bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute and chronic wounds: differences in self-reported health-related quality of life
Authors: Price P.E. , Harding K.G
Published: May 2014

Seventeen patients (10 female) with acute wounds (pilonidal sinus) and 32 patients (19 female) with chronic wounds (venous leg ulcers) attending a specialist wound clinic completed a condition-specific health-related quality of life (HRQoL) tool on two occasions five to seven days apart.

The ratings from the two groups were statistically different for two sub-scales, with those with acute wounds rating themselves more positively.

There were no differences between the groups for overall HRQoL or satisfaction with HRQoL – although there was a trend for those with chronic wounds to rate their overall HRQoL as higher than those with acute wounds, possibly indicating adaptation to their health status.

While possible demographic and aetiological differences must be borne in mind, the tool used in this study appears to be sensitive to different types of wound.
Assessing nurses' knowledge of wound management
Authors: King B.M.
Published: May 2014

An understanding of the principles and theories of wound healing is vital for the delivery of high-quality care. This literature review suggests that wound management is often undertaken by health-care professionals who have not received sufficient training in this speciality.
The SIGN guideline on the care of chronic leg ulcers: an aid to improving practice
Authors: Finnie A.
Published: May 2014

Implementation of national guidelines and local protocols can help practitioners to ensure their practice is evidence-based. This article describes how the implementation of the SIGN guideline on the care of chronic leg ulcers will help to address any deficiencies in practice.
Using a topical anaesthetic cream to reduce pain during sharp debridement of chronic leg ulcers
Authors: Rosenthal D. , Murphy F. , Gottschalk R. , Baxter M. , Lycka B. , Nevin K.
Published: May 2014

This multicentre, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of using Emla (lignocaine/prilocaine) anaesthetic cream to achieve pain control during sharp debridement of chronic leg ulcers of arterial, venous or arteriovenous aetiology. A total of 101 patients (51 Emla, 50 placebo), aged 29–99 years, who had experienced pain associated with previous debridement were included. Patients with an amide anaesthetic allergy, anaesthetic diabetic ulcers, or ulcers >50cm2 were excluded. Debridement was initiated approximately 30 minutes after the application of a thick layer of Emla or placebo cream to an ulcer occluded with a plastic wrap. The patient and investigator assessed the pain associated with debridement on a 100mm visual analogue scale (VAS).

The median patient VAS scores were 18mm and 53.5mm in the Emla and placebo groups, respectively (p<0.0001). The corresponding investigator values in the two groups were 20mm and 49.5mm, respectively (p=0.004). Local reactions were mainly transient and mild, and were observed in roughly the same percentage of placebo and Emla-treated patients. After a 30-minute application Emla cream significantly reduced the pain of debridement compared with the placebo.
The dark side of evidence-based wound management
Authors: Falanga V.
Published: May 2014

The drive towards evidence-based practice is not without its risks. It may reduce access to some treatments and discourage innovation, says Vincent Falanga.
The pressure ulcer benchmark: will it improve patient care?
Authors: Hampton S.
Published: May 2014

A benchmarking resource pack has been produced in an attempt to reduce national variations in pressure ulcer prevention and management. How likely is it to meet its objectives?
Understanding research: 1 Methodologies used to answer research questions
Authors: Baxter H.
Published: May 2014

An awareness of the research process will help practitioners to critique study findings. This article, the first in a series about understanding research, describes the types of methodologies used.
Can individualised nutritional support improve healing in therapy-resistant leg ulcers?
Authors: Wissing U.E. , Ek A-C. , Wengström Y. , Sköld G. , Unosson M.
Published: May 2014

Objective:

This study investigated whether an individually designed programme of nutritional support can improve healing in otherwise therapy-resistant venous leg ulcers.

Method:

Six primary health-care patients, aged between 79 and 93 years, with venous ulcers that had been open for one year or more (range: 1.5–8 years) were recruited into the study. The patients were asked to follow an individualised diet plan which included the use of liquid dietary supplements. Ulcer area, anthropometric and biochemical variables, and energy and nutrient intake were assessed before intervention and then regularly for nine months.

Results:

At nine months ulcer healing had occurred in two patients, of whom one had had ulcers on both legs. In a third patient the ulceration on one leg had healed and that on the other leg had almost healed. In a fourth patient, the ulcer area reduced by approximately 90%.

Conclusion:

The use of nutritional support might have assisted the wound healing in these patients. Although the relationship between nutritional supplementation and wound healing is not well defined, an appropriate nutritional plan is recommended if undernourishment is suspected and leg ulcers are not healing.

Declaration of interest:

Grants were obtained from the Swedish Nutrition Foundation, the research fund of the County of Östergötland and the ‘Vårdalstiftelsen’, Sweden. Nutricia AB provided the supplements.
Evaluating the cost and efficacy of leg ulcer care provided in two large UK health authorities
Authors: Ellison D.A. , Hayes L. , Lane C. , Tracey A. , McCollum C.N.
Published: May 2014

Objective:

This prospective study investigated the cost and efficacy of leg ulcer care over a three-month period during 1993, 1994 and 1999. It compared two health authorities (Stockport and Trafford) whose populations totalled 540,000.

Method:

All patients with active leg ulcers were invited to community leg ulcer clinics offering research-based innovations in care. Patients without significant arterial disease (ankle brachial pressure index less than 0.8) were treated with multilayer compression bandaging.

Results:

The 42% healing rate reported in the original Stockport study was maintained at 40% in 1999, although the 65% healing rate achieved by the leg ulcer clinics in 1993 was not replicated, with rates falling to 46%. Following the opening of community leg ulcer clinics in Trafford, healing rates rose from 20% to 42%. The annual expenditure on leg ulcer care in Stockport increased from £65,545.56 to £83,344.30, while in Trafford the cost of care dropped from £151,375.35 to £53,176.76 between 1994 and 1999.

Conclusion:

This study suggests that reductions in costs and improvements in healing rates can be sustained in a mature community leg ulcer clinic programme staffed by specialist leg ulcer nurses.

Declaration of interest:

The study was funded by the Wellcome Trust.
Silver I: its antibacterial properties and mechanism of action
Authors: Lansdown A.B.G.
Published: May 2014

Silver products have two key advantages: they are broad-spectrum antibiotics and are not yet associated with drug resistance. This article, the first in a two-part series, describes the main mechanism of action of this metallic element.
Evaluation of the stability and efficacy of rhGM-CSF as a topical agent in a gel formulation
Authors: Senet P. , Mons B. , Aractangi S. , Tilleul P.
Published: May 2014

Objective:

It has been reported that recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF), applied as a solution or an emulsion, improves wound healing. In order to confirm these data, the wound-healing efficacy of this growth factor was studied in a murine model.

Method:

In this double-blind randomised study, murine excisional wounds were treated with either sterilised rhGM-CSF gel (10μg/cm2) or a sterilised placebo gel (control group). rhGM-CSF was applied at dosages of 10μg/cm2/day to wounds until complete closure occurred.

Results:

rhGM-CSF stability in gel formulation was excellent during the first week but decreased thereafter. Full wound healing occurred within 9.7 days (mean time) in the intervention group compared with 10 days in the control group. This difference was not statistically significant. Histological evaluation of the healed wounds indicated that there was a similar percentage of neutrophils in the cellular infiltrate in both groups.

Conclusion:

rhGM-CSF sterile gel had an excellent safety profile and was easy to use, but did not significantly accelerate the healing rate in this model.

Declaration of interest:

None.
Effect of Traumacel P on the growth of human dermal fibroblasts in vitro
Authors: Hughes M.A. , Yang Y. , Cherry George W.
Published: May 2014

Objective:

It has been postulated that Traumacel P, a haemostatic powder, might assist the wound-healing process. This in vitro study investigated the effect of the powder on human dermal fibroblasts.

Method:

Experiments using fibroblasts from a 50-year-old donor were carried out using suspensions of Traumacel P ranging from 0.1 to 10.0mg/ml. Dulbecco's Modified Eagle Medium with 10% or 0.4% foetal calf serum (FCS) and 5.5mM or 25mM glucose was used. The powder was either placed in contact with the cells or separated from them by a porous membrane. The response of the fibroblasts was assessed using the MTT assay.

Results:

Concentrations of 0.5mg/ml and 1.0mg/ml stimulated the metabolic activity of the fibroblasts in both high and low glucose medium with 10% FCS, regardless of whether the powder was in contact with or separated from the cells. The greatest stimulation, to 174% of the controls, was produced by 0.5mg/ml Traumacel P in low glucose/10% FCS with the powder in contact with the cells (p<0.0001). Traumacel concentrations ranging from 0.5 to 5.0mg/ml in 0.4% FCS significantly stimulated the metabolic activity of fibroblasts in low glucose medium, but not in the high glucose medium.

Conclusion:

These studies indicate that direct stimulation of fibroblast proliferation may be one of the ways in which Traumacel P aids the healing of ulcers observed in the clinic.

Declaration of interest:

This study was funded by an educational grant from B Braun UK, who also provided the Traumacel P.
Assessing patients' nutritional needs in the wound-healing process
Authors: Williams L.
Published: May 2014

Like all illnesses, successful wound management depends on appropriate nutritional support. This article outlines which nutrients are relevant to the various stages of wound healing and discusses the consequences of poor nutrition.
Pain at first dressing change after toenail avulsion: the experience of nurses, patients and an observer: 1
Authors: King B.
Published: May 2014

Objective:

Ingrowing toenails are often treated surgically by nail avulsion, with paraffin tulle gauze applied to the toenail bed afterwards. In one large city's primary care trusts, community nurses reported that patients felt pain when the gauze was removed postoperatively. This study looked at patients' general pain experience, and their pain during the first dressing change after toenail avulsion. Patients' perceptions of their pain were investigated, along with nurses' experience of redressing toenail beds, their technique and their interaction with patients, especially in relation to pain prevention.

Method:

First an extensive literature review was conducted. Then a collective instrumental case study design was used. This allowed triangulation of data sources using patient and nurse interviews, and non-participant observation, from six cases recruited from the city's primary care trusts. Data were subjected to thematic content analysis, with two main categories identified. These were ‘setting up of expectations’ and ‘a painful experience: but for whom?’

Results and conclusion:

This study provides a unique description of the type of pain patients experience. It raises serious issues about the adequacy of nurses' management of pain, including assessment, documentation and advice on pain-relief strategies. It supports discontinuing the use of paraffin tulle gauze as the postoperative dressing, and raises ethical issues about changing treatments and lack of communication with secondary care. Finally, it identifies a gap in knowledge of the most suitable dressing product to apply immediately after surgery. A randomised controlled trial is needed to clarify these preliminary findings.

Declaration of interest:

None.
Assessing the value of a leg ulcer education programme in Hong Kong
Authors: Wong I.
Published: May 2014

Patients with leg ulcers require expert care, but nurses do not always receive full training and education on this subject. A short education programme devised for community nurses in Hong Kong resulted in significant gains in knowledge.
Comparison of different wound dressings on cultured human fibroblasts and collagen lattices
Authors: Viennet C. , Bride J. , Gabiot A.C. , Humbert P.
Published: May 2014

Objective:

We compared the effects on cultured human fibroblasts of a new non-adhesive wound dressing, Urgotul, with five other wound dressings. Urgotul is a hydrocolloid dressing; the comparator dressings included impregnated gauze and modern wound dressings.

Method:

Cultures in monolayer were used to study the morphology and growth of fibroblasts. The Bell model of cultured dermis equivalents was used to investigate myofibroblast differentiation. These cultures were labelled a-SM actin and F-actin.

Results:

Two of the tested dressings induced cytotoxic effects. They were found to inhibit cell growth (greater than 60%) and to disturb cell shape and cytoskeletal differentiation. Urgotul and the remaining three dressings showed no effect on proliferation. However, some of them modified fibroblast morphology and affected F-actin distribution.

Conclusion:

Depending on their nature and components, wound dressings may respect or affect fibroblast behaviour in vitro (proliferation, morphology and a-SM actin and F-actin distribution). The significance of these in vitro observed findings require further investigations.

Declaration of interest:

This study was supported by Urgo Laboratories.
Evaluation of mattresses using interface pressure mapping
Authors: Bain D. , Ferguson-Pell M. , McLeod A.
Published: May 2014

Objective:

To compare the ranking of mattresses using several different performance indices, calculated from interface pressure-mapping data.

Method:

Five mattresses were compared using interface pressure-mapping on 10 healthy volunteers. Mattresses were ranked in order, on the basis of several different specified performance indices.

Results:

Different performance indices ranked the mattresses in different orders.

Conclusion:

Elaborate performance indices should be used with care, since it is possible to construct a ‘tailor-made’ performance index to make any chosen mattress rank as the best. Care should be taken to ensure that a performance index is validated, preferably by some demonstrated link to clinical outcomes.

Declaration of interest:

This work was paid for by a grant from Huntleigh Technology Plc.
Sensory testing in patients with chronic venous leg ulcers using a 10g Owen Mumford monofilament
Authors: Arseculeratne Y.M. , Cherry G.W.
Published: May 2014

Objective:

Chronic venous insufficiency in the lower legs may directly contribute to tissue damage, and there is increasing evidence that neuronal damage may be involved. This study was carried out to determine the feasibility of using a simple neuropathy screening test in the community to diagnose sensory neuropathy in the feet of patients with chronic venous insufficiency.

Method:

We tested 15 randomly selected patients with documented chronic venous insufficiency with the 10g Owen Mumford monofilament, in order to ascertain objectively sensory blunting.

Results:

Forty-seven per cent of the patients had normal sensation in the foot of the ulcerated leg and 53% showed some degree of neuropathy. A recent study comparing the performance of commercially available 10g monofilaments showed that the Owen Mumford filament was one of the most accurate, with 100% buckling within ±1g of 10g.

Conclusion:

This preliminary study indicates that the 10g monofilament is an easy method of testing the sensory status of patients with chronic venous insufficiency in the community.

Declaration of interest:

None.
Patients’ perceptions and experiences of larval therapy
Authors: Kitching M.
Published: May 2014

Objective:

To gain an insight into patients’ perceptions and experiences of larval therapy.

Method:

A phenomenological approach was adopted in which six patients who recently had had larval therapy were interviewed using an open, unstructured approach in two hospital settings. Data analysis was loosely based on Colaizzi’s structured analysis technique.

Results:

Five themes emerged: past experiences of wounds leads to expectations of recurrence and a reduced quality of life; living with a chronic wound led to feelings of hopelessness; the skills and expertise of the nurse made patients feel hopeful; being informed helped patients to choose whether or not to have the therapy; the experience of larval therapy was not as scary as imagined.

Conclusion:

The findings suggest that, although initially repellent, larval therapy is acceptable once treatment starts. The nurse-patient relationship was a significant factor in acceptance, along with autonomy and informed choice.

Declaration of interest:

None.
Making sense of the venous leg ulcer debate: a literature review
Authors: Leach M.J.
Published: May 2014

The generation of new information on the epidemiology, pathophysiology and implications of venous leg ulceration has improved practitioners’ understanding and stimulated the development of new treatments. This paper aims to provide practitioners with a greater understanding of venous leg ulceration, and highlights the lack of consensus in the literature and the need for further research
Pressure ulcer grading tools: how reliable are they?
Authors: Sharp A.
Published: May 2014

Reports have indicated that 45% of some hospital populations have a degree of tissue damage as a result of pressure. The reliability and validity of pressure ulcer risk assessment tools have been discussed in the literature, but little has been written about pressure-damage grading tools, the development of which does not appear to have been subjected to rigorous research. Despite this, these grading tools are in everyday use. Additionally, some knowledge is required to interpret them, yet nurses are not always able to identify the underlying tissues exposed.
Colloidal silver as an antimicrobial agent: fact or fiction?
Authors: P. van Hasselt , B.A. Gashe , Ahmad J.
Published: May 2014

Objective:

Colloidal silver preparations are marketed on the internet as omnipotent antimicrobial agents, but scientific support for these claims is lacking. This study reports the results of in vitro tests of colloidal silver’s antimicrobial activity against several pathogenic or non-pathogenic microorganisms.

Method:

Three samples of colloidal silver were tested: one available commercially on the internet (silver concentration of 22ppm) and two samples (concentrations of 403 and 413ppm) which were prepared in our laboratory using standard chemical methods.

Results:

In an agar-well diffusion assay none of the three colloidal silver solutions had any effect on the growth of the test organisms. All tested bacterial strains were sensitive to ciprofloxacin. Colloidal silver 22ppm showed no bactericidal activity in phenol coefficient tests.

Conclusion:

As the tested colloidal silver solutions did not show any antimicrobial effect in vitro on the microorganisms, claims of colloidal silver’s antimicrobial potency are misleading and there is no place for it as an antiseptic.

Declaration of interest:

None.
Moist wound healing: a concept that changed our practice
Authors: Bryan J.
Published: May 2014

Improved wound healing in a moist environment, as opposed to dry conditions, was first described in the early 1960s. This article examines the origins of the theory of moist wound healing and explores the influence of relevant experimental and clinical trials on modern practice.
Does leg ulcer treatment improve patients’ quality of life?
Authors: Charles H.
Published: May 2014

Objective:

To investigate the impact of ‘disease’ and treatment on quality of life in patients with venous leg ulceration.

Method:

Sixty-five patients with venous leg ulcers were recruited and treated. At study entry and exit or following complete wound closure, whichever occurred first, each patient was assessed using the SF-36 quality-of-life questionnaire. Data analysis included an investigation of the study population as whole, differences between patients whose ulcers did and did not heal and between gender and age. Health domain means for all patients were compared with age equivalent norms (AENs) at both entry and exit.

Results:

There was a significant improvement in the SF-36 domains of bodily pain, health transition, mental health and social functioning for all 65 patients. Patients whose ulcers healed also showed a statistically significant improvement in the vitality domain. Patients whose ulcers did not heal had statistically significant improved scores for bodily pain and health transition. At entry all SF-36 values, except for general health, were lower than the AENs. On exit, scores for bodily pain, general health and mental health were comparable with the AEN; values for the remaining five domains increased at exit.

Conclusion:

The results highlight that good wound management and effective compression therapy can improve quality of life in patients with venous leg ulceration, whether or not the patient’s leg ulcer healed following treatment.

Declaration of interest:

None.
Diagnosis, assessment and management of mixed aetiology ulcers using reduced compression
Authors: Stevens J.
Published: May 2014

Aminority of leg ulcers have a mixed arterial/venous aetiology. Unfortunately, there is little clinical evidence on the management of these ulcers, although local guidelines are available. This article, the fourth in a six-part series on leg ulceration, outlines the factors to consider when assessing and treating these potentially complex ulcers. The benefits of treating patients with reduced compression bandaging are also described.
An evaluation of non-adherent wound-contact layers for acute traumatic and surgical wounds
Authors: Burton F.
Published: May 2014

The lack of comparative studies into the effectiveness of non-adherent dressings means selection is often based on individual preference. This small non-randomised evaluation of five such dressings set out to gather some preliminary evidence
Psychological needs of patients when dressing a fungating wound: a literature review
Authors: Goode M.L.
Published: May 2014

Living with a malodorous, fungating wound can cause psychological and physical distress. This review explores whether nurses consider the psychological impact of dressing such wounds and how equipped they are to deal with psychological care. Literature results were obtained through a search of five databases, limited to the past five years (Box 1). Complementary therapies, such as aromatherapy and reflexology, are not discussed because they were not prominent from the search conducted. Neither were counselling or adjuvant psychological therapy, which were shown to be beneficial in a research study by Greer et al. of cancer patients.
The open abdomen: aetiology, classification and current management strategies
Authors: Swan M.C. , Banwell P.E.
Published: May 2014

The open abdomen (Fig 1) can pose a formidable management challenge for the general, trauma and plastic surgeon. The condition often proves to be a considerable burden for nurses involved in the care of such patients, who are often critically ill and usually managed in the intensive therapy unit.
Information leaflets for venous leg ulcer patients: are they effective?
Authors: Clarke Moloney M. , Moore A. , Adelola O.A. , Burke P.E. , McGee H. , Grace P.A.
Published: May 2014

Objective:

To validate the usefulness of written information for patients with venous leg ulcers and test the hypothesis that patients who receive written information retain more knowledge than those who receive verbal information alone.

Method:

Twenty patients newly diagnosed with venous leg ulcers were recruited into this prospective trial. Patients were randomised either to the control group (given verbal information on their condition) or the intervention group (same verbal information and an information leaflet). The verbal information was in the same format as in the leaflet. Patients’ knowledge of the condition was ascertained at an initial interview and at follow-up four to six weeks later.

Results:

At follow-up both groups showed an overall improvement in knowledge, with no statistical difference between them.

Conclusion:

The results indicate there is limited value in providing information leaflets to this patient group, who were predominantly older patients with low levels of education. The relatively small sample size may explain the disappointing results. Further research may reveal a benefit of providing these leaflets to carers.

Declaration of interest:

None.
An economic evaluation of the use of TNP on full-thickness wounds
Authors: Mouës C.M. , van den Bemd G-J.C.M , Meerding W.J. , Hovius S.E.R
Published: May 2014

Objective:

Topical negative pressure (TNP) (vacuum therapy) is frequently used in the management of acute, traumatic, infected and chronic full-thickness wounds. This prospective clinical randomised trial compared the costs of TNP with conventional therapy (moist gauze) in the management of full-thickness wounds that required surgical closure.

Method:

The direct medical costs of the total number of resources needed to achieve a healthy, granulating wound bed that was ‘ready for surgical therapy’ were calculated.

Results:

Fifty-four patients admitted to a department of plastic and reconstructive surgery were recruited into the trial. Cost analysis showed significantly higher mean material expenses for wounds treated with TNP (₠414 ± ₠229 [SD]) compared with conventional therapy (₠15 ± ₠11; p<0.0001), but significantly lower mean nursing expenses (₠33 ± ₠31 and ₠83 ± ₠58 for TNP and conventional therapy respectively; p<0.0001). Hospitalisation costs were lower in the TNP group (₠1788 ± ₠1060) than in the conventional treatment group (₠2467 ± ₠1336; p<0.043) due to an on average shorter duration until they were ‘ready for surgical therapy’. There was no significant difference in total costs per patient between the two therapies (₠2235 ± ₠1301 for TNP versus ₠2565 ± ₠1384 for conventional therapy).

Conclusion:

TNP had higher material costs. However, these were compensated by the lower number of time-consuming dressing changes and the shorter duration until they were ‘ready for surgical therapy’, resulting in the therapy being equally as expensive as conventional moist gauze.

Declaration of interest:

This work was partly supported by the Plastic and Reconstructive Surgery Esser Foundation, and KCI Medical, Houten, The Netherlands. The authors have no conflicts of interest.
Upregulation of inducible nitric oxide synthase (iNOS) expression in faster-healing leg ulcers
Authors: Luk P.P. , Sinha S.N. , Lord R.
Published: May 2014

Objective:

Chronic leg ulcers represent a growing clinical problem in the light of today’s ageing population. Nitric oxide (NO), which is mostly produced by inducible nitric oxide synthase (iNOS) in healing wounds, exerts beneficial effects on many processes of healing, including bactericidal effects, angiogenesis, epithelialisation and ECM formation. This study sought to investigate whether iNOS expression in chronic leg ulcers can be correlated with the healing process.

Method:

Sixteen patients with chronic leg ulcers were recruited and attempts were made to take punch biopsies at two separate time points (however, a second biopsy could not be obtained on seven patients). A linear healing rate was derived using the obtained ulcer area and perimeter. The iNOS levels in the biopsy samples were assessed using immunoblotting.

Results:

The mean linear healing rate of patients with high iNOS levels was significantly higher (p<0.01) than that of patients with low iNOS levels. An incidental finding was that the linear healing rate was significantly higher (p<0.05) post-biopsy than before biopsy in the same patients.

Conclusion:

This study therefore shows for the first time that high iNOS levels are associated with higher healing rates and have the potential to be used in prognostication. This also opens the possibility of augmentation of ulcer healing through the manipulation of wound NO levels.

Declaration of interest:

This work was supported by a discipline of surgery operating grant from the University of Tasmania, Australia.
Extraperitoneal bladder leakage after provision of topical negative therapy: a case report
Authors: Heuser M. , Laabs S.O. , Plothe K.D.
Published: May 2014

Topical negative pressure (TNP) is widely used in the treatment of secondary wound healing and has led to a significant improvement in surgical wound care. While application of negative pressure on the wound margins may benefit the formation of granulation tissue, it should be used with caution on lower abdominal wounds near internal organs as fistula formation may occur.
Evaluation of pressure ulcer prevention devices: a critical review of the literature
Authors: Jones J.
Published: May 2014

With at least 75 different types of pressure ulcer prevention devices on the market, it is understandable that controversy continues over which are the most clinically efficacious and cost-effective. Despite recently published NICE guidelines, the onus remains on the health-care provider to make the right decision.
Using the principle of hydrophobic interaction to bind and remove wound bacteria
Authors: Ljungh Å. , Yanagisawa N. , Wadström T.
Published: May 2014

Skin, soft-tissue and wound infections are usually caused by wound pathogens such as Staphylococcus aureus and group A Streptococci (GAS), Pseudomonas aeruginosa, members of the Enterobacteriaceae, Enterococci, and other Streptococci families and anaerobic microbes such as Fusobacterium necrophorum and Bacteroides fragilis.
Use of topical negative pressure to manage a complex wound with a vesicocutaneous fistula
Authors: Bertelsen C.A. , Wille-Jrgensen P.
Published: May 2014

Topical negative pressure (TNP) has become an alternative treatment modality for complex wounds. The TNP system (Vacuum Assisted Closure [VAC], KCI International, San Antonio, USA) involves placing a polyurethane sponge in the wound, covered by an occlusive film. A TNP of 75–200mmHg is then applied to the foam by a pump, which collects fluid from the wound. The therapy has been shown to accelerate the formation of granulation tissue and reduce the time taken for wound healing.
Effect of a sustained silver-releasing dressing on ulcers with delayed healing: the CONTOP study
Authors: Munter K.-C. , Beele H. , Russel L. , Gröchenig E. , Basse P. , Crespi A. , Alikadic N. , Fraulin F. , Dahl C.A. , Jemma A.P.
Published: May 2014

Objective:

To compare the effect of the sustained silver-releasing foam dressing Contreet Foam (Coloplast A/S) with local best practice (LBP) on delayed healing ulcers using a real-life setting.

Method:

A total of 619 patients with ulcers of varying aetiologies were treated for four weeks with either the silver foam dressing or LBP.

Results:

Wound area was reduced by 50% with the silver foam and 34% with LBP. Less slough and maceration, a faster reduction in exudate level and more positive wound progress was achieved with the silver foam. In addition, exudate handling, ease of use, odour and pain improved. Less time was spent on dressing changes, and mean wear time was longer for the silver foam (3.1 days) than for LBP (2.1 days). All differences were statistically significant (p<0.05). The silver foam dressing outperformed all of the other dressing categories including moist wound healing products and other silver dressings.

Conclusion:

This large-scale comparative real-life study shows that the silver foam dressing supports faster healing of delayed healing wounds.

Declaration of interest:

The study was financially supported by Coloplast A/S, Humlebaek, Denmark.
Evaluation of a self-adherent soft silicone dressing for the treatment of hypertrophic postoperative scars
Authors: Colom Maján J.I.
Published: May 2014

Objective:

The primary objective was to compare the efficacy of a self-adherent soft silicone dressing (Mepiform) with ‘left-alone’ management of hypertrophic scars using the Vancouver Scar Scale. Secondary objectives were to follow photographs of the scars, patients’ opinions of the scars, and doctors’ and patients’ assessments of the overall dressing performance, safety and tolerance.

Method:

An exploratory open randomised controlled clinical investigation was undertaken on 11 female patients aged 21–43 years with postoperative scars (nine following breast surgery, two following lower abdominal-glutealplasty). Treatment was initiated between two weeks and two months (mean 4.7 weeks) after surgery. Ten patients completed the 12-month investigation; one patient in the treatment group discontinued for personal reasons.

Results:

All parameters in the Vancouver Scar Scale improved in both groups, although patients treated with the soft silicone dressing showed greater and more rapid improvements compared with the non-treated patients, while their assessments of the condition of the scar were more favourable. Medical staff rated the overall dressing performance as ‘very good’ or ‘good’. One adverse event was reported – local skin irritation at the site of the scar.

Conclusion:

The results suggest that patients treated with the soft silicone dressing experienced greater and more rapid improvements compared with non-treated patients. These results concur with those of previous studies. The fact that Mepiform is self-adhesive and causes limited damage to the stratum corneum on removal gives it an added value compared with non-adhesive silicone gel dressings.

Declaration of interest:

This study was supported by Mölnlycke Health Care AB, Gothenburg, Sweden.
Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review
Authors: de Laat E.H.E.W. , Schoonhoven L. , Pickkers P. , Verbeek A.L.M. , van Achterberg T.
Published: May 2014

The prevalence of pressure ulcers in intensive care units (ICU) is between 14% and 42%. Intensive care patients generally do not notice increased tissue pressure or cannot react accordingly due to sedation, analgesia and/or muscle relaxants. Additionally, underlying disease and haemodynamic instability increases their risk of developing pressure ulcers.
Use of topical negative pressure with a lipidocolloid dressing: results of a clinical evaluation
Authors: Téot L. , Lambert L. , Ourabah Z. , Bey E. , Steenman C. , Wierzbiecka E. , Malikov S. , Charles J.P. , Vives F. , Bohbot S.
Published: May 2014

Objective:

To evaluate the protection and acceptability of Urgotul wound dressing in the local management of acute or chronic wounds receiving topical negative pressure (TNP) therapy.

Method:

This was a prospective multicentre non-comparative open-label trial. At each dressing change the investigating physician clinically evaluated and photographed the wound. Planimetric measurement was undertaken and wound depth was assessed at the start and end of the treatment. Follow-up was undertaken until deemed clinically unnecessary by the investigator.

Results:

Sixty-six patients were included (42 acute wounds and 24 chronic wounds) and followed up for an average of 17 days. Dressing changes were deemed entirely painless in 52% of cases (compared with 18% at baseline) and pain between two consecutive dressing changes was absent in 66% of cases (34% at baseline). Removal of the TNP-interface dressing combination was considered ‘very easy’ or ‘easy’ in 94% of cases and adherence to the wound was recorded as ‘absent’ in 88%. On average, the dressings were changed every 3.8 ± 1.1 days (all wounds were considered), and wound area and depth were reduced by 19% and 54% respectively by the end of the follow-up period.

Conclusion:

Use of the interface dressing in combination with TNP substantially reduced the pain caused by dressing changes. It therefore makes more acceptable the use of this technique, which aims to optimise the management of wounds that are sometimes considered to be in a therapeutic impasse.

Declaration of interest:

This study was sponsored by Laboratoires Urgo, Dijon, France.
A point prevalence survey of wounds in north-east England
Authors: Srinivasaiah N , Dugdall H , Barrett S , Drew P.J
Published: May 2014

Objective:

To review current wound-care practice and the standard of wound care in Hull and East Yorkshire; obtain information on prevalence, treatment and outcomes; provide a basis for estimating the extent of the problem, treatment modalities used, service provision and future needs; highlight areas of care in need of improvement; highlight areas with excellent wound practices and gain information for future research projects within the population of the region.

Method:

Point prevalence interface audit of community and acute trusts.

Results:

The cumulative wound prevalence for the region was 12%. Community nurses were involved in caring for 70.1% of patients with wounds, with 52.7% of wounds being treated in the patient’s home. The largest proportion of wounds were surgical wounds (n=699, 41.5%), followed by leg and foot ulcers (n=629, 37.3%) and pressure ulcers (n=294, 17.4%). Diabetes and cancer were related to 15.1% and 9.7% of the wounds respectively. 41.9% of the wounds were on the lower leg. The primary and secondary dressings used the most were low/non-adherent dressings at 25.9% and 27.3% respectively. Almost half of the patients with a venous leg ulcer (46%) did not receive multilayer compression and 7% of patients with an arterial ulcer did; 23.6% of the leg and foot wounds were not assessed with a Doppler.

Conclusion:

Wounds represent a significant cause of morbidity in the general population. A systematic focus is necessary on effective and timely diagnosis, on ensuring treatment is appropriate to the cause and condition of the wound and on active measures to prevent complications. A number of initiatives have commenced in order to provide a effective and efficient wound care.

Declaration of interest:

None.
Does VAC increase the risk of venous thromboembolism?
Authors: Leijnen M. , Steenvoorde P. , van Doorn L. , Zeillemaker A.M. , da Costa S.A. , Oksam J.
Published: May 2014

Seventeen years after its introduction, topical negative pressure (TNP), in particular Vacuum Assisted Closure (VAC), is widely accepted as a treatment for complicated acute and, increasingly, chronic wounds. Indications for its use include:
Pilonidal sinus: healing rates, pain and embarrassment levels
Authors: Stewart A. , Donoghue J. , Mitten-Lewis S.
Published: May 2014

Objective:

To identify the healing rates, wound hygiene practices, types of primary wound dressings used, antibiotics prescribed, pain intensity and embarrassment levels in patients with pilonidal sinus.

Method:

A prospective descriptive design was used. We followed 55 patients for three months following excision of pilonidal sinus. Digital photographs were taken and the wound area was calculated using the Alfred and Medseed Wound Imaging System on the first postoperative day, at 2–3 weeks and again at 12 weeks. Data were collected from the nurses and patients using piloted questionnaires.

Results:

Sixty per cent of the participants had closed wounds within 12 weeks of surgery. Various dressing types were used. There was no significant correlation between dressing type and healing, or wound size and healing. There was no significant association between antibiotic usage and faster healing rates. A mean pain intensity score of 4.8 on a 0–10 scale was reported at the first dressing change for saline gauze dressings, which was the most painful experience with this wound. Average levels of embarrassment were low and decreased over time.

Conclusion:

Forty per cent of participants who had unhealed wounds at 12 weeks had other factors involved, which were not measured in this study.

Declaration of interest:

None.
Effect of low-intensity direct current on the healing of chronic wounds: a literature review
Authors: Ramadan A. , Elsaidy M. , Zyada R.
Published: May 2014

Few studies have assessed the effectiveness of electrical stimulation on chronic wounds. Nevertheless, the evidence suggests it is a potentially useful, accessible and cheap therapy, which might play a valuable role in everyday practice
Effect of an ibuprofen-releasing foam dressing on wound pain: a real-life RCT
Authors: Domenech R. Palao i , Romanelli M. , Tsiftsis D.D. , Slonkov V. , Jortikka A. , Johannesen N. , Ram A. , Persson L.M. , Altindas M. , Orsted H. , Schäfer E.
Published: May 2014

Objective:

To compare an ibuprofen-releasing foam dressing (Biatain Ibu, Coloplast A/S) with local best practice in the treatment of painful exuding wounds.

Method:

In this large-scale randomised comparative study, 853 patients were randomised to either ibuprofen-releasing foam (test) dressing (n=467) or local best practice (n=386). Primary endpoint was wound pain relief from day 1–7, assessed by the patients twice daily using a five-point verbal rating scale. Secondary endpoints were reduction in pain intensity from day 0–7 (assessed using an 11-point numeric box scale), quality of life (assessed using the WHO-5 well-being index and effect on health-related activities of daily living) and the incidence of adverse events.

Results:

After seven days significantly more patients in the experimental group experienced relief from temporary and persistent pain and a reduction in pain intensity, when compared with patients in the local best practice group (p<0.0001). They also experienced a greater improvement in quality of life. The number of adverse events in both groups was low.

Conclusion:

The test dressing provided an appropriate wound healing environment, relieved temporary and persistent wound pain, and decreased pain intensity. It was also associated with an improvement in quality of life.

Declaration of interest:

This study was partly funded by Coloplast A/S, Humlebaek, Denmark. Data analysis were performed by an external consultant using validated SAS Macro (SN Lophaven, Roskilde, Denmark).
A review of the physical, biological and clinical properties of a bacterial cellulose wound
Authors: Thomas S.
Published: May 2014

Almost paper thin, this new dressing is sufficiently permeable to cope with moderately exuding wounds, such as burns and donor sites. This review assesses the existing laboratory and clinical data on this novel dressing type
Malignant fungating wounds: managing pain, bleeding and psychosocial issues
Authors: Alexander S.
Published: May 2014

Management of these non-healing wounds typically involves practices that diverge from those used in other settings. The final article of this four-part series explores the holistic approach required in dealing with the complex symptoms
Human aqueous placental extract as a wound healer
Authors: Chakraborty P.D. , De D. , Bandyopadhyay S. , Bhattacharyya D.
Published: May 2014

The healing properties of placental extract are well established in various skin conditions, including chronic wounds, pressure ulcers and burns. However, its biochemical composition and mechanisms of action are still largely unknown
Regular debridement is the main tool for maintaining a healthy wound bed in most chronic wounds
Authors: Wolcott R.D. , Kennedy J.P. , Dowd S.E.
Published: May 2014

Sharp debridement is the most clinically and cost-effective way of physically removing and suppressing a biofilm. Continued debridement, as part of a multifaceted treatment strategy, will keep the biofilm in a weakened state
Identification of yeast in chronic wounds using new pathogen-detection technologies
Authors: Leake J.L. , Dowd S.E. , Wolcott R.D. , Zischkau A.M. , Sun Y.
Published: May 2014

Objective:

To evaluate the ability of two new diagnostic methods to detect and accurately identify yeast associated with chronic wound infections.

Method:

Fungal tag-encoded FLX amplicon pyrosequencing (fTEFAP), a universal fungal identification method, bacterial tag-encoded FLX amplicon pyrosequencing (bTEFAP), a universal bacterial identification method, and a new quantitative polymerase chain reaction (qPCR) wound pathogen panel were used to evaluate three chronic wounds suspected to contain yeast.

Results:

Forty wound samples were analysed in addition to the three samples suspected of containing yeast. The qPCR panel, which targets Candida albicans, detected this yeast in two of the three wound samples. In contrast, fTEFAP detected yeast in each of the three samples: two showed Candida albicans and the third Candida parapsilosis. fTEFAP also identified a lower level of Candida tropicalis in one of the wounds that was positive for Candida albicans. The qPCR wound panel results were returned within two hours, while the fTEFAP results were returned within 24 hours.

Conclusion:

Two new molecular methods have been developed to aid wound pathogen diagnostics. The quantitative PCR wound panel is rapid but is limited to major wound-associated bacteria and yeasts. The universal fTEFAP and bTEFAP methods take 24 hours to return results but are able to detect the relative contribution of any bacteria of yeast in a chronic wound diagnostic sample.

Declaration of interest:

Southwest Regional Wound Care Center is a clinical wound-care provider seeking to improve the ability of wound care practitioners to help patients. The Research and Testing Laboratory develops molecular methods including fTEFAP, bTEFAP and the quantitative PCR wound panel.
Clinical experience with a glucose oxidase-containing dressing on recalcitrant wounds
Authors: Davis P. , Wood L. , Wood Z. , Eaton A. , Wilkins J.
Published: May 2014

This large open study investigated the clinical benefits of a new hydrogel dressing when used on chronic wounds of different aetiologies in real-life clinical settings. Nearly three-quarters of the patients assessed either healed or improved
Effect of TNP on the microbiology of venous leg ulcers: a pilot study
Authors: Khashram M. , Huggan P. , Ikram R. , Chambers S. , Roake J.A. , Lewis D.R.
Published: May 2014

Objective:

To investigate the effect of topical negative pressure, delivered using Vacuum Assisted Closure (VAC, KCI), on the microbiology of chronic, non-infected venous leg ulcers (VLUs).

Method:

Patients receiving compression therapy for a chronic VLU were recruited into this prospective pilot study. The ulcer was swabbed and VAC was applied at 125mmHg continuous subatmospheric pressure on day 1 for six days. Standard methods for bacteriological sampling and measuring the wound surface area were applied at baseline and at the VAC dressing changes on days 3 and 6. Log median colony forming units (CFUs) per cm2 were used for statistical analyses. The bacterial species were identified.

Results:

Seven patients were recruited into and completed the study. The median log10 CFU/cm2 on days 1, 3 and 6 were 3.5, 4.7 and 5.1 respectively. There was a significant increase in bacterial colonisation between days 1 and 6 (p<0.02). No change was observed in the identified microbiological species during therapy with VAC.

Conclusion:

This pilot study suggests that VAC therapy increases absolute numbers of bacteria colonising non-infected leg ulcers.

Declaration of interest:

KCI supplied the VAC equipment and ARANZ the SilhouetteMobile, but both had no other infl uence on the study.