bluuebunny/crossref_metadata_2025 huggingface dataset:
An in vitro study of antimicrobial activity and efficacy of iodine-generating hydrogel dressings
Authors: Thorn R.M.S. , Greenman J. , Austin A.S.
Published: May 2014

Objective:

To determine the antimicrobial activity and efficacy of different formulations of novel bioxygenating hydrogel dressings (which deliver both iodine and oxygen into the wound) against various target organisms by means of an in vitro test system that more effectively mimics the conditions encountered when dressings are in contact with wounds.

Method:

Three bioxygenating hydrogels were tested: Oxyzyme, which releases low levels of iodine into the wound, and Iodozyme 402 and Iodozyme 401, which release higher levels of iodine, with Iodozyme 402 releasing twice the amount of 401. Cellulose filter disks (n=32) were inoculated with indicator species and placed equidistant from each other as a matrix onto agar test beds. Cut squares of control or test dressings were placed on top of each disk. Kill curves were constructed from determinations of the numbers of survivors (log cfu per disk) over time by removing disk samples at various time points.

Results:

Significant differences (p<0.05) were observed between the controls and test samples. The order of sensitivity for Oxyzyme was Fusobacterium nucleatum, Bacteroides fragilis, Propionibacterium acnes, Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus (MRSA), Candida albicans and Pseudomonas aeruginosa. The order of efficacy of the three hydrogel dressings (Iodozyme 402, followed by Iodozyme 401 and then Oxyzyme) was the same regardless of the target species.

Conclusion:

The novel hydrogel skin surface wound dressings are broad-spectrum in activity, encompassing antibiotic-resistant organisms, anaerobes and yeasts; their antimicrobial function appears to be rapidly effective.

Declaration of interest:

The authors wish to thank Insense for supplying various hydrogel test dressings and for summer studentship financial support (for RMS Thorn).
A cost-effectiveness analysis of two community models of care for patients with venous leg ulcers
Authors: Gordon L. , Edwards H. , Courtney M. , Finlayson K. , Shuter P. , Lindsay E.
Published: May 2014

Aim:

To conduct a cost-effectiveness analysis based on data from a randomised controlled trial comparing traditional community home nursing with a community Leg Club model for chronic venous leg ulcer management in the south-east metropolitan area of Queensland, Australia.

Method:

Participants were randomised to the Leg Club (n=28) or home visits (n=28). Data were obtained on resources/related costs incurred by the service provider, clients and carers, and the community.

Results:

From the collective perspective (service provider, clients and carers, and the community), at six months the incremental cost per healed ulcer was $AU515 (₠318) and the incremental cost per reduced pain score was $AU322 (₠199). For the service provider, Leg Club intervention resulted in cost savings and better health effects when compared with home nursing.

Conclusion:

On both clinical and economic grounds, the Leg Club model appears to be more cost-effective than traditional home nursing for the treatment of chronic venous leg ulcers. However, clients and the local community contribute substantial financial and in-kind support to the operation of both services.

Declaration of interest:

This project has been supported by a grant from the Queensland Nursing Council, Australia. The views expressed do not necessarily represent the views of the Council or the members, executive officer or staff of the Council.
Advances in tissue engineering and use of type 1 bovine collagen particles in wound bed preparation
Authors: Rudnick A.
Published: May 2014

At least 15% of people with diabetes develop ulcers of the lower extremity. These are generally caused by peripheral neuropathy and ischaemia, combined with unrecognised repetitive trauma (for example, due to ill-fitting shoes, injury and ingrown toenails). Delayed or inadequate treatment of foot infections in diabetic patients often results in limb loss — 24% of these amputations are of the toe, 5.8% are mid-foot, 38% are below the knee and 21.4% are above the knee; the remaining 10% include the hip, pelvis, knee and other sites.
An exploration of current leg ulcer management practices in an Irish community setting
Authors: Clarke-Moloney M. , Keane N. , Kavanagh E.
Published: May 2014

Objective:

To establish the prevalence of leg ulceration in the Irish Health Service Executive (HSE) mid-western region and to determine the level of assessment and treatment patients have been receiving in the local community.

Method:

Before the introduction of a Doppler training programme, all public health and community health nurses working in the Irish HSE mid-western area were requested to complete an audit form on each patient being treated for leg ulceration during a predefined one-week period. This form recorded details on patient demographics, ulcer aetiology, assessment and treatment. Out of 97 nurses, 96 responded to this audit, giving a response rate of 98.9%.

Results:

A total of 429 patients with 449 leg ulcers were identified. Mean age was 75.5 years (standard deviation 10.7). Overall prevalence was 0.12%, which increased to 1.2% in those aged 70 years and over. Women were almost twice as likely as men to be affected (ratio of 1.8:1). The main causes of ulceration were reported as venous incompetence accounting for 63.3% (284/449) and arterial insufficiency accounting for 8% (36/449) of all ulcers. Only 59.9% (269/449) of all ulcerated limbs had ABPI measurements performed. Of those reported as venous in origin, 71.8% (204/284) had ABPI measurements recorded. Evidence-based care was generally apparent in this group, with 47.5% (97/204) receiving high compression and 18.1% (37/204) receiving reduced compression. However, in venous leg ulcers where ABPIs were not recorded (n=80) care appeared haphazard and inappropriate.

Conclusion:

Our study has identified the benefit of ABPI Doppler assessment. This assessment could be done in local health centres by trained nurses who could provide more appropriate and timely care to patients, thereby improving outcomes and relieving pressure on acute hospital clinics.

Declaration of interest:

None.
Extracellular matrix prevents split-skin grafting in selected cases
Authors: Barendse-Hofmann M.G , van Doorn L.P , Oskam J , Steenvoorde P
Published: May 2014

Definitive wound closure in large open wounds can be achieved by split-skin grafting. In our hospital large split-skin grafts are performed in the operating room. However, many patients in our wound clinic are at high risk of developing postoperative complications such as delirium, pneumonia, urinary tract infection and pressure ulceration. In such cases, hospital admission might not only result in higher morbidity but also increased mortality. 1 In addition, surgery is delayed if routine preoperative swabs identify bacterial colonisation with microorganisms such as Staphylococcus aureus, Streptococci and Pseudomonas. We are therefore constantly searching for alternative products to splitskin grafting that preferably can be used in the outpatient department. Such alternatives need to be effective, easy to use, pain-free, inexpensive and require infrequent dressing changes. Extracellular matrix products seem to be a possible option. They promote granulation and epithelialisation in dermal wounds, and effectively regulate evaporation of moisture and absorption of exudation.
Use of polarised light as a method of pressure ulcer prevention in an adult intensive care unit
Authors: Verbelen J.
Published: May 2014

Objective:

This single-centred randomised pilot study aimed to examine whether the wound-healing properties of polarised light are effective in preventing grade II or above pressure ulcers in patients admitted to an adult intensive care unit.

Method:

Standard pressure ulcer prevention techniques were applied in both research groups. Patients allocated to the test group received supplementary treatment with polarised light once daily for 10 minutes (sacral area and both heels) starting on the first day after admission. The control group received no polarised light.

Results:

A control group of 13 patients and an intervention group of 10 patients were included in the study between 1 March and 1 May 2006. There was no statistically significant difference between the groups for composition, standard pressure ulcer prevention or pressure ulcer risk. Observations revealed a statistically significant difference (p=0.019) between the groups when comparing development of grade II or above sacral or heel pressure ulcers.

Conclusion:

Patients treated with polarised light developed significantly (p=0.019) fewer grade II or above sacral or heel pressure ulcers when compared with a control group receiving no polarised light. Further research is required.

Declaration of interest:

Two Bioptron light sources were lent by Haromed Wound and Skin Care Solutions and a number of grids for use with a Visitrak system by Smith & Nephew. The supporting sources had no involvement in the study design, data collection or analysis, interpretation of data, writing of the article or the decision to submit the article for publication. None of the contributors received any financial compensation.
Wound healing activity of Matricaria recutita L. extract
Authors: Shivananda Nayak B. , Sivachandra Raju S. , Chalapathi Rao A.V.
Published: May 2014

Objective:

To evaluate the wound healing activity of M. recutita (chamomile) extract in rats.

Method:

Wound healing activity was determined using excision, incision and dead space wound models. The animals were divided into two groups of six for each model: animals in the test group were treated with the aqueous extract of M. recutita (120mg/kg/day), which was mixed in their drinking water. Animals in the control group were maintained with plain drinking water. Healing was assessed by the rate of wound contraction, period of epithelialisation, wound-breaking strength, granulation tissue weight and hydoxyproline content. Antimicrobial activity of the extract against various microorganisms was assessed.

Results:

On day 15 animals in the test group exhibited a greater reduction in the wound area when compared with the controls (61% versus 48%), faster epithelialisation and a significantly higher wound-breaking strength (p<0.002). In addition, wet and dry granulation tissue weight and hydroxyproline content were significantly higher.

Conclusion:

The increased rate of wound contraction, together with the increased wound-breaking strength, hydroxyproline content and histological observations, support the use of M. recutita in wound management. However, this needs to be studied further before it can be considered for clinical use.

Declaration of interest:

None.
Venous ulceration and the measurement of movement: a review
Authors: Abadi S , Nelson E. A , Dehghani A.
Published: May 2014

The aim of this review is to investigate the current literature concerning venous leg ulceration — specifically the place of venous anatomy and blood pressure in the development and treatment of venous ulceration — and the measurement of human movement using different devices and equipment. The combination of these two literature reviews will enable us to examine the relationship between human lower limb activity and the development and healing of venous ulceration, and identify any gaps in the literature.
Effect of amelogenin extracellular matrix protein and compression on hard-to-heal venous leg ulcers: follow-up data
Authors: Romanelli M. , Kaha E. , Stege H. , Wnorowski J.W. , Vowden P. , Majamaa H. , Lazaro J.L.
Published: May 2014

Objective:

To undertake a follow-up of patients with hard-to-heal venous leg ulcers (VLUs) who had participated in a randomised controlled trial in which they had been treated with either compression therapy in combination with amelogenin extracellular matrix protein or compression therapy alone for 12 weeks or until their ulcers had healed, whichever occurred first.

Method:

Patients were randomised to receive either high compression therapy plus amelogenin (n=42) or high compression therapy alone (n=41) for a period up to and including 12 weeks. The method and initial findings are detailed in an earlier paper. Twelve weeks after the final visit, the patients were followed up and the wounds were re-evaluated.

Results:

The initial results demonstrated clinically and statistically significant benefits for the patients in the amelogenin group. The results of the follow-up showed that the successful healing response had been maintained. Significantly more patients continued to show a reduction in ulcer size from baseline in the amelogenin-treated group versus the control group (p=0.02), and there was a statistically significant (p=0.01) larger reduction in the amelogenin-treated group. This group also had a significantly (p=0.02) higher percentage of patients with decreases in wound size. The overall number of patients with healed wounds was greater (n=9) in the amelogenin-treated group than in the control group (n=3). Pain continued to be significantly reduced in the amelogenin-treated group compared with the control group (p=0.001).

Conclusion:

Amelogenin therapy in conjunction with high compression therapy was beneficial in the treatment of hard-to-heal VLUs when compared with treatment with high compression alone. These beneficial effects were maintained post-treatment and were identified at follow-up.

Declaration of interest:

This study was funded by Mölnlycke Health Care, Göteborg, Sweden.
Biofilms in wounds: management strategies
Authors: Rhoads D.D. , Wolcott R.D. , Percival S.L.
Published: May 2014

Biofilms probably induce a chronic and/or ‘quiet’ inflammation in the chronic wound and so delay healing. This paper reviews current strategies that can be used to suppress biofilms in chronic wounds until better options are available
Clinical experiences of using a silver hydroalginate dressing in Austria, Switzerland and Germany
Authors: Kammerlander G. , Afarideh R. , Baumgartner A. , Berger M. , Fischelmayer K. , Hirschberger G. , Hangler W. , Huber A. , Kramml M. , Locherer E. , Scandella C. , Süss-Burkhard A. , Wipplinger P.
Published: May 2014

This retrospective study, which involved patients with a range of colonised or infected wounds from 12 central European wound-care centres, found that this dressing combated infection, reduced pain and promoted healing
An 18th century account of leg ulcer care that speaks to us today
Authors: Thomas S.
Published: May 2014

In 1766, a French physician proposed a protocol of care for patients with leg ulcers that anticipates much modern thinking on this topic. So, has our understanding increased as much as we think or is there still much to learn and do?
Role of macrophages in normal wound healing: an overview
Authors: Adamson R.
Published: May 2014

Macrophages play an essential role during inflammation in normal wound healing. They promote the recruitment and proliferation of fibroblasts, and express some of the key growth factors that stimulate angiogenesis
Assessment of the antimicrobial effectiveness of a new silver alginate wound dressing: a RCT
Authors: Trial C. , Darbas H. , Lavigne J-P. , Sotto A. , Simoneau G. , Tillet Y. , Toét L.
Published: May 2014

Objective:

To compare the efficacy and tolerability of a new ionic silver alginate matrix (Askina Calgitrol Ag) with that of a standard silver-free alginate dressing (Algosteril).

Method:

Patients with locally infected chronic wounds (pressure ulcers, venous or mixed aetiology leg ulcers, diabetic foot ulcers) or acute wounds were eligible for this prospective, open-label, controlled and randomised trial. Patients were randomised to receive one of the two dressings for a two-week period. Criteria of efficacy were based on the evolution, from day 1 to day 15, of local signs of infection using a clinical score ranging from 0 to 18, and the evolution of the bacteriological status for each wound. The latter was determined by (blind) bacteriological examinations of results obtained from two biopsies performed at days 1 and 15. A three-point scale (deterioration, unchanged, improvement) was also used. Acceptability, usefulness and tolerance were also assessed.

Results:

Forty-two patients (20 women and 22 men, 68.9 ± 18.8 and 66.5 ± 15.7 years old respectively) were randomly assigned to receive either Askina Calgitrol Ag (n=20) or Algosteril (n=22). Most had chronic wounds such as pressure ulcers (57%) or venous or mixed aetiology leg ulcers and diabetic foot ulcers (29%); few had acute wounds (14%). Clinical scores of infection were comparable in both groups at inclusion, 8.9 ± 2.4 and 8.6 ± 3.2 in the Askina Calgitrol Ag group and the Algosteril group respectively (not signifi cant), but decreased signifi cantly in both groups at day 15, 3.8 ± 2.9 in the Askina Calgitrol Ag group (p=0.001) and 3.8 ± 3.4 in the Algosteril group (p=0.007). There was no signifi cant difference between the two groups at day 15. Although there was also no signifi cant difference in bacteriological status between the treatment groups, a trend in favour of Askina Calgitrol Ag was found for the relative risk of improvement, especially in patients who were not treated with antibiotics either at the beginning of the study or during it. No differences between groups were observed regarding local tolerance, acceptability and usefulness of the dressings.

Conclusion:

The regression of local signs of infection, local tolerance, acceptability and usefulness were similar for the two dressings. However, Askina Calgitrol Ag improved the bacteriological status of the wounds. Further trials are required to show that it has a positive impact on the healing process.

Declaration of interest:

The study was sponsored by B. Braun Medical SAS.
A discussion of the potential mechanisms for wound dressings' apparent analgesic effects
Authors: Richardson C. , Upton D.
Published: May 2014

Evidence has been developing about the potential analgesic effects of wound dressings. Several theories have been formulated as to how a dressing placed over a wound might contribute to pain relief. This paper reviews these potential mechanisms. In all, 10 are discussed here, most of which will probably overlap, leading to a high degree of complexity and interdependence. The psychological components inherent in the biopsychosocial model of pain make a key contribution to any analgesic effects that occur following dressing application. The 10 mechanisms identified in this paper will need significant and rigorous testing to determine which, if any, can be confirmed as analgesic
Molecular diagnosis of Raoultella planticola infection of a surgical site
Authors: Wolcott R. , Dowd SE.
Published: May 2014

Raoultella planticola has been rarely diagnosed in clinical specimens. A case of a polymicrobial surgical site infection primarily caused by R. planticola in a 66-year-old Caucasian male with a fractured left tibia after an open reduction internal fixation of his left ankle is described and confirms this organism to be an opportunistic human pathogen. This pathogen was diagnosed with rapid clinical molecular pathogen diagnostic methods, which allowed an appropriate therapy to be implemented, thereby improving prognosis
Prevalence of diabetic foot syndrome and its risk factors in the UK
Authors: Lauterbach S. , Kostev K. , Kohlmann T.
Published: May 2014

Objective

To determine the prevalence of diabetic foot syndrome (DFS) and its risk factors (diabetic neuropathy, peripheral vascular disease, open wounds and mycoses of the feet) at GP practices in the UK in 2008.

Method

We searched the IMS Disease Analyzer database, which stores representative information on approximately 4.2 million patients. All documented diagnoses of diabetes mellitus in 2008, based on either ICD-10 (international classification of diseases) codes or free text comments from doctors, were analysed.

Results

Data from 34,198 patients with type 2 diabetes (47.1% female, mean age 66.1 years [SD 15.1], mean diabetes duration 7.4 years [SD 5.1]) and 2,576 patients with type 1 diabetes (43.2% female, mean age 39.2 years [SD: 18.0], diabetes duration 11.0 years [SD: 6.1]) were analysed. DFS was registered in 7.6% (95% CI: 6.6–8.6) of patients with type 1 diabetes and 8.5% (95% CI: 8.2-8.8) with type 2 diabetes. Many more patients were at high risk of developing DFS, with diabetic neuropathy, diabetic angiopathy, foot mycoses and/or open wounds of the feet.

Conclusion

Results from this analysis of one of the large representative databases show that even though the prevalence of DFS among patients with diabetes mellitus is relatively low, the prevalence of its main risk factors is high. Preventive efforts should target these risk factors.

Conflict of interest

None.
Wound dressings: 21st century performance requirements
Authors: Cutting Keith F
Published: May 2014

A wide range of wound dressing performance parameters exist. This paper discusses those dressing attributes that, within the constraints of current technology, favourably influence the biological actions/processes that may occur within the wound so that they actively contribute to the healing process.
Telemedicine in the management of patients with chronic wounds
Authors: Jelnes R.
Published: May 2014

The following article presents a telemedicine system that has been introduced in southern Jutland, Denmark. Using ‘low-tech’ equipment, such as camera-equipped mobile phones and normal desktop computers with an internet connection, health professionals have been able to communicate and collect data in a clinical database more effectively. This system aims to improve interdisciplinary collaboration, through facilitating the interaction between health professionals and also other parties that are involved in the provision of care, such as administrative staff and local reimbursement authorities.
Reaching for the moon: achieving zero pressure ulcer prevalence, an update
Authors: I. Bales I. , Duvendack T.
Published: May 2014

Following implementation of a programme to eradicate hospital-acquired pressure ulcers in one US hospital, prevalence fell from 9.5% in 2007 to zero in December 2008. This article reviews the ongoing success of the management programme over 2 years later, highlighting the efforts to sustain and refine the programme.
Use of a silicon microsensor for pressure monitoring inside the wound and outcomes on healing
Authors: Mejzlik J.
Published: May 2014

• Objective:

To ascertain the extent to which pressure within a defined neck compartment could be used as predictor for wound healing.

• Method:

Thirty patients with various head and neck malignancies that were treated surgically, were considered prospectively. In the course of surgery a pressure microsensor was implanted into the defined neck compartment and data were collected over the first 48 hours postoperatively. logistic regression analysis was used to determine the strength of interfascial pressure (IP) as predictor for wound healing.

• Results:

Mean IP was 7.45 ± 6.15mmHg (95%Cl 7.13; 7.77). A logistic regression model relating good/disturbed healing outcome revealed that the mean pressure is the key variable, with a major influence on healing outcome. However, this type of model only explains approximately 46% of the total variation in the responses. This implies, that although pressure change contributes significantly in explaining variations in healing, there may be other significant predictors that were not included in the study.

• Conclusion:

This study demonstrates the feasibility of IP measurement in the neck, verifies it in a human clinical experiment and highlights its potential in the prediction of wound healing complications. The study seems to suggest that for high probability of good wound healing (> 90%) the IP values should be monitored and maintained below 7mmHg. At present, there are no comparator studies, as this kind of measurement in the neck area has not been reported yet.

• Declaration of interest:

This study received financial support from the Internal Grant Agency, ministry of Health of the czech republic (grant study no. NR8387). The author has no economic or social conflicts of interest to report.
Clinicians' rationale for using a silver dressing: the French OMAg+E observational study
Authors: Truchetet F. , Guibon O. , Meaume S.
Published: May 2014

• Objective:

To describe motivations for using a silicone, silver-releasing dressing and the type of wounds treated with this dressing, and to evaluate its short-term impact on wound characteristics.

• Method:

A French, prospective, observational study of adult patients prescribed a soft-silicone, silver-releasing dressing (Mepilex Ag; Mölnlycke Health Care) in the community. Each participating physician was asked to include the first two consecutive patients they treated with the silver dressing, reporting patient and wound characteristics, as well as the presence of 10 local signs compatible with wound infection (abscesses, purulent or copious exudate, erythema, increase in local warmth, pain, oedema, lymphangitis or satellite adenitis, malodour and delayed wound healing). Clinicians were also asked to select from a list their rationale for prescribing the silver dressing for each patient, including treating a wound infection, to stimulate granulation tissue formation, to promote wound healing, to reduce wound exudate, and to decrease wound pain. Local and general treatment were also reported.

• Results:

Overall, 794 patients (58% females), with a mean age of 69.0 ± 15.4 years, were included by 128 general practitioners, 51 dermatologists and 63 vascular specialist. Sixty-seven per cent were venous leg ulcers (VLUs), 26% were acute wounds (post-traumatic, surgical, burn wounds and animal bites) and 6.3% were other chronic wounds (pressure ulcers, diabetic foot ulcers and oncology wounds). On average 3.7 ± 1.5 local signs of infection were present and mean pain intensity (on a visual analogue scale) was 50 ± 24mm. According to prescribers, infection and healing delay were the primary rationale in 82% of cases, with oral antibiotics started concurrently in 19% of these wounds. Patients were followed-up at a median of 19 days, by which time all wound parameters were documented as significantly improved. Tolerability and efficiency of the silver dressing was considered as ‘good'/'very good’ in more than 97% of cases.

• Conclusion:

While there are some variances with the French reimbursement indication, for the clinicians surveyed in this study, the primary rationale for prescription of a silver dressing was treatment of a possible wound infection. Although this indication might not always be clinically funded, based on wound characteristics, the short-term impact of this prescription in this series was favourable.

• Declaration of interest:

This study was funded by a grant from Mölnlycke Health Care, France. The authors have no conflicts of interest to declare.
The use of maggot debridement therapy in the treatment of chronic wounds in hospitalised and ambulatory patients
Authors: Gilead L. , Mumcuoglu K.Y. , Ingber A.
Published: May 2014

Objective:

To summarise our experience of the use of medicinal maggots for the debridement of necrotic chronic wounds and to try and identify prognostic factors for debridement success and associated pain.

Method:

During the years 1996–2009, 723 wounds of 435 patients (180 females and 255 males) were treated with maggot debridement therapy (MDT) in 16 departments and units of the Hadassah Hospital in Jerusalem, Israel. overall, 261 patients were treated during hospitalisation, while 174 were treated as ambulatory patients. In 90.5% of the patients the wounds were located on the leg, but only 48.0% had diabetic foot ulcers. The wound duration range from one to 240 months (mean=8.9; median=4 months). Sterile maggots of the green bottle fly, Lucilia sericata, were used for MDT. In 90.6% of the cases, maggots were placed directly on the wound using a cage-like dressing and left for 24 hours, while in 9.4% of the patients maggots concealed in a tea-bag like polyvinyl netting were used. The concealed maggots were left on the wound for 2–3 days.

Results:

The number of treatments was 1–48 (mean=2.98; median=2) and the duration of the treatment varied between one and 81 days (mean=4.65; median=3). In 357 patients (82.1%) complete debridement of the wound was achieved, while in 73 patients (16.8%) the debridement was partial and in five (1.1%) it was ineffective. Increased pain or discomfort during MDT were reported in 38% of the patients.

Conclusion:

MDT is a very safe, simple and effective treatment modality for chronic wounds in ambulatory and hospitalised patients.

Declaration of interest:

There were no external sources of funding for this study. The authors have no additional conflicts of interest to declare.
An overview of biofilm and its detection in clinical samples
Authors: Alavi M.R. , Stojadinovic A. , Izadjoo M.J.
Published: May 2014

In many instances, wound colonising-bacteria are thought to be capable of forming biofilms, a significant factor contributing to delays or failure in wound healing. This review summarises the accumulated knowledge of biofilm and addresses the unmet need of biofilm detection in clinical wound samples.
Well-wound therapy: use of NPWT to prevent laparotomy breakdown
Authors: Dutton M. , Curtis K.
Published: May 2014

The use of negative pressure wound therapy (NPWT) for the treatment of wounds is not uncommon in modern health-care systems. However, use of NPWT as a wound prevention strategy, or ‘well-wound therapy’, is not so common. To date, papers that do discuss the use of NPWT in this way have focused mainly on orthopaedic and sternotomy wounds. This case study will present the use of NPWT with the goal of preventing laparotomy breakdown, utilising an innovative splinting technique.
Pain related to maggot debridement therapy
Authors: Mumcuoglu K.Y. , Davidson E. , Avidan A. , Gilead L.
Published: May 2014

Objective:

To summarise our experience with maggot debridement therapy (MDT) in relation to pain observed in patients treated in 16 departments and units of the Hadassah Hospital in Jerusalem, Israel.

Method:

A secondary analysis of data from 435 patients. Maggots were either placed directly on the wound using a cage-like dressing (DA), or they were applied to the wound encased in a previously prepared hermetic tea-bag like pouch (TBA). During each treatment, patients were asked whether they felt any difference in the level of pain before and during MDT treatment.

Results:

Overall, 165 patients (38%) reported increased pain during MDT. Seventeen patients (41%), who were treated with the TBA technique, and 148 patients (38%), who were treated with the DA technique, reported increased pain and were treated with analgesics before or during MDT. In five patients, the treatment had to be discontinued due to uncontrolled pain during MDT. Pain control measures were undertaken in patients who were already in intense pain prior to the initiation of MDT and in those patients who reported intense pain during DA treatment. The measures included shorter periods of application of maggots, use of the TBA rather than DA technique, and applying relatively small maggots as well as a smaller number of maggots during an MDT session. In patients who continued reporting intense pain, systemic analgesic medications and peripheral nerve blocks were used.

Conclusion:

Since a full debridement requires an average of 2–3 maggot cycles, which last 3–5 days, and since a large percentage of patients treated with MDT complain of pain that may last throughout the therapy period, it is deemed worthwhile and even essential to titrate analgesics as needed and be prepared to treat patients even with potent analgesics, such as opioids. In cases when pain is intense and uncontrolled with systemic medications, peripheral nerve blocks should be considered.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Incidence and risk factors of sternal wound infection at site of incision after open-heart surgery
Authors: Hosseinrezaei H. , Rafiei H. , Amiri M.
Published: May 2014

Objective:

To identify the incidence of sternal wound infection and the risk factors before, during and after open-heart surgery in an Iranian critical care unit.

Method:

A descriptive, analytic study investigating all open-heart surgery patients from March 2010 to March 2011, in terms of the incidence of sternal wound infection and the risk factors before, during, and after surgery. Patients were examined for signs of infection at the site of surgical incision on presentation to the ward, daily during their stay, and on discharge. The same investigator reviewed all wounds, every day.

Results:

The incidence of sternal wound infection was found to be 10%. Multivariate regression analysis identified the following risk factors: diabetes (OR: 0.439; 95%CI: 0.21–0.95; p=0.04), age (OR: 1.033; 95%CI: 1.003–1.064; p=0.03), hyperlipidaemia (OR: 1.008; 95%CI: 1.005–1.011; p < 0.001), history of respiratory disorders ([COPD] OR: 2.952; 95%CI: 1.3–6.4; p=0.007), female gender (OR: 2.06; 95%CI: 1.40–3.03; p < 0.008), and history of addiction to opiates (OR: 2.33; 95%CI: 1.56–3.49; p < 0.006).

Conclusion:

This study found a high rate of surgical sternal wound infection in open-heart surgery patients in an Iranian critical care unit, suggesting that the medical and care-giving team in the cardiac intensive care unit need further education.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Patients' experiences of negative pressure wound therapy for the treatment of wounds: a review
Authors: Upton D. , Stephens D. , Andrews A.
Published: May 2014

Objective:

To review the research on patients' experiences of undergoing negative pressure wound therapy (NPWT).

Method:

A literature search was carried out using the following databases: Academic Search Complete, CINAHL, PsychINFO, MEDLINE, PubMed and PsyARTICLES. The search covered the period from 2001 to 2012, using the key words: [‘negative pressure wound therapy’ OR ‘vacuum-assisted closure’ OR ‘topical negative therapy’] AND [‘patients' experiences’ OR ‘psychological’ OR ‘stress’ OR ‘anxiety’ OR ‘wellbeing’ OR ‘pain’ OR ‘quality of life’ OR ‘physical’].

Results:

Twenty-five relevant articles were included. NPWT is generally considered to be successful in reducing wound depth and facilitating healing. However, studies have highlighted a number of issues that need to be considered. For example, the type of dressing used during treatment can have a significant effect on patients' experience of pain. Furthermore, the NPWT system can cause patients to feel anxious due to both the patient and the health professional being unfamiliar with this form of treatment. It can also restrict patients' daily care and wider social life, which may result in a negative self-image and low self-esteem. Despite this, some studies have reported positive improvements to patients' quality of life. Additionally, since NPWT can lead to faster healing, any detrimental impact upon patients' wellbeing may be short-term and less prolonged than that of other treatments.

Conclusion:

Compared with other treatments, there is evidence to show that NPWT can lead to faster wound healing, and a reduced frequency of dressing changes and other treatments. However, there are a number of challenges with the use of NPWT, which need to be explored further so that improvements can be made. Specifically, certain aspects of NPWT may impact negatively on patients' wellbeing, albeit short-term. Therefore, research needs to explore patients' experiences of NPWT throughout the treatment process and to consider how this can be improved to minimise any negative effects.

Declaration of interest:

There were no external sources of funding for this study. The authors have no commercial or financial conflicts of interest to declare.
Disrupted abdominal laparotomy wounds in gynaecologic oncology patients: benefits of active surgical re-closure
Authors: Peled Y. , Krissi H. , Sabah G. , Levavi H , Eitan R.
Published: May 2014

Objective:

To assess the outcome of active management of disrupted wounds through surgical approximation and re-closure.

Method:

A prospective, non-comparative study, on all consecutive patients with disrupted laparotomy wounds treated at a tertiary medical centre, from November 2009 to December 2011. Data on patient demographics, diagnosis, type of abdominal incision, initial closure technique, infections and results of secondary re-closure were collected from the medical files. All patients underwent bedside closure with an en bloc mass suture mattress technique, performed by two attending gynaecologic oncologists.

Results:

Of 197 patients who underwent abdominal laparotomy during the study period, 31 (16%) had a disrupted wound. Following surgical re-closure, 26 wounds (84%) were completely healed or needed only minor additional care by follow up on day 10. Five wounds (16%) failed primary management and required re-suturing; all subsequently healed. There were no long-term complications.

Conclusion:

Active surgical re-closure of disrupted abdominal laparotomy wounds is safe and effective in patients after treatment surgically for Müllerian malignancies.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Coping with an exulcerated breast carcinoma: an interpretative phenomenological study
Authors: Probst S. , Arber A. , Faithfull S.
Published: May 2014

Objective: To explore how women living at home with a malignant fungating wound (MFW) cope with such wounds.

Method: To explore coping through the lived experiences of patients a methodological framework, using Heideggerian hermeneutic phenomenology and semi-structured interviews. Nine patients were interviewed from January until November 2009.

Results: The results are divided into two categories: ‘living with a MFW’ and ‘feeling different’. These categories demonstrate how it is to live with the unpredictability, and uncontrollability of a MFW due to symptoms such as malodour, bleeding, exudate, pain and itching. The loss of control of the body boundary due to uncontrollable symptoms led to significant levels of distress and suffering for the patients. Different coping strategies were used to live with this wound.

Conclusion: This study demonstrates how difficult it is to live and cope with a malignant fungating wound. Coping strategies, including going into isolation, or denying any issues, were used. When taking care of patients with MFWs, strategies need to integrate a palliative, holistic, empathic approach.

Declaration of Interest: There were no external sources of funding for this study. The authors have no additional conflicts of interest to declare.
A review of PU risk assessment and prevention in Scandinavia, Iceland and Ireland (Part II)
Authors: Moore Z. , Johansen E. , van Etten M.
Published: May 2014

• Objective:To provide a critical appraisal of nurses risk assessment and pressure ulcer (PU) preventive practices across scandinavia, Iceland and Ireland.

• Method:An integrative research review following Cooper's five stages. Studies published in peer-reviewed journals, involving any study design, but specifically exploring PU risk assessment or preventative practices, in any care setting, were included.

• Results:Risk assessment practice was primarily investigated in the acute care setting and was found to be irregular, based on both numeric scales and clinical judgments. This irregular practice means that some vulnerable patients are not screened for pressure ulcer risk, conversely, when risk assessed, a care plan is not necessarily provided. A significant gap in nurse documentation, together with a lack of supporting evidence for repositioning and use of appropriate redistribution devices was also identified, indicating a lack of a standardised approach to pressure ulcer prevention.

• Conclusion:Despite an abundance of literature exploring this subject, it is clear that current practice in pressure ulcer prevention is not embedded within best practice recommendations. Therefore, to address the potential patient safety implications, clinical practice could benefit from exploration and identification of practical methods for improving actual pressure ulcer preventive practice.

• Declaration of interest:This work is partly funded by a research grant from the Norwegian College of Nursing (Norsk Sykepleierforbund NSF) in 2012. The authors have no conflict of interest to declare.
Use of 1540nm fractionated erbium:glass laser for split skin graft resurfacing: a case study
Authors: Narinesingh S. , Lewis S. , Nayak B.S.
Published: May 2014

The field of laser skin resurfacing has evolved rapidly over the past two decades from ablative lasers, to nonablative systems using near-infrared, intense-pulsed light and radio-frequency systems, and most recently fractional laser resurfacing. Although fractional thermolysis is still in its infancy, its efficacy in in the treatment of skin disorders have been clearly demonstrated. Here we present a case report on the safety and efficacy of a 1540nm erbium:glass laser in the treatment of the waffle pattern of a meshed skin graft in a 38-year-old patient with type V skin in the Caribbean.
Physiological and appearance characteristics of skin maceration in elderly women with incontinence
Authors: Ichikawa-Shigeta Y. , Sugama J. , Sanada H. , Nakatani T. , Konya C. , Nakagami G. , Minematsu T. , Yusuf S. , Supriadi  , Mugita Y.
Published: May 2014

Objective:

To identify the physiological and appearance characteristics of skin maceration caused by urine and/or faeces and determine their suitability as risk indicators for incontinence-associated dermatitis.

Method:

This cross-sectional, comparative study involved sixty-nine elderly women with urinary and/or faecal incontinence who provided informed consent to participate. Exclusion criteria included serious medical problems, acute illness and the presence of damaged skin on the buttocks. The physiological and appearance characteristics of macerated skin on the buttocks of the patients were examined. Stratum corneum and dermis hydration levels, transepidermal water loss and skin pH were used to assess skin condition. Skin morphology (sulcus cutis) was confirmed using images at x15 magnification. The erythema index and white index were used to evaluate colour in the macerated skin areas.

Results:

Forty-four patients exhibited skin maceration. Stratum corneum and dermis hydration levels were significantly greater in the maceration group than in the non-maceration group, as were transepidermal water loss, skin pH and differences in sulcus cutis interval between the buttock of interest and the subumbilical region. Furthermore, differences in the erythema and white indices between these two regions were significantly higher and lower, respectively, in the maceration group than in the non-maceration group.

Conclusion:

To our knowledge, this is the first report to note that there are interesting changes not only in the epidermal layer but also in the dermis layer in patients with skin maceration. This finding confirmed that skin maceration caused by incontinence is a severe condition. Moreover, the erythema index was the best index for identifying skin maceration caused by incontinence, indicating that it can be used for precise and easy identification of the condition in clinical practice.

Declaration of interest:

Funding for this study was obtained from the Japan Society for the Promotion of Science (JSPS) KAKENHI (Grant-in-Aid for Young Scientists) under grant agreement number 21890217. The authors have no conflicts of interest to declare.
Negative pressure wound therapy for sternal wound infections following congenital heart surgery
Authors: Costello J.P. , Amling J.K. , Emerson D.A. , Peer S.M. , Afflu D.K. , Zurakowski D. , Jonas R.A. , Nath D.S.
Published: May 2014

Objective:

This study examines the efficacy of a comprehensive, multidisciplinary wound management team and negative pressure wound therapy (NPWT) for the treatment of sternal wound infections in congenital heart surgery patients.

Method:

A single-institution retrospective review of all congenital heart surgery patients with post-operative sternal wound infections who were treated with NPWT was performed. Patients were evaluated based on (a) whether NPWT occurred before or after the establishment of a multidisciplinary wound management team, and (b) whether NPWT was initiated early (within 2 days) or late (greater than 2 days) after diagnosis of a sternal wound infection.

Results:

The median duration of NPWT was 12 days (range 2–50 days). NPWT was successfully initiated in patients as young as 15 days of age. There was a trend toward shorter duration of both NPWT and antibiotic use following (a) the implementation of the multidisciplinary wound management team, and (b) in patients with early use of NPWT; however, these results did not achieve statistical significance.

Conclusion:

NPWT can be successfully utilised in congenital heart surgery patients, including young neonates, for the treatment of sternal wound infections. The trends observed in the reduction of wound therapy duration and antibiotic duration with early implementation of negative pressure therapy and multidisciplinary wound management require further investigation to verify their clinical efficacy in patient care.

Declaration of interest:

There were no external sources of funding for this study. The author has no conflicts of interest to declare.
A novel use of amniotic membrane for fingertip injuries
Authors: Fijan A. , Hashemi A. , Namazi H.
Published: May 2014

Objective:

Fingertip injuries, which are the most common hand injury, represent management challenges for hand surgeons. Full thickness skin grafts are routinely used to cover the fingertip site, but has significant donor site morbidity. As amniotic membranes (AM) are used as a dressing substitute in burns, we decided to evaluate the efficacy of AM as a biologic wound dressing material for coverage of these injuries.

Method:

In this clinical study, 30 patients with full-thickness zone 1 fingertip skin loss were included. The patients were divided into 2 groups using the block randomisation method. In the first group, a skin graft was used for coverage and in the second group, AM was used. All patients were operated on by the same hand surgeon between February 2012 to October 2012. The minimum follow-up period was 6 months. Two point discrimination (T.P.D), light touch, healing time, days lost from work and infection rate were evaluated and recorded.

Result:

This study recruited 30 patients with full-thickness zone 1 fingertip skin loss (age range 13–47 years). Fingertips in both groups were assessed. T.P.D, light touch and days lost from work were significantly lower in the AM group than in the skin graft group. Healing time was lower in the skin graft group. In the both groups, no infection was detected. Patients of both groups were satisfied of their treatment and healing progress.

Conclusion:

Our results showed the effectiveness and safety of AM for the treatment of fingertip amputation, which can produce better sensation and functional outcomes than skin graft transplantations.

Declaration of interest:

This paper was extracted from the thesis of Abouzar Fijan, MD. This study was supported by Shiraz University of Medical Sciences, grant number 4037. The authors have conflicts of interest to declare.