of crust formation. Patients who were young or had oilier skin had a shorter period of downtime, according to Dr. Negishi.

The presenters of each of the studies reported having no conflicts of interest with Cutera, although Dr. Negishi reported borrowing the device from the company to perform her study.

A patient is shown before treatment with a yttrium-scandium-gallium-garnet laser.

The patient is shown 28 days after her second treatment with the new laser. Photos courtesy Dr. David M. Verebelyi

KISSIMMEE, FLA. — A new 2,790-nm yttrium-scandium-gallium-garnet laser provides an option for skin resurfacing that appears to require less downtime than does resurfacing with either CO2 or er:YAG lasers.

This was the finding in two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery. The results suggest that each treatment session with Cutera Inc.'s Pearl system 2,790-nm YSGG laser typically requires a recovery period from erythema and swelling of 3–4 days, unlike the several weeks of healing usually necessary with CO2 laser resurfacing.

A study conducted by Dr. David M. Verebelyi used the 2,790-nm YSGG laser to treat facial rhytids, dyschromia, and texture abnormalities in 19 patients aged 18–63 years with Fitzpatrick Skin types I-IV. One side of the face of each patient was randomly selected for treatment while the other side was left untreated. Dr. Verebelyi used the laser at a fluence of 3–3.5 J/cm

In Dr. Verebelyi's study and the other study, investigators performed two treatments with the laser on each patient, separated by about 4 weeks. A physician who did not know which side received treatment graded photos on a 10-point scale on which 0 equaled no improvement and 10 equaled excellent improvement.

The physician gave the treated side much higher average ratings than the untreated side in 17 patients who completed two treatment sessions, as follows: for fine lines (6.5 vs. 0.2), erythema (3.5 vs. 0.4), skin texture (7.7 vs. 1.5), scar improvement (3.2 vs. 0.2), and overall appearance (6.9 vs. 0.7), reported Dr. Verebelyi, who is in private practice in Highlands Ranch, Colo.

Erythema and swelling lasted for a mean of 4 days (range of 3–7 days); no patients experienced any permanent side effects.

Dr. Kei Negishi of Tokyo Women's Medical University performed a separate study with the laser to treat 23 patients aged 30–74 years with Fitzpatrick skin types III or IV. Each procedure was performed at a fluence of 1.5–2 J/cm

Improvement was graded as excellent or moderate by 91% of patients for skin texture and elasticity, by 52% for fine lines and elasticity, by 86% for irregular or overall pigmentation, and by 18% for mottled solar lentigos.

A total of 78% of patients rated overall satisfaction as excellent or moderate.

The patients had a mean downtime of 3.4 days with erythema, followed by a mean of 6.7 days of crust formation. Patients who were young or had oilier skin had a shorter period of downtime, according to Dr. Negishi.

The presenters of each of the studies reported having no conflicts of interest with Cutera, although Dr. Negishi reported borrowing the device from the company to perform her study.

A patient is shown before treatment with a yttrium-scandium-gallium-garnet laser.

The patient is shown 28 days after her second treatment with the new laser. Photos courtesy Dr. David M. Verebelyi

KISSIMMEE, FLA. — A new 2,790-nm yttrium-scandium-gallium-garnet laser provides an option for skin resurfacing that appears to require less downtime than does resurfacing with either CO2 or er:YAG lasers.

This was the finding in two studies presented at the annual meeting of the American Society for Laser Medicine and Surgery. The results suggest that each treatment session with Cutera Inc.'s Pearl system 2,790-nm YSGG laser typically requires a recovery period from erythema and swelling of 3–4 days, unlike the several weeks of healing usually necessary with CO2 laser resurfacing.

A study conducted by Dr. David M. Verebelyi used the 2,790-nm YSGG laser to treat facial rhytids, dyschromia, and texture abnormalities in 19 patients aged 18–63 years with Fitzpatrick Skin types I-IV. One side of the face of each patient was randomly selected for treatment while the other side was left untreated. Dr. Verebelyi used the laser at a fluence of 3–3.5 J/cm

In Dr. Verebelyi's study and the other study, investigators performed two treatments with the laser on each patient, separated by about 4 weeks. A physician who did not know which side received treatment graded photos on a 10-point scale on which 0 equaled no improvement and 10 equaled excellent improvement.

The physician gave the treated side much higher average ratings than the untreated side in 17 patients who completed two treatment sessions, as follows: for fine lines (6.5 vs. 0.2), erythema (3.5 vs. 0.4), skin texture (7.7 vs. 1.5), scar improvement (3.2 vs. 0.2), and overall appearance (6.9 vs. 0.7), reported Dr. Verebelyi, who is in private practice in Highlands Ranch, Colo.

Erythema and swelling lasted for a mean of 4 days (range of 3–7 days); no patients experienced any permanent side effects.

Dr. Kei Negishi of Tokyo Women's Medical University performed a separate study with the laser to treat 23 patients aged 30–74 years with Fitzpatrick skin types III or IV. Each procedure was performed at a fluence of 1.5–2 J/cm

Improvement was graded as excellent or moderate by 91% of patients for skin texture and elasticity, by 52% for fine lines and elasticity, by 86% for irregular or overall pigmentation, and by 18% for mottled solar lentigos.

A total of 78% of patients rated overall satisfaction as excellent or moderate.

The patients had a mean downtime of 3.4 days with erythema, followed by a mean of 6.7 days of crust formation. Patients who were young or had oilier skin had a shorter period of downtime, according to Dr. Negishi.

The presenters of each of the studies reported having no conflicts of interest with Cutera, although Dr. Negishi reported borrowing the device from the company to perform her study.

A patient is shown before treatment with a yttrium-scandium-gallium-garnet laser.

The patient is shown 28 days after her second treatment with the new laser. Photos courtesy Dr. David M. Verebelyi

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — Fractional CO2 laser treatment is highly effective for neck rejuvenation, offering substantial improvement in skin laxity, rhytids, texture, and pigmentation with a favorable adverse events profile, reported Dr. Lori Brightman.

In a study of 13 patients aged 30–75 years who underwent treatment of the neck using the Fraxel CO2 laser, improvement on these outcome measures was mostly in the 25%-75% range after two treatments, with some patients experiencing 75%-100% improvement, she said at the annual meeting of the American Society for Laser Medicine and Surgery.

The mean improvement for each measure was well above 50%, she said, noting that "this is something we consistently reproduced." Some patients also experienced platysmal band improvement, added Dr. Brightman of the Laser & Skin Surgery Center of New York.

The patients were treated using a 15-mm spot size, an energy setting of 4–70 mJ, and 100–200 microthermal zones with a 30%-50% density for each pass. Between two and four passes were made, depending on the degree of skin laxity and rhytids. Each patient underwent two treatments at 1–3 months apart, with follow-up at 3 months following the second procedure.

Three blinded dermatologic physicians evaluated pre- and posttreatment photos to determine improvements in the degree of rhytids, crepe-like skin, skin tightening, and pigmentation.

All patients experienced posttreatment erythema and some slight edema with resolution in about 1 week. There were no cases of scarring, hyperpigmentation, or hypopigmentation in the short or long term.

"We feel that these results strongly support the use of the fractional CO2 laser off of the face, in particular to rejuvenate the neck with a very low risk of adverse events," Dr. Brightman concluded.

Dr. Brightman stated that she had no disclosures relevant to her presentation.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A second-generation erbium-doped 1550-nm laser is highly effective for fractional nonablative treatment of acne and surgical scars, and for moderate photoaging, data from a review of 877 cases revealed.

All patients had clear photographic documentation of improvement, with most achieving 70%-80% improvement, Dr. Vic A. Narurkar reported at the annual meeting of the American Society for Laser Medicine and Surgery.

Patients with Fitzpatrick skin types I-VI were treated over an 18-month period between 2005 and 2007 using the Fraxel laser (Reliant Technologies Inc.). Treatment parameters and treatment number varied based on skin type and indication. Patient charts and standardized photography were used to analyze clinical indication with efficacy, adverse effects, and skin types, said Dr. Narurkar, a dermatologist in private practice in San Francisco.

"We found that the best results were achieved with scars," he said, noting that the average improvement in his patients with acne and nonacne scars was about 80%. The next best results were seen with resurfacing on and off the face, with improvement ranging from 60% to 80%. The results were best in patients with Glogau photoaging II-III.

The most variable results were seen in patients undergoing treatment for melasma and deep rhytids; these patients had 20%-40% improvement.

The most common short-term adverse events in this study were transient edema and erythema, which occurred in all patients but resolved within 48 hours, and acne flares, which occurred in 26% of patients. The most common long-term side effect was postinflammatory hyperpigmentation, which was most common in those with type V skin, and which resolved in all patients, Dr. Narurkar said, noting that there were no permanent side effects.

Dr. Narurkar, who disclosed that he has received consulting fees and honoraria from Reliant, concluded that the second-generation erbium-doped 1550-nm laser is safe and effective for all skin types.

KISSIMMEE, FLA. — A novel fractional CO2 resurfacing device significantly and safely improved moderate to severe acne scarring in a recent study.

More than 75% of the patients studied sustained moderate to significant improvement in their acne scarring at 3 months following final treatment, Dr. Arisa Ortiz reported at the annual meeting of the American Society of Laser Medicine and Surgery.

The 15 patients, who were aged 21–60 years, had moderate to severe acne scars and had Fitzpatrick skin types I-IV. They underwent up to three treatments with the Fraxel re:pair 10,600-nm fractional CO2 laser system (Reliant Technologies Inc.), said Dr. Ortiz, who is with the University of California, Irvine.

Treatment parameters ranged from 20 to 70 mJ with 600–1,200 microthermal zones/cm

Patient evaluations were conducted using digital photographic assessment at 3 days, 1 week, 1 month, and 3 months following treatment. Specifically, skin texture, wrinkles, pigmentation, skin laxity, scarring, and overall appearance were evaluated.

Of the 15 patients, 13 were considered to have shown improvement in the appearance of scarring, with an added benefit of improved overall appearance based on physician assessment, noted Dr. Ortiz, who reported that she received equipment and honoraria from Reliant.

Of 13 who had pigmentation, 11 were improved, and of 8 with rhytids, 6 improved.

Of eight who had only one treatment, one had no improvement, five had minor improvement, and two had moderate improvement. Of two who had two treatments, both had moderate improvement. Of five who had three treatments, one had no improvement, three had moderate improvement, and one had "very significant" improvement, she said.

Smoother skin texture was an example of minor improvement, and substantial improvement in ice pick scarring was an example of moderate improvement, Dr. Ortiz pointed out, explaining that higher fluences appeared to result in greater improvements, compared with lower fluences in patients who had the same number of treatments.

In those with the greatest improvements, three treatments at fluences of 40–70 mJ were used, and those patients had the added benefit of improvements in rhytids as well as in acne scarring, Dr. Ortiz said.

All of the patients experienced transient erythema, which resolved within 3 months.

No serious patient complications occurred, and any serosanguineous oozing resolved within 48 hours of treatment.

When compared with traditional ablative resurfacing, the fractional CO2 laser treatment resulted in less patient downtime and reduced complication rates, Dr. Ortiz concluded.

KISSIMMEE, FLA. — A novel fractional CO2 resurfacing device significantly and safely improved moderate to severe acne scarring in a recent study.

More than 75% of the patients studied sustained moderate to significant improvement in their acne scarring at 3 months following final treatment, Dr. Arisa Ortiz reported at the annual meeting of the American Society of Laser Medicine and Surgery.

The 15 patients, who were aged 21–60 years, had moderate to severe acne scars and had Fitzpatrick skin types I-IV. They underwent up to three treatments with the Fraxel re:pair 10,600-nm fractional CO2 laser system (Reliant Technologies Inc.), said Dr. Ortiz, who is with the University of California, Irvine.

Treatment parameters ranged from 20 to 70 mJ with 600–1,200 microthermal zones/cm

Patient evaluations were conducted using digital photographic assessment at 3 days, 1 week, 1 month, and 3 months following treatment. Specifically, skin texture, wrinkles, pigmentation, skin laxity, scarring, and overall appearance were evaluated.

Of the 15 patients, 13 were considered to have shown improvement in the appearance of scarring, with an added benefit of improved overall appearance based on physician assessment, noted Dr. Ortiz, who reported that she received equipment and honoraria from Reliant.

Of 13 who had pigmentation, 11 were improved, and of 8 with rhytids, 6 improved.

Of eight who had only one treatment, one had no improvement, five had minor improvement, and two had moderate improvement. Of two who had two treatments, both had moderate improvement. Of five who had three treatments, one had no improvement, three had moderate improvement, and one had "very significant" improvement, she said.

Smoother skin texture was an example of minor improvement, and substantial improvement in ice pick scarring was an example of moderate improvement, Dr. Ortiz pointed out, explaining that higher fluences appeared to result in greater improvements, compared with lower fluences in patients who had the same number of treatments.

In those with the greatest improvements, three treatments at fluences of 40–70 mJ were used, and those patients had the added benefit of improvements in rhytids as well as in acne scarring, Dr. Ortiz said.

All of the patients experienced transient erythema, which resolved within 3 months.

No serious patient complications occurred, and any serosanguineous oozing resolved within 48 hours of treatment.

When compared with traditional ablative resurfacing, the fractional CO2 laser treatment resulted in less patient downtime and reduced complication rates, Dr. Ortiz concluded.

KISSIMMEE, FLA. — A novel fractional CO2 resurfacing device significantly and safely improved moderate to severe acne scarring in a recent study.

More than 75% of the patients studied sustained moderate to significant improvement in their acne scarring at 3 months following final treatment, Dr. Arisa Ortiz reported at the annual meeting of the American Society of Laser Medicine and Surgery.

The 15 patients, who were aged 21–60 years, had moderate to severe acne scars and had Fitzpatrick skin types I-IV. They underwent up to three treatments with the Fraxel re:pair 10,600-nm fractional CO2 laser system (Reliant Technologies Inc.), said Dr. Ortiz, who is with the University of California, Irvine.

Treatment parameters ranged from 20 to 70 mJ with 600–1,200 microthermal zones/cm

Patient evaluations were conducted using digital photographic assessment at 3 days, 1 week, 1 month, and 3 months following treatment. Specifically, skin texture, wrinkles, pigmentation, skin laxity, scarring, and overall appearance were evaluated.

Of the 15 patients, 13 were considered to have shown improvement in the appearance of scarring, with an added benefit of improved overall appearance based on physician assessment, noted Dr. Ortiz, who reported that she received equipment and honoraria from Reliant.

Of 13 who had pigmentation, 11 were improved, and of 8 with rhytids, 6 improved.

Of eight who had only one treatment, one had no improvement, five had minor improvement, and two had moderate improvement. Of two who had two treatments, both had moderate improvement. Of five who had three treatments, one had no improvement, three had moderate improvement, and one had "very significant" improvement, she said.

Smoother skin texture was an example of minor improvement, and substantial improvement in ice pick scarring was an example of moderate improvement, Dr. Ortiz pointed out, explaining that higher fluences appeared to result in greater improvements, compared with lower fluences in patients who had the same number of treatments.

In those with the greatest improvements, three treatments at fluences of 40–70 mJ were used, and those patients had the added benefit of improvements in rhytids as well as in acne scarring, Dr. Ortiz said.

All of the patients experienced transient erythema, which resolved within 3 months.

No serious patient complications occurred, and any serosanguineous oozing resolved within 48 hours of treatment.

When compared with traditional ablative resurfacing, the fractional CO2 laser treatment resulted in less patient downtime and reduced complication rates, Dr. Ortiz concluded.

KISSIMMEE, FLA. — Treatment with a fixed array fractional 1540-nm erbium laser was effective for improving acne scars, a review of 181 patients found.

At 3-month follow-up, the patients who underwent three treatments at 4-week intervals with the Lux1540 laser (Palomar Medical Technologies Inc., Burlington, Mass.) had a median improvement of 3 by Canfield blinded photographic evaluation (Canfield Scientific Inc. Omnia system), which translates to a 50%-75% improvement in scar appearance, Dr. Robert A. Weiss reported at the annual meeting of the American Society of Laser Medicine and Surgery.

Treatments were given using the 10-mm, 100-microbeam per pulse handpiece for a minimum of three passes per treatment site at 10-millisecond pulse duration. Fluence was set at 50–70 mJ/microbeam, said Dr. Weiss of the Maryland Laser, Skin, and Vein Institute, Baltimore.

Self-assessed treatment results indicated that the patients were pleased with the outcomes, with 85% rating their skin as improved. Patient self-assessment indicated that pain was minimal, with a reported average pain score of 2.75 out of 10.

Side effects were minimal and included mild erythema and edema, which resolved in all patients within 24 hours.

The findings suggest that a minimal fluence of 50 mJ/microbeam with three passes is required to achieve improvement in acne scars with this laser, Dr. Weiss noted.

The study was supported by Palomar, which provided Dr. Weiss with equipment, discounts, a research grant, and honoraria.

KISSIMMEE, FLA. — Treatment with a fixed array fractional 1540-nm erbium laser was effective for improving acne scars, a review of 181 patients found.

At 3-month follow-up, the patients who underwent three treatments at 4-week intervals with the Lux1540 laser (Palomar Medical Technologies Inc., Burlington, Mass.) had a median improvement of 3 by Canfield blinded photographic evaluation (Canfield Scientific Inc. Omnia system), which translates to a 50%-75% improvement in scar appearance, Dr. Robert A. Weiss reported at the annual meeting of the American Society of Laser Medicine and Surgery.

Treatments were given using the 10-mm, 100-microbeam per pulse handpiece for a minimum of three passes per treatment site at 10-millisecond pulse duration. Fluence was set at 50–70 mJ/microbeam, said Dr. Weiss of the Maryland Laser, Skin, and Vein Institute, Baltimore.

Self-assessed treatment results indicated that the patients were pleased with the outcomes, with 85% rating their skin as improved. Patient self-assessment indicated that pain was minimal, with a reported average pain score of 2.75 out of 10.

Side effects were minimal and included mild erythema and edema, which resolved in all patients within 24 hours.

The findings suggest that a minimal fluence of 50 mJ/microbeam with three passes is required to achieve improvement in acne scars with this laser, Dr. Weiss noted.

The study was supported by Palomar, which provided Dr. Weiss with equipment, discounts, a research grant, and honoraria.

KISSIMMEE, FLA. — Treatment with a fixed array fractional 1540-nm erbium laser was effective for improving acne scars, a review of 181 patients found.

At 3-month follow-up, the patients who underwent three treatments at 4-week intervals with the Lux1540 laser (Palomar Medical Technologies Inc., Burlington, Mass.) had a median improvement of 3 by Canfield blinded photographic evaluation (Canfield Scientific Inc. Omnia system), which translates to a 50%-75% improvement in scar appearance, Dr. Robert A. Weiss reported at the annual meeting of the American Society of Laser Medicine and Surgery.

Treatments were given using the 10-mm, 100-microbeam per pulse handpiece for a minimum of three passes per treatment site at 10-millisecond pulse duration. Fluence was set at 50–70 mJ/microbeam, said Dr. Weiss of the Maryland Laser, Skin, and Vein Institute, Baltimore.

Self-assessed treatment results indicated that the patients were pleased with the outcomes, with 85% rating their skin as improved. Patient self-assessment indicated that pain was minimal, with a reported average pain score of 2.75 out of 10.

Side effects were minimal and included mild erythema and edema, which resolved in all patients within 24 hours.

The findings suggest that a minimal fluence of 50 mJ/microbeam with three passes is required to achieve improvement in acne scars with this laser, Dr. Weiss noted.

The study was supported by Palomar, which provided Dr. Weiss with equipment, discounts, a research grant, and honoraria.