bluuebunny/crossref_metadata_2025 huggingface dataset:
Nutritional intake in community patients with pressure ulcers
Authors: Green S.M. , Winterberg H. , Franks P.J. , Moffatt C.J. , Eberhardie C. , McLaren S.
Published: May 2014

Nutritional status has been associated with the development and healing of pressure ulcers. This study aimed to examine the dietary intake of adults who had pressure ulcers (n = 75) and a control group with no pressure ulcers (n = 100), randomly selected from those receiving treatment from community nurses. All participants were considered to be at risk of developing pressure damage. Dietary intake was assessed using a 24-hour recall method (completed by 84 participants) and a nutritional questionnaire (completed by all 175 participants). The mean age of participants was 79 ± 6 years and 70% were women. Patients who had pressure ulcers had a lower energy intake (mean difference -185kcal, 95% confidence interval −413 to 43) and intake of protein (mean difference −6.73g/day, 95% CI -16.20 to 2.74) but neither factor achieved a standard level of statistical signifiance. However, when protein was categorised into quartiles, a significantly higher proportion of participants with low intake had pressure ulcers on chi-squared analysis (p = 0.043).

More participants who had pressure ulcers required assistance with eating (odds ratio 4.55, 95% CI 1.53 to 13.54) and more had experienced recent taste changes (odds ratio 3.28, 95% CI 1.19 to 9.10). While these differences were significant, there were few major differences between those who had pressure ulcers and the control group. A number of participants in both groups had poor nutritional intake and other risk factors for malnutrition were also found.

Poor nutrition is a problem for all patients receiving community nursing care, not just those with pressure ulceration. Due to acknowledged difficulties in recording nutritional intake in elderly patients, further assessment of dietary intake in those receiving community nursing services should be undertaken to support these results.
Comparison of a new foam mattress with the standard hospital mattress
Authors: Gray D.G. , Smith M.
Published: May 2014

This study evaluates pressure ulcer incidence rates and comfort perceptions in 100 subjects admitted to a district general hospital. Subjects were divided into two groups, Group A using the standard hospital mattress (Transfoam), which had been in use in the hospital for three years, and Group B using the study mattress (Transfoamwave), which was new at the beginning of the trial.

Due to the low observed incidence of pressure ulcers, it has not been possible to determine whether there is a difference in the clinical performance of the mattresses. Both appear to provide similar levels of comfort. Seat cushions were provided for each trial subject but staff failed to make good use of them, which suggests that more education is required in this area.
Randomised controlled trial of two pressure-relieving systems
Authors: Russell L. , Reynolds T.M. , Carr J. , Evans A. , Holmes M.
Published: May 2014

A study comparing the efficacy of two alternating-cell mattress and cushion combinations in the treatment of pressure ulcers in hospital patients

The primary objective of this randomised controlled trial was to determine whether there were significant differences between two pressure-relieving systems. A secondary aim was to investigate whether the availability of extra pressure-relieving equipment would reduce the incidence of ulcers in an acute hospital setting.

A total of 141 patients in a care-of-theelderly unit, who were assessed to have a high risk of developing pressure ulcers using the Waterlow score, were recruited; 70 were nursed using Huntleigh Nimbus 3 in conjunction with the Aura cushion (Group A), and 71 using the Pegasus Cairwave Therapy System in conjunction with the Proactive 2 Seating cushion (Group B). The main outcome measure was visual assessment, supported by a photographic record.

There were three main findings: for nonheel ulcers and overall improvement, there was no statistically significant difference between the two products tested; for heel ulcers there was a significant difference (P = 0.019) with more patients healing in Group A than in Group B.

The average length of stay of patients who completed the trial was 21.6 days (Group A) and 21.7 days (Group B) for patients completing alive (range 1-121 days) and for patients who died 29.7 days (Group A) and 24.3 days (Group B).

Routine monitoring showed that, before the trial, the incidence of hospital-acquired pressure ulcers (Torrance grade 2+) was 0.2%; during the trial, this dropped to 0.13%. The study showed differences in the efficacy of different mattress products; with a sufficiently large study, it is possible to demonstrate statistically significant results.

Provision of extra pressure-relieving equipment can reduce the incidence of pressure ulcers but may not influence length of stay.
Alginate dressings in surgery and wound management — part 1
Authors: Thomas S.
Published: May 2014

The first article in a series of three looks at the history and use of seaweed-derived dressing

Large quantities of alginate dressings are used each year to treat exuding wounds, such as leg ulcers, pressure sores and infected surgical wounds. Originally these dressings were a loose fleece formed primarily from fibres of calcium alginate. More recently they have been developed so that the fibres have been entangled to form a product with more cohesive structure, which increases the fabric's strength when it is soaked with exudate or blood. Some products also contain a significant proportion of sodium alginate to improve the gelling properties of the dressing in use. Other dressings have been produced from freeze-dried alginate.

Once in contact with an exuding wound, an ion-exchange reaction takes place between the calcium ions in the dressing and sodium ions in serum or wound fluid. When a significant proportion of the calcium ions on the fibre have been replaced by sodium, the fibre swells and partially dissolves forming a gellike mass. The degree of swelling is determined principally by the chemical composition of the alginate, which depends on its botanical source.

Although it is recognised that the differences between the various brands of dressings may influence their handling characteristics – particularly when wet – it is generally assumed that these differences are of limited relevance to the dressing's performance clinically or at a cellular level. There is some evidence to suggest, however, that these assumptions may be wrong and that alginates may influence wound healing in a number of ways not yet fully understood.

This three-part review of the literature encompasses the history, origin, structure, chemistry and clinical applications of alginates and alginate dressings.

This review reveals that, despite their widespread use, alginates have been the subject of very few well-controlled clinical studies. There is fairly convincing evidence, however, that they do offer advantages over more traditional dressings for at least some clinical indications. It has also become obvious that there is a general lack of understanding about the importance of secondary dressing systems that must be used in with alginate dressings.

Careful examination of the design and outcomes of the published studies suggests that the choice of both the primary alginate dressing and the secondary dressing can play a major role in determining treatment outcomes.
The assessment and management of leg ulcers in rheumatoid arthritis
Authors: McRorie E.R.
Published: May 2014

Patients with rheumotoid arthritis appear to be at increased risk of developing chronic leg ulcers. This review identifies the factors that predispose these patients to leg ulceration and highlights how this problem can be managed and the risk of recurrence reduced.
The impact of minor acute wounds on quality of life
Authors: O'Flynn L.
Published: May 2014

A study was undertaken to explore the experiences of patients with minor acute wounds following discharge from either inpatient or day care. The sample comprised patients attending the plastic surgery dressing clinic of a district general hospital. Patients whose wounds were considered to be chronic were not included. A conceptual framework was developed from the literature, postulating that the patient is ‘eclipsed’ by the wound and enters the sick role before healing and recovery take place.

A self-administered questionnaire was used to collect data for a mainly quantitative analysis, with some open questions to indicate avenues for further study. Unfortunately, the response rate was low, and insufficient data were obtained for effective analysis. Howewver, trends were identified which indicated that these wounds had a significant impact on patients and their families, and recommendations were made for future studies. The survey would need to be repeated on a larger, more representative sample and include semi-structured interviews to produce generalisable results
Evaluating a superabsorbent hydropolymer dressing for exuding venous leg ulcers
Authors: Schulze H.-J. , Lane C. , Charles H. , Ballard K. , Hampton S. , Moll I.
Published: May 2014

A new hydropolymer dressing was compared with an alginate dressing in a multicentre, prospective, controlled, randomised, stratified, open label trial of 113 patients with exuding venous leg ulcers. The study aimed to evaluate the performance of the dressings in terms of their ability to handle exudate, patient and user acceptability and cost-effectiveness. Patients were stratified according to volume of wound exudate (moderate/heavy) and randomised to the hydropolymer dressing or the alginate plus a secondary dressing.

A statistically significant difference between treatment groups was observed in mean wear time, with a longer wear time observed in the hydropolymer group (3.91 days) compared with the alginate group (3.09 days, p=0.001). In terms of patient and user acceptability, all 10 overall evaluations made by both patient and investigator were markedly in favour of the hydropolymer dressing (p<0.001 to p=0.020).

The use of the hydropolymer dressing for patients with moderate to heavily exuding venous leg ulcers has statistically significant advantages over the alginate dressing in terms of wear time and investigator and patient acceptability. It is anticipated that this reduction in dressing frequency will translate into a cost-effective wound treatment.
Pinch grafting in hospital and primary care: a cost analysis
Authors: Öien R.F. , Håkansson A. , Ahnlide I. , Bjellerup M. , Hansen B.U. , Borgquist L.
Published: May 2014

The cost of treating venous leg ulcers with pinch grafting was evaluated for 58 consecutive patients: 29 in hospital care and 29 in primary care. The mean age was 76.8 and 74.3 years and the mean ulcer size 15.1 and 13.5 cm2, respectively.
Comparison of hydrocellular foam and calcium alginate in the healing and comfort of split-thickness skin-graft donor sites
Authors: Vaingankar N.V. , Sylaidis P. , Eagling V. , King C. , Elender F.
Published: May 2014

This is a comparative study of a hydrocellular foam (Allevyn, Smith and Nephew) and a calcium alginate (Kaltostat, ConvaTec) in dressing split-thickness skin-graft donor sites. The dressing materials were used in equal halves of each donor site in 20 patients undergoing skin-graft harvest.
Nurses' views about pain and trauma at dressing changes: a central European perspective
Authors: Kammerlander G. , Eberlein T.
Published: May 2014

Objective:

This study investigated nursing and medical practitioners' perceptions of pain and trauma at dressing change in three German-speaking European countries: Austria, Germany and Switzerland. It follows a similar study by Hollinworth and Collier conducted in the UK.

Method:

A total of 3300 questionnaires were posted to practitioners in the three countries. All of the practitioners had attended at least one educational event on wound management organised by the researchers. The questionnaire contained closed questions about the participants' experience of dressing change and pain, their place of work and their freedom to select wound management products.

Results:

A 15.1% response rate was achieved. The main aim at dressing change was to prevent trauma to the wound (30%) and to prevent infection (29%) and pain (21%). Dressing removal (51%) and wound cleansing (41%) were cited as the phases of dressing pain most likely to cause pain. Factors perceived to cause pain during dressing changes included dressings that adhere to the wound area (35%), particularly direct adherence to the wound (29%) and dried-out dressings (28%). Techniques used to prevent pain included rehydrating dressings. The responses also pointed to insufficient knowledge about low-adherent or non-adherent dressings among some respondents.

Conclusion:

The respondents perceived dressing removal and wound cleansing to be the most painful wound-care interventions. Their key objectives were to prevent pain and trauma at dressing changes. Lack of information on low- and non-adherent dressings needs to be addressed.

Declaration of interest:

This study was funded by Mölnlycke Health Care AG, Switzerland.
Moist wound healing: does the theory apply to chronic wounds?
Authors: Parnham A.
Published: May 2014

Winter's research on moist wound healing continues to exert a strong influence on tissue viability practice. But does this theory, which is based on porcine acute wounds, apply to human chronic wounds. This review explores the evidence.
The effect of varying cuff position on recording ankle systolic blood pressure
Authors: Anderson I.
Published: May 2014

Objective:

Ankle brachial pressure index (ABPI) aids the diagnosis of leg ulcer aetiology, although there is potential for patient anxiety or discomfort when the cuff is placed over an ulcerated ankle. This study aimed to ascertain any differences in systolic pressure if the cuff is positioned proximal to the ankle and to determine the feasibility of varying the cuff position to avoid ulcerated areas.

Method:

The systolic blood pressure in the lower limbs of healthy volunteers (n=60) was measured with the cuff at two discrete sites on the lower limb.

Results:

There was a statistical difference in systolic blood pressure readings between the two sites (0–4mmHg; p=0.02) and a statistically significant ABPI difference (−0.08 to 0.05; p<0.002).

Conclusion:

Blood pressure recording is subject to considerable variation in clinical practice and the ABPI has to vary by more than 0.15 to be clinically significant. Therefore, the differences in systolic pressure between sites and the ABPI calculations are not clinically significant in this study. An additional finding was that some subjects found the upper cuff position uncomfortable during the procedure.

Declaration of interest:

None
Inflammation 2: its role in the healing of chronic wounds
Authors: Hart J.
Published: May 2014

Why do some wounds fail to heal in the expected time? Part two of this article on inflammation discusses the possible causes, which include recurrence of trauma, bacterial and other contamination and perhaps, above all, the ageing process
Compression bandaging: are practitioners achieving the ideal sub-bandage pressures?
Authors: Moore Z.
Published: May 2014

Compression bandaging is the mainstay of conservative management of patients with venous ulceration. But debate is growing over what levels of pressure to apply and how to balance this with what patients can tolerate
Setting up a dedicated pressure ulcer unit in a geriatric ward
Authors: Jaul E.
Published: May 2014

A geriatric hospital in Israel set up a unit for older patients with pressure ulcers who had other serious, sometimes terminal, conditions. A one-year follow-up study showed overall improvements in their condition and number of ulcers.
Wound measurement: can it help us to monitor progression to healing?
Authors: Flanagan M.
Published: May 2014

Wound measurement can help practitioners to monitor the progression to healing. The most effective way of doing this is to calculate the percentage reduction of wound area over time, particularly within the first four weeks.
Exploring the psychosocial concerns of outpatients with disfiguring conditions
Authors: Rumsey N. , Clarke A. , White P.
Published: May 2014

Objective:

This study was undertaken to establish the extent and type of psychosocial need in outpatients attending for treatment for a variety of disfiguring conditions.

Method:

A total of 220 outpatients receiving treatment for burns, skin conditions or head and neck cancer, together with those seeking plastic surgery for other appearance concerns, completed standardised measures of anxiety, depression, social anxiety and quality of life. Participants also completed a semi-structured interview exploring individual concerns and satisfaction with care.

Results:

A considerable proportion of the outpatients with disfiguring conditions experienced psychosocial difficulties, displaying raised levels of anxiety, depression, social anxiety and social avoidance and reduced quality of life. Levels of psychosocial distress were not well predicted by the severity of disfigurement.

Conclusion:

The psychosocial needs of these patients are not well met in the outpatient setting. Recommendations are made on how patients' concerns might be more effectively addressed.

Declaration of interest:

None.
The link between the peel force of adhesive dressings and subjective discomfort in volunteer subjects
Authors: Dykes P.J. , Heggie R.
Published: May 2014

Objective:

The study compared the level of discomfort experienced by healthy volunteers on the removal of a range of adhesive wounds.

Method:

This was an open, within subject comparative study of six adhesive dressings in 24 volunteers. The test site was the lower back. Allocation of test materials to the test sites was randomised. The peel force of removal was recorded after 24 hours of application using a device that removed the dressing at a constant speed and angle to the skin surface. The discomfort experienced at each removal was assessed by the subjects themselves using an electronic visual analogue scale.

Results:

Overall, Mepilex Border was given a significantly lower discomfort score (p≤0.01) by the subjects than the other dressings. There were no clear differences between the five other products tested. Tielle and Allevyn Adhesive had significantly higher (p≤0.05) peel force than the other products. Mepilex Border caused less discomfort on removal than Duoderm Extra Thin, Biatain and Versiva, even though the peel force was similar. Tielle and Allevyn had higher peel force, but the levels of discomfort were not significantly higher for these products.

Conclusion:

It may be that the level of discomfort experienced by subjects on removal of an adhesive dressing is not entirely dependent on the peel force and that other aspects of the interaction of the skin surface and adhesive play a role.

Declaration of interest:

This study was supported by a grant from Mölnlycke Healthcare AB, Gothenburg, Sweden.
A randomised controlled study of four-layer compression versus Unna’s Boot for venous ulcers
Authors: Polignano R. , Boneado P. , Gasbarro S. , Allegra C.
Published: May 2014

Objective:

This study set out to compare healing rates, handling properties and patient comfort of a four-layer bandage system (Profore) and Unna’s Boot in the treatment of venous leg ulcers.

Method:

This was a prospective randomised parallel-group trial. Patients with venous leg ulcers from four centres in Italy were randomised to receive treatment with either Unna’s Boot or Profore. Time to healing was recorded for a maximum of 24 weeks. Pain was assessed using a visual analogue scale. Staff assessed ease of application, while patients rated comfort.

Results:

Data were available for 68 patients with 68 wounds. At 24 weeks complete healing was seen in 74% of the Profore group compared with 66% of the Unna’s Boot group. The median time spent in the study was 50 days (range: 7–175 days), corresponding to 51 days (range: 7–175 days) for Profore patients and 49 days (range: 7–168 days) for Unna’s Boot patients. There was no difference (p=0.13) between the groups in time to closure. Overall, more Profore than Unna’s Boot applications were rated as excellent. There was a significant difference, in favour of Profore, in ease of application at the final application (p=0.013). At the initial application, there was a significant difference in bandage appearance (p=0.04), again favouring Profore, but this was not sustained at the final application (p=0.18).

Conclusion:

Profore is as effective as Unna’s Boot in the treatment of venous leg ulcers.

Declaration of interest:

This study was funded by Smith and Nephew.
A trial to determine the role of placental extract in the treatment of chronic non-healing wounds
Authors: Shukla, V.K. , Rasheed M.A. , Kumar M. , Gupta S.K. , Pandey S.S.
Published: May 2014

Objective:

To investigate the effect of topical placental extract in the treatment of non-healing wounds.

Method:

One hundred patients attending the wound clinic at University Hospital, Varanasi, India, with wounds of more than six weeks’ duration were recruited. Fifty patients were treated with placental extract, and 50 were controls. Wound biopsy and swab culture and sensitivity were performed and the area surrounding the wound was X-rayed. Wound size was measured and the rate of epithelialisation assessed at weekly follow-ups. In nine cases biopsies were repeated after two weeks of treatment and sent for histopathological examination, including angiogenesis.

Results:

Thirty patients dropped out, leaving 40 cases in the treatment group and 30 in the control group. Over an eight-week period, 27 patients (67.5%) in the treatment group showed more than 50% epithelialisation, compared with only seven patients (23.3%) in the control group.

Conclusion:

Placental extract has a beneficial role to play as a topical agent in the management of chronic non-healing wounds.

Declaration of interest:

None.
Effects of warming on healing
Authors: MacFie C.C. , Melling A.C. , Leaper D.J.
Published: May 2014

Many cultures in developing countries still use warming therapies, such as applying hot leaves to wounds, in contrast to the West, which has not explored the potential benefits of warming on healing and infection. This paper reviews the research evidence on this therapy.
The role of fibronectin in fibroblast migration during tissue repair
Authors: Briggs S-L.
Published: May 2014

Tissue repair begins with the formation of a blood clot, and moves through the stages of chemotaxis, migration of neutrophils, macrophages and fibroblasts, angio genesis, formation of a provisional matrix, synthesis of collagen, assembly of collagen matrix, migration and proliferation of keratinocytes and, finally, wound closure. Each process requires groups of cells to perform various functions in consort and is controlled by growth factors and cytokines through cell signalling.
Study to determine the efficacy of topical morphine on painful chronic skin ulcers
Authors: Vernassiere C. , Cornet C. , Trechot P. , Alla F. , Truchetet F. , Cuny J.F. , Commun N. , Granel Brocard F. , Barbaud A. , Schmutz J.L.
Published: May 2014

Objective:

To assess the efficacy of the topical application of morphine on painful chronic skin ulcers.

Method:

A prospective bi-centric controlled double-blind randomised study was conducted involving 24 patients with painful chronic skin ulcers using topically applied morphine versus placebo. Ten milligrams of morphine hydrochloride with Intrasite Gel or Intrasite Gel with placebo were applied daily for five days. All patients were treated with a level II analgesic treatment. A numeric pain scale lower than 4/10 and no need for a ‘rescue’ treatment (morphine sulphate) indicated that the treatment was successful. Local and systemic tolerance of the treatments was analysed daily.

Results:

Twenty-four patients were included in the study, but only 18 started the protocol. Only 2/11 patients were completely relieved in the morphine group compared with 1/7 in the placebo group. Local and general tolerance of morphine was good. The peripheral efficacy of morphine is under discussion.

Conclusion:

The results suggest that topical morphine cannot be an alternative to morphine administered by other routes (subcutaneously or orally) in painful chronic skin ulcers. Stimulation of peripheral morphine receptors by systemic morphine could explain the difference between these results and those of previous studies.

Declaration of interest:

This study was supported by the University Hospital of Nancy and the Association Lorraine d’Etude et de Recherche en Dermatologie, France.
A prospective study: hyperbaric oxygen therapy in diabetics with chronic foot ulcers
Authors: Löndahl, M. , Katzman P. , Nilsson A. , Hammarlund C. , Sellman A. , Wykman A. , Hugo-Persson M. , Apelqvist J.
Published: May 2014

Diabetic foot ulcers are one of the most common and devastating complications of diabetes mellitus. Despite improved patient care using a multidisciplinary team approach, amputation rates and the frequency of unhealed ulcers are still high, and the need for new treatment strategies persists.
Conservative debridement of postoperative Meleney’s gangrene following a Caesarean section
Authors: Tandon A. , Sharma D. , Dawar P. , Singh M.K. , Shukla V.K.
Published: May 2014

Meleney’s gangrene (also called Meleney’s ulcer) is a form of gangrene of the skin and subcutaneous tissues. It usually manifests following surgery and is caused by interaction between multiple bacteria. It produces extensive tissue necrosis with ulceration. The diagnostic criteria for Meleney’s gangrene include:
Are theories of altered body image applicable to patients with chronic wounds?
Authors: Henderson E.A.
Published: May 2014

Authors have attempted to define the concept of body image, discussing how it is formulated through the interplay of a complex series of dynamic psychosocial influences which grow, alter and adapt to natural changes in the body and psyche over time. This review considers concepts of altered body image (ABI) and related models, and suggests how they might be applied to patients with chronic wounds.
Surgical management of ischial and perineal pressure ulcers with urethrocutaneous fistulae
Authors: Hayashi T. , Murazumi M.A. , Mol W. , Yamamoto Y.
Published: May 2014

The pelvic region, including the gluteal, ischial and trochanteric areas, is a common site for pressure ulcer development. In such cases non-healing ulceration may spread widely into the urethra, rectum, vagina and joints.
Bacterial resistance to silver in wound care and medical devices
Authors: Lansdown A.B.G. , Williams A.
Published: May 2014

This review discusses the molecular and genetic evidence for silver resistance in bacteria isolated from skin wounds and medical devices with reference to a case study of resistant Enterobacter cloacae from the leg ulcers of an elderly woman
The effects of non-steroidal anti-inflammatory drug application on incisional wound healing in rats
Authors: Krischak G.D. , Augat P. , Claes L. , Kinzl L. , Beck A.
Published: May 2014

Objective:

There is evidence that non-steroidal anti-inflammatory drugs (NSAIDs) delay both epithelialisation and angiogenesis in the early phases of wound healing because of an antiproliferative effect. We investigated the influence of diclofenac, a non-selective NSAID, on incisional wound healing.

Method:

Ten male Wistar rats were given 5mg diclofenac per kg bodyweight per day; 10 rats were given placebo pellets. After 10 days, unimpaired healing occurred independently of drug treatment both macroscopically and microscopically. Histomorphometry revealed a significant reduction (p=0.006) in fibroblasts after diclofenac application (median 3166 cells per mm2) compared with the placebo group (median 3940 cells per mm2). Epidermal thickness was not statistically different between the two groups.

Results:

Diclofenac diminished the amount of fibroblasts in connective tissue, reflecting the known antiproliferative effect of NSAIDs on fibroblasts. Clinical healing was not affected.

Conclusion:

We recommend short-term diclofenac application for post-surgical and post-traumatic patients with wounds who would benefit from its antiphlogistic and analgesic effect. However, if wound healing is disturbed, the negative effect of diclofenac on fibroblasts should be considered. This is particularly relevant for patients with chronic wounds or conditions such as diabetes which can delay wound healing.

Declaration of interest:

Novartis Pharma (Nuremberg, Germany) provided financial support.
Wound-healing activity of Morinda citrifolia fruit juice on diabetes-induced rats
Authors: Nayak B.S. , Isitor G.N. , Maxwell A. , Bhogadi V. , Ramdath D.D.
Published: May 2014

Objective:

Morinda citrifolia L. is a traditional Polynesian medicinal plant which is apparently useful for bowel disorders, skin inflammation, infection, mouth ulcers and wound healing. This study aimed to evaluate the wound-healing activity of Morinda citrifolia fruit juice in streptozotocin-induced diabetic rats.

Method:

An excision wound model was used. The animals were weight-matched and placed into three groups (n=6 per group). Group 1 animals served as normal controls, while animals in groups 2 and 3 served as diabetic controls and experimental diabetic animals respectively. All animals were anaesthetised and a full-thickness excision wound (circular area of 300mm2 and 2mm deep) was created. Group 3 animals were given the juice of Morinda citrifolia fruit (100ml per kilogram of body weight) in their drinking water for 10 days. Wound area measurements were taken on days 1, 5 and 11. Blood samples were collected simultaneously for glucose measurement. Granulation tissue that had formed on the wound was excised on day 11 and processed for histological and biochemical analysis.

Results:

The wound area of the Morinda citrifolia-treated group reduced by 73% (p<0.001) when compared with the diabetic controls (63%). Significant increases in the weight of granulation tissue (p<0.001) and hydroxyproline content (p<0.001, 92.16 ± 4.02) were observed. The protein content was moderately high. Histological studies showed that collagen was laid down faster in the experimental diabetic animals than in the normal control and diabetic control groups. Fasting blood glucose values in the diabetic experimental group had reduced by 29% (p<0.001) compared with the diabetic control animals. There was a good correlation between the wound contraction rate and blood glucose values.

Conclusion:

This study demonstrates that the juice of Morinda citrifolia fruit significantly reduces blood sugar levels and hastens wound healing in diabetic rats.

Declaration of interest:

None.
Oral transmucosal fentanyl citrate versus placebo for painful dressing changes: a crossover trial
Authors: MacIntyre P.A. , Margetts L. , Larsen D. , Barker L.
Published: May 2014

Objective:

Fentanyl is a potent opioid that is well absorbed via the oral mucosa. It can be given as an oral lozenge. The onset of analgesia is rapid and matches the pain profile observed at dressing changes.

Method:

Patients experiencing pain during daily dressing changes were given entonox plus either placebo or oral transmucosal fentanyl citrate (OTFC) for two consecutive dressing changes in a randomised double-blind placebo-controlled crossover trial.

Results:

Nine patients were recruited. The mean worst pain score during dressing changes was 7/10 with placebo and 4/10 with OTFC; the reduction in pain achieved with OTFC was significant. The mean number of breaths of entonox taken during the dressing change was 27.67 with placebo and 4.67 with OTFC; the reduction in the number of entonox breaths with OTFC was significant. One patient in the OTFC group suffered nausea.

Conclusion:

Compared with placebo, OTFC improved analgesia during painful dressing changes without an increase in side-effects.

Declaration of interest:

None.
Use of a nanocrystalline silver dressing on lymphatic ulcers in patients with chronic lymphoedema
Authors: Forner-Cordero I. , Navarro-Monsoliu R. , Muñoz-Langa J. , Alcober-Fuster P. , Rel-Monzó P.
Published: May 2014

Objective:

A prospective evaluation to explore the effect of treating patients with chronic lower limb lymphoedema and lymphatic ulcers using a nanocrystalline dressing and multilayer bandaging.

Method:

Ulcers were cleansed and dressed with a nanocrystalline silver dressing, an alginate dressing and a hydrocellular dressing, followed by multilayer short-stretch compression bandages. A digital planimetry system was used to calculate the ulcer surface area. In cases of multiple ulcers, the areas were added together.

Results:

Eight patients with chronic lower limb lymphoedema plus ulcers were included. Median age was 53.7 years (range 39.2–72.3). Mean ulcer size was 10.5cm2 (range: 0.8–33.8). All ulcers completely healed after one to nine weeks of treatment.

Conclusion:

This protocol has been effective in healing lymphatic ulcers and was well accepted by patients. There were no adverse effects or withdrawals. Further studies with larger numbers of patients are required to support these results.

Declaration of interest:

Smith & Nephew Spain supported this study by supplying a measuring device. They did not provide any dressings or bandages.
Topical diphenylhydantoin sodium can improve healing in a diabetic incisional animal wound model
Authors: Chan F.C , Kennedy C , Hanson R.P , O’Sullivan B , Kelly J , Bouchier-Hayes D
Published: May 2014

Objective:

Anecdotally, topical application of diphenylhydantoin sodium (DpH) (phenytoin) has been shown to aid wound healing. We previously reported improved healing following topical infiltration of DpH in a healthy animal wound model. This study evaluates its effect on an incisional wound model in diabetic animals.

Method:

Twenty-five male Sprague-Dawley rats were rendered diabetic by a single intraperitoneal injection of streptozotocin. Two caudal and two cephalad wounds were made on the dorsal surface. A polyvinyl alcohol sponge was placed in a subcutaneous pocket created proximal to both cephalad wounds. Each wound was either treated topically with 10mg DpH in a 200µl carrier or an equal volume of the saline vehicle (control) on the day of wounding and days 3 and 6 post-incision. The animals were sacrificed on day 10. The breaking strength of fresh and fixed wounds was determined by tensiometry, and the hydroxyproline content was determined spectrophotometrically.

Results:

There was a significant overall increase in both fresh (24%) and fixed (18%) wound-breaking strength of the DpH-treated wounds when compared with the controls (p<0.05). This was associated with an increase in collagen synthesis as indicated by the increased hydroxyproline content in the DpH-infiltrated sponges when compared with the controls.

Conclusion:

Our data suggest that topical DpH improves healing in a diabetic wound model. Topical administration of DpH has the potential to accelerate diabetic wound healing and should be evaluated in human diabetic wounds.

Declaration of interest:

None.
Necrotising fasciitis in children and neonates: current concepts
Authors: Pandey A. , Gangopadhyay A.N. , Upadhyaya V.D.
Published: May 2014

While the incidence is very low, necrotising fasciitis in neonates and children is a potentially life-threatening infection that requires rapid diagnosis and treatment. This review describes its aetiology, symptoms, clinical feature and treatment
Critical evaluation of the reliability and validity of ABPI measurement in leg ulcer
Authors: Keen D.
Published: May 2014

Clinimetric analysis of the measurement of ABPI by Doppler ultrasound suggests this method is valid and reliable if the practitioner is competent and able to interpret the result within the context of a full clinical assessment
An observational study of the use of a soft silicone silver dressing on a variety of wound types
Authors: Meuleneire F.
Published: May 2014

Routine use of this dressing in a specialist wound care centre eradicated clinical signs of localised infection in most cases. Healing progression was generally reported as good and there was a reduction in the level of pain intensity
Should chlorhexidine gluconate be used in wound cleansing?
Authors: Main R.C.
Published: May 2014

The antiseptic chlorhexidine gluconate is available as a hand scrub and, in a weaker dilution, as a wound cleanser. The former is often used in wound care, although there is little evidence to support the use of either dilution as a cleanser
Wound healing activity ofPersea americana(avocado) fruit: a preclinical study on rats
Authors: Nayak B.S. , Raju S.S. , Chalapathi Rao A.V.
Published: May 2014

Objective:

Avocado (Persea americana) oil is rich in nutrient waxes, proteins and minerals, as well as vitamins A, D and E. It is an excellent source of enrichment for dry, damaged or chapped skin. This study aimed to evaluate the wound-healing activity of fruit extract of Persea americana in rats.

Method:

The effect of topical and oral administration of Persea americana fruit extract (300mg/kg/day) on excision and dead space wound models was evaluated. The rats used in the excision wound model were divided into four groups of five each and received either topical or oral treatment. The rats used in the dead space wound model were divided into two groups of five each and were treated orally. Healing was assessed by the rate of wound contraction, period of epithelialisation, granulation tissue weight and hydoxyproline content.

Results:

In the excision wound model, complete healing (full epithelialisation) was observed on average on day 14 in the rats who receive oral or topical treatment. In contrast, the controls took approximately 17 days to heal completely. The extract-treated wounds were found to epithelialise faster than the controls (p<0.001). Wet and dry granulation tissue weight and the hydroxyproline content of the tissue obtained from extract-treated animals used in the dead space wound model were significantly higher (p<0.05) compared with the controls.

Conclusion:

Rate of wound contraction, epithelialisation time together with the hydroxyproline content and histological observations support the use of Persea americana in the management of wound healing.

Declaration of interest:

None.
Critical evaluation of the clinimetrics of laser Doppler imaging in burn assessment
Authors: Sainsbury D.C.G
Published: May 2014

Just under a third of clinical assessments of intermediate burn depth overestimate the extent of the injury, potentially resulting in unnecessary surgery. Research evidence suggests that laser Doppler imaging may be a more accurate alternative
A randomised controlled trial on the effectiveness of an advanced wound dressing used in Iran
Authors: Kordestani S. , Shahrezaee M. , Tahmasebi M.N. , Hajimahmodi H. , Ghasemali D. Haji , Abyaneh M.S.
Published: May 2014

Objective:

To compare the wound healing rate and incidence of infection in wounds treated with either a bioactive dressing (containing hydrophilic mucopolysaccharide, chitosan) or conservative treatment (gauze).

Method:

Eighty-five patients with diabetic foot ulcers, pressure ulcers or leg ulcers were randomised to receive either the bioactive study dressing (n=33 patients, 45 wounds) or the control dressing (n=52 patients, 53 wounds) for 21 days. Wound size, stage where appropriate and the presence of infection were recorded at each dressing change. Thirty-one of these 85 patients dropped out of the study during the three-month post-treatment follow-up, when wound size and grade were assessed on a monthly basis. Data were therefore analysed on 54 patients, of whom 32 (34 wounds) were in the treatment group and 22 (26 wounds) in the control group.

Results:

In the control group, four pressure ulcers healed, but the remaining wounds all deteriorated and became infected, requiring antibiotics. In contrast, in the treatment group 29/34 wounds healed completely, and none became infected; the remaining five wounds healed during the follow-up period. The difference between the two groups in the number of wounds that healed was statistically significant (p<0.001), as was that for the number of healed pressure ulcers p<0.05.

Conclusion:

Use of a moist bioactive wound dressing significantly increased the healing rate when compared with the traditional dressings used in the participating hospitals. This will in turn bring significant cost savings.

Declaration of interest:

This study was sponsored by ChitoTech.
Biofilms and chronic wound inflammation
Authors: Wolcott R.D. , Rhoads D.D. , Dowd S.E.
Published: May 2014

In contrast to the commonly accepted hypothesis of host-centred pathology, it is possible that surface bacteria, not host dysfunction, cause the chronicity and perpetual inflammation associated with chronic non-healing wounds
The impact of topical phenytoin on recalcitrant neuropathic diabetic foot ulceration
Authors: El-Nahas M. , Gawish H. , Tarshoby M. , State O.
Published: May 2014

Objective:

To study the impact of topical phenytoin on the healing of recalcitrant neuropathic diabetic foot ulcers in patients with no clinical evidence of ischaemia or infection, and to evaluate its antibacterial effect.

Method:

Thirty-two patients were enrolled into the study. Topical phenytoin in the form of 2% aerosol powder was applied once daily in addition to the patient's usual treatment (weekly sharp debridement, offloading and use of a gauze dressing) for eight weeks. The primary outcome was change in ulcer area over time, measured by grid tracing. Secondary outcomes were the ability of topical phenytoin to eradicate bacterial isolates, and the occurrence of adverse events.

Results:

Topical phenytoin significantly improved healing of recalcitrant neuropathic diabetic foot ulcers. Baseline wound area was 319.3 ± 340.4mm2, reducing to 286.1 ± 341.1mm2 and 269.1 ± 341.2mm2 after four and eight weeks respectively. However, the overall reduction in ulcer size was only 18.3% ± 27.5% and 25.7% ± 38.6 % respectively. Topical phenytoin therapy over eight weeks did not eradicate any of the bacterial wound isolates (Staphylococcus spp., Proteus spp. or Pseudomonas spp.). Of the 32 patients evaluated, only eight (25%) achieved more than 50% reduction in ulcer size after eight weeks of treatment.

Conclusion:

Topical phenytoin can enhance wound healing in recalcitrant neuropathic diabetic foot ulcers, although only one-quarter of patients achieved more than 50% reduction in ulcer size after eight weeks of therapy. Further research is needed to characterise those patients who will satisfactorily respond to such therapy.

Declaration of interest:

None.
Do short-stretch bandages affect distal blood pressure in patients with mixed aetiology leg ulcers?
Authors: Top S. , Arveschoug A.K. , Fogh K.
Published: May 2014

Compression is considered inappropriate for patients with mixed aetiology leg ulcers. However, digital blood pressure measurements suggest that short-stretch bandages do not increase the risk of peripheral ischaemia in these patients
Comparison of interface pressures of three compression bandaging systems used on healthy
Authors: Jünger M. , Ladwig A. , Bohbot S. , Haase H.
Published: May 2014

Objective:

To compare changes in interface pressures of three compression systems (four layer, two layer and short stretch) recorded over seven days in healthy volunteers in different positions: supine, sitting, active standing and working pressure during exercise.

Method:

Twenty-four volunteers were bandaged with one of the three compression systems on both legs. Interface pressures were measured at inclusion (day 0) and on days 1, 3 and 7 using an air sensor system, with the sensor placed in the medial B1 position above the inner ankle. In addition, the volume of the lower legs were also measured on days 0 and 7 using a three-dimensional imaging system. Comfort and tolerability were also assessed.

Results:

The performance, based on the loss of interface pressure compared with baseline, of the two-layer system was partially better than that of the short-stretch system for maximal working pressure and loss of volume. The two-layer system and short-stretch system had similar results for the supine, sitting and active standing positions. No difference was observed between the two-layer system and the four-layer system for the maximal working pressure. However, the two-layer system compared better than the two other systems for comfort and tolerability: 25% of the patients treated with the four-layer system discontinued the treatment after three days because of pain.

Conclusion:

The two-layer bandage system maintained, over one week, a similar level of sub-bandage pressure similar to a four-layer system and was partially better than short-stretch bandaging. However, the volunteers found the two-layer system more comfortable and tolerable than the other two systems.

Declaration of interest:

The investigators received an education grant from Urgo for the study. However, Urgo had no infl uence on the data analysis or interpretation.
Marjolin's ulcer associated with chronic osteomyelitis
Authors: Pandey M. , Kumar P. , Khanna A.K.
Published: May 2014

Marjolin's ulcer is a squamous cell carcinoma that is sometimes associated with chronic osteomyelitis. It occurs when soft tissue degenerates after a long period of chronic inflammation. A good outcome depends on a prompt wound biopsy
A review of the current research on the role of bFGF and VEGF in angiogenesis
Authors: Przybylski M.
Published: May 2014

Basic fibroblast growth factor and vascular endothelial growth factor are thought to play a synergistic role in angiogenesis. They are released into the wound bed during haemostasis and promote the formation of new blood vessels
Malignant fungating wounds: an analysis of the lived experience
Authors: Piggin C. , Jones V.
Published: May 2014

Objective:

The current understanding of living with a malignant fungating wound is derived from professionals' rather than the patient's perspective. An appreciation of the lived experience may assist in the development of more empathetic support approaches. This paper reports upon a study that aimed to illuminate the meaning and experience of living with a malignant fungating wound.

Method:

A Heideggerian hermeneutic phenomenological approach was used as the philosophical framework. Unstructured interviews were conducted with a purposive sample of five participants. Content hermeneutic analysis was adopted to analyse the data.

Result:

Four themes were identified: representing the worst part of the patient's cancer; living within a body that cannot be trusted; a changing relationship with the patient's family and friends; and a loss of identity while continuously striving to be normal, yet feeling different.

Conclusion:

Health care professionals must possess a heightened awareness of: the importance of the impact of the wound upon day-to-day living, identity and purpose; the value of adopting the phrase used by the patient to describe their wound; and to focus more upon the subjective meaning of a visibly changing wound rather than objective measurement.

Declaration of interest:

None.
Pedicled gracilis myocutaneous flap for treatment of recalcitrant hidradenitis suppurativa of the groin and perineum
Authors: Solanki N.S. , Roshan A , Malata C.M.
Published: May 2014

Use of this flap achieved immediate closure of a complex groin wound following a radical excision. The patient recovered quickly and was pleased with the aesthetic results, while there was no sign of recurrence at three-month follow-up