In nature, trace element toxicities occur in all living organisms. The consequences of these toxicities have been described in crops, livestock and humans. In some instances, the toxicities are a direct consequence of the organism's position in the food chain and their environment, while in others, they are based upon genetic abnormalities resulting in physiological impairment.Nutrient toxicities in crops are more frequent for manganese (Mn) and boron (B) than for other nutrients. Manganese toxicity is found on acid soils in many parts of the world. Boron toxicities occur in irrigated regions where the well or irrigation waters are exceptionally high in B. Most other nutrient toxicities occur when large amounts of nutrients in question have been added in waste, e.g., sewage sludge. Crops grown near mines and smelters are prone to nutrient toxicities. Generally, the symptoms of toxicity in crops occur as burning, chlorosis and yellowing of leaves. Toxicities can result in decreased yield and/or impaired crop quality. Toxicity levels of trace elements range from 20 to 50 μg g^‐1 for copper (Cu) and B to several hundred μg g^‐1 for Mn, molybdenum (Mo) and zinc (Zn). With the exception of Mo, toxicity of other nutrients can be reduced by liming. Following recommended rates of fertilizers and the safe and controlled use of waste materials, such as sewage sludge and coal fly ash, should reduce metal loading and nutrient toxicity in crops. Use of crop species and genotypes less susceptible to toxicity are recommended where toxicity is suspected. Toxicities of trace elements in animals are caused by the consumption of either feeds or grazing on pastures with high contents of the element in question. Accidental excess applications of minerals in grain mixes or oral ingestions of elements have been described as causing toxicity. Some toxicities, e.g., of Mo result in deficiency of other elements such as Cu. Some of the most toxic elements for livestock include Cu, lead (Pb), mercury (Hg), Mo, and selenium (Se). Under certain conditions, toxicities of arsenic (As), cobalt (Co), fluoride (Fl), iodine (I), iron (Fe), Mn, and Zn have also been reported. Symptoms of toxicity have been described in detail in the animal section. Trace elements, when in excess quantities, accumulate chiefly in the blood, liver, and kidneys. Measures of control for various trace element toxicities include removal of animals from affected areas or removal of the source of toxicity; gastric lavage and the specific use of oral doses of salts and chelates depending upon the element in question. Trace element/metal toxicities in humans are not common under normal conditions. Most toxicities are caused by environmental and/or genetic abnormalities, from excessive intake, by deliberate or accidental overdose, or from induced deficiencies (e.g. excess Zn causing Fe deficiency). Among the elements causing relatively frequent cases of toxicity are Pb, cadmium (Cd), Hg, Cu, Zn, and Fe. Selenium toxicity is generally limited to those areas/regions of the world, e.g. in certain parts of China, where soils with abnormally high Se content produce food crops containing highly toxic Se concentrations. Effective measures to control metal toxicities include gastric lavage, resuscitation, and the use of chelating agents in the acute phase. Protective legislation against the use of metal alloy utensils used for cooking is the long‐term control strategy.

Effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy (NPWT) is a well‐established advanced therapy that has been successful in adjunctive management of acute and chronic wounds. In recent years, the introduction of topical wound solution delivery in combination with NPWT has provided further benefits to wound healing. A commercially available system now offers automated, volumetric control of instilled topical wound solutions with a dwell time in combination with NPWT (NPWTi‐d; V.A.C. VeraFlo™ Therapy, KCI, an Acelity company, San Antonio, TX). This NPWTi‐d system differs from other instillation systems in that a timed, predetermined volume of topical wound solution is intermittently delivered (versus continuously fed) and allowed to dwell in the wound bed (without NPWT), for a user‐selected period of time before NPWT is resumed. This added accuracy and process simplification of solution delivery in tandem with NPWT have prompted use of NPWTi‐d as first‐line therapy in a wider subset of complex wounds. However, considerably more research is required to validate efficacy of NPWTi‐d in various wound types. The purpose of this review is to provide a relevant overview of wound healing, describe current literature supporting the adjunctive use of NPWTi‐d, propose a clinical approach for appropriate application of NPWTi‐d and conclude with case studies demonstrating successful use of NPWTi‐d. Based on this review, we conclude that either a large case series examining effects of NPWTi‐d on different wound types or possibly a large prospective registry evaluating NPWTi‐d with real‐world topical wound solutions versus immediate debridement and closure would be valuable to the medical community in evaluating the efficacy of this promising therapy.

Artificial dermis has been used successfully for coverage of full-thickness wounds with a well-vascularized surgical bed. However, the use of artificial dermis in the reconstruction of partial- and full-thickness scalp defects has not been well documented. Seven patients (six men and one woman; mean age, 70 ± 14 years) with partial-thickness (three patients) and full-thickness (four patients) soft-tissue defects of the scalp (mean defect area, 97 ± 58 cm2) following resection of recurrent malignant tumors and/or previous failed reconstructions underwent staged scalp reconstruction with a bilaminate skin substitute (Integra). After adequate débridement of scalp wounds, including burring the outer table of the calvaria down to bleeding bone for full-thickness defects, Integra was scored and applied unexpanded. A split-thickness skin graft (0.011 ± 0.0 inch in thickness) was placed on the operative site at postoperative day 36 ± 15 after removal of the silicone layer of the artificial dermis. Two patients required repeated applications of artificial dermis to compensate for contour deficits before skin grafting. Clinically, all reconstructed areas showed well-vascularized neodermis before skin grafting. There was a 100 percent take of the skin grafts, with no infections or other complications noted. All reconstructive procedures were performed in less than 3 hours of combined operative time, with the last stage performed on an outpatient basis. Artificial dermis can be used successfully for reconstruction of complex scalp defects following oncologic resection, offering minimal donor-site morbidity, expedient operative time, and when needed, temporary quality closure until final pathologic results are known. Integra skin may offer another option for definitive management of extensive full-thickness scalp defects.