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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Negative Pressure Wound Therapy: A Pilot Study
Correspondence Address :
Sachin Upadhyay,
622, Poonam Sneh Nagar, State Bank Colony, Jabalpur, Madhya Pradesh, India.
E-mail: drsachinupadhyay@gmail.com
Introduction: Impaired wound healing has a significant socio-economic impact. The introduction of Vacuum Assisted Closure (VAC) has been one of the major breakthroughs in the management of nonhealing wounds owing to its property of granulation tissue formation via effects related to local sub atmospheric pressure and fluid drainage.
Aim: To study the efficacy of Negative Pressure Wound Therapy (NPWT) in wound healing.
Materials and Methods: A pilot study was performed on 50 patients out of which 41 were males 82% and 9 were females (18%) with chronic non healing wounds of different aetiologies between the age of 15-70 years. Eligible patients were treated with NPWT at two days interval for an average of two dressings. Patients were evaluated after two dressings for appearance of granulation tissue, reduction in wound size and decrease of bacterial load in the wound. Paired t-test and Chi-square tests were used. The p<0.05 was considered significant.
Results: The use of NPWT in different types of open wounds, pressure sores, postoperative wounds resulted in reduction of wound size (p-value=0.001), infection rate (p-value=0.001) within a week after two dressings to finally be closed with split skin grafting or secondary suturing.
Conclusion: NPWT dressing is a safe, reliable intervention for patients with chronic wounds associated with impaired wound healing, particularly with wounds larger in surface area which requires closure by split skin grafting or musculocutaneous flaps.
Infected wound, Non healing wound, Vacuum assisted closure
Impaired wound healing causes significant socio-economic impact to the healthcare sector and society at large. There is a plethora of wound care techniques (moist wound healing dressings, platelet rich plasma therapy etc.,) advocated for impaired healing (1),(2),(3),(4),(5). However, none of these are universally reliable. Moist wound healing dressings require a long duration for the wound to heal. Similarly, platelet rich plasma therapy requires multiple injections of autologous plasma which is quite painful for the patients and quite a cumbersome procedure for the clinicians too (6). Therefore, impaired healing or nonhealing wounds remain a challenging problem in current practice.
Currently, there is a focus on negative pressure therapy for the treatment of nonhealing ulcers (7),(8). The introduction of Vacuum Assisted Closure (VAC) has been one of the major breakthroughs in the management of nonhealing wound. It hastens granulation tissue formation by stimulating local angiogenesis (9). The primary objective of present study was to assess the potential therapeutic effects of negative pressure therapy as VAC in the healing of wound.
A pilot study with prospective cohort design was performed in Department of Orthopaedic, Traumatology and Rehabilitation, Netaji Subhash Chandra Bose Medical College Jabalpur, Madhya Pradesh, India from December 2018 to October 2020. Informed consent was obtained from each subject. Institutional Ethical Comittee clearance for the study was obtained with number IEC/2021/2824.
Inclusion criteria: All participants aged 15-70 years of either sex having chronic ulcers or nonhealing wounds; ulcers of various aetiologies (lacerated wounds associated with open fractures, amputation wounds, diabetic foot ulcer, post operative wounds and bed sores) were included.
Exclusion criteria: Patients with vascular injury, severe head injury, uncontrolled blood sugar in patients with diabetes mellitus and patients with coagulopathies, were excluded from the study.
Eligible patients were treated with NPWT with an average of two dressings at an interval of 48 hours. Thorough debridement of the wound was done. An open cell structured sponge was cut to fit the size of the wound adequately and placed inside wound cavity. This foam was next covered by a transparent adhesive layer which extended and adhered, to the skin surrounding the wound. This seal was broken at a single point where a drain was placed to allow direct contact to the underlying foam. The other end of the drain was connected to a vacuum machine for the drainage of the fluid away from the wound (Table/Fig 1)a-d.
Statistical Analysis
Data was analysed by descriptive statistics such as mean, standard deviation Paired t-test and Chi-square tests were used. The p-value <0.05 was considered statistically significant. Data was entered in Microsoft (MS) Excel and analyzed by SPSS Version 24.0.
Among the included patients 41 (82%) were males and 9 (18%)were females with a mean age of 39.14±13.38 years. In this study, different types of wounds were treated with VAC. Of these, the majority of cases were bed sores (44%, n=22). Open wounds comprised 40% of the total cases (n=20), post operative infected wounds were in 14% (n=7) and a single case had diabetic foot (Table/Fig 2). Before dressing, culture of the 40% (n=20) of the wounds showed no growth of organism. After two VAC dressings, most of the wounds 92% (n=46) did not show any growth (Table/Fig 3). Thus, NPWT decreased the infection rate by almost 82%. The mean predressing wound size was 18.08±17.70 cm2. After application of VAC dressing the mean wound size was observed to be 16.07±16.55 cm2 (p-value 0.001), after four days (Table/Fig 4). The area of the wound size reduced at an average of 0.5 cm2 per day. Of the 50 patients included in this study, 50% (25) wounds required closure by split skin grafting, 42% (21) wounds healed by secondary closure and rest of the 8% (4) healed by flap closure (Table/Fig 5). Few images of the cases are illustrated in (Table/Fig 6), (Table/Fig 7).
This study aimed to evaluate the response of chronic non healing wounds toward NPWT. The overall findings showed that NPWT is a viable option for such chronic wounds. It helps in granulation tissue formation and also reduces the microbial burden on the wound (9).
Study done by Fleishmann W et al., showed no infection in patients except one which was due to insufficient sealing of the wound (10). When the correct technique was applied the infection cleared up. In our study, we also found that out of 50 patients granulation tissue appeared in all of the patients and space reduced by almost 82% after two VAC dressings. Contrary to our findings Costa ML et al., found no difference in the number of surgical site infections or other complications at any point in the 12 months after surgery (11). Probably, it was due to their faulty sealing technique of the wound.
Several studies (12),(13) also showed that a definitive closure technique like secondary suturing, split skin grafting or musculocutaneous flap was required after VAC dressing in which adequate granulation tissue has appeared. These findings is in concordance with the present study findings. Philbeck TE Jr et al., showed that the healing can be enhanced with NPWT that accelerated granulation tissue formation and decreased wound size at an average of 0.23 cm2 per day in pressure ulcers (14). Mullner T et al., treated 45 patients with bed sores, open and infected compound wounds after rigid stabilisation of lower extremity fractures using vacuum sealing technique (15). Total 84% of the patients treated with the VAC showed decrease in the size of the initial wound, and quicker healing and the removal of any associated infection. Wound closure by granulation, secondary closure, or split thickness skin grafting was achieved in 35 wounds. Thus, they concluded that VAC is an effective option in the management of infected wounds. In this study, wound closure was achieved in 100% of the patients, of which 50% (25) wounds healed by secondary closure, 42% (21) wounds healed by SSG and rest of the 8% (4) healed by flap closure.
Hou Z et al., studied 32 patients in his study with Gustilo type IIIB open tibia fractures which were applied VAC therapy (16). All wounds closed after being treated with the primary VAC closure. The average time required for definitive intervention was 10.9 days. Eleven patients out of 32 developed infections. The infection rate increased significantly in patients who underwent flap coverage after more than 7 days of injury. In our study, flap closure was required in only 8%(4) of the wounds. It was probably due to lesser area of the wounds and lesser soft tissue loss in the wounds included in our study. Stannard JP et al., treated 62 severe high-energy open fractures which were all treated with initial irrigation and debridement every 48-72 hours until wound closure (17).
Interval NPWT was used in 37 fractures and 25 were subjected to standard fine mesh gauze dressing. The NPWT group had significantly less infections than the control group. These findings were in concordance with the present study findings. Sinha K et al., studied 30 open musculoskeletal injuries to NPWT dressings that was changed every 3-4 days versus standard daily dressings (18). Measurements were taken at day 4 and day 8 after initial debridement. In the NPWT group, a significant reduction in wound size was observed over the eight days (mean 13.24 mm versus 3.02 mm, p=0.0001). Reduced bacterial load by day 8 (60% no growth versus 20%), as well as a significant increase in angiogenesis, granulation tissue and fibrosis was also noted. These findings were in agreement with the present study findings. Lee HJ et al., in his study included 16 patients with open wounds in the foot and ankle region with exposed tendon or bone (19). After debriding the wound properly NPWT was applied. The dressing was changed every 3-4 days for 11-29 days. He observed that 15 of the 16 patients healed by secondary intention (production of granulation tissue), and a single case required free flap. Infection was not seen in any of the case. A pilot study in 2015 was done at a paediatric burns Outpatient Department (OPD). Twenty children were included in the study with acute burns half were given a combination of NPWT and silver-impregnated dressings whilst the other half received silver dressings alone. It was found that the NPWT group exhibited moderately faster healing and reported lower pain scores (20).
Thus, it was observed that the outcome of this study was comparable to other similar studies done to assess the utility of negative pressure therapy in management of various wounds. Wounds treated with this therapy showed lower infection rates, significant decrease in wound size, and an overall lesser time for appearance of healthy granulation tissue, ultimately leading to quicker final closure of the wound.
Limitation(s)
The limtations of the present study included a small cohort and absence of any control group. Age was a confounding factor in this study.
In conclusion, NPWT remains a reliable, intervention for patients with chronic wounds associated with impaired healing, particularly with wounds larger in surface area which requires closure by split skin grafting or musculocutaneous flaps.
10.7860/JCDR/2021/48821.15127
Date of Submission: Feb 07, 2021
Date of Peer Review: Feb 26, 2021
Date of Acceptance: Apr 16, 2021
Date of Publishing: Jul 01, 2021
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 09, 2021
• Manual Googling: Apr 15, 2021
• iThenticate Software: May 28, 2021 (23%)
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