NewsWound digest Skin Integrity 7


Liposomal delivery of oleic acid a promising new approach to management of MRSA infections of skin for the future


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n This study was designed to evaluate a potential new approach to management of drug resistant Staphylococcus aureus, a major cause of both community-acquired and nosocomial infection


n This study assessed the in vitro antimicrobial activity and in vivo therapeutic efficacy of oleic acid in a liposomal formulation, as a bactericide against methicillin-resistant S. aureus (MRSA)


n Preliminary fluorescence binding studies were performed to confirm that liposomes containing oleic acid would fuse effectively with samples of MRSA in vitro. Further experiments were then carried out in which varying concentrations of oleic acid-loaded liposomes were incubated with a fixed amount of MRSA. Finally, the effect of oleic acid-containing liposomes on skin lesion development in mice infected with MRSA was studied


n The binding experiments revealed that liposomes containing oleic acid fused readily with the MRSA bacterial cell membrane


n The minimal bactericidal concentration of liposomes containing oleic acid, defined as the concentration required to kill 99.9% of the target bacteria, was found to be 12.5µg/ml.


n The authors reported an enhanced bactericidal effect (12-fold) of LipoOA versus free oleic acid, which they attribute to the rapid binding of liposomes to the bacterial membranes and a resulting “burst” of lethal oleic acid


n Treatment of the mouse model skin with oleic acid- containing liposomes preserved skin integrity in the presence of MRSA, whereas treatment with “bare” liposomes was associated with epidermal rupture and severe suppurative inflammatory infiltration in response to MRSA.


n Analysis of skin samples showed that use of liposomes containing oleic acid reduced the amount of MRSA 500-fold compared to when bare liposomes were administered


n The authors conclude that liposome delivery of oleic acid represents a highly promising potential antimicrobial strategy in the management of MRSA.


Huang C-M, Chen C-H, Pornpattananangkul D, Zhang L, Chan M, Hsieh M-F, Zhang L. Eradication of drug resistant Staphylococcus aureus by liposomal oleic acids. Biomaterials 32 (2011) 214e221.


39 Wounds International Vol 2 | Issue 1 | ©Wounds International 2011 8


An approach to improving management of Marjolin’s ulcer


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n The aim of this study was to define the aetiology, topography, histopathology and surgical management of Marjolin’s ulcer, an aggressive malignancy found in patients with compromised skin integrity of various origins including burns, chronic non-healing wounds and ulcers


n Marjolin’s ulcers occur commonly as squamous cell carcinoma; more rarely as basal cell carcinoma and melanoma. There is no universally accepted treatment protocol or prognosis for the condition


n The authors evaluated cases of the condition in 16 individuals (10 men and six women) treated at the Dicle University Department of Plastic, Reconstructive, and Aesthetic Surgery and Burn Center, Turkey, between May 2005 and December 2009. They assessed each case according to its aetiology, topography, and histopathology, established a surgical plan for management; and developed a treatment algorithm with the aim of improving management


n Study subjects were aged 32 to 85 years; over 90% of the participants had a history of ulcer of 30 years or more. Most lesions occurred on the leg (25%), gluteal region or trunk (each 18.7%), and the thigh, scalp or hand (each 12.5%)


n More than half of the Marjolin’s ulcers occurred following a burn (62.5%) and over a third after a scald (37%)


n Treatment required amputation in two cases with bone and joint involvement. In a further 14 cases, treatment involved tumour resection (with a minimum margin of 3cm) followed by partial-thickness skin grafting. Superficial inguinal lymph node dissection was performed in four cases with tumour in the thigh and a positive inguinal lymph node


n Squamous cell carcinoma was diagnosed post- operatively in 14 individuals, and basal cell carcinoma in two cases


n The authors found that over 80% of Marjolin’s ulcers occurred in patients in whom burn defects had not been repaired originally. In addition, most lesions were found in areas of the body in constant contact with clothing, leading them to conclude that chronic trauma is an important triggering factor


n The authors devised an algorithm ––for evaluation and treatment planning of Marjolin’s ulcers, and recommend that surgical planning based on recent literature needs to be carried out more intensively to improve prognosis.


Bozkurt M, Kapi E, Kuvat SV, Ozekinci S. Current concepts in the management of Marjolin’s ulcers: outcomes from a


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