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Three-dimensional (3D) wound measurements enable the evaluation of wound healing from the wound bed, which may be a more sensitive measure than traditional two-dimensional (2D) area measurements at the level of the skin surface. Few studies have investigated 3D measurements for monitoring wound healing over time. The aim of this study was to compare the changes in 3D area measurements with traditional (2D) area measurements of diabetic foot ulcers during 8 weeks. Approach: In a prospective cohort study, we monitored the wound healing of 150 diabetic foot ulcers using the 3D-wound assessment monitor camera (3D area) and the digital imaging method (2D area) at baseline, weeks 2, 4, and 8. The following statistical approaches were used to compare the changes in 2D area and 3D area measurements: linear regression analysis, paired Wilcoxon rank test, Bonett-Price 95% confidence interval, and Spearman's correlation coefficient. Results: The overall changes in 3D area were significantly larger compared with 2D area as assessed by Wilcoxon test (p < 0.0001) and Bonett-Price 95% confidence interval of 0.009-0.163. In addition, comparison of 2D area and 3D area measurements showed that the majority of the wounds had larger decrease in 3D area compared with 2D area over time. Innovation: 3D area appears to provide a more sensitive method to monitor wound healing. Conclusion: Our study highlights the potential benefit of a novel 3D camera for monitoring wound healing of diabetic foot ulcers, which was found particularly useful in monitoring wound healing in large wounds. However, in small wounds ( more...

A randomised, controlled multicentre clinical trial was conducted at 14 wound care centres in the United States to confirm the efficacy of dehydrated human amnion/chorion membrane allograft (dHACM) for the treatment of chronic lower extremity ulcers in persons with diabetes. Patients with a lower extremity ulcer of at least 4 weeks duration were entered into a 2-week study run-in phase and treated with alginate wound dressings and appropriate offloading. Those with less than or equal to 25% wound closure after run-in were randomly assigned to receive weekly dHACM application in addition to offloading or standard of care with alginate wound dressings, for 12 weeks. A total of 110 patients were included in the intent-to-treat (ITT) analysis, with n = 54 in the dHACM group and n = 56 in the no-dHACM group. Of the participants, 98 completed the study per protocol, with 47 receiving dHACM and 51 not receiving dHACM. The primary study outcome was percentage of study ulcers completely healed in 12 weeks, with both ITT and per-protocol participants receiving weekly dHACM significantly more likely to completely heal than those not receiving dHACM (ITT-70% versus 50%, P = 0.0338, per-protocol-81% versus 55%, P = 0.0093). A Kaplan-Meier analysis was performed to compare the time-to-healing performance with/without dHACM, showing a significantly improved time to healing with the use of allograft, log-rank P < 0.0187. Cox regression analysis showed that dHACM-treated subjects were more than twice as likely to heal completely within 12 weeks than no-dHACM subjects (HR: 2.15, 95% confidence interval 1.30-3.57, P = 0.003). At the final follow up at 16 weeks, 95% of dHACM-healed ulcers and 86% of healed ulcers in the no-dHACM group remained closed. These results confirm that dHACM is an efficacious treatment for lower extremity ulcers in a heterogeneous patient population. more...

Epidermolysis bullosa (EB) is a group of genetic disorders characterized by blisters and erosions/ulcerations in response to otherwise benign mechanical forces applied to the skin. Pretibial epidermolysis bullosa (PEB) is a form of EB that most often presents with blistering, ulceration, scarring, and milia localized to the bilateral legs. We report a case of man in his 50s presenting with blistering and scarring of his bilateral legs caused by PEB found to be associated with a mutation in COL7A1 that results in exon skipping. more...