bluuebunny/crossref_metadata_2025 huggingface dataset:
Wound debridement, Part 2: sharp techniques
Authors: Vowden K.R. , Vowden P.
Published: May 2014

An update on the skills and knowledge required by the practitioner in order to undertake the sharp debridement of wounds.
Varidase: the science behind the medicament
Authors: Rutter P.M. , Carpenter B. , Hill S. S. , Locke I.C.
Published: May 2014

Varidase used throughout the world for the topical treatment of purulent and suppurating wounds. The efficacy of the product is centred on two enzymes streptokinase and streptodornase; but these represent only a small proportion of the bulked solid. This article gives an overview of the preparation and mode of action of Varidase as well as showing some of the research and development that has gone into improving the assessment of its quality and composition.
The diagnosis and treatment of pyoderma gangraenosum
Authors: Coady Karin
Published: May 2014

Pyoderma gangraenosum is a rare condition and its symptoms are often misdiagnosed. This article presents an overview of this form of ulceration, and includes a case study showing how it is diagnosed and treated in a patient following an arthroscopy.
What can we learn from interface pressure measurements?
Authors: Fletcher J.
Published: May 2014

Interface pressure measurements are imprecise and subject to many variables. When selecting pressure support systems, it is best to take these into account along with other important factors.
Treating hypertrophic scars for 12 or 24 hours with a self-adhesive hydroactive polyurethane dressing
Authors: Schmidt A. , Gassmueller J. , Hughes-Formella B. , Bielfeldt S.
Published: May 2014

Treatment with a self-adhesive hydroactive polyurethane dressing (Cutinova thin, Beiersdorf AG, Hamburg, Germany) applied over a period of eight weeks has been shown to have a beneficial effect on hypertrophic scars. However, the use of such dressings during the daytime on visible parts of the body is often problematic and might lead to reduced compliance.
Incidence and management of ulcers in diabetic Charcot feet
Authors: Larsen K. , Fabrin J. , Holstein P.E.
Published: May 2014

This study followed 115 patients with diabetes — who between them had 140 feet with Charcot's arthropathy — over six to 114 months (median: 48). A total of 43 patients (37%) developed ulcers in 53 feet. Their treatment was multifactorial. An offloading regimen was adopted, with the use of crutches and therapeutic sandals with soft, individually moulded insoles, followed by adjusted or bespoke shoes. Recalcitrant ulcers were treated with surgery in 16 patients (37%). Antibiotics were needed by 21 patients (49%).
Pain relief and wound care in a young woman with special needs
Authors: McArthur L. , Dooley F.
Published: May 2014

This article focuses on a teenage girl with cerebral palsy admitted for an orthopaedic procedure, and highlights the problems of pain and wound management discussed in this journal's Challenges in Wound Care study days.
2: Obtaining consent in wound care: what are the key issues?
Authors: Sharp K. , Baxter H.
Published: May 2014

When undertaking a therapeutic intervention, health-care professionals must ensure that they receive informed consent from the patient in order to protect both the individual and themselves.
Cost-effectiveness of treating deep diabetic foot ulcers with Promogran in four European countries
Authors: Ghatnekar O. , Willis M. , Persson U.
Published: May 2014

Objective:

This study aimed to estimate the cost-effectiveness of treating non-superficial diabetic foot ulcers with Promogran plus good wound care (GWC) compared with GWC alone in four European countries (France, Germany, Switzerland and UK).

Methods:

An existing Markov-based health economic model of non-superficial diabetic foot ulcers was adapted to incorporate the relative efficacy of Promogran compared with GWC alone as demonstrated in a randomised controlled trial. Treatment with Promogran was modelled for a maximum of three months. Country-specific treatment costs were used to estimate the incremental cost per ulcer-free day gained over 12 months. Some parameter assumptions were changed to assess the sensitivity of the results.

Results:

Within the first three months of treatment, 26% of ulcers in the Promogran cohort healed compared with 20.7% in the GWC cohort. Over the 12 months, the average number of months spent in the healed state was 3.41 (GWC) and 3.75 (Promogran). Promogran treatment was found to be cost-saving in all four countries, using year 2000 Euro values.

Conclusion:

Promogran with GWC may be cost-effective, perhaps even cost-saving, under a wide variety of assumptions for the treatment of neuropathic foot ulcers.

Declaration of interest:

This study was funded by Ethicon Gmbh (Johnson and Johnson), Germany.
Digital imaging versus conventional contact tracing for the objective measurement of venous leg ulcers
Authors: Samad A. , Hayes S. , French L. , Dodds S.
Published: May 2014

Objective:

This study aimed to compare the accuracy and inter-observer reproducibility of leg ulcer measurements made using digital images and conventional contact tracing.

Method:

The accuracy of measurements made with these two methods by four observers of 11 shapes with a known area was assessed. The time taken to do this was also measured. Following this, the accuracy and inter-observer reproducibility of the two methods was measured for patients with leg ulcers presenting to the vascular clinic, with contact tracing as the reference.

Results:

For the reference shapes, both methods had a mean error of less than 5%. Contact tracing significantly underestimated the area by 3.9% (p<0.05), while digital tracing showed no significant error. Digital tracing was quicker than contact tracing, especially for larger shapes (p<0.05). For leg ulcers, there was no significant difference between area measurements made by the two methods. Inter-observer variation of digital tracing was greater for the ulcers than the reference shapes. This was due to differences in subjective interpretation and technical problems in recording some images.

Conclusion:

Measurement of leg ulcer area using computer-aided tracing of digital camera images is more accurate and quicker than contact tracing provided that appropriate care is taken when taking the pictures. Digital images offer considerable advantages in the shared hospital-community care of patients with leg ulcers.

Declaration of interest:

None.
Hot sand burns on the sole of a patient with diabetes
Authors: Valdés V. Gaztelu , Fornells M. Gago , González R.F. Garcia , del Castillo A.J. Guijón , Gutiérrez A. Morales , Torra i Bou J-E.
Published: May 2014

A patient with diabetes who burnt his feet by walking on hot sand was treated with an amorphous hydrogel, which resulted in full wound healing within four weeks. These patients should avoid walking barefoot on sand whenever possible
Maceration of the skin and wound bed 1: its nature and causes
Authors: Cutting Keith F. , White Richard J
Published: May 2014

Maceration, caused by prolonged exposure to moisture, can complicate the healing of wounds, especially chronic ones. This paper — the first of three reviewing the literature on its aetiology and management — looks at how maceration occurs.
Wound remodelling and scarring
Authors: O'Kane S.
Published: May 2014

Wound healing usually results in a scar. No therapy currently exists for removing scars, so treatments focus on making them less obvious. Research is investigating how to prevent scars forming, inspired by what happens to foetuses in the womb.
Two US practitioners' experience of using essential oils for wound care
Authors: Hartman D. , Coetzee J.C.
Published: May 2014

Though essential oils are a proven antiseptic, little work has investigated their use on chronic wounds. This article describes the progress and problems of a small study of five patients, who were treated with lavender and chamomile essential oils.
The protective effects of a new preparation on wound edges
Authors: Neander K-D. , Hesse F.
Published: May 2014

Objective:

This study investigated the effect of Cavilon No Sting Barrier Film (NSBF) (3M Healthcare) on erythema on the edges of highly exuding wounds in patients with venous stasis ulcers.

Method:

An intra-individual double-blind randomised test was performed on 239 patients. The two sides of each wound on each patient were treated with two different dressings: Cavilon NSBF was applied to the wound edges of one side and a control (water) to the edges of the other. Erythema was assessed daily using a chromameter.

Results:

These are based on the 227 patients who completed the study. The researchers were surprised by their unambiguity: in 88.1% of patients, the erythema completely disappeared within three days of treatment with the test material; in the remaining 11.9% it had completely disappeared after four days. With the control, erythema intensity remained more or less unchanged throughout the four-day observation period.

Conclusion:

This study demonstrates that Cavilon NSBF helped control erythema in all the patients: in 97.3% examined, the measurable and objectively recordable erythema receded within two days.

Declaration of interest:

None.
A novel formulation of metal ions and citric acid reduces reactive oxygen species in vitro
Authors: Van Den Berg A.J.J. , Halkes S.B.A. , Quarles Van Ufford H.C. , Hoekstra M.J. , Beukelman C.J.
Published: May 2014

Objective:

Reactive oxygen species, including superoxide anions, are thought to play an important role in impairing wound healing. Additionally, superoxide anions react with nitric oxide produced by macrophages to form peroxynitrite, another strong oxidant with detrimental effects on surrounding tissue. This in vitro study investigated whether samples of metal ions and citric acid are able to reduce levels of reactive oxygen species.

Method:

Samples of materials were tested in assays for the following: inhibition of reactive oxygen species production by human polymorphonuclear neutrophils (PMNs); antioxidant activity (scavenging of superoxide anions in a cell-free system); inhibition of human complement (limiting the generation of complement factors that attract and stimulate PMNs, thereby reducing levels of reactive oxygen species).

Results:

Metal ions were shown to inhibit both PMN production of reactive oxygen species and the activation of complement via the classical pathway, whereas citric acid was found to be a scavenger of superoxide anions.

Conclusion:

The beneficial effects of using formulations containing metal ions and citric acid on chronic wounds may be explained in part by a reduction of reactive oxygen species in these wounds.

Declaration of interest:

The research was financed by Greystone Medical Group.
Pain at first dressing change after toenail avulsion 2: findings and discussion of the data analysis
Authors: King B.
Published: May 2014

A qualitative study was carried out on patients' and nurses' perceptions of pain following toenail avulsion. In part two of her award-winning paper, Brenda King discusses the patients' and nurses' responses to questions on expectations and pain.
A step-by-step guide to classifying and managing pretibial injuries
Authors: Dunkin C.S.J. , Elfleet D. , Ling C. , Brown T. P. La H.
Published: May 2014

Even in cases of relatively minor trauma, pretibial injuries to older patients can cause significant damage as a result of poor blood supply to the skin. This paper offers a classification of pretibial injuries and an algorithm for their management.
A comparison of the antimicrobial effects of four silver-containing dressings on three organisms
Authors: Thomas S. , McCubbin P.
Published: May 2014

Objective:

To compare the antimicrobial activity of four silver-containing dressings: Acticoat (Smith and Nephew), Actisorb Silver 220 (Johnson and Johnson), Avance (SSL International) and Contreet-H (Coloplast).

Method:

The dressings were tested against three micro-organisms: a Gram-positive bacterium, Staphylococcus aureus; a Gram-negative organism, Escherichia coli; and a yeast, Candida albicans, using three different techniques. Each dressing also had its silver content analysed.

Results:

Acticoat is likely to produce the most rapid antimicrobial effect in vitro because of the rapid release of relatively large concentrations of highly active silver ions. Contreet-H has broadly similar antimicrobial activity to Acticoat, but has a slower onset of action. Actisorb Silver 220 appears to offer less prospect of killing bacteria within the wound itself, but the dressing is capable of removing micro-organisms from wound exudate and sequestering them until they are inactivated by the silver within the charcoal fibres. Little convincing evidence for any antimicrobial activity of Avance was found.

Conclusion:

Although caution must always be exercised when extrapolating the results of laboratory-based studies to the clinical situation, potentially important differences were detected in the antimicrobial activity of the four products examined. It is also possible that the silver ions released by the dressings may have effects on wound healing that are unrelated to their antimicrobial activity. Further work is needed to address this issue.

Declaration of interest:

This study was supported by Smith and Nephew.
Importance of moisture balance at the wound-dressing interface
Authors: Bishop S.M. , Walker M. , Rogers A.A. , Chen W.Y.J.
Published: May 2014

This paper considers the significance of achieving the correct moisture balance — neither too moist nor too dry — at the wound-dressing interface and discusses the importance of using new dressing formats designed with this in mind.
Short-stretch versus multilayer compression for venous leg ulcers: a comparison of healing rates
Authors: Ukat A. , Konig M. , Vanscheidt W. , Münter K-C.
Published: May 2014

Objective:

To compare the performance of two compression systems, (multilayer elastic [Profore], Smith and Nephew) and (short stretch [Comprilan], Beiersdorf), in the treatment of venous leg ulcers in a randomised controlled trial.

Method:

Eighty-nine patients with venous leg ulcers were randomised to receive treatment with Profore (44 patients) or short-stretch (45 patients) compression bandages. Allevyn (Smith and Nephew) was used as the wound contact layer under both systems.

Results:

Patients treated with Profore healed significantly faster than those treated with short stretch (p=0.03) and were 2.9 times more likely to heal at any given time during the study period. Younger wounds healed significantly faster than older wounds (p=0.01).

Conclusion:

Patients treated with Profore healed faster than those treated with short-stretch bandages. In addition, treatment costs are lower with Profore. In this trial the average cost per patient was €1345 (short stretch) and €587 (Profore).

Declaration of interest:

The study was supported by a research grant from Smith and Nephew GmbH, Lohfelden, Germany.
Why gauze dressings should not be the first choice to manage most acute surgical cavity wounds
Authors: Bethell E.
Published: May 2014

Acute surgical wounds left to heal by secondary intention are often routinely managed with gauze fabric dressings. This paper reviews research that suggests newer, modern dressings are more cost-effective and cause less pain on removal.
Clinical performance of a new silver dressing, Contreet Foam, for chronic exuding venous leg ulcers
Authors: Karlsmark T. , Agerslev R.H. , Bendz S.H. , Larsen J.R. , Roed-Petersen J. , Andersen K.E.
Published: May 2014

Objective:

This study aimed to evaluate the safety and performance of a new sustained silver-releasing dressing, Contreet Foam (Coloplast A/S), in the treatment of moderately to highly exuding chronic venous leg ulcers in which healing is delayed due to the presence of bacteria.

Method:

The clinical performance of Contreet Foam was studied for four weeks in 25 patients with moderately to highly exuding delayed-healing venous leg ulcers. Healing was assessed on a weekly basis with reference to the wound-bed tissue composition, degree of odour and pain, dressing performance and the dressing's effect on the peri-ulcer area. Blood samples were analysed for silver content.

Results:

Twenty-three out of 25 patients completed the study. One ulcer healed and no wound infections occurred during the study period. A mean 56% reduction in ulcer area (from 15.6 to 6.9cm2) was recorded during the four weeks, and there was a mean 25% reduction in granulation tissue from dull to healthy after one week. Wound odour reduced significantly after one week. Mean dressing wear time was 3.1 days, and there were only minimal incidences of leakage. Serum silver levels did not exceed reference values.

Conclusion:

Contreet Foam was found to be safe and performed well when used in the treatment of delayed-healing chronic venous leg ulcers, combining effective antibacterial properties with excellent exudate management.

Declaration of interest:

This study was supported by Coloplast A/S, Humlebæk, Denmark.
PRIMOS: an optical system that produces three-dimensional measurements of skin surfaces
Authors: Roques C. , Téot L. , Frasson N. , Meaume S.
Published: May 2014

Current methods of measuring changes in the thickness of scarred tissue are prone to error, making it hard to assess the effectiveness of treatment. PRIMOS is a digital system that makes accurate measurements of three-dimensional images.
A silver sulphadiazine-impregnated lipidocolloid wound dressing to treat second-degree burns
Authors: Carsin H. , Wasserman D. , Pannier M. , Dumas R. , Bohbot S.A.
Published: May 2014

Objective:

To evaluate the efficacy and tolerance of Urgotul SSD dressing (Laboratoires Urgo) in the treatment of second-degree burns.

Method:

This was a national multicentre phase III non-comparative open-label prospective study involving 10 burns units. The 41 subjects were non-immunosuppressed adults with second-degree thermal burn(s), which were clinically non-infected, less than 24 hours old, had a surface area less than 500cm2 and warranted the local use of silver sulphadiazine. For four weeks, subjects were followed up weekly with a clinical assessment, bacteriological swabs and photographic recording.

Results:

Of the 41 patients, 24 healed within a mean of 10.8 days and 13 had a skin graft on the study burn within a mean of 11.5 days. There were four premature study withdrawals. The total number of cumulative treatment days was 445, and 298 treatments were performed (including 257 dressing changes). Mean dressing wear time was 1.73 days. None of the subjects acquired a secondary infection. Researchers took 121 bacteriological samples, and wound colonisation with Staphylococcus aureus was found in only one patient. At follow-up nursing staff reported that dressing acceptability was good.

Conclusion:

Use Of Urgotul Ssd Led To A Good Wound Outcome — Wounds Healed Or Were Grafted.

Declaration of interest:

This study was sponsored by Laboratoires Urgo, Dijon, France.
Acceptability to patients of a honey dressing for non-healing venous leg ulcers
Authors: Dunford C.E. , Hanano R.
Published: May 2014

Objectives:

This four-centre feasibility study was undertaken to determine whether Medihoney, a proprietary blend of honeys, is an acceptable treatment for patients with leg ulcers in terms of pain relief, odour control and overall patient satisfaction.

Method:

Forty patients whose leg ulcers had not responded to 12 weeks of compression therapy were recruited. Medihoney dressings were applied on their ulcers for the 12-week study period. All other aspects of their care, including the use of compression bandaging, remained unchanged. Their leg ulcers were assessed every two weeks. This included the use of a patient questionnaire.

Results:

Overall, ulcer pain and size decreased significantly and odorous wounds were deodorised promptly. This had a positive impact on patient satisfaction with the Medihoney treatment.

Conclusion:

The results support the previously reported positive effects of honey and revealed a high patient acceptance for this treatment. Following these results, comparative clinical trials, which should also consider pain, are now recommended.

Declaration of interest:

This study was supported by Paul Hartmann AG, Germany.
The effectiveness of oral nutritional supplementation in the healing of pressure ulcers
Authors: Frias Soriano L. , Lage Vzquez M.A. , Prez-Portabella Maristany C. , Xandri Graupera J.M. , Wouters-Wesseling W. , Wagenaar L.
Published: May 2014

Objective:

To investigate the effectiveness of an oral nutritional supplement that is rich in protein and enriched with arginine, vitamin C and zinc on the healing of pressure ulcers.

Method:

Thirty-nine patients with grade III or IV pressure ulcers were enrolled into this open intervention study. Subjects received an oral nutritional supplement daily for three weeks. Wound area and the wound condition of the ulcers were assessed weekly.

Results:

After three weeks of supplementation, median wound area reduced significantly (p<0.001) from 23.6cm2 (1.6–176.6cm2) to 19.2cm2 (1.2–132.7cm2), a reduction of 29%. Median healing of wound area was 0.34cm2 per day, taking approximately two days to heal 1cm2. Within three weeks the amount of exudate in infected ulcers (p=0.012) and the incidence of necrotic tissue (p=0.001) reduced significantly.

Conclusion:

Nutritional intervention in the form of a specific oral nutritional supplement resulted in a significant reduction in wound area and an improvement in wound condition in patients with grade III and IV pressure ulcers within three weeks.

Declaration of interest:

This study was supported by Nutricia, Madrid, Spain.
Linguistic validation of the Cardiff Wound Impact Schedule into French, German and US English
Authors: Acquadro C. , Price P. , Wollina U.
Published: May 2014

Objective:

Chronic leg wounds can represent a major health problem and have a negative emotional impact on patients’ lives. The Cardiff Wound Impact Schedule (CWIS) was developed by the Wound Healing Research Unit at University of Wales College of Medicine to assess the quality of life in patients with chronic wounds.

Method:

To perform the linguistic validation (translation) of the CWIS into German, French and US English as a first step in making the questionnaire available globally. The standard linguistic validation process employed by the Mapi Research Institute was used to translate the CWIS into French and German. An adjusted process was used for the US English translation.

Results:

The linguistic validation of the US English version was straightforward as it shares the same root language with the original UK version. The problems encountered in the French and German translations were mostly related to semantics and syntax.

Conclusion:

The CWIS is now available for further validation testing by the international community (the psychometric evaluation of each translated questionnaire). These translations will be useful to health-care providers undertaking formal quality-of-life assessments of patients with chronic leg wounds.

Declaration of interest:

Sponsored by Ethicon SAS, Johnson & Johnson Wound Management.
Prophylactic antibiotic use in clean neurosurgery: of potential benefit or harm to the patient?
Authors: Jones J.
Published: May 2014

The use of prophylactic antibiotics in surgical procedures continues to provoke debate as they can lead to resistance. Prophylaxis is therefore only indicated in contaminated or dirty surgery, or in implant surgery. However, in clean neurosurgery the consequence of infection suggests there is a need for prophylaxis, in spite of the inconclusive clinical evidence.
A review of studies that examine the impact of infection on the normal wound-healing process
Authors: Penhallow K.
Published: May 2014

While microbial colonisation of both acute and chronic wounds is inevitable, wound infection disrupts the normal healing process. Using topical antimicrobials to reduce the wound bioburden is integral to wound bed preparation, but indiscriminate prescribing of systemic and topical antibiotics has contributed to the development of multi-resistant bacteria.
Pressure ulcers and spinal-cord injury: incidence among admissions to the Irish national specialist unit
Authors: Sheerin F. , Gillick A. , Doyle B.
Published: May 2014

Unlike many other countries, Ireland does not have a pathway to facilitate rapid transfer to its national spinal injuries unit. This retrospective study investigated the effect of this on the incidence of pressure ulceration in new admissions to the unit
How does ageing affect the wound healing process?
Authors: Crooks A.
Published: May 2014

While wound repair is believed to be impaired in older people, there is no consensus on the precise mechanisms involved in delayed healing. Studies are often unable to determine whether ageing alone is responsible or if systemic factors such as medication, nutrition or vascular effects may be synergistic. This paper reviews the research literature on the effects of ageing on various aspects of wound healing.
A study comparing two objective methods of quantifying the production of wound exudate
Authors: Dealey C. , Cameron J. , Arrowsmith M.
Published: May 2014

Objective:

The objective assessment of chronic wound therapies for exudate management (WRAP study) tested a variety of methods that could be used to improve understanding of dressing performance in the presence of wound exudate, including measurement of the levels of exudate production. The aim of this study was to identify a valid and reliable method of measuring wound exudate production per unit area of wound surface.

Method:

Two methods were tested. Method A measured the weight of exudate collected in dressings by ‘before and after’ weighing of all dressing materials that came into contact with wound exudate. Method B measured wound exudate collected as part of topical negative pressure (TNP) therapy.

Results:

Method A: Complete data were collected on three patients (at which point the study was halted), but it was only possible to obtain accurate measurements for two of these. Exudate production was 0.10g/cm2/24 hours and 0.21g/cm2/24 hours. It was time-consuming and required special equipment. Method B: Fifteen measurements from five patients were analysed and showed a mean exudate production of 1.3g/cm2/24 hours.

Conclusion:

There are problems with both methods of exudate measurement, but measuring wound fluid collected in TNP canisters seems simpler than weighing dressings and deserves further investigation.

Declaration of interest:

This study was part of the Wrap project and was funded by the Engineering and Physical Science Research Council.
A cost analysis of monoplace hyperbaric oxygen therapy with and without recirculation
Authors: Treweek S. , James P.B.
Published: May 2014

Objective:

Hyperbaric oxygen therapy is covered by the NHS under Specialist Services Definition Set 28. The indications and availability of the therapy have been influenced by educational failures, perceived costs and, compared with drug studies, the small number of controlled trials. This study aimed to inform this debate by calculating the direct costs to the health service of hyperbaric oxygen therapy for inpatients using a single, one-person chamber.

Method:

The costs included in this cost analysis were: hyperbaric chambers, staff, oxygen, property and cleaning, miscellaneous and general overheads. All costs are for 2004.

Results:

Lower and upper costs were calculated. Start-up costs range from £64,800 to £110,000 depending on the hardware selected. Annual costs, including 10-year amortisation of capital costs, range from £40,069 to £57,618 and per-treatment costs range from £30 to £41. Oxygen recirculation becomes cost effective after four to six years.

Conclusion:

Hyperbaric oxygen therapy is an inexpensive treatment that should be routinely available for conditions where evidence indicates that tissue hypoxia is a significant component of the injury or disease.

Declaration of interest:

None.
A pilot study on the effect of topical negative pressure on quality of life
Authors: Mendonca D.A. , Drew P.J. , Harding K.G. , Price R.E.
Published: May 2014

Objective: To discover the impact of topical negative pressure (TNP) on quality of life. Method: An exploratory prospective cohort study was conducted on 26 patients undergoing TNP. The Cardiff Wound Impact Schedule (CWIS), a wound-specific tool, was used to investigate quality-of-life scores before therapy and four weeks after therapy or at wound closure. Wound dimensions were measured at both assessments, and the values for the CWIS domains (physical symptoms, social functioning, well-being and overall quality of life) were investigated using parametric and non-parametric tests. Results: The mean duration of TNP therapy was 3.3 ± 1.7 weeks. Topical negative pressure therapy helped to achieve complete wound closure in 14 patients (54%), and there was a mean reduction in wound surface area from 52.2cm2 (range 4–150) to 26.8cm2 (0–120). While there was no significant change in quality of life in patients whose wounds healed (1 ± 11.9), the physical-functioning domain improved in obese patients (20 ± 21, p<0.05) and worsened in ambulatory patients (-3 ± 13, p<0.05). The portable TNP system had no significant impact on quality of life (-3 ± 16), while the global quality-of-life score worsened with surgical intervention (-0.5 ± 2, p<0.05). Conclusion: Although TNP aids wound closure in patients with complex wounds, in selected cases their quality of life can worsen. This is the first exploratory cohort study of its kind, and has identified an urgent need to validate the use of patient-based outcome measures in TNP therapy. Such data can be useful in allocating resources and justifying funding in wound care. Declaration of interest: No benefits in any form have been or will be received from KCI International, San Antonio, Texas, USA.
Using wound bed preparation to heal a malignant fungating wound: a single case study
Authors: Lo S-F , Hsu M-Y , Hu W-Y
Published: May 2014

This case report describes how wound bed preparation was used in the management of a malignant fungating wound in a woman with breast cancer. The patient had received routine cancer chemotherapy, radiotherapy and conventional wound care in an oncology ward. Six months later she presented with a wound infection, malodour, bleeding related to dressing changes and heavy exudate, which had not responded to treatment. By applying wound bed preparation in accordance with the TIME paradigm — Tissue management, Infection and Inflammation control, Moisture balance, and protect wound Edges — the malignant fungating wound was successfully treated in two months.
Pressure ulcer predictors in ICU patients: nursing skin assessment versus objective parameters
Authors: Compton F. , Hoffmann F. , Hortig T. , Strauß M. , Frey J. , Zidek W. , Schäfer J-H.
Published: May 2014

Objective:

To evaluate objective parameters and subjective nursing assessment as pressure ulcer risk factors for intensive care unit (ICU) patients, and compared them with the performance of a general assessment tool (Waterlow scale). To validate the newly developed assessment method.

Method:

This prospective epidemiological study involved 698 patients admitted to an ICU between April 2001 and December 2004 without pressure ulcers and who stayed in the ICU for more than 72 hours. Objective parameters routinely determined during the first 24 hours in the ICU as well as subjective nursing assessment on admission were analysed for their significance as pressure ulcer risk predictors.

Results:

Of the 698 patients 121 (17%) developed pressure ulcers in the ICU. With univariate analysis, a variety of objectively measurable parameters relating to organ dysfunction, circulatory impairment and sepsis showed significant association with the occurrence of pressure ulcers. When multiple logistic regression was performed, subjective nursing skin assessment parameters outweighed these parameters as pressure ulcer risk predictors. A risk function comprised of five skin-related and one other parameter yielded an overall correct pressure ulcer prediction proportion of 84.6%. With receiver-operator characteristic curve analysis, the area under the curve (AUC) was 0.82. Results were validated in 329 patients treated in the same ICU between January 2005 and May 2006, yielding an AUC of 0.80.

Conclusion:

Nursing skin assessment is an important pressure ulcer risk stratification tool in the ICU despite the availability of a large number of objectively measureable ICU specific parameters in these patients.

Declaration of interest:

None.
Wound-related pain is underestimated in patients with diabetic foot ulcers
Authors: Bengtsson L. , Jonsson M. , Apelqvist J.
Published: May 2014

Few studies have assessed pain in neuropathic and neuroischaemic foot ulcers. This pilot study found that patients with these ulcers do experience pain, and that the intensity and nature of the pain was similar in both types of ulcer
Foot ulceration in a non-diabetic population: a cross-sectional audit of staff in one health district
Authors: Bristow I.
Published: May 2014

Patients without diabetes are increasingly presenting with foot ulcers at podiatry clinics. This audit found that the prevalence of non-diabetic foot ulcers was 0.21% in patients over 60, pointing to a need to set up non-diabetic foot ulcer clinics
Moisture lesion or pressure ulcer? A review of the literature
Authors: McDonagh D.
Published: May 2014

Distinguishing between pressure ulcers and moisture lesions can be challenging, even for experienced practitioners. Measures therefore need to be taken as part of an evidence-based regimen to avoid the risk of skin damage in the first place
Exostectomy for chronic midfoot plantar ulcer in Charcot deformity
Authors: Laurinaviciene R. , Kirketerp-Moeller K. , Holstein P.E.
Published: May 2014

Charcot midfoot ulcers are rare and very difficult to heal, with surgery being an option. This retrospective study assessed healing rates, complications, and the incidence of re-ulceration and other foot ulcer problems following exostectomies
Use of a moderate-pressure irrigation system to effect debridement in the home setting
Authors: Dijoux C. , Ribal E. , Téot L.
Published: May 2014

Rapid debridement in the home setting could represent a cost-effective way of accelerating healing rates. This retrospective study offers an insight into whether a new moderate-pressure irrigation system could help achieve this objective
A review of research examining the regulatory role of lymphocytes in normal wound healing
Authors: Keen D.
Published: May 2014

Lymphocytes play a distinct, regulatory role in normal wound healing through the secretion of lymphokines. This paper evaluates the current research on the regulatory role of lymphocytes and their secretions in normal wound healing
Management of a hypertensive ulcer with an epidermal growth factor-based formulation
Authors: Hernández-Cañete C. , Betancourt B.Y.
Published: May 2014

This rare ulcer was treated with a human recombinant epidermal growth factor-based formulation and antihypertensive drugs. Full granulation was achieved in 49 days and complete wound closure in 79 days. No adverse events were reported
Can ultrasonographic evaluation of subcutaneous fat predict pressure ulceration?
Authors: Yabunaka K. , Iizaka S. , Nakagami G. , Aoi N. , Kadono T. , Koyanagi H. , Uno M. , Ohue M. , Sanada S. , Sanada H.
Published: May 2014

High-resolution ultrasound may be able to detect pressure ulcers before clinical signs emerge. This retrospective study found that one such early indicator is inflammatory oedema in the subcutaneous fat, which resolves as healing occurs
Bacteriophage therapy of venous leg ulcers in humans: results of a phase I safety trial
Authors: Rhoads D.D. , Wolcott R.D. , Kuskowski M.A. , Wolcott B.M. , Ward L.S. , Sulakvelidze A.
Published: May 2014

Objective:

This phase 1 trial set out to examine the safety of a bacteriophage-based preparation for difficult-to-treat wounds.

Method:

The intention-to-treat sample comprised 42 patients with chronic venous leg ulcers (VLUs); 39 patients completed the trial. The ulcers were treated for 12 weeks with either a saline control or bacteriophages targeted against Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli. Follow-up continued until week 24.

Results:

No adverse events were attributed to the study product. No signifi cant difference (p>0.05) was determined between the test and control groups for frequency of adverse events, rate of healing, or frequency of healing.

Conclusion:

This study found no safety concerns with the bacteriophage treatment. Efficacy of the preparation will need to be evaluated in a phase II efficacy study.

Declaration of interest:

One of the authors (AS) holds an equity interest in Intralytix. The other authors do not have any interest in commercial activities.
An overview of techniques used to measure wound area and volume
Authors: Little C. , McDonald J. , Jenkins M.G. , McCarron P.
Published: May 2014

If wound area is to be used as an indicator of healing, then it is vital that all measurements are accurate and consistent. This depends largely on the measurement tool used. This paper offers an insight into the available evidence
Bacterial diversity in surgical site infections: not just aerobic cocci any more
Authors: Wolcott R.D. , Gontcharova V. , Sun Y. , Zischakau A. , Dowd S.E.
Published: May 2014

Objective:

To evaluate the microbial diversity in chronic surgical site infections (SSIs).

Method:

Bacterial populations in 23 chronic SSIs were identified using bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP), which is an universal bacterial identification method. These results were then validated using quantitative polymerase chain reaction (qPCR).

Results:

bTEFAP identified two previously uncharacterised Bacteroidales in all of the SSIs and showed that it was the predominant population in the majority of these chronic wounds. Other bacteria identifi ed included Corynebacterium spp., Peptoniphilus spp., Staphylococcus spp., Staphylococcus aureus, Serratia marcescens, Prevotella spp. and Pseudomonas aeruginosa. Rarefaction analysis of the data indicated that, on average, six genera occurred in any given SSI, suggesting that such infections are multispecies. On average, over 60% of the bacteria evaluated in the SSIs were anaerobic bacilli. The previous literature indicates that aerobic cocci predominate in such wounds.

Conclusion:

This modern molecular survey indicates that our previous understanding of which bacteria cause SSIs may be faulty. The high prevalence of anaerobic bacilli and the overwhelming predominance of two previously uncharacterised Bacteroidales suggest that such bacteria may be a leading contributor to such infections. Further research on the identification and treatment of such bacteria are warranted.

Declaration of interest:

Scott E. Dowd is director of a clinical molecular diagnostic company.
In vitro comparison of antimicrobial activity of iodine and silver dressings against biofilms
Authors: Thorn R.M.S. , Austin A.J. , Greenman J. , Wilkins J.P.G. , Davis P.J.
Published: May 2014

Objective:

To compare the antimicrobial effectiveness of silver- and iodine-containing wound dressings against preformed mature biofilms of pathogenic wound bacteria grown in vitro.

Method:

Biofilms of Pseudomonas aeruginosa and Staphylococcus aureus were grown within an in vitro flat bed perfusion biofilm model. Mature biofilms were removed and exposed to wound dressings containing either silver or iodine (Aquacel Ag and Iodozyme) within a static diffusion method, for up to 24 hours. This method was designed to reflect certain key features that determine antimicrobial activity within the wound. The numbers of viable bacteria surviving in the biofilms were determined at set time intervals over the test period.

Results:

Both test dressings exerted an antimicrobial effect against the target species biofilms, although the iodine dressing was more efficacious under the experimental conditions employed.

Conclusion:

There are large and potentially significant differences (as measured in vitro) in the effectiveness of wound dressings containing broad-spectrum antimicrobial agents such as silver and iodine against specific types of bacterial biofilms.

Declaration of interest:

Prof. Paul Davis is an employee of Insense; John Wilkins and Andrew Austin are funded by Insense; Robin Thorn's PhD studies have been supported by a grant from Insense.
Chronic wounds and the medical biofilm paradigm
Authors: Wolcott R.D. , Rhoads D.D. , Bennett M.E. , Wolcott B.M. , Gogokhia L. , Costerton J.W. , Dowd S.E.
Published: May 2014

There is a growing recognition that biofilms are the principal cause of wound chronicity. The development of treatments for wound biofilms raises the prospect that chronic wounds can be treated, potentially saving many patients’ lives
Clinical experience with an antimicrobial hydrogel dressing on recalcitrant wounds
Authors: Wood L. , Wood Z. , Davis P. , Wilkins J.
Published: May 2014

Objective

To assess the performance of a newly-introduced, iodine-based antimicrobial wound dressing (Iodozyme) within normal clinical practice.

Method

51 case records were collected from 30 wound care locations in England. Reporting clinicians used Iodozyme on one or more difficult wounds of their own choice (of various aetiologies) from their current case loads. Basic patient-specific data were collected, relating to both their own and their patients' experience with the product over a 6-week period of treatment (or less, if healing was achieved earlier). In every case, the wound continued to be treated in accordance with local ‘best practice’, in accordance with the manufacturer's instructions and by the same clinician. Each wound was assessed in terms of size, condition (margins and wound bed), exudate (type and amount), comfort/pain, overall satisfaction (by patient and clinician) and healing status (in terms of healed, improved, static or deteriorated). In addition, clinicians were asked to use their own local criteria and parameters where possible, with general guidance as and when it was needed.

Results

The mean duration of all wounds was 25.8 months (median 13 and range 1–312). Nine patients had a wound of less than six months' duration, and 17 had one of two years' or more duration. Within the 6-week study period, 6 wounds healed fully, 37 were judged to have improved, 7 remained static and 1 deteriorated. Overall, the majority of clinicians and patients were ‘satisfied’ or ‘very satisfied’ with product performance and 77% of clinicians concluded that the dressing was ‘better’ or ‘much better’ than other dressings they had previously used on similar wounds.

Conclusion

While we cannot generalise from this study, the encouraging clinical results and positive patient and clinician feedback lead us to believe that Iodozyme is a dressing worthy of consideration when treating chronic wounds. These encouraging preliminary fi ndings are now to be followed up with a randomised control trial.

Declaration of interest

All authors are either previous or current employees of Archimed.
Resistance carrying plasmid in a traumatic wound
Authors: Alavi M.R. , Ravizee A. , Burgess R. , Antonic V. , Izadjoo M. , Stojadinovic A.
Published: May 2014

Objective

To isolate and identify antibiotic-resistant bacteria from the exudate of a complex wound and determine if antibiotic resistance genes are chromosomal or plasmid borne.

Method

Antibiotic resistant bacteria from wound exudate of a single clinical sample were selected on agar media with ampicillin. A single colony was further screened for resistance to kanamycin by antibiotic-supplemented agar and to other antibiotics by an automated Phoenix instrument. Identifi cation of the isolate was carried out by biochemical profi ling and by 16S rDNA analysis.

Results

Approximately 51% of total bacteria in the wound exudate with identical colony morphotype were resistant to 100μg/ml of ampicillin. A single colony from this population also demonstrated resistance to 50μg/ml of kanamycin on kanamycin-supplemented agar. Further antimicrobial sensitivity testing by the Phoenix instrument indicated resistance to inhibitory concentrations of amoxicillinclavulanate, ampicillin-sulbactam, cefazolin, gentamicin, nitrofurantoin, tobramycin, and trimethoprimsulfamethoxazole. Biochemical and 16S rDNA analysis identifi ed this bacterial isolate as a member of genus Enterobacter. A plasmid preparation from this isolate successfully transferred ampicillin and kanamycin resistance to E. coli competent cells. E. coli transformants displayed two resistance phenotypes and the plasmids from these transformants displayed two different restriction type patterns, with one correlating to ampicillin and kanamycin resistance and the other only to ampicillin resistance.

Conclusion

A multiple antibiotic-resistant Enterobacter spp. from the wound fluid of a clinical sample was found to carry an antibiotic-resistant plasmid in a closely related species E. coli. The presence of antibiotic resistance plasmid in Enterobacteria that are part of the normal microbial flora of the human gut and skin could lead to the spread of resistance phenotype and emergence of antibiotic resistant pathogens. This study suggests normal human microbial fl ora could be a potential reservoir for resistance genes.

Declaration of interest

None.
Complex lower extremity wounds treated with skin grafts and NPWT: a retrospective review
Authors: Ross R.E. , Aflaki P. , Gendics C. , Lantis J.C.
Published: May 2014

Objective:

To evaluate a single centre experience with the use of NPWT for securing split-thickness skin grafts in the management of specifically lower extremity chronic wounds, including revascularised arterial wounds, amputations, diabetic and venous leg ulcers.

Method:

A seven-year retrospective review of a prospectively maintained database of all the patients who underwent primary split-thickness skin grafts (STSGs) with immediate postoperative NPWT for at least 96 hours was carried out. the percentage graft take after removal of NPWT device and clinical follow-up date were reviewed.

Results:

A total of 59 skin grafts procedures had adequate follow up to be reviewed. this included 39% post-debridement/ amputation wounds in patients who presented with diabetic foot infection/ gangrene, 31% venous leg ulcers, and 31% other post-surgical wounds (arterial ulcers that had undergone revascularisation). the mean percentage graft survival after removal of v.A.c. was 94%; 63% of cases had complete graft survival, 25% had 90–99% survival, and 8.5% had 80–89% survival. outpatient follow up ranged from 2 weeks to 5 years (mean of 10 months). Fifteen per cent of patients were lost to follow up, and, of the remaining patients, 76% remained completely healed, 10% remained partially healed, and 14% lost the entire STSG.

Conclusion:

Patients with STSGs secured with NPWT required fewer repeated grafting procedures, had very high initial graft survival with complete recipient bed coverage, and had good long-term wound closure rates compared with historical controls. While retrospective reviews, such as this, support NPWT as a good method of STSG affixation, the paucity of reviews with other study designs does not allow for good historic comparison, so a well-enrolled prospective trial would be of use.

Declaration of interest:

Dr J.c. lantis is a member of the speakers’ bureau, has been a site principal investigator of four multicentre trials and has been a consultant for KcI Inc. the same author has no equity in the company and has no financial benefit from positive results for the company's product(s). No external funding was sought nor obtained for this study.