Contact Sensitization in Patients with Chronic Leg Ulcers: Results of a 5-Year Retrospective Analysis OBJECTIVES To determine the frequency of contact sensitization among patients with chronic leg ulcers; to identify the most common allergens; and to examine possible relationships to ulcer duration, itching, exudate, and leg eczema. METHODS Researchers conducted a 5-year retrospective analysis of 145 patients diagnosed with chronic leg ulcers who underwent skin patch testing with S-1000, LU-1000, and the commonly used dressing and antiseptic series. RESULTS Investigators included 88 females (60.7%) aged 64 ± 15.1 years and 57 males (39.3%) aged 61 ± 16.4 years. Of these, 62.8% (n = 91) of patients were sensitized to at least one substance (2.6 ± 1.4 allergens on average). The most common allergens were benzalkonium chloride (18.6% [n = 27]), balsam of Peru (17.9% [n = 26]), and povidone-iodine 10% (17.2% [n = 25]). Finally, 40% (n = 58) of patients presented with pruritus around the ulcer, which was strongly associated with a positive patch test reaction (74.1% [n = 43] vs 55.2% [n = 48]; P = .021) and polysensitization (3.5 sensitivities [95% confidence interval, 2.4–4.6] vs 2 [95% confidence interval, 1.2–2.8]). CONCLUSIONS Contact sensitization is very common in patients with chronic leg ulcers, and pruritus around the ulcer is associated with contact allergy as well as polysensitization. The authors have disclosed no financial relationships related to this article. Submitted October 7, 2018; accepted in revised form December 11, 2018. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pediatric Tracheostomy Wound Healing: A Retrospective Cohort Study OBJECTIVE To compare wound products by measuring time to granulation tissue and time to complete wound healing for tracheostomy wounds in the pediatric population. METHODS Investigators identified 134 charts of patients treated January 2013 and June 2017; 93 charts met the inclusion criteria. This study compared the use of a foam dressing (n = 34) to the foam dressing plus a wound filler (n = 59) in patients who developed or were admitted with a wound caused by a tracheostomy device. PRIMARY OUTCOME MEASURES Time in days to granulation tissue and to wound closure. RESULTS The average time to complete wound closure for participants in this study was 14 days. There was no statistically significant difference in time to granulation tissue or wound closure formation between the wound care products (F2,34 = 1.11, P = .34). Cluster analysis (10 splits) revealed that pressure injury stage was the best predictor, accounting for 41% of the variance in the high treatment response group (those healing in <14 days). Patients who were African American with a stage 2 pressure injury, had a PUSH score of 5 or more, and were using a foam plus a wound filler dressing were 86% more likely to be in the high-response group. CONCLUSIONS All wounds reviewed healed with current wound care practices without surgical intervention. Best practice for healing tracheostomy wounds in pediatric patients should include the wound filler in the first 14 days based on variable interaction. Acknowledgment: Drs Yates and Lowe disclose that they have received an unrelated pilot grant from the National Institute of General Medical Sciences, IDeA Program Award P30 GM 110702. The authors have disclosed no other financial relationships related to this article. Submitted November 30, 2018; accepted in revised form January 18, 2018. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Filling in the Gaps of Scleroderma Ulcer Care: A Review Digital ulcers are a serious complication in 50% of patients with scleroderma. These ulcers have the potential to resist conventional therapies. There have been several reviews of scleroderma care over the last 5 years, but there are new developments in this field that advance clinician knowledge. This review provides an overview of previous digital ulcer management and a concise summary of new peer-reviewed literature on the topic since 2015 to provide guidance to practitioners and researchers seeking well-supported and novel/off-label therapies to consider. The authors have disclosed no financial relationships related to this article. Submitted December 1, 2018; accepted in revised form January 29, 2019. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Health Economic Impact of Living Cell Tissue Products in the Treatment of Chronic Wounds: A Retrospective Analysis of Medicare Claims Data OBJECTIVE To investigate differences in wound-related costs; product waste; lower-extremity amputations; and number of applications, hospitalizations, and emergency room visits among patients treated with three cellular and/or tissue-based products. METHODS This retrospective intent-to-treat matched-cohort study analyzed the full Medicare claims dataset from 2010 to 2014. Patients who received either a bilayer cellular construct (BLCC), dermal skin substitute (DSS), or cryopreserved human skin allograft (CHSA) were concurrently matched for Charlson Comorbidity Index, age, sex, and region. Key variables were reported at 60, 90, and 180 days after the first product application. RESULTS There were no statistically significant differences in the distribution of Charlson Comorbidity Index, age, sex, and region among cohorts (n = 14,546). Wound-related costs and product wastage were lower for CHSA patients relative to both BLCC and DSS patients at all time intervals, and those treated with CHSA received fewer product applications than DSS at 90 and 180 days (P < .05). Amputations were significantly higher among patients treated with DSS than either CHSA or BLCC (P < .0001). CONCLUSIONS The data demonstrate that wound-related costs, product waste, amputations, and frequency of applications are lower for CHSA than DSS. Wound-related costs and product waste are lower for CHSA compared with BLCC. Further claims analysis and prospective clinical trials are needed. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.