Pyoderma Gangrenosum Associated with Sunitinib: A Case Report Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that presents with painful, sterile ulcers. Drug-induced PG is a rare condition; propylthiouracil, granulocyte colony-stimulating factor, and sunitinib are drugs that have been implicated to date. This article presents a case of PG associated with sunitinib. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Nurses’ Education, Confidence, and Competence in Appropriate Dressing Choice BACKGROUND Wound assessment and treatment are essential aspects of nursing care. Dressing-associated complications can delay wound healing, causing unnecessary patient distress. Despite evidence suggesting that dressings should be changed infrequently, there still remains a tendency for healthcare professionals to remove dressings regularly, increasing the risk of complications and the cost of wound care. OBJECTIVE To understand the experiences and current practices of tissue viability nurses (TVNs) involved in wound care and dressing wear time in the acute and community settings. METHODS This quality improvement project used a mixed-methods design. A retrospective audit was undertaken to establish nurse rationale for the renewal of foam dressings on patients with acute/chronic wounds. Semistructured qualitative interviews were conducted with registered TVNs (n = 12) working in acute and community care settings and focused on their experiences with all dressing types. MAIN RESULTS The analysis identified several key themes, including Training and Education (including the subthemes of TVN Experience and TVN Training), Knowledge and Information, Lack of Confidence (including the subthemes Reasons for Dressing Change and Ritualistic Practice), and Dressing Choice. CONCLUSIONS Fundamental changes in staff attitudes and beliefs about dressing wear time are essential to optimizing dressing performance and increasing patient quality of care. Flexible community services that are reflective of the needs of the service are central to changing practice and increasing dressing wear time in these settings. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Use of Platelet-Rich Plasma and Rosuvastatin in Wound Healing in Rabbits: A Longitudinal Study OBJECTIVE To test the hypothesis that platelet-rich plasma (PRP) improves wound healing in rabbits by analyzing morphologic alterations in lesions with the use of PRP alone or combined with rosuvastatin (RSV). METHODS Eight adult male New Zealand rabbits were used in this study. Researchers created four wounds on the back of each rabbit with an 8-mm punch. The control wound was treated with a 0.9% sodium chloride solution. Experimental wounds were treated with PRP, RSV, or both PRP and RSV. Dressings were changed with a new application of PRP and RSV every 4 days for 16 days. Wounds were biopsied on days 0, 7, 10, 14, and 17 for histopathologic evaluation of the scar tissue. MAIN RESULTS Histopathology revealed reepithelialization in 100% of wounds treated with PRP alone after 17 days of treatment, compared with 50% of wounds treated with RSV alone and 75% of the wounds treated with PRP and RSV. Further, combining RSV and PRP reduced blood loss. The use of PRP alone induced 100% neovascularization, compared with 50% and 62.5% in wounds treated with PRP and RSV and RSV alone, respectively. All experimental wounds had a higher percentage of collagen fibers on day 17 postlesion when compared with control wounds (78.27% ± 4.69%). There were no significant differences among treatments; however, wounds treated with RSV alone had the lowest amount of collagen fibers (85.98% ± 3.51%). Wounds treated with PRP alone or PRP and RSV had 90.07% ± 6.20% and 90.76% ± 3.51% collagen fibers, respectively. CONCLUSIONS The results of this study indicate that PRP elicits higher healing activity in the first 7 days postlesion. Treatments with RSV alone or RSV and PRP did enhance other healing phases. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Is Negative-Pressure Wound Therapy a “Bridge to Reconstruction” for Poststernotomy Mediastinitis? A Systematic Review OBJECTIVE: To assess the efficacy of negative-pressure wound therapy (NPWT) in preparing sternal wounds for flap reconstruction. METHODS: Investigators searched standard research databases with terms including “post-sternotomy mediastinitis,” “deep sternal wound infection,” “negative pressure wound therapy,” “vacuum assisted closure,” and “VAC.” Of 434 reports, 14 studies described patients diagnosed with poststernotomy mediastinitis who underwent NPWT followed by flap reconstruction. Eligible studies were assessed for length of stay, mortality, manufacturer involvement, and methodological rigor. MAIN RESULTS: Among a total 429 patients, median length of stay was 29 (±16) days. There were 41 deaths in this inpatient group (10%). Seventy-one percent of the reports were nonrandomized, and 36% of the studies accurately accounted for baseline differences in severity, whereas 14% failed to report diagnostic criteria. Only one study reported follow-up results. Nine studies (64%) failed to make a statement regarding conflicts of interest. In this analysis of quality, 48% (n = 8) of the studies were of very low to low quality. One study was of high quality. CONCLUSIONS: Investigators failed to find ample support for routine use of NPWT as a “bridge to reconstruction.” Serious complications related to the use of NPWT including right ventricular rupture, atrial fibrillation, respiratory arrest, recurrent infection, and a retained sponge were reported in this group of studies. Rigorous evaluative studies that assess the true effectiveness of NPWT as a “bridge to reconstruction” must precede its adoption. The authors have disclosed no financial relationships related to this article. Submitted September 1, 2018; accepted October 9, 2018. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A Prospective, Multicenter, Single-Arm Clinical Trial for Treatment of Complex Diabetic Foot Ulcers with Deep Exposure Using Acellular Dermal Matrix OBJECTIVE This prospective, multicenter study evaluated the efficacy and safety of an acellular dermal matrix allograft, DermACELL (D-ADM; LifeNet Health, Virginia Beach, Virginia), in the treatment of large, complex diabetic foot ulcers (DFUs) that probed to tendon or bone. METHODS Inclusion criteria were Wagner grade 3 or 4 DFUs between 4 weeks and 1 year in duration. All participants received one application of D-ADM at baseline and could receive one additional application if wound healing arrested. Ulcers were assessed weekly for 16 weeks using a laser measuring device. RESULTS Sixty-one participants were enrolled, with an average wound area of 29.0 cm2; 59 of these ulcers showed exposed bone. The entire per-protocol population (n = 47) achieved 100% granulation. The mean time to 100% granulation was 4.0 weeks with an average of 1.2 applications of D-ADM. Mean percent wound area reduction was 80.3% at 16 weeks. Those DFUs 15 cm2 or smaller were substantially more likely to close than DFUs larger than 29 cm2 (P = .0008) over a 16-week duration. No complications were associated with the use of the studied matrix. CONCLUSIONS The D-ADM demonstrated the ability to rapidly reduce the size of large, complex DFUs with exposed bone. Some wounds did not completely heal by 16 weeks; however, the significant reduction in size suggests that these large, complex wounds may heal if given more time. Acknowledgments: The authors thank Collin Smith for data analysis support. This study was funded by LifeNet Health, a nonprofit organization that processes the studied acellular dermal matrix. Dr Cazzell and Dr Moyer were among the clinical trial investigators for this study and received research funding. Mr Samsell, Ms Dorsch, Dr McLean, and Dr Moore are employees of LifeNet Health. All patient outcomes were evaluated solely by the investigators to minimize potential for bias. The authors have disclosed no other financial relationships related to this article. Submitted January 3, 2019; accepted in revised form March 8, 2019. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Use of Silver-Containing Hydrofiber and Chlorhexidine-Impregnated Tulle Gras Dressings for Second-Degree Burns OBJECTIVE: This study evaluated the use of silver-containing hydrofiber and chlorhexidine-impregnated tulle gras dressings for second-degree burns. METHODS: This randomized clinical study consisted of 60 patients with second-degree burns. Data were collected using a Patient Identification Form, Wound Assessment Form, and Pain Assessment Scale. Following dressing application, wounds were assessed on days 7, 15, and 22. Study procedures were continued until full epithelialization occurred. RESULTS: After the seventh day of follow-up, significant improvement was noted in the experimental group in terms of wound exudate, wound debridement, pain intensity, and analgesic agent administration. After the 15th day of follow-up, there was a significant decrease in epithelialization time in the experimental group. Exudate control was better in patients whose burns were treated with silver-containing hydrofiber dressings, and they needed less debridement and fewer analgesics because of infrequent dressing changes. Lower pain scores were reported, the burn area reduced more quickly, and faster epithelialization and wound healing were achieved. CONCLUSIONS: The authors conclude that silver-containing hydrofiber dressings are an effective wound care material that improve the wound healing process. More studies comparing it and other wound care materials could improve the quality of healthcare for patients with burns. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.