Emerging Research Reported at National Meeting

At SAWC Spring 2023, four high-scoring abstracts were presented as oral abstracts for podium presentations in the session “Advanced Clinical Practice and Emerging Research (SAWC Oral Abstracts)” moderated by Oscar M. Alvarez, PhD, CCT, FAPWCA. The abstract overviews are provided in this article.

The first abstract presented was a report titled, Multicenter, Randomized Controlled Clinical Investigation Evaluating a Unique Micro Water Jet Technology Device Versus Standard Debridement in the Treatment of Diabetic Foot; the investigators for this study included David G. Armstrong, DPM, MD, PhD; Robert D. Galiano, MD; Dennis P. Orgill, MD, PhD; Paul M. Glat, MD; Marissa J. Carter, PhD; and Charles M. Zelen, DPM. In their study, the investigators sought to compare the healing rates and wound area reduction in wounds debrided weekly with micro water jet technology and standard of care wound dressings against those who received sharp debridement and the standard of care alone. Of the 85 patients screened, 50 patients were enrolled for the preliminary analysis in a 2 arm, randomized controlled trial. Patients who met inclusion criteria were randomized to either the micro water jet arm or sharp debridement arm to receive weekly treatments. Both groups received 16 weeks of follow-up. Study endpoints included healing at 16 weeks and percent wound area reduction during the 16-week treatment. The micro water jet arm showed more favorable healing results over the sharp debridement arm (72% vs 40%, respectively). At 16 weeks, the percent wound area reduction was also more favorable in the micro water jet arm versus the sharp debridement (86.5% vs 35.1%, respectively). From this study, the investigator showed statistical significance in closing refractory diabetic foot ulcers over the 16-week study period. According to the investigators, “Early data show great promise that better debridement tools can improve wound closure and decrease diabetic foot-related complications and infections.”

With the second abstract presented, Marzanna T. Zaleska, PhD discussed the topic of compression and lymphedema from their study, A High-force 3 x 30 Minute Compression Method of Foot and Calf Removes Most Edema Fluid, Enables Immediate Usage of High-compression Garment, and Prevents Fluid Leakage and Ulcer Development. In their study, Dr. Zaleska applied an elastic bandage to the foot and calf (pressure, 90 mm Hg-125 mm Hg; duration, 30 minutes) over 3 consecutive days to assess the volume of fluid removed on plethysmography. There were 21 patients with 30 lower limbs with lymphedema stage III of post-inflammatory type that met inclusion criteria. The elastic bandage (10-cm wide) was applied to the foot and calf with an interface pressure of 90 mm Hg to 130 mm Hg. Measured variables included deep tissue tonometry, leg circumference, and drop of interface pressure. Also performed before and after compression was strain gauge plethysmography. According to Dr. Zaleska, “Calf circumference decreased by 20% ± 5%, deep tissue stiffness by 50% ± 8%, and skin water concentration by 43% ± 10%; interface pressure dropped to 45 mm Hg to 70 mm Hg, and plethysmography and USG images showed less mobile fluid in lower limbs tissue.” The results were notable in that 30 minutes of high-pressure leg compression showed success in removing excess edema fluid within the 3 consecutive days. It also allowed for the adjustment of pressure non-stretch stockings as well as prevention of further destructive changes.

The third abstract presented was Biological Therapy in Pyoderma Gangrenosum: The Experience of the Department of Dermatology of Pisa by Giammarco Granieri, MD; Alessandra Michelucci, MD; Flavia Manzo Margiotta, MD; Cristian Fidanzi, MD; Giorgia Salvia, MD; Matteo Bevilacqua, MD; Valentina Dini, MD, PhD; and Marco Romanelli, MD, PhD. In their study, the investigators chose to report their clinical experience with monoclonal antibodies (mAbs) in cases in which patients encounter relapses and multiresistant pyoderma gangrenosum (PG). One patient was received Ixekizumab (anti IL-17 mAb), 3 patients received Risankizumab (anti IL-23 mAb), 1 patient received Bimekizumab (anti IL-17 mAb), and 2 patients received Adalimumab (anti TNF-alpha mAb) in this study. Patients were assessed at 3 months and 6 months from initiation of mAb therapy via assessment of wound bed score (WBS) and Dermatology Life Quality Index (DLQI). Dr. Dini noted, “All patients treated with these molecules showed a significant improvement in terms of DLQI and WBS (Delta DLQI, 80%; and Delta WBS, 60%).” However, the patients did not achieve favorable disease control. In summary, their study results showed mAbs could be an excellent therapeutic option in cases of recalcitrant PG. In closing, Dr. Dini commented that these were their experiences with biologics and pyoderma gangrenosum and that more cases would be needed to confirm results.

The final abstract, A Novel Therapeutic for Drug-resistant Candida auris, was reported by Mina Izadjoo, PhD; Vanessa Marcel, MS; and Salman Izadjoo, PhD. In their laboratory, the investigators focused on developing new, cost-effective antimicrobials, including antifungals, and found a novel Bacillus strain. Through genomic sequencing, the organism was determined to be a new species, and it is larger than all known Bacillus strains. This new organism and its extracts were found to be highly effective against a broad spectrum of fungal pathogens. Through additional testing, the investigators were able to determine expression of antifungal products such as surfacants and lipoproteins. Cytotoxicity testing was based on US Food and Drug Administration-accepted parameters per ISO-10993. This did not show any toxicity. According to Dr. Izadjoo, “This study demonstrated the potential application of probiotic strains for prevention and/or treatment of wound infections caused by invasive fungal pathogens.”

-Jaclyn Gaydos, Senior Managing Editor