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Human growth hormone for treating burns and skin graft donor sites

Growth hormone is produced by the pituitary gland. For decades, it could only be obtained by extraction from pituitary glands but more recently it has been produced through genetic engineering and made available for therapy as recombinant human growth hormone (rhGH). The aim of this review was to determine the effects of rhGH when used to treat burns and skin graft donor sites and to determine its safety compared with other treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Skin grafts to improve leg ulcer healing

Approximately 1% of people in industrialised countries have a leg ulcer at some time, mainly caused by poor blood flow back from the legs towards the heart. Skin grafts, either using the patient's own skin, artificial skin or donor skin/cells, have been evaluated to see whether they improve the healing of ulcers. The review of trials found evidence that tissue‐engineered skin composed of two layers increases the chance of healing. There was not enough evidence to recommend any other type of graft, and further research is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Hyperbaric oxygen therapy for acute surgical and traumatic wounds

Acute surgical and traumatic wounds occur as a result of a trauma or surgical procedures and whilst many heal uneventfully, sometimes poor local blood supply, infection, damage to the blood vessels, or a combination of factors result in these acute wounds taking longer to heal. Hyperbaric oxygen therapy (HBOT), which involves placing the person in an airtight chamber and administering 100% oxygen at a pressure greater than 1 atmosphere, is sometimes used with the aim of speeding wound healing. The aim is to bathe all fluids, tissues and cells of the body in a high concentration of oxygen.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Negative pressure wound therapy for acute surgical wounds

Negative pressure wound therapy (NPWT) is the application of suction (negative pressure) to wounds that are healing. NPWT has been used for many years for the treatment of chronic wounds, such as leg ulcers and bed sores. More recently, the system has been modified for use on clean surgical wounds, including skin grafts. We undertook a review of studies that compared NPWT with other wound treatments in order to see whether NPWT really works. We found nine trials to consider. These showed that it is still not clear whether NPWT promotes faster healing and reduces complications associated with clean surgery or skin grafts, or not.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Anti‐thymocyte globulins for the prevention of graft‐versus‐host disease in patients receiving allogeneic stem cell transplantation

Allogeneic haematopoietic (blood) stem cell transplantation (HSCT) is a potentially curative therapeutic option for a variety of malignant and some non‐malignant haematological (blood‐related) diseases. For this therapy, blood stem cells are transferred from a healthy person who has compatible tissue markers, so‐called human leukocyte antigen (HLA) markers, to a matched recipient. Even though the donor and the recipient are matched concerning these markers, immune cells that are part of the transferred cells ('the graft') are prone to recognise tissues of the recipient ('the host') as being to some extent incompatible or foreign, which then can induce inflammation ('graft‐versus‐host‐disease' or 'GVHD'). GVHD typically involves the skin, the gastrointestinal tract and the liver. GVHD is divided into acute and chronic forms based on the clinical features and the time of occurrence after transplantation. In order to prevent this potentially life‐threatening condition, reactive immune cells can be depleted in the recipient by administering antibodies which are directed against them. These antibodies are called anti‐thymocyte globulins (ATG) and are derived from animals which were immunised with human thymocytes or T‐cells. Different types of ATG have been used for decades to decrease the occurrence and severity of GVHD but they bear the risk of severe side effects such as increased infection rates or the risk of disease relapse. Also, severe side effects such as allergic reactions or serum sickness with shortness of breath and fever, blood coagulation disturbances or liver failure can harm the patient during the infusion of ATG. So far, no systematic analysis of the advantages and disadvantages of the use of ATG has been done.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Extracorporeal photopheresis for acute graft‐versus‐host disease after haematopoietic stem cell transplantation in paediatric patients

Acute graft‐versus‐host disease is a common complication after haematopoietic stem cell transplantation (HSCT; transplant of blood‐forming stem cells). Immune cells (white blood cells) from the donor recognise the patient's cells as foreign ('non‐self'). Therefore, the transplanted immune cells attack the cells of the patient. The main affected organs are skin, liver and gut among other organ tissues. These immune reactions may cause acute inflammation (sudden swelling) followed by chronic (long‐term) changes of the organs (e.g. fibrosis; scarring of the lungs). First‐line therapy usually consists of immunosuppressive drugs (which reduce the strength of the body's immune system) such as corticosteroids in combination with other immunosuppressive agents in refractory cases (where the disease is resistant to treatment). The use of these immunosuppressive drugs is designed to suppress the immune‐mediated attack of the patient's cells. Limited effectiveness and severe side effects of these immunosuppressive drugs have led to the application of several alternative approaches.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Extracorporeal photopheresis treatment for chronic graft‐versus‐host disease after haematopoietic stem cell transplantation in paediatric patients

Chronic graft‐versus‐host disease is a common complication after haematopoietic stem cell transplantation (HSCT; transplant of blood‐forming stem cells). Immune cells (white blood cells) from the donor recognise the patient's cells as foreign ('non‐self'). Therefore, the transplanted immune cells attack the cells of the patient. The main affected organs are skin, liver and gut, among others. These immune reactions may cause acute inflammation (sudden swelling) followed by chronic (long‐term) changes of organs (e.g. fibrosis; scarring of the lungs). First‐line therapy usually consists of immunosuppressive drugs (which reduce the strength of the body's immune system) in the form of corticosteroids in combination with other immunosuppressive agents in refractory cases (where the disease is resistant to treatment). These drugs are supposed to suppress the immune‐mediated attack of the patient's cells. Limited effectiveness and severe side effects of these drugs have led to the application of several alternative approaches.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Staples versus sutures for closing leg wounds after vein graft harvesting for coronary artery bypass surgery

Surgical wounds are usually closed by using either an interrupted or continuous suture using absorbable or non absorbable suture materials. Skin staples are an alternative to sutures and are usually used at the discretion of the surgeon. Skin wound closure with metallic clips is considered to be a fast and effective alternative to sutures. Furthermore, it is commonly believed that staples are less traumatic and may reduce wound complications. This makes the use of staples attractive as it may reduce the risk of postoperative wound complications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The role of allogeneic stem cell transplantation for patients with advanced stage primary cutaneous T‐cell lymphoma

Primary cutaneous T‐cell lymphomas (CTCLs) are a subgroup of blood cancers called non‐Hodgkin lymphomas. CTCL is usually seen first in the skin. It is characterised by an uncontrolled increase in T‐lymphocytes, which are a special kind of white blood cell. Most people who get the disease are older than 60 years of age. Compared to other T‐lymphocyte diseases, this type usually progresses slowly. The likely course and outcome of the disease is also better for this type of cancer. However, there is still no cure yet. The most common subtype of CTCL is Mycosis fungoides (MF) which typically grows slowly in the early stages. However, approximately 20% of people in early‐stage of the disease will get worse and progress to tumour stage or develop a type of leukaemia called Sézary syndrome. Most of these people are then subjected to chemotherapies to kill off the cancer cells. The chemotherapy may involve one or more drugs (known as monochemotherapy or polychemotherapies). Although some patients respond well at the beginning of treatment, the disease often returns and life expectancy is uncertain. Furthermore, many patients can experience severe side effects from the treatment. In the last few years, several publications have reported durable responses following a procedure called allogeneic stem cell transplantation (alloSCT). This is when the patient receives a transplant of stem cells from another donor. Before the transplant begins, the patient undergoes treatment to reduce the size of the tumour. This is called full‐intensity or reduced‐intensity conditioning (RIC). Reduced‐intensity conditioning allows the patient to avoid the standard regimes of high‐dose therapy. It appears to be equally effective but with significantly less toxicity. The use of reduced‐intensity conditioning means that older people, who are the majority of patients with this disease, can be treated with stem cells.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Chronic wounds: Venous leg ulcers: Do skin grafts help?

There are a number of different types of skin grafts that can be used to treat leg ulcers caused by venous insufficiency. There is a lack of research on most of them, but some studies suggest that bilayer artificial skin made from human cells can improve the likelihood of venous leg ulcers healing within six months.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 23, 2015

Treatment for POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M‐protein, and skin changes)

POEMS syndrome is a rare disorder of the blood which can cause a polyneuropathy (nerve symptoms such as numbness, tingling, pain, and muscle weakness) but can also involve many of the organs of the body, causing enlarged organs or organomegaly (usually liver, spleen, and lymph nodes), changes in hormone production or endocrinopathy (gynecomastia in men), abnormal blood protein (M‐protein), and skin changes such as increased pigmentation or skin thickening. Its cause is not known. The quality of life of people with POEMS deteriorates because of progressive neuropathy, and accumulation of fluid in the limbs or in the abdominal cavity or cavity around the lungs. It is a potentially fatal disease, and serious complications can arise due to multiorgan failure. There is no established treatment regimen, but potentially effective treatments that have been tried include chemotherapy, irradiation, corticosteroids, thalidomide or lenalidomide, and blood stem cell transplantation. This review found no randomized controlled trials of treatments for POEMS syndrome. Prospective treatment trials are needed to establish the relative values of different treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Skin grafting and tissue replacement for treating foot ulcers in people with diabetes

Foot ulceration is a major problem in people with diabetes and is the leading cause of hospital admissions and limb amputations. Despite the current variety of strategies available for the treatment of foot ulcers in people with diabetes, not all ulcers heal completely. Additional treatments with skin grafts and tissue replacement products have been developed to help complete wound closure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Stem cell transplantation for treating cancer

Stem cell transplantation is used in treating the various forms of blood cancer, for instance leukemia. It is a very strong, high-dose form of chemotherapy that destroys the stem cells in our bone marrow. The body is then immediately provided with healthy stem cells via the blood, which settle in the bone marrow and produce fresh blood cells.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 12, 2013

Skin puncture versus exposing the femoral artery for minimally invasive repairs of abdominal aortic aneurysms

Abdominal aortic aneurysms are a ballooning of the largest blood vessel in the abdomen, the abdominal aorta, due to weakness of the vessel wall. This ballooning may lead to life threatening rupture. Repair of the aneurysm is recommended if it is felt to pose a significant risk. All repairs involve putting in an artifical graft, a tube composed of fabric, to help reinforce the artery wall. There are two main methods for repair. One is an open technique in which the whole abdomen is opened and the graft is put inside the blood vessel. The other technique is an endovascular aneurysm repair. With this technique the graft is fed into the abdominal aorta through an artery in the groin (the femoral artery) and it avoids the large abdominal incision. This review looked at an alternative method for introducing the graft into the femoral artery, percutaneous access. Instead of making an incision in the groin to expose the femoral artery (a cut‐down), a small hole is made in the skin and then a needle with a plastic tube sitting over it is introduced into the femoral artery. Once introduced, the needle can be pulled back up the tube leaving the tube in place in the artery. The graft and all other materials can then be fed into the artery via the plastic tube. Once the procedure is complete the tube can be withdrawn. The surface incision can usually be closed with one stitch.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Bone grafts and bone substitutes for treating distal radial fractures in adults

A 'broken wrist' (from a fracture at the lower end of the two forearm bones) often results from a fall onto an outstretched hand in older adults and from high‐energy trauma, such as a road traffic accident, in young adults. Surgery may be considered for more seriously displaced fractures. Surgical treatment can involve the implantation of bone scaffolding materials (bone grafts and substitutes) into bony defects that may affect the stability of the fracture fragments after they have been put back into place.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence following bladder surgery

The normal urinary bladder is a hollow muscular organ that lies deep in the pelvis. It functions through the balanced activity of many inter‐related nerves and muscles that contain or empty urine as needed. If the bladder has been damaged by disease, surgery can be performed to divert the urine from the bladder (urinary diversion), to reconstruct the bladder or to replace the bladder with intestinal segments. The review did not find enough evidence from trials to show which surgical options are the most effective. One small trial suggested that the ileum bowel segment (small bowel) may be better compared to ileocolonic bowel segment (combination of small and large bowel) for night time incontinence. More research is needed to determine the most effective surgical methods for urinary diversion, reconstruction or replacement of the urinary bladder that has been damaged by disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Negative pressure wound therapy for treating leg ulcers

Leg ulcers are wounds that occur between the ankle and the knee as a result of poor blood flow in the legs. These wounds are relatively common often affecting older people. There are several different treatments for these ulcers and the underlying problems that cause them. Negative pressure wound therapy (NPWT) is a treatment currently beng used for wounds including leg ulcers. NPWT involves the application to the wound of a dressing to which a machine is attached. The machine then applies a carefully controlled negative pressure (or vacuum), and sucks any wound and tissue fluid away from the treated area into a canister.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Steroid avoidance or withdrawal for pancreas and pancreas with kidney transplant recipients

People with type 1 diabetes and kidney failure have a poor survival. In the clinical course, they suffer from several diabetic vascular complications and usually have progressive kidney impairment. Pancreas transplantation improves survival and quality of life and controls blood glucose without the need for insulin therapy, making pancreas with kidney transplantation the treatment of choice in most patients with type 1 insulin‐dependent diabetes and kidney failure. More than 95% of transplant recipients are treated with steroids as part of their immunosuppression. Steroid treatment has complications including: hypertension, hyperglycaemia or hyperlipidaemia, increase risk of infection, obesity, cataracts, muscle disease, bone metabolism alterations and skin problems. However, without adequate immunosuppression, transplant patients are at risk of transplant rejection and transplant failure. This review looked at two strategies ‐ steroid avoidance and steroid withdrawal ‐ to investigate their impact on short‐ and long‐term outcomes. These strategies could be used in adults in the first few days after transplantation when used in combination with more powerful immunosuppressive agents. Twenty‐one studies were identified and evaluated in this review although only three RCTs enrolling 144 participants met our inclusion criteria. Steroid avoidance and steroid withdrawal strategies in pancreas and pancreas with kidney transplantation were not apparently associated with increased mortality, graft loss or acute rejection, although more studies are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

What are the treatment options for chronic wounds?

At first, chronic wounds are regularly cleaned and covered using wound dressings and bandages. If a wound still has not healed after a long time, special treatments such as vacuum-assisted closure or skin grafts are used.If someone has a wound for a long time without any signs of healing, it is considered to be a chronic wound. Chronic wounds usually arise as a result of poor blood circulation, diabetes or a weak immune system.As well as tending to the wound, pain relief is important. Some people with complex, poorly healing wounds find psychological support helpful too.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 23, 2015

Surgery for Dupuytren's disease of the fingers

We conducted a review of the effects of surgery for people with Dupuytren’s disease of the fingers and found 13 studies with 940 participants; 93 participants were reported twice in separate articles describing early and late outcomes of one trial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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