Practice Innovations
An entropic, wound state ensues when this physiology stalls at the inflammatory phase preventing the wound from entering the proliferation phase where the myofibroblast elaborates elastin and collagen increasing granulation tissue density with its attendant microcirculation.(1)
Micro-needling leads to the release of growth factors forming new collagen and elastin in the papillary dermis in addition, new capillaries are formed. This procedure is aptly called "percutaneous collagen induction therapy.(2-3) It has also been described that utilizing autologous whole blood as an advanced wound dressing increases healing times with proven clinical efficacy.(4) Interlacing these two methodologies describes the m-perforation technique presented here.
Methods:
Approaching an entropic ulceration, clean and prep using a skin neutral hypocholorus acid solution dwelling for 2 minutes. In a quilted pattern regular, consistent microperforations are created within the wound base using a 25G hypodermic needle or stamping a synthetic hook array of on average 25 evenly (1 mm) separated sickle-hooks mounted on a round, convex applicator platform tip.(5) Micropunctate bleeding constructs an in situ autologous whole blood clot in the wound base. Biologics may then be applied per their respective indications for use. A sterile secondary dressing is applied. Repeat weekly until a confluent layer of epithelial cells develops.
Results:
The cost of a 25G single microneedle is $0.04 while the hook array device averages under $5.00, and the method shall approximate the cost of a typical E&M code for a wound visit; average $75. This technique is tissue preserving and does not require the volume of phlebotomized blood seen with the previously described whole blood advanced wound dressing technique.(4)
Discussion:
Reduction in utilization costs and increased clinical efficacy should be the two biggest value propositions of any advanced wound care modality or dressing. Wound m-perforation offers both. The authors also propose that the aforementioned methodology will improve the bioavailability of extracellular matrix substrates and cellular bases tissue products used for entropic wound states, and facilitate graft adherence and engraftment. Additionally this method reduces the removal of viable and proliferating cells that would otherwise be extricated using curettage.
Gross studies are required to further elucidate the velocity by which neodermal regeneration occurs following deployment and will be the authors next venture.
Trademarked Items: SoftBiopsy® with Kylon® hook array tip
m-Perfarray TM methodology
References: 1.https://www.woundsource.com/sites/default/files/whitepapers/using_the_entropic_wound_cycle_as_the_basis_for_making_effective_treatment_choices.pdf
2. Bhardwaj, D. (2013). Collagen Induction Therapy With Dermaroller. Community Based Medical Journal, 1(1), 35–37. https://doi.org/10.3329/cbmj.v1i1.13854
3. https://onlinelibrary.wiley.com/doi/full/10.1111/exd.12723
4. https://reddressmedical.com/wp-content/uploads/2021/04/ActiGraft-Brochure_Digital_v10.pdf
5. Winter et al. Fabric-Based Exocervical and Endocervical Biopsy in Comparison with Punch Biopsy and Sharp Curettage, Journal of Lower Genital Tract Disease - 2012 Apr; 16(2):80-7