DoD Funds Pilot Wound Closure Study at Grady
The Department of Defense (DoD) is funding a pilot wound closure study based at Grady Memorial Hospital entitled "The effect of inflammatory biomarker expression on decisions to close traumatic wounds." Dr. Christopher Dente, associate professor of surgery of the Emory University School of Medicine and a surgeon-researcher-educator in the trauma/surgical critical service service at Grady, is the principal investigator. The study is the first of its kind in the country at a civilian medical center.
While outcomes in wound care have improved due to such methods as serial debridement and vacuum-assisted closure devices, decisions regarding the optimum timing of wound closure have remained subjective. The need for standardization of this sensitive treatment stage has been underscored by recent military conflicts, where U.S. military surgeons have had to grapple with large numbers of traumatic and extreme combat injuries. Complications that can follow inappropriate closure include wound breakdown and secondary infections.
To address this issue, the Naval Medical Research Center (NMRC) of the DoD has developed an algorithm based on objective criteria for guiding the decision to close a wound. The criteria itself was derived from the collection and analysis of tissue and blood from military patients over time and the subsequent identification of chemical and molecular biomarkers that appear to predict successful closure.
The Grady-based study hopes to lead to the development of a similar system in the civilian medical setting. Samples from Grady patients will primarily be acquired during routine surgical debridements, after which they will be examined for the presence of the same biomarkers used as indicators for closure in military patients. "Ideally, we'll acquire an understanding of the similarities and differences between civilian and military wounds and then be able to use either the NMRC's mathematical model or create one of our own," says Dr. Dente. "The best result is that we could then enact a predictive system that would greatly improve patient care in the future."
The viability of the Grady-based study is enhanced by the fact that the patient volume of the Atlanta hospital makes it an ideal center for tissue collection. "We treat more than 100 patients a year in our level I trauma center with the types of severe wounds that are comparable to critical battle injuries," says Dr. Dente. "The study is approved for three years, so I’m confident that we will acquire enough informed consent-derived tissue and fluid samples to work with.'
The study will involve processing and storage of samples at the tissue bank of the Emory Transplant Center and the collaborative interpretation of data with NMRC researchers.