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Pearls and Pitfalls
in Skin Ulcer
Management
Michele Maruccia
Giovanni Papa
Elia Ricci
Giuseppe Giudice
Editors
123

Pearls and Pitfalls in Skin Ulcer
Management

Michele Maruccia
Giovanni Papa • Elia Ricci
Giuseppe Giudice
Editors
Pearls and Pitfalls in Skin
Ulcer Management

Editors
Michele Maruccia
Unit of Plastic and Reconstructive
Surgery, Department of Precision and
Regenerative Medicine and Jonic Area
University of Bari
Bari, Italy
Elia Ricci
Difcult Wound Healing Unit
Policlinico di Monza
Vercelli, Italy, Italia
Giovanni Papa
Plastic Surgery Unit
University of Trieste, Cattinara Hospital
Trieste, Italy
Giuseppe Giudice
Plastic and Reconstructive Surgery
University of Bari Aldo Moro
Bari, Italy
ISBN 978-3-031-45452-3 ISBN 978-3-031-45453-0 (eBook)
https://doi.org/10.1007/978-3-031-45453-0
The volume editors and authors gratefully thank professor Chiara Fedele from the University
Aldo Moro (Bari, Italy) for the English language review of the book.
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
whether the whole or part of the material is concerned, specically the rights of translation,
reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any
other physical way, and transmission or information storage and retrieval, electronic adaptation,
computer software, or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Paper in this product is recyclable

Preface
https://t.me/medicina_free
Wound care presents various challenges and complexities, requiring a multidisciplinary approach with input from specialists in different elds. While
some wounds heal quickly with minimal intervention, others can become
chronic and lead to complications such as infections, delayed healing, and
amputations.
To address the needs of healthcare professionals involved in ulcer management, a team of world experts in the eld has compiled Pearls and Pitfalls in
Skin Ulcer Management. This is a comprehensive guidebook, with the participation of experts from two major Italian recognized scientic societies
(approved by the Ministry of Health) specializing in chronic ulcers, wound
healing, and plastic, aesthetic, regenerative, and reconstructive treatments:
AIUC (Italian Association for Cutaneous Ulcers) and SICPRE (Italian
Society of Reconstructive, Regenerative Plastic Surgery). The book covers all
aspects of wound care and is divided into eight main parts.
Part I provides an introduction to wound care, including cleansing, antiseptics, and local treatment. The second part covers dressing and bandages,
discussing the different types, their advantages and disadvantages, and indications for their use. Part III discusses instrumental treatments, including
hydrosurgery, negative pressure wound therapy, and photobiomodulation.
Regenerative medicine and tissue bioengineering, including the use of
growth factors and stem cells, are covered in Part IV.Measurement and documentation, infection in wound care, the role of plastic surgery, and other
aspects of ulcer management are discussed in Parts V through VIII.
Each chapter includes practical tips, case studies, and real-world examples
to help readers apply the information to their own practice. The book’s goal
is to be a practical and accessible resource for healthcare professionals at all
levels of experience. It is a valuable “survival manual” for the management of
complex wounds and ulcers and may inspire collaboration among different
specialties to improve patient outcomes.
v

vi
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The authors extend their sincere gratitude to the contributors who made
this book possible, including the multidisciplinary team of experts and the
publisher. They hope that healthcare professionals will nd this book to be a
valuable addition to their library and an indispensable resource in their clinical practice.
Bari, Italy MicheleMaruccia
Trieste, Italy GiovanniPapa
Pecetto Torinese, Torino, Italy EliaRicci
Bari, Italy GiuseppeGiudice
Preface

Contents
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Part I Introduction to Wound Care, Cleasing,
Antiseptic and Local Treatment
1 Vulnology (Also Known as Wound Care): History
and Myths of Chronic Wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Elia Ricci and Monica Pittarello
2 Aetiology, Classification and Advocating for a Holistic,
Multidisciplinary Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Alessandra Michelucci, Giammarco Granieri, Valentina Dini,
and Marco Romanelli
3 Anatomical Base for Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Iris Zalaudek and Michele Pauluzzi
4 Wound Hygiene: From Traditional to Microenvironment
in Cleansing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Arturo Caniglia
5 Principles of Antiseptic Treatments . . . . . . . . . . . . . . . . . . . . . . . . 33
Elisabetta Iacopi, Francesco Giangreco, and Alberto Piaggesi
6 The TIMEH Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Claudio Ligresti
Part II Dressing and Bandages
7 Ulcer Debridement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Tedeschi Pasquale and Michele Maruccia
8 Advanced Moist Wound Dressing: Classification
by Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Alessandro Greco, Mastronicola Diego, Natascia Mennini,
and Magnoni Cristina
9 Dressing: Indications on Applications . . . . . . . . . . . . . . . . . . . . . . 89
Gianmarco Turriziani, Federico Lo Torto, and Diego Ribuffo
10 Dressing in Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Antongiulio Mangia, Agostino Rodda,
and Antonio Di Lonardo
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viii
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11 Innovative Dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Evelin Makuc
12 Compression Therapy in Ulcer Care . . . . . . . . . . . . . . . . . . . . . . . 123
Giovanni Mosti
Part III Instrumental Treatments in Wounds
13 Scientific Principles and Clinical Application
of Negative Pressure Wound Therapy (NPWT) . . . . . . . . . . . . . . 141
Franco Bassetto and Scarpa Carlotta
14 Latest Applications of Negative Pressure Wound Therapy . . . . . 149
Laura Torrano, Susana López, and Gemma Pons
15 Electrical Stimulation in Wound Care . . . . . . . . . . . . . . . . . . . . . 155
Elia Ricci
16 Phototherapy in Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Fabrizio Malan
17 Laser in Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Elia Ricci
18 Treatment of Chronic Wounds and Ulcers
with Focused and Defocused Shock Waves . . . . . . . . . . . . . . . . . . 175
Raoul ul Saggini, Rosa Grazia Bellomo, and Andrea Saggini
Contents
19 Hydrosurgery in Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Ferdinando Campitiello
20 Ultrasound in Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Alessandro Scalise, Ortensia Pirro, Cesare Foggetti,
Marina Pierangeli, Matteo Torresetti,
and Giovanni Maria Di Benedetto
21 Topical Oxygen in Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Harikrishna K. R. Nair
Part IV Regenerative Medicine and Tissue Bioingeneering
22 Evidence-Based and Clinical Experimentation
on Cell Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Andrea Ferrari, Chiara Stocco, Roberta Bulla,
Serena Zacchigna, and Giovanni Papa
23 Bioinductive Dressing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Francesco D’Andrea and Francesca Mosella
24 Skin Substitutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Vito Cazzato, Grace Marchi, Maria Giulia Spazzapan,
and Giovanni Papa

Contents
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ix
25 Mesenchymal Cells from Adipose Tissue . . . . . . . . . . . . . . . . . . . 263
Paolo Persichetti, Giovanni Francesco Marangi, Carlo Mirra,
Marco Gratteri, and Lucrezia Arcari
26 Peripheral Blood Mononuclear Cells . . . . . . . . . . . . . . . . . . . . . . 273
Sara Carella and Maria Giuseppina Onesti
27 Platelet-Rich Plasma (PRP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Valerio Cervelli and Andrea A. Pierro
28 Minimal Invasive Modality (MIMo) in Burn Wound Care . . . . . 299
Alessio De Cosmo, Giuseppe Di Gioia, Giulio Maggio,
and Giuseppe Giudice
29 Thermal Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Albin Stritar and Marko Mikša
Part V Measurement and Documentation
30 Imaging and Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Jacopo Secco
31 Wound Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Valentina Dini and Giammarco Granieri
32 Telemedicine and Artificial Intelligence . . . . . . . . . . . . . . . . . . . . 347
Michele Blasina, Martina Pangos, and Sergio Pillon
Part VI Infection in Wound Care
33 Infection Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
Giovanni Papa, Paola Pini, Stefano Di Bella,
and Giulia Benedetta Sidoti
34 Classification of Wound Infections . . . . . . . . . . . . . . . . . . . . . . . . 369
Matteo Bassetti, Antonio Vena, and Nadia Castaldo
35 Infected Wound Bed Management: The Diabetic Foot . . . . . . . . 385
Giacomo Clerici, Fabrizio Losurdo, Andrea Casini,
Iulia Valeria Rusu, and Robert G. Frykberg
36 Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Giovanni Vicenti, Guglielmo Ottaviani, and Biagio Moretti
Part VII Plastic Surgery: When and How
37 Grafting and Micrografting in Wound Care . . . . . . . . . . . . . . . . 417
Alberto Bolletta, Davide Di Seclì, Mirco Pozzi,
and Emanuele Cigna

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38 Surgical Debridement in Wound Care . . . . . . . . . . . . . . . . . . . . . 429
Stefano Bottosso, Silvia Pasquali, Riccardo Ricci,
and Zoran M. Arnež
39 Reconstructive Options in Wound Care:
From Simplest to Most Complex . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Marco Pappalardo, Francesca Lolli, Melba Lattanzi,
and Giorgio De Santis
40 Surgical Indications in All Diagnostic
and Care Pathways (DTCP) Settings . . . . . . . . . . . . . . . . . . . . . . 453
Emanuele Cammarata, Francesca Toia, Antonino Speciale,
Martina Maltese, Tiziano Pergolizzi, and Adriana Cordova
41 Microsurgery in Wound Healing . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Joon Pio Hong and Asli Datli
42 Advanced Reconstruction in Wound Care . . . . . . . . . . . . . . . . . . 481
Hung-Chi Chen and Burak Kaya
43 Lower Limb Ulcers: Clinical and Diagnostic Workout . . . . . . . . 499
Vittorio Ramella, Martin Iurilli, Alessia De Grazia,
and Laura Grezar
Contents
Part VIII Ulcer Management Further Issues
44 Wound Care in Aesthetic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 511
Valeriano Vinci, Riccardo Di Giuli,
Ana Paula Fontoura Andrade Reis, and Marco Klinger
45 Correction of Postural Deficit Promoting Lower Limb
Hemodynamics, for Feet Proprioceptive Stimulation . . . . . . . . . 523
Gianluca Bernabei
46 Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Angela Peghetti, Roberta Seri, Enrica Cavalli,
and Valentina Martin
47 Nutrition and Metabolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571
Lucilla Crudele, Marica Cariello, and Antonio Moschetta
48 Diabetic Foot Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581
Irene Caruso, Anna Leonardini, Francesca Guarini,
Mattia Bernardis, Luca Cellamare,
Ilaria Immacolata Matichecchia, Rebecca Annicchiarico,
Aurelia Bellomo Damato, Luigi Laviola,
and Francesco Giorgino
49 Ozone Therapy in Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 593
Fabio Sallustio, Marco Fiorentino, Paola Pontrelli,
Mariagiovanna Di Chiano, Annalisa Casanova,
Nicla Campobasso, and Loreto Gesualdo
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