bluuebunny/crossref_metadata_2025 huggingface dataset:
Leg wound infections following cardiac surgery: a scoring system for assessment and management
Authors: Elahi M.M. , Haesey A.M. , Graham K.C. , Battula N.R. , Manketlow B. , Dhannapuneni R.R.V. , St Hickey M.
Published: May 2014

Objective:

Well-defined criteria are needed to provide guidance for the appropriate management of leg wounds following saphenous vein harvest in coronary artery bypass graft surgery (CABG).

Method:

A score named DISINFECT was devised to carefully define the variables to be considered for assessing saphenous vein harvest wounds.

Results:

This preliminary study included 100 consecutive patients undergoing first-time isolated CABG requiring the saphenous vein as a conduit. Wounds were assessed and the points combined to create a daily score (D) according to the presence of increased C-reactive protein/white blood cells (I), surrounding tissue (S), quality of the incision (I), new skin (N), foreign material (F), exudate (E), positive cultures (C) and temperature (T).

Conclusion:

Taking into account the stages of wound healing, severity of infection and appropriate use of antibiotics, this method of wound management would improve the consistency with which leg wounds are managed, reduce hospital stays and increase resistance to hospital-acquired infection.

Declaration of interest:

None.
Use of a hydrocapillary dressing in the management of highly exuding ulcers: a comparative study
Authors: Norkus A. , Dargis V. , Thomsen J.K. , Harding K.G. , Ivins N. , Serra N. , Torres de Castro O.G. , Galindo A. , Andersen K.E. , Roed-Petersen J. , Gottrup F. , Blanco J.L. , Mena de , Hauschild A. , Moll I. , Svensson, Å. , Carter K.
Published: May 2014

Objective:

To evaluate the safety and performance of Alione Hydrocapillary dressing (Coloplast A/S) in the management of highly exuding chronic venous leg ulcers and compare it with two hydropolymer dressings, Tielle and Tielle Plus (Johnson & Johnson).

Method:

A comparative clinical trial was conducted on 97 patients with an ankle brachial pressure index ≥0.8 and a highly exuding leg ulcer. Ulcer duration was at least four weeks. Treatment continued until healing or for a maximum of 12 months.

Results:

There was no statistically significant difference in healing time or wound area reduction between the two treatment protocols. The test dressing (Alione Hydrocapillary) had better absorption capacity and was more comfortable for the patients than the comparator dressings (Tielle/Tielle Plus) and adhered less to the wound bed. Also, more patients preferred the test dressing to their previous treatment. Although severe leakage and maceration were observed more frequently in the comparator group compared with the test group, this was not statistically significant.

Conclusion:

Both treatment protocols were safe and effective in treating highly exuding chronic venous leg ulcers. The test dressing performed as well as or better than the comparator dressings for all study parameters and more patients preferred the test dressing to their previous dressing compared with the comparator dressings.

Declaration of interest:

The study was funded by Coloplast A/S, Humlebaek, Denmark.
Bacterial and fungal absorption properties of a hydrogel dressing with a superabsorbent polymer core
Authors: Bruggisser R.
Published: May 2014

Objective:

To study in vitro the micro-organism absorption properties of a hydrogel wound dressing, TenderWet.

Method:

Microbial films on agar plates and suspensions with common wound bacteria (Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa) and a fungal strain (Candida albicans) were studied.

Results:

The hydrogel dressing reduced the number of micro-organisms significantly, both on the agar plate and in suspension. The in vitro data show that the hydrogel dressing absorbed the micro-organisms from the environment. Electron microscopic imaging clearly demonstrated that the germs were attached to the surface of the dressing’s superabsorbent polymer core.

Conclusion:

In vitro data show that the hydrogel dressing TenderWet attracts and retains micro-organisms and reduces the number of viable germs. Clinical experience underlines this fast cleansing and debriding effect of the hydrogel wound dressing.

Declaration of interest:

This study was supported by IVF HARTMANN AG, Neuhausen, Switzerland.
Epidemiology, aetiology and management of abnormal scarring: a review of the literature.
Authors: Pellard S.
Published: May 2014

Scarring is a normal part of the healing process after dermal injury. All wounds proceed through the inflammatory, proliferative and maturation phases, with the scar being the final product of healing. In general, scars do not cause problems to the individual, but in some cases abnormal scars develop, which can be extremely distressing as they may be aesthetically disfiguring, and cause functional disability as well as pain, itching and tenderness. This can lead to psychosocial problems.
Efficacy of a skin-protection powder for use as a dressing for intractable ulcers
Authors: Ohura N. , Kurita T. , Takushima A. , Shibata M. , Harii K.
Published: May 2014

Objective:

Stomahesive skin-protection powder has been reported to be useful as a skin-care and skin-barrier product for the management of stomas. This study aimed to evaluate its efficacy, in terms of wound healing, moisture retention and pain management, as an alternative to conventional dressing materials. Both clinical and animal studies were undertaken.

Method:

The efficacy of the Stomahesive powder was tested by measuring the thickness of granulation tissue formed in a total skin defect in a db/db mouse model. We then compared the healing process using either the skin-protection powder or a conventional film dressing material. In the clinical study 17 patients with various intractable ulcers were treated with Stomahesive powder, and healing was evaluated.

Results:

In the mouse model, granulation tissue in the wounds treated with the powder was 2.86 times thicker than that of the wounds treated with the film dressing. In the clinical study, 16 out of 17 wounds healed completely.

Conclusion:

The Stomahesive powder could be an effective treatment modality for contact ulceration, superficial ulcers with complex contours and morphology, and superficial ulcers contaminated by liquid faeces or vaginal discharge that have not responded to conventional dressings.

Declaration of interest:

None.
An overview of the two widely accepted, but contradictory, theories on wound contraction
Authors: Pellard S.
Published: May 2014

A wound repairs itself in three phases: inflammation, proliferation and maturation. Wound contraction is a final feature of the proliferation phase, and is defined as the mechanism by which the edges of an open wound are drawn together as a result of forces within the wound.
Are modern wound dressings a clinical and cost-effective alternative to the use of gauze?
Authors: Jones A.M. , San Miguel L.
Published: May 2014

In the 1960s two landmark studies established the concept of moist wound healing and heralded the development of modern dressings. However, despite the publication of a number of systematic reviews, there is no consensus on which dressings are most clinically and cost effective. This is due in part to the difficulty of conducting large randomised controlled trials (RCTs) as patients with wounds are not a heterogeneous group and often have complex underlying pathologies. It is also ethically questionable to conduct trials with dressings such as gauze that fail to provide optimal healing conditions.
Issues in wound care: empowering patients - developing a framework for practitioners
Authors: Bethell Elaine , Cadogan Jane , Charles Dr Hildegard , Clarkson Ayesha , Fraser Moira , Green Karen , Hampton Sylvie , Kenny Pat , King Brenda , McMullen Marie , Glover Deborah
Published: May 2014

In October 2004 a group of tissue viability practitioners came together to discuss issues around communicating with and empowering patients in wound care. The aim of the forum, sponsored by Mölnlycke Health Care Tendra Academy, was to develop a consensus framework for health-care professionals to enable patient partnership and empowerment at a level acceptable to individual patients. Here, we present a summary of the resulting document.
Topical negative pressure in the treatment of infected wounds with exposed orthopaedic implants
Authors: Pelham F.R. , Kubiak E.N. , Sathappan S.S. , Di Cesare P.E.
Published: May 2014

A number of factors, including traumatic injury, diabetes mellitus, peripheral vascular disease, rheumatoid arthritis, congestive heart failure, lymphoedema and infection in wounds with exposed orthopaedic implants, can result in musculoskeletal wounds becoming difficult to heal. Topical negative pressure (TNP) therapy:
Can near infrared spectroscopy measure the effect of pressure on oxygenation of sacral soft tissue?
Authors: Keller B.P.J.A. , Schuurman J.P. , van der Werken C.
Published: May 2014

Objective:

To test whether near infrared spectroscopy (NIRS) is applicable for the examination of the influence of external pressure on oxygenation of the soft tissues in the sacral area.

Method:

Tissue oxygenation was measured in 33 healthy volunteers in the prone position. A NIRS probe was positioned over the sacrum and external pressure was applied in 10mmHg increments, from 20mmHg to 200mmHg and then decreased. At each level, tissue oxygen saturation (StO2) was measured. To test reproducibility, the protocol was repeated in six volunteers, in whom the thickness of the soft-tissue envelope at different levels of external pressure was assessed using ultrasound.

Results:

There was wide variability in StO2 courses between the 33 subjects, with a non-linear relationship between pressure and StO2. The only consistent finding was that the StO2 was significantly higher after decreasing pressure than at the initial pressure of 20mmHg, which is indicative of reactive hyperaemia. Despite the application of high external pressures, reasonable tissue oxygenation was maintained in 19 of 33 subjects. Reproducibility of the measurements was poor. Comparison of soft-tissue thickness with corresponding StO2 values showed that, with increasing pressure, the percentage decrease in tissue thickness was higher than the decrease in tissue oxygenation.

Conclusion:

This study confirms that NIRS is not useful for assessing tissue oxygenation in pressure ulcer research due to unacceptable inter-individual variability and poor reproducibility of measurements.

Declaration of interest:

The InSpectra Tissue Spectrometer was provided free charge by Hutchinson Technology (Arnhem, the Netherlands). None of the authors had a financial interest in or link with the company.
Use of a bioengineered human dermis on a large acute foot ulcer
Authors: Tsang K.K.
Published: May 2014

When there is a lack of available skin, full-thickness wounds are often closed with meshed and expanded split-thickness skin grafts. However, as there is a lack of dermis beneath the healed graft interstices, hypertrophic scarring, wound contraction and instability of the skin may occur. Moreover, some patients may not be suitable for or refuse surgery.
The safety and efficacy of topical negative pressure in non-healing wounds: a systematic review
Authors: Pham C.T. , Middleton P.F. , Maddern G.J.
Published: May 2014

Topical negative pressure (TNP) therapy was developed as an alternative to ‘standard’ forms of wound management and can be used for the early management of acute trauma or when more conventional methods have failed. Conventional methods of wound management include surgical debridement or the Healthpoint System (Healthpoint, Fort Worth, USA) which involves the use of three Food and Drug Administration (FDA)-approved gel products:
Use of a protease-modulating matrix dressing on a non-healing tendo-Achilles surgical wound
Authors: Noble T.
Published: May 2014

Simon, a 34-year-old, married, Caucasian male, was first seen in our fracture clinic on 13 October 2003 with a ruptured right tendo-Achilles, sustained while playing football. Given the choice of conservative treatment or surgery, he opted for the latter, which was undertaken three days later.
Delays to the definitive surgical management of pretibial lacerations in the elderly
Authors: Lamyman M.J. , Griffiths D. , Davison J.A.
Published: May 2014

Wounds to the pretibial region in the elderly are common and have been estimated to account for 5.2 per 1000 emergency department attendances.1 In this patient population, such an injury can precipitate a rapid decline in mobility and independence. Minimising the period of immobility associated with such an injury has been shown to reduce this effect.2 In many cases this is best achieved through early debridement and split skin-graft coverage. However, unacceptable delays often occur in the care pathway of these patients. This frequently leads to a considerably longer period of hospitalisation and immobility than is necessary.
Results of a comprehensive hospital-based wound survey
Authors: Mahé E. , Langlois G. , Baron G. , Girard L. , Macrez A. , Fargeot C. , Crickx B.
Published: May 2014

Objective:

To evaluate the prevalence, clinical aspects and management of wounds in a hospital.

Method:

A one-day survey was undertaken in our university hospital. All hospitalised patients (n=624) were examined. The clinical aspects, aetiology and management (pain, cleansing and primary dressing) of wounds were systematically evaluated.

Results:

A total of 327 patients (52%) had 933 wounds (mean 2.8 per patient). The prevalence was higher in surgical departments (82%) than medical departments (37%), although wounds in the latter departments were larger, deeper, more painful and less numerous per patient. Pain at wound dressing changes was treated in 89% of cases; antiseptics were used for wound cleansing in 14% of cases; the primary dressing used was appropriate in fewer than 50% of cases in the medical departments.

Conclusion:

This study highlights the high prevalence of wounds in this hospital setting. Many problems with their management have been identified and measures will be taken to optimise care.

Declaration of interest:

None.
Venous leg ulcer treatment and practice—part 1: the causes and diagnosis of venous leg ulcers
Authors: Rajendran S. , Rigby A.J. , Anand S.C.
Published: May 2014

Venous ulceration of the lower limb is associated with chronic venous insufficiency (CVI). It mainly affects older people, especially women, and is a result of previous venous thrombosis or an incompetent venous valve within the superficial or communicating veins. The ulcers are often difficult to heal, have high recurrence rates and are chronic, painful and debilitating.
Use of porcine dermal collagen graft and topical negative pressure on infected open abdominal wounds.
Authors: Jehle K.S. , Rohatgi A. , Baig M.K.
Published: May 2014

Management of the open abdomen in the presence of severe abdominal infection remains a challenge. Septic dehiscence after a laparotomy or partial loss of the abdominal wall often precludes early definitive closure of the abdomen. Techniques advocated in such scenarios include progressive abdominal closure, topical negative pressure (TNP) therapy or the use of biological mesh2 for abdominal wall reconstruction. We describe two cases in which porcine dermal collagen graft was successfully used in conjunction with TNP therapy to achieve closure of a septic abdomen.
A collaborative approach to education provision will help save our specialism
Authors: Fletcher J
Published: May 2014

The education and training of nurses has changed considerably since the introduction of Project 2000 in the early 1990s. Curriculum redesigns and a move into higher education have resulted in staff with good academic qualifications but a reduced practice base when they qualify. Additional problems relating to recruitment and retention of qualified staff mean that nurses struggle to balance their workload, juggling clinical practice demands with their needs for professional development.
Venous leg ulcer treatment and practice — part 2: wound management
Authors: Rajendran S. , Rigby A.J. , Anand S.C.
Published: May 2014

The management of a venous ulcer is determined by the level of exudate, presence (or absence) of infection, condition of the wound bed, ulcer size and the condition of the peri-ulcer tissue. If necrotic or sloughy tissue is present, this must be debrided to prevent infection and promote healing. Subsequently, exudate is controlled, healing stimulated by wound bed preparation and the wound protected by a dressing.
Bacterial profiling using skin grafting, standard culture and molecular bacteriological methods
Authors: Andersen, A. , Hill K.E. , Stephens P. , Thomas D.W. , Jorgensen B. , Krogfelt K.A.
Published: May 2014

Objective:

Wound healing can be delayed by the presence of colonising bacteria, and in polymicrobial wounds they may act synergistically to the further detriment of wound healing. In this pilot investigation, biopsy and swab samples were obtained as part of skin-graft operations performed on a chronic venous leg ulcer in order to study the spatial microbial diversity and to compare standard bacteriological and molecular biological techniques.

Method:

The wound was sampled before excision, and sampling was undertaken at multiple locations across the wound. Swab samples and biopsies were subjected to culture analysis and 16S rRNA polymerase chain reaction (PCR), and to denaturing gradient gel electrophoresis (DGGE).

Results:

Within the wound samples, DGGE identified the major wound microflora components and established the extent of local differences in bacterial diversity.

Conclusion:

This ongoing investigation has verified DGGE as a powerful tool for elucidating the clinical microbiology of a chronic disease state. It also suggests that skin graft operations are a novel way of obtaining multiple samples for in vivo bacteriology and for establishing the spatial distribution of bacteria in the complex micro-environment of chronic wounds.

Declaration of interest:

None.
A new initiative aiming to improve our understanding of shear force
Authors: Call E. , Edsberg L.E.
Published: May 2014

Pressure, shear and friction forces are among the major factors known to contribute to the development of pressure ulcers. For many years research has focused on the effect of pressure on tissue, and the inverse relationship between pressure and time is well known. Interface pressure mapping has often been used to evaluate the benefits of support surfaces and wheelchair cushions. The growing interest in deep tissue injuries has led to an increased interest in improving our understanding of how shear contributes to the development of pressure ulcers. Studies have already demonstrated that the presence of shear leads to more rapid tissue damage at lower normal forces.
Role of diabetic microvascular disease in the development of foot wounds
Authors: Henderson E.A.
Published: May 2014

The pathophysiological relationship between aetiology and impaired healing of diabetic foot wounds is complex, with vascular, neuropathological, immune funct ion and biochemical abnormalities contributing to a poor prognosis.
The endotoxin binding and antioxidative properties of ceramic granules
Authors: Opoku A.R. , Sithole S.S. , Mthimkhulu N.P. , Nel W.
Published: May 2014

Objective:

To investigate the possible antimicrobial activities and the detoxification (endotoxin binding and free radical scavenging) properties of Cerdak.

Method:

In order to measure the antimicrobial activity of Cerdak, microorganisms were separately inoculated into nutrient agar in the presence of Cerdak, and growth was observed over 48 hours. Cerdak was incubated with 4000EU/ml endotoxin, and the residual endotoxin was determined over 24 hours. The decrease in the colour of ABTS and DPPH (inorganic free radicals) in the presence of Cerdak was colourimetrically monitored as a measure of Cerdax’s free radical scavenging ability. DNA was exposed to hydrogen peroxide and ultraviolet irradiation in the presence and absence of Cerdak. The DNA strand break was then observed through electrophoresis.

Results:

While Cerdak had little or no antibacterial activities, it demonstrated a high water and endotoxin-binding capacity. It also protected DNA from damage by reactive oxygen species.

Conclusion:

The detoxification properties of Cerdak could contribute to its healing abilities.

Declaration of interest:

None.
Parathyroidectomy, excision and skin grafting with topical negative pressure for calciphylactic ulcers
Authors: Bronson N. , Menon R. , Butler J. , Gordon I.
Published: May 2014

Distal calcific uremic arteriolopathy, known more simply as calciphylaxis, is characterised by the excessive deposition of calcium and phosphate in the media of small arteries and in the microcirculation, resulting in chronic skin ulcers. It is prevalent in approximately 4% of haemodialysis patients, and is very rarely associated with primary hyperparathyroidism and malignancy, with renal failure being the predominant cause.
Nitric oxide restores impaired healing in normoglycaemic diabetic rats
Authors: Schaffer M. , Bongartz M. , Fischer S. , Viebahn R. , Proksch B.
Published: May 2014

Objective:

Hyperglycaemia impairs wound healing. However, little is known about the underlying cellular mechanisms that lead to diminished wound repair in insulin-controlled and non-insulin-controlled diabetes. This study investigated the role of endogenous and exogenous nitric oxide on incisional wound healing in diabetic rats.

Method:

Groups of 10 wild-type Wistar control rats — 10 genetically diabetic BioBreeding rats and 10 genetically diabetic BioBreeding rats treated with subcutaneous insulin implants to render them normoglycaemic — underwent dorsal skin incision followed by subcutaneous insertion of polyvinyl alcohol sponges. The rats were sacrificed 10 days later to determine the wound-breaking strength and reparative collagen deposition. Nitric oxide, an important mediator in diabetic wound healing and collagen synthesis, was measured in wound fluid. Wound-derived fibroblasts were tested for ex vivo synthesis of nitric oxide and collagen. Exogenous nitric oxide was used for the therapeutic interventions.

Results:

Wound-breaking strength and wound collagen deposition were significantly impaired in the hyperglycaemic diabetic animals (p<0.01). Wound nitric-oxide synthesis and ex vivo wound fibroblast nitric-oxide production were reduced in the hyperglycaemic rats (p<0.01). Insulin treatment partially reversed some of the effects of hyperglycaemia on wound repair (p<0.05). Exogenous nitric oxide further restored wound mechanical strength, collagen deposition and fibroblast collagen synthesis (p<0.01) in insulin-treated (normoglycaemic) diabetic animals.

Conclusion:

Wound healing is impaired in hyperglycaemic and normoglycaemic diabetic rats. This is reflected in impaired wound fibroblast nitric-oxide synthesis. Used in combination with insulin, exogenous nitric oxide further improves healing outcomes, making it a potential target for therapeutic intervention in insulin-treated normoglycaemic diabetes.

Declaration of interest:

This work was supported by a grant to MS from the Deutsche Forschungsgemeinschaft Scha 657/4–1.
Efficacy of TNP on lower limb wounds: a meta-analysis
Authors: Sadat U. , Chang G. , Noorani A. , Walsh S.R. , Hayes P.D. , Varty K.
Published: May 2014

This meta-analysis of the three RCTs that have compared topical negative pressure with conventional treatment in patients with lower limb ulcers found that it significantly reduced healing times and increased the number of healed wounds
Wound healing in guinea pigs after topical application of starfish Pentaceraster regulus extract
Authors: Gupta A. , Lakshmi V. , Jain G.K. , Raghubir R.
Published: May 2014

Objective:

To investigate the healing efficacy of Pentaceraster regulus (starfish) aqueous-methanol extract on cutaneous wounds in guinea pigs.

Method:

Freshly collected starfish were washed with distilled water and soaked in methanol for transportation. After filtering, soaking and concentration, the extract was fractionated into chloroform soluble (5g), 50% aqueous-methanol soluble (20g) and insoluble fractions (25g). Primary screening demonstrated moderate wound-healing activity in male Swiss-strain guinea pigs, so further fractionation into chloroform, 50% aqueous-methanol and insoluble fractions was undertaken. Wound-healing activity was concentrated only in the aqueous-methanol fraction, so this was used for the study. Animals received either 1% aqueous-methanol extract, the vehicle alone or 5% providone-iodine. The following were measured: wound area, wound tensile strength, DNA, total protein and hydroxyproline levels in excised granulation tissue. Histological changes were observed under microscope.

Results:

Extract-treated wounds healed faster, indicated by a significant contraction in wound area (42%). Cellular proliferation and collagen synthesis at the wound site increased, demonstrated by increase in DNA (33%), protein (29%) and hydroxyproline (37%) content when compared with the controls and povidone-iodine-treated animals (standard care). These findings were confirmed by histological examination. Proper folding of collagen was demonstrated by a significant increase in tensile strength (34%).

Conclusion:

The results suggest that the aqueous-methanol extract of starfish P. regulus promotes wound-healing activity.

Declaration of interest:

None
Changes in leg ulcer management practice following training in an Irish community setting
Authors: Clarke-Moloney M. , Keane N. , Kavanagh E.
Published: May 2014

Objective: To identify regional changes in leg ulcer management following leg ulcer training for community-based nurses which incorporated Doppler ankle brachial pressure index (ABPI) assessment.

Methods: This was a two-part study conducted in the Irish Health Service Executive, Mid-Western Area. An initial audit in 2005 gathered details on all leg ulcer patients treated in the community in one week, including patient demographics, ulcer aetiology, assessment and treatment1. The first audit was carried out before the introduction of a training course for community-based nurses in leg ulcer assessment and management. The training programme was delivered in 2005 and again in 2006. In total 30 public health nurses and community registered nurses from this region completed the course. The second part of the study involved repeating the audit in 2007. By comparing the results from 2005 with 2007 we were able to identify changes in leg ulcer assessment and management.

Results: A total of 426 and 449 leg ulcers were identified, with a prevalence of 0.12% and 0.1% in 2005 and 2007 respectively. Prevalence increased to 1.2% (2005) and 1.1% (2007) in those aged over 70 years. Most ulcers were venous in origin (63.3% in 2005 versus 68.8% in 2007). From 2005 to 2007 the number of venous leg ulcers treated with high compression increased significantly, by almost 16% (p<0.0001). Once-weekly dressing changes increased by a significant 10%, reducing the number of dressings requiring more frequent changes (p=0.002).

Conclusion: Significant improvements in leg-ulcer practices were noted in the 18-month study period. The results show very significant increases in number of patients treated with high compression and a significant reduction in more than once-weekly dressing changes. These positive changes may be partly attributed to the enhanced knowledge and skills nurses gained by participating in training.

Declaration of interest: None.
An in vitro examination of the antioxidant and anti-inflammatory properties of buckwheat honey
Authors: van den Berg A.J.J. , van den Worm E. , Quarles van Ufford H.C. , Halkes S.B.A. , Hoekstra M.J. , Beukelman C.J.
Published: May 2014

Objective:

Hydroxyl radical and hypochlorite anion formed at the wound site from superoxide anion produced by activated polymorphonuclear neutrophils (PMNs) are considered important factors in impaired wound healing. Superoxide anion may also react with nitric oxide produced by macrophages to form peroxynitrite, a third strong oxidant that damages surrounding tissue. In order to select honey for use in wound-healing products, different samples were compared for their capacity to reduce levels of reactive oxygen species (ROS) in vitro.

Method:

Honey samples were tested in assays for inhibition of ROS production by activated human PMNs, antioxidant activity (scavenging of superoxide anion in a cell-free system) and inhibition of human complement (reducing levels of ROS by limiting formation of complement factors that attract and stimulate PMNs). For buckwheat honey (New York, US), moisture and free acid content were determined by refractive index measurement and potentiometric titration respectively. Honey constituents other than sugars were investigated by thin layer chromatography, using natural product reagent to detect phenolic compounds. Constituents with antioxidant properties were detected by spraying the chromatogram with DPPH.

Results:

Although most honey samples were shown to be active, significant differences were observed, with the highly active honey exceeding the activities of samples with minor effects by factors of 4 to 30. Most pronounced activities were found for American buckwheat honey from the state of New York. Phenolic constituents of buckwheat honey were shown to have antioxidant activity.

Conclusion:

As buckwheat honey was most effective in reducing ROS levels, it was selected for use in wound-healing products. The major antioxidant properties in buckwheat honey derive from its phenolic constituents, which are present in relatively large amounts. Its phenolic compounds may also exert antibacterial activity, whereas its low pH and high free acid content may assist wound healing.

Declaration of interest:

Research was financed by Greystone Medical Group.
Microbiology of amputation wound infection in a Nigerian setting
Authors: Akinyoola A.L. , Ojo O.D. , Oginni L.M.
Published: May 2014

Objective:

To identify the microbial pathogens responsible for amputation wound infections, their distribution and antibiotic-sensitivity patterns.

Method:

Consecutive patients who had limb amputations from April 2002 to March 2006 in an Nigerian hospital were recruited into this prospective observational study. The patients’ demographic features, indications for amputation, microbiology of stump wound infections and the effects on length of hospital stay were reported.

Results:

Fifty-seven patients (mean age 34.6 ± 19.2 years) had amputations in 58 limbs. Trauma leading to limb gangrene following treatment by traditional bone setters was the most common indication for amputation (64%). Approximately 76% of the amputations were in the lower limbs. Wound infection occurred in 48% of the stumps, of which 71% had been amputated because of a trauma injury. Pseudomonas aeruginosa was the most commonly isolated pathogen (40%). There was a very low correlation between the aetiologic bacterial agents and the age of patient, source of referral, indication for amputation and level of amputation. Amputation wound infections significantly prolonged the patients’ length of hospital stay (p=0.002).

Conclusion:

Amputation wound infection constitutes a serious morbidity in our practice. Most of the causes are preventable.

Declaration of interest:

None.
Combined use of an ibuprofen-releasing foam dressing and silver dressing on infected leg ulcers
Authors: Jørgensen B. , Gottrup F. , Karlsmark T. , Bech-Thomsen N. , Sibbald R.G.
Published: May 2014

Objective:

To investigate the effect and safety of an ibuprofen-releasing foam (Biatain-Ibu, Coloplast A/S) combined with an ionised silver-releasing wound contact layer (Physiotulle Ag, Coloplast A/S) on painful, infected venous leg ulcers.

Method:

This open non-comparative study involved 24 patients with painful, exuding, locally infected, and stalled venous leg ulcers. Persistent pain and pain at dressing change were monitored using a 11-point numerical box scale (NBS). The composition of the wound bed, the dressing combination’s ability to absorb exudate and minimise leakage, ibuprofen content in the exudate, reduction in wound area and adverse effects were also recorded.

Results:

Persistent wound pain decreased from a mean of 6.3 ± 2.2 to 3.0 ± 1.7 after 12 hours and remained low thereafter. Pain at dressing change also decreased and remained low. Forty-eight hours after the first dressing application, the mean concentration of ibuprofen in the wound exudate reached a constant level of 35 ± 21µg/ml. After 31 days, the relative wound area had reduced by 42%, with an associated decrease in fibrin and an increase in granulation tissue. The number of patients with wound malodour decreased from 37% to 4%. No serious adverse events were reported.

Conclusion:

The combined use of the ibuprofen-releasing foam dressing and silver-releasing contact layer reduced wound pain and promoted healing without compromising safety.

Declaration of interest:

This study was supported by Coloplast A/S, Humlebæk, Denmark and its affiliates. However, Coloplast A/S cannot be held responsible for the opinions expressed in this paper by the authors.
Cost implications of using an atraumatic dressing in the treatment of acute wounds
Authors: Rippon M. , Davies P. , White R. , Bosanquet N.
Published: May 2014

Three randomised controlled trials have compared a soft silicone dressing with traditional treatment on acute wounds. This analysis shows the former reduced overall costs by accelerating healing and reducing wound pain and resource use
Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT
Authors: Gethin G. , Cowman S.
Published: May 2014

Objective:

To determine the qualitative bacteriological changes that occurred during a four-week treatment period with either manuka honey or a hydrogel dressing. This was the secondary outcome of a randomised controlled trial (RCT) that compared the efficacy of the two treatments in desloughing venous leg ulcers.

Method:

This was a prospective open label multicentre RCT with blinded microbiological outcome analysis. Randomisation was conducted via remote telephone. To be included, the wound bed needed to comprise at least 50% slough. Wound swabs were taken at the start of treatment and after four weeks.

Results:

In all, 108 patients (35 males, 73 females) aged 24–89 years (mean 68) enrolled into the study. Both groups were comparable at baseline. Eighteen patients (17%) were withdrawn due to a wound infection: six in the honey group and 12 in the hydrogel group. Staphylococcus aureus was the most common isolate, being identified in 41 wounds (38%). At baseline, meticillin-resistant Staphylococcus aureus was identified in 16 wounds (10 honey versus six hydrogel). After four weeks 70% (n=7) of the manuka-honey treated wounds versus 16% (n=1) of the hydrogel treated wounds had MRSA eradicated. Pseudomonas aeruginosa was reported in 14% (n=16) of all wounds at baseline. After four weeks 33% (n=2) treated with honey and 50% (n=5) treated with hydrogel had this eliminated. The number of wounds (n=11 at baseline; n=15 at week 4) with ≥3 bacteria species remained constant over the four weeks.

Conclusion:

Manuka honey was effective in eradicating MRSA from 70% of chronic venous ulcers. The potential to prevent infection is increased when wounds are desloughed and MRSA is eliminated. This can be beneficial to prevent cross-infection.

Declaration of interest:

None.
Role of oxygen in wound healing
Authors: Bishop A.
Published: May 2014

Acute wounds are initially hypoxic. This state triggers the diffusion of oxygenated plasma from the surrounding intact tissue to the hypoxic area, and sets in train processes resulting in oxidative killing, angiogenesis and collagen synthesis
Current thoughts on angiogenesis
Authors: Chan L.K.W.
Published: May 2014

Research into the distinct phases of the process of angiogenesis has informed the development of growth factor therapy and tissue-engineered products, but more studies are needed to ensure the development of new therapeutic strategies
Effect of dressing choice on outcomes after hip and knee arthroplasty: a literature review
Authors: Tustanowski J.
Published: May 2014

Selecting the right dressing for these wounds can prevent blistering, maceration and the risk of infection. Ideally, the dressing should be permeable, waterproof, transparent, absorbent and flexible enough to withstand joint movement
Effects of biofilm treatments on the multi-species Lubbock chronic wound biofilm model
Authors: Dowd S.E. , Sun Y. , Smith E. , Kennedy J.P. , Jones C.E. , Wolcott R.
Published: May 2014

Objective:

To evaluate the efficacy of several biofilm effectors in inhibiting biofilm formation in an in vitro multi-species chronic wound biofilm model.

Method:

The Lubbock Chronic Wound Biofilm (LCWB) model has been described in detail elsewhere. Pathogens used in the model are Pseudomonas aeruginosa, Enterococcus faecalis and Staphylococcus aureus. These are three of the most important species associated with biofilms. Here, the model was exposed to the following biofilm effectors: xylitol, salicylic acid, farnesol, erythritol and two proprietary, semi-solid, wound-dressing formulations currently under development (Sanguitec gels).

Results:

Biofilm formation was completely inhibited in the LCWB model following treatment with 20% xylitol, 10% erythritol, 1,000μg/ml farnesol, 20mM salicylic acid or 0.1% of either of the two Sanguitec gel formulations. Salicylic acid specifically inhibited S. aureus (p<0.01) at 10mM and 20mM, consequently increasing the ratios of P. aeruginosa and E. faecalis within the biofilm. Xylitol had an increasing inhibitory effect on P. aeruginosa (p<0.01) at all concentrations evaluated. Erythritol had an inhibitory effect on P. aeruginosa and S. aureus growth (p<0.01) at over 5% concentrations. The inhibitory effect of both Sanguitec gel formulations was more broadly effective, with an increasingly inhibitory effect on all LCWB species (p<0.01).

Conclusion:

The LCWB model provides a multi-species format with which to evaluate the effect of biofilm effectors on wound flora in a biofilm phenotype. These results suggest that different treatments can target specific populations within a biofilm. Salicylic acid preferentially targeted S. aureus, xylitol preferentially targeted P. aeruginosa, while erythritol preferentially targeted both P. aeruginosa and S. aureus. In contrast, the two Sanguitec gel formulations provided a broad, less preferential, inhibition of biofilm development.

Declaration of interest:

Research and Testing Laboratory is a for-profit enterprise that develops molecular methods and performs service research work on biofilms. Sanguitec gel was developed by JPK and CEJ.
Managing wound exudate using a super-absorbent polymer dressing: a 53-patient clinical evaluation
Authors: Cutting K.F.
Published: May 2014

This real-life, observational evaluation shows that, by absorbing and retaining within its structure the corrosive enzymes found in chronic exudate, this dressing both reduces the likelihood of peri-wound maceration and promotes healing
Efficacy of a polyurethane dressing versus a soft silicone sheet on hypertrophic scars
Authors: Wigger-Albert W. , Kuhlmann M. , Wilhelm D. , Mrowietz U. , Eichhorn K. , Ortega J. , Bredehorst A. , Wilhelm K-P.
Published: May 2014

Objective:

To compare the efficacy and safety of a polyurethane dressing with a silicone sheet in the treatment of hypertrophic scars.

Method:

Sixty patients participated in this intra-individual 12-week clinical trial. Each scar was divided into two areas, to which the polyurethane dressing and the silicone sheet were randomly allocated. The primary outcome measure was the percentage change in the overall scar index (SI) between baseline and week 12. Secondary outcome measures included changes in skin redness, objectively measured by chromametry, and patients' views on the aesthetic outcome of treatment.

Results:

Both therapies achieved favourable results for all of the above outcome measures. Results were comparable for the primary outcome measure: 29.4% versus 33.7% for the silicone sheet and polyurethane product respectively. The decrease in the overall SI was significantly more pronounced for the polyurethane product after week 4 (5.6% versus 15.8% for the silicone sheet; p<0.0001) and week 8 (20.2% versus 27.1%; p=0.012).

Conclusion:

Both regimens were associated with a significant reduction in the clinical signs of hypertrophic scars over 12 weeks of treatment. The polyurethane dressing demonstrated a significantly more pronounced reduction in severity of these clinical signs after four and eight weeks of treatment and was better tolerated than the silicone sheet.

Declaration of interest:

This study was funded by Beiersdorf AG. proDERM is an independent research company, and none of the authors have an interest in the sponsor's commercial activities.
Wound infection-associated pain
Authors: White R. J.
Published: May 2014

Not only does wound infection and the release of pro-inflammatory modulators result in pain and delayed healing, but pain-related stress reduces the immune response to infection. Treatment of pain and infection should be equal priorites
Using VAC to facilitate healing of traumatic wounds in patients with chronic lymphoedema
Authors: Wollina U. , Hansel G. , Kränert C. , Heinig B.
Published: May 2014

Healing of traumatic injuries in patients with chronic lymphoedema is often delayed. This article describes how topical negative pressure was used to promote healing in two such cases. It also eliminated pain and prevented re-infection
Superficial swab cultures in open fracture management: insights from a resource-poor setting
Authors: Ojo O.D. , Oluwadiya K.S. , Ikem I.C. , Oginni L.M. , Ako-Nai A.K. , Daniel F.V.
Published: May 2014

Objective

To identify bacterial isolates from superficial swabs of open fracture wounds at presentation and after infection has been established, and to determine if there are correlations between them.

Method

Patients who presented with open fractures at the Wesley Guild Hospital, Ilesa, Nigeria between December 2004 and May 2006 were recruited into this prospective study. Superficial wound swabs were taken at presentation and if patient showed evidence of wound infection.

Results

Sixty patients had open fractures. The initial bacteria culture of wound swabs taken on the day of presentation was positive in 41 (68.3%) patients. Of these, 19 (46.3%) yielded one bacteria isolate, 17 (41.5%) yielded two and 5 (12.2%) yielded three, making a total of 68 organisms. The most common organism was Staphylococcus aureus. However, as a group, more aerobic Gram-negative rods were isolated than any other bacteria groups. Eleven (18.3%) patients developed wound infections, all of which were polymicrobial. In 10 (90.9%) of these, the microbial isolate of the final wound swab included at least one organism that was present in the initial wound culture. No patient with an initial negative culture went on to develop a wound infection. The mean presentation interval of patients with wounds that became infected was 15.2 ± 7.9 hours (95% CI 9.8–20.5 hours) compared with 2.9 ± 3.1 hours (95% CI 2.0–3.8 hours) for those who did not develop a wound infection (p>0.01).

Conclusion

In a resource-poor setting, where pre-hospital care is unavailable and patients present late, superficial wound swabs are effective in predicting subsequent organisms that may cause wound infections.

Conflict of interest

None.
Treatment of symptomatic abnormal skin scars with electrical stimulation
Authors: Perry D. , Colthurst J. , Giddings P. , McGrouther D.A. , Morris J. , Bayat A.
Published: May 2014

Objective

To evaluate the effect of non-invasive biofeedback electrical stimulation on symptomatic abnormal skin scars.

Method

Thirty patients with over 140 scars with long-term pain and itch were recruited into the study. Patients monitored the intensity of symptoms (pain and itching) on a numerical rating scale. In addition, a modified Manchester scar scale was used to objectively assess digital photographs of each scar in terms of colour, contour, distortion and texture, while a non-invasive spectrophotometric intracutaneous analysis was used to monitor the scars' physical characteristics.

Results

The electrical stimulation device resulted in a clinically and statistically significant (p<0.05) reduction of symptoms and scar scores. Pain and itch scores were both reduced to a median score of 0 by 2 months, from a baseline of 7 and 6 respectively. Scar scores were reduced from a baseline of 14 to a median score of 11 by 2 months.

Conclusion

These results give a preliminary indication of the potential role of non-invasive biofeedback electrical stimulation in the management of chronic scar pain and itch. However, further large scale controlled studies are warranted to elucidate its overall efficacy and mechanistic action.

Conflict of interest

Funding was provided from Fenzian Ltd for this study.
Using a bilayer matrix wound dressing for closure of complicated diabetic foot wounds
Authors: Ramanujam C.L. , Capobianco C.M. , Zgonis T.
Published: May 2014

Foot infection is a frequent and potentially devastating complication of diabetes mellitus. Approximately 25% of patients with diabetes mellitus develop foot ulcers during their lifetime and more than half of these ulcers become infected.1 Such complications are the leading cause of hospitalisation among patients with diabetes mellitus and are often the precursors to lower extremity amputation.2-4
Managing chronic venous leg ulcers part 2: time for a new pragmatic approach?
Authors: Brown A.
Published: May 2014

To improve the lives of people with these chronic wounds, the focus of care needs to be on enabling them to adapt to living with their ulcer, rather than striving for complete healing when this not a viable option
The effect of stochastic electrical noise on hard-to-heal wounds
Authors: Ricci E. , Afaragan M.
Published: May 2014

Objective:

To evaluate the effect of electrical stochastic noise stimulation on hard-to-heal wounds.

Method:

This open-label observational case series aimed to evaluate the effect of the Bioelectrical Signal Therapy (BST) device on the treatment of hard-to-heal (recalcitrant) wounds. The study group comprised nine patients (three males and six females), with a total of 11 ulcers that had not healed (ulcer duration range: 18 months to 20 years) despite being treated with other standard methods. Ulcer aetiologies were: EPUAP grade IV pressure ulcers (n=6) and grade III pressure ulcer (n=1), vasculitic ulcer (n=1), post-actinic lesion (n=1), ischaemic (n=1) and post-surgical lesion (n=1). The median patient age was 75. Treatment was delivered for 30 minutes, three times a day for 60 days.

Results:

Four patients (five ulcers) closed completely. Ulcers in three patients reduced in size with signs of epithelialisation. No imp0rovement was observed in one patient (who had paraplegia). One patient stopped treatment due to skin irritation at electrode sites. No other adverse effects were observed and all of the treated patients defined the treatment as painless.

Conclusion:

Stochastic white noise applied to hard-to-heal ulcers for 60 consecutive days reduced the wound surface area by an overall mean closure rate of 82.5% (SD=25.2%). This open-label observational case series provides preliminary indication of the possible role of stochastic resonance in wound healing.

Declaration of interest:

This study was supported by Vivisol (Italy), a distributor of Lifewave's BST.