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Wound Fluid in Diabetic Foot Ulceration: More Than Just an Undefined Soup?
Abstract
Valid and reproducible sampling techniques as well as processing protocols are required for the assessment of biomarkers and mediators contained in wound exudate. Moreover, the ideal technique should be easy to use even in daily clinical routine. This is challenging since wound fluid represents an inhomogeneous mixture of different exogenous and endogenous sources. Analyzing wound fluid, however, may facilitate clinical decision making. Many techniques for obtaining wound fluid have been described. There is very little validation data, and the array of different techniques appears confusing. Structuring and new standards are needed to avoid wound fluid sampling yielding an “undefined soup.” A lot of wound fluid parameters have been analyzed, although none of them have made its way into clinical practice. Nevertheless, basic principles of wound healing have been established from wound fluid analysis. With adequate techniques suitable for daily practice, basic research might foster our clinical understanding of wound healing with implications for new therapies. So far, research has mainly concentrated on analyzing available sample material with respect to either a wide variety of analytes or comparing acute with chronic wound exudate. Clinical endpoints such as healing or wound infection as well as longitudinal data may indeed be more valuable for clinical practice, enabling the discovery of meaningful biomarkers using a suitable technique.
  • References (138)
  • Cited By (8)
2000 in Ostomy Wound ManagementIF: 0.99
Staiano-Coico L1
Estimated H-index: 1
,
Higgins Pj1
Estimated H-index: 1
+ 2 AuthorsGoncalves J1
Estimated H-index: 1
Analyzing acute and chronic wound fluids provides an important and intriguing insight into the wound milieu. This review outlines some of the salient features of wound repair and the wound fluid environment. Most studies support the premise that the contents of the wound fluid reflect the status of the wound and can be indicative of whether a wound is on the course of a normal or impaired response to injury. For example, chronic wound fluids often differ from acute wound fluids in their prolifer...
23 Citations Source
Laura E. Edsberg13
Estimated H-index: 13
(Daemen College),
Jennifer T. Wyffels8
Estimated H-index: 8
(Daemen College)
+ 1 AuthorsKristin M. Fries6
Estimated H-index: 6
(Daemen College)
Analysis of the proteomic profile of pressure ulcers over time is a critical step in the identification of biomarkers of healing or nonhealing in pressure ulcers. The wound fluid from 32 subjects with 42 pressure ulcers was evaluated over 6 weeks at 15 time points. Samples specific to both the interior and the periphery of the wound bed were collected. Antibody screening arrays, isobaric tags for relative and absolute quantitation with mass spectrometry and multiplexed microarrays were used to c...
27 Citations Source Cite
H. Trøstrup1
Estimated H-index: 1
,
R. Lundquist1
Estimated H-index: 1
+ 4 AuthorsMagnus S. Ågren12
Estimated H-index: 12
Summary Background Knowledge on the underlying mechanisms for nonhealing chronic wounds is fragmentary. Objectives To increase our understanding of the pathogenesis, the relationship between healing ability and a large panel of proteins was studied using a specially designed wound-healing antibody-based microarray. Methods Wound fluid from nondiabetic patients with nonhealing venous leg ulcers was compared with that from patients with healing open granulating acute wounds. The high-throughput me...
21 Citations Source Cite
1999 in Acta neurochirurgicaIF: 1.93
L. Hillered1
Estimated H-index: 1
(Uppsala University Hospital),
L. Persson1
Estimated H-index: 1
(Uppsala University Hospital)
The application of microdialysis for neurochemical monitoring in neurosurgery and neurointensive care is rapidly expanding in a number of clinical centers around the world. In order for microdialysis to become a future routine method in these clinical settings a number of problems, outlined in this communication, must be solved by the clinical researchers and the commercial companies. Regardless of the future success as a routine method, it is already obvious that microdialysis will be an import...
22 Citations Source Cite
2011 in Diabetic MedicineIF: 3.13
M. Löffler1
Estimated H-index: 1
,
D. Zieker1
Estimated H-index: 1
+ 7 AuthorsStefan Beckert16
Estimated H-index: 16
Diabet. Med. 28, 175–178 (2011) Abstract Aims To investigate the impact of wound fluid lactate concentration on diagnosing soft-tissue infection in diabetic foot ulcers. Methods Lactate concentration in wound fluid obtained from diabetic foot ulcers was determined using a lactate analyser and compared with clinical examination findings. Results Overall median wound fluid lactate concentration was 21.03 mm (5.58–80.40 mm). Wound lactate levels were significantly higher in infected compared with n...
19 Citations Source Cite
Melissa Laura Fernandez4
Estimated H-index: 4
(Queensland University of Technology),
James A. Broadbent7
Estimated H-index: 7
(Queensland University of Technology)
+ 2 AuthorsZee Upton30
Estimated H-index: 30
(Queensland University of Technology)
Summary Background Chronic venous leg ulcers are a significant cause of pain, immobility and decreased quality of life for patients with these wounds. In view of this, research efforts are focused on multiple factors in the wound environment to obtain information regarding the healing of ulcers. Objectives Chronic wound fluid (CWF), containing a complex mixture of proteins, is an important modulator of the wound environment, and therefore we hypothesized that these proteins may be indicators of ...
35 Citations Source Cite
Øystein Grimstad5
Estimated H-index: 5
(Norwegian University of Science and Technology),
Øystein Sandanger9
Estimated H-index: 9
(Norwegian University of Science and Technology)
+ 4 AuthorsTerje Espevik65
Estimated H-index: 65
(Norwegian University of Science and Technology)
Acute wounds contain many biological active molecules, including several cytokines and growth factors. However, the cellular sources of each molecule, as well as the stimuli inducing them, are poorly characterized. We quantified the levels of 27 cytokines, chemokines, and growth factors in acute wound fluid in a luminex-based assay. The acute wound fluid contained particularly high levels of IL-6 and IL-8, as well as elevated levels of MCP-1, IL-1RA, PDGF, IP-10, IFN-γ, and TNF-α. Surprisingly, ...
42 Citations Source Cite
Nicholas N. Nissen2
Estimated H-index: 2
(Loyola University Chicago),
Peter J. Polverini14
Estimated H-index: 14
+ 3 AuthorsLuisa A. DiPietro41
Estimated H-index: 41
Angiogenesis is an essential component of normal wound repair, yet the primary mediators of wound angiogenesis have not been well described. The current study characterizes the contribution of vascular endothelial cell growth factor (VEGF) to the angiogenic environment of human surgical wounds. Surgical wound fluid samples (n = 70) were collected daily for up to 7 postoperative days (POD) from 14 patients undergoing mastectomy or neck dissection. VEGF levels in surgical wound fluid were lowest o...
620 Citations Source
2002 in Molecular MicrobiologyIF: 3.82
Artur Schmidtchen40
Estimated H-index: 40
,
Inga-Maria Frick24
Estimated H-index: 24
(Lund University)
+ 2 AuthorsLars Björck60
Estimated H-index: 60
(Lund University)
Summary Effectors of the innate immune system, the antibacterial peptides, have pivotal roles in preventing infection at epithelial surfaces. Here we show that proteinases of the significant human pathogens Pseudomonas aeruginosa , Enterococcus faecalis , Proteus mirabilis and Streptococcus pyogenes, degrade the antibacterial peptide LL-37. Analysis by mass spectrometry of fragments generated by P. aeruginosa elastase in vitro revealed that the initial cleavages occurred at Asn-Leu and Asp-Phe, ...
286 Citations Download PDF Cite
2011 in Experimental DermatologyIF: 2.61
Andrea Hasmann8
Estimated H-index: 8
(Graz University of Technology),
Ulrike Gewessler4
Estimated H-index: 4
+ 8 AuthorsGeorg M. Guebitz41
Estimated H-index: 41
(Graz University of Technology)
Human neutrophil elastase (HNE) and cathepsin G (CatG) are involved in the pathogenesis of a number of inflammatory disorders. These serine proteinases are released by neutrophils and monocytes in case of infection. Wound infection is a severe complication regarding wound healing causing diagnostic and therapeutic problems. In this study we have shown the potential of HNE and CatG to be used as markers for early detection of infection. Significant differences in HNE and CatG levels in infected a...
30 Citations Source Cite
  • References (138)
  • Cited By (8)
2013 in Journal of Wound CareIF: 1.67
David Voegeli16
Estimated H-index: 16
,
Bashir A. Lwaleed15
Estimated H-index: 15
Despite the advances in our understanding of normal and abnormal wound healing over the past decade, a specific biomarker which can be used clinically to identify ‘hard-to-heal’ wounds still remains elusive. Tissue and exudate samples extracted from the site of the wound are traditionally analysed using histological, microbiological and biochemical laboratory techniques. The aim of this paper is to review the advantages of these techniques, their limitations and the rapid developments in the fie...
2 Citations Source Cite
Xiaoyan Ji3
Estimated H-index: 3
(Tianjin Medical University),
Peng Jin1
Estimated H-index: 1
(Tianjin Medical University)
+ 2 AuthorsPenghua Wang4
Estimated H-index: 4
(Tianjin Medical University)
The objective was to determine multidrug-resistant organisms’ (MDROs) profile in diabetic foot ulcers (DFU), antibiotic resistance of MDROs, and to find the potential risk factors for infection with MDROs. In 157 patients with DFU admitted to Tianjin Metabolic Disease Hospital, China, from January 2011 to January 2012, microbiological specimens were taken on admission. The patients were divided into 2 groups according to the infection of MDROs. Potential risk factors for MDRO-positive specimens ...
4 Citations Source Cite
Nikolaos Papanas31
Estimated H-index: 31
(Democritus University of Thrace),
Raj Mani9
Estimated H-index: 9
(University Hospital Southampton NHS Foundation Trust)
15 Citations Download PDF Cite
2016 in Advanced MaterialsIF: 21.95
Anna McLister4
Estimated H-index: 4
(Ulster University),
Jolene McHugh2
Estimated H-index: 2
(Ulster University)
+ 1 AuthorsJames Davis29
Estimated H-index: 29
(Ulster University)
The pH of wound fluid has long been recognized as an important diagnostic for assessing wound condition, but as yet there are few technological options available to the clinician. The availability of sensors that can measure wound pH, either in the clinic or at home could significantly improve clinical outcome – particularly in the early identification of complications such as infection. New material designs and electrochemical research strategies that are being targeted at wound diagnostics are...
17 Citations Source Cite
2015 in MedicineIF: 2.03
Tobias Kisch4
Estimated H-index: 4
,
Julia Maria Klemens1
Estimated H-index: 1
+ 7 AuthorsMatthias Brandenburger2
Estimated H-index: 2
The regrowth of amputated digit tips represents a unique regenerative healing in mammals with subcutaneous volume regrowth, restoration of dactylogram, and suppression of scar formation. Although factor analysis in amphibians and even in mice is easy to obtain, safety of harvesting biomaterial from human digit tip amputations for analysis has not yet been described. The aim of this study was to evaluate if recovering wound exudate does hamper clinical outcome or influence microbiologic or inflam...
2 Citations Source Cite
2016
J. Davis1
Estimated H-index: 1
(Ulster University),
A. McLister1
Estimated H-index: 1
(Ulster University)
Diagnostics play an increasingly important role in the wound management plan for chronic wounds as they can provide valuable insights into why a wound is failing to progress. Active interventions to encourage healing will often require several different approaches and there is little doubt that the provision of detailed information on the chemical dynamics at play within the wound environment would be of tremendous benefit in facilitating more informed treatment decisions and dressing selection....
1 Citations Source Cite
Natarajan Krishnan1
Estimated H-index: 1
(Bharathidasan University),
Balasubramanian Velramar1
Estimated H-index: 1
(Bharathidasan University)
+ 1 AuthorsRajesh Kannan Velu2
Estimated H-index: 2
(Bharathidasan University)
AbstractPseudomonas aeruginosa and its lipopolysaccharides play a key role in the pathogenesis of diabetic foot infection, for which, currently no effective therapeutic agents are available. Hence, newer forms of therapeutic agents are required for treating Pseudomonas aeruginosa infection. In this present study, nanocrystalline silver nanoparticles (AgNPs) were synthesized using culture filtrate of Brevibacillus brevis KN8(2) followed by an investigation of its in vivo anti-pseudomonal and anti...
4 Citations Source Cite
Maggie J Westby4
Estimated H-index: 4
,
Jo C Dumville33
Estimated H-index: 33
+ 4 AuthorsRichard D Riley37
Estimated H-index: 37
(Keele University)
This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows: To determine whether protease activity is an independent prognostic factor for the healing of venous leg ulcers.
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2019 in Journal of ProteomicsIF: 3.72
Nayara Rodrigues Vieira Cavassan1
Estimated H-index: 1
(Sao Paulo State University),
Caio Cavassan de Camargo3
Estimated H-index: 3
(Sao Paulo State University)
+ 5 AuthorsLucilene Delazari dos Santos13
Estimated H-index: 13
(Sao Paulo State University)
Abstract Chronic venous ulcers affect the quality of life of patients around the world. The aims of this study were to identify the proteins expressed in chronic venous ulcer exudates, to categorize them according to their roles and to correlate them with the clinical and epidemiological aspects of the disease. The study population consisted of 37 ulcers from 28 patients, and the inflammatory exudates of these thirty-seven ulcers were subjected to tryptic digestion and mass spectrometry analysis...
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