bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of a two-component compression system for the therapy of venous leg ulcers
Authors: Escaleira R. , Cardoso M. , Rego J. , Macedo P. , Midões A.
Published: May 2014

Objective:

The performance of a two-component compression system in daily practice was assessed in an outpatient clinic where patients with a wide variety of comorbidities and wound characteristics are treated.

Methods:

In the single-centred observational study, patients with venous leg ulcers (VLUs) on one or both legs were treated with a two-component compression system for up to 12 months or until the ulcer healed. The only exclusion criteria were an ABPI <0.8, immobilisation and limited ankle joint fl exibility. Study assessment parameters included ulcer size on entry into the study, the presence of skin irritations, occurrence of adverse events and ulcer recurrence. The primary outcome measure was the mean time to healing.

Results:

In total, 136 patients with VLUs were included. Baseline median ulcer duration was 7.5 months and the baseline median size was 4.3cm2. The average reduction in total ulcer surface was 2.9 ± 5.5cm2per month. Of the wounds, 90.4% healed after 12 months; the mean healing time was three months (Kaplan-Meier, CI 95%: 3–4). The baseline wound size had a significant influence on mean healing time (Cox proportional hazards model; p<0.0001), wounds >4.3cm2healed within a mean of five months, while wounds <4.3cm2healed within a mean of two months (log rank test: p<0.00001).

Conclusion:

Healing results were encouraging and suggest a good applicability in the daily practice of VLU therapy. Further studies will include systematic assessment of patient concordance.

Declaration of interest:

None.
Transcutaneous oxygen tension: a useful predictor of ulcer healing in critical limb ischaemia
Authors: Ruangsetakit C. , Chinsakchai K. , Mahawongkajit P. , Wongwanit C. , Mutirangura P.
Published: May 2014

Objective

To investigate the threshold of transcutaneous oxygen tension (TcPO2) values in predicting ulcer healing in patients with critical limb ischaemia in a prospective study.

Method

50 patients suffering from critical limb ischaemia with chronic ischemic ulcers or gangrenous toes were enrolled in this study between January and December 2008. Their demographic data and ankle brachial pressure index (ABPI) were collected. Baseline ulcers were measured with a wound measurement system (Visitrak, Smith & Nephew). TcPO2 was measured at rest in the supine position and with 30° leg elevation. The patients with infective and ischemic ulcers underwent debridement and gangrenous toes were amputated. Ulcer outcome was classifi ed as either: (1) A healing ulcer, showing good epithelialisation or granulation at both base and edges, or a decrease in ulcer area during the study; or (2) A non-healing ulcer, showing poor granulation tissue formation or a pale base and necrotic edges, or deterioration in an ischaemic ulcer.

Results

The mean age of the patients was 67.6 ± 10.8 years. The most common risk factor was hypertension (90%). Mean ABPI was 0.75 ± 0.39. 13 patients (26%) had a TcPO2 of less than 20mmHg, of which none showed any improvement in ulcer healing (p<0.001). 15 patients (30%) had a TcPO2 of more than 40mmHg, of which all progressed to complete ulcer healing (p<0.001). In the borderline group (20–40mmHg, 22 patients, 44%), 10 patients (45%) had a TcPO2 drop of <10mmHg with 30° leg elevation, of which 8 achieved complete ulcer healing (p<0.001). 12 patients (55%) had a TcPO2 drop of >10mmHg with 30° leg elevation, of which 11 showed no ulcer healing (p<0.001).

Conclusion

TcPO2 measurement is an accurate, non-invasive, and good predictor of ischemic ulcer healing, for cut-off TcPO2 values of less than 20mmHg and more than 40mmHg. In addition, the leg elevation method for TcPO2 might provide an important adjunct in the assessment of patients with borderline values.

Declaration of interest

None.
Testing wound dressings using an in vitro wound model
Authors: Lipp C. , Kirker K. , Agostinho A. , James G. , Stewart P.
Published: May 2014

Objective

To determine whether or not there are any significant differences in the effects of wound dressings on bacterial bioburden.

Method

A selection of non-occlusive, non-adhesive dressings was tested for their effect on bacterial bioburden. The dressings selected included two dressings with antimicrobial properties (one containing silver and one containing PHMB), a cotton-based dressing enclosed in a perforated sleeve of poly(ethylene terephthalate), a carboxymethyl cellulose-based dressing, a fibre-free alginate dressing, and a 12-ply 100% cotton gauze. Using the colony-drip flow reactor (DFR) model, a meticillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa biofilm was grown underneath a dressing sample. Biofilm growth was examined via plate counts, fluorescent microscopy and scanning electron microscopy.

Results

The dressings containing antimicrobial agents had the greatest effect on bacterial load. In the MRSA experiments, both antimicrobial dressings produced lower bacteria counts than the other dressings (p≤0.001), while in the P. aeruginosa experiments, only the silver-containing sample had fewer bacteria (p≤0.0001). However, neither antimicrobial dressing was able to completely eradicate the bacteria when testing with either microorganism.

Conclusion

The results presented herein illustrate that bacteria can grow unchallenged within the dressing environment and that an antimicrobial dressing can limit this bacterial growth.

Declaration of interest

None.
Human skin allografts as a useful adjunct in the treatment of purpura fulminans
Authors: Gaucher S. , Stéphanazzi J. , Jarraya M.
Published: May 2014

Objective

The aim of this report is to discuss the role of human skin allografts in surgical coverage procedures for patients with purpura fulminans.

Method

We describe cases of purpura fulminans in three adults and one infant treated at our burns unit between October 2006 and January 2008.

Results

The application of cryopreserved human skin allografts allowed us to obtain immediate wound closure after necrosis excision and enabled our team to subsequently perform autografts on favourable graft recipient sites.

Conclusion

Recourse to human skin allografts must be considered a pertinent therapeutic option in patients with purpura fulminans.

Conflict of interest

None.
Quality of nursing care from the perspective of patients with leg ulcers
Authors: Törnvall E. , Wilhelmsson S.
Published: May 2014

Objective

To investigate and analyse the quality of nursing care in a primary care setting from the perspective of patients with leg ulcers and determine the subjective importance that patients attach to various aspects of quality of care.

Method

All of the patients with leg ulcers at 15 primary care centres in the south east of Sweden were invited to participate. They were given the short version of the Quality from the Patient's Perspective questionnaire (QPP) to fill in. This included a number of closed and open questions relating to their perceptions of the quality of their nursing care and the importance of this care to them.

Results

Overall, the patients in this study perceived that the quality of nursing care was high. However, important areas for improvement were revealed, including the need for an increase in patient-focused care, continuity of care and better pain relief.

Conclusion

To address the weak points highlighted by the study, we recommend that nurses explore patient perceptions of pain in greater detail and invite patients take a more active role in the management of their leg ulcers.

Conflict of interest

None. This study was funded by the county council of Östergötland and by Linköping University, Sweden.
Use of ultrasound in assessment of necrotic tissue in pressure ulcers with adjacent undermining
Authors: Ueta M. , Sugama J. , Konya C. , Matsuo J. , Matsumoto M. , Yabunaka K. , Nakatani T. , Tabata K.
Published: May 2014

Objective:

To reveal the specific ultrasonic imaging findings of non-visible necrotic tissue in pressure ulcers (PUs) with undermining and describe the images objectively. The predictive validity of the specific images of the undermined necrotic tissue was also determined.

Method:

Using digital ultrasonography (12mHz linear transducer, mylab25; Hitachi medical Corporation), we imaged PUs with undermining every 2 weeks. PUs were also monitored by DESIGN-R, a PU assessment tool, at the same time.

Results:

Ten patients had 11 PUs with undermining and all ulcers were located in the sacral region. The necrotic tissue showed high echogenicity with no layers, unclear borders and an uneven gray level (cloud-like image). Granulation tissue appeared as a low echoic image which had no layers, was of coarse resolution and an even gray level. There were significant differences between the pixel uniformity of the necrotic tissue (84.0) and granulation tissue (53.9) compared with uninjured tissue (65.5; p=0.000 and 0.005, respectively). The sensitivity, specificity, and positive and negative predictive values of cloud-like image were 87.5%, 91.7%, 77.8% and 95.6%, respectively.

Conclusion:

The results suggest that cloud-like image is the most useful diagnostic indicator for non-visible necrotic tissue in PUs with undermining and is the best prognostic indicator for PU healing.

Declaration of interest:

The authors have no conflicts of interest to declare. There were no external sources of funding for this study.
Gauze-based negative pressure wound therapy as an adjunct to collagen-elastin dermal template resurfacing
Authors: Goutos I. , Ghosh S.J.
Published: May 2014

Objective:

To report the first case series of gauze-based negative pressure wound therapy (NPWT) as an adjunct to collagen-elastin dermal template resurfacing and provide a brief overview of the current knowledge and controversies regarding NPWT in association with dermal templates.

Method:

In this prospective study, patients undergoing single stage resurfacing with Matriderm (Dr Suwelack Skin & Health Care, Germany) between September 2007 and September 2008 at Stoke Mandeville Hospital were identified and followed up. A gauze-based NPWT system (V1STA) was used to secure the dermal template and split skin graft to the wound bed. Rates of epithelialisation, the patients’ analgesic requirements and patient concordance with the device were all recorded.

Results:

In the 10 patients studied (7 males and 3 females) this modality of vacuum therapy was found to be effective in all cases for bolstering single stage collagen-elastin dermal templates onto wounds, and contributed to excellent rates of epithelialisation (mean: 94%, range: 70–100%). Additionally, patient concordance with the device was excellent and the costs associated with its use were much lower compared with foam-based NPWT.

Conclusion:

We recommend the consideration of gauze-based NPWT as cost-effective alternative to foam based modalities in association with the use of dermal templates.

Conflict of interest:

None.
In vitro antimicrobial efficacy of a silver alginate dressing on burn wound isolates
Authors: Thomas J.G , Slone W. , Linton S. , Okel T. , Corum L. , Percival
Published: May 2014

Objective: To test the antimicrobial effectiveness of a silver alginate dressing on opportunistic pathogens, namely meticillin-sensitive Staphylococcus aureus (MSSA) and meticillin-resistant Staphylococcus aureus (MRSA), Klebsiella spp., Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Escherichia coli, Enterobacter sakazakii, Enterobacter cloacae, Serratia marcescens, Chryseobacterium indologenes, Proteus vulgaris and Acinetobacter baumannii. Method: In total, 40 microorganisms were isolated from patients attending three burn centres in the US and evaluated for their susceptibility to a silver alginate wound dressing, employing a corrected zone of inhibition assay, conducted on Mueller Hinton agar (MHA). Results: The sizes of the corrected zones of inhibition varied between and within genera. For example, all Acinetobacter baumannii strains were found to be sensitive to ionic silver at PH 7, with a mean of 2.8mm, compared with 3.5mm at PH 5.5. The silver alginate dressing also demonstrated activity on all strains of Enterobacter and Escherichia coli, with susceptibility to the silver alginate dressing enhanced at PH 5.5. For Enterococcus spp. the average corrected zone of inhibition at PH 7 was 3.6mm, versus 4.9mm at pH 5.5. ALL strains of Pseudomonas aeruginosa were found to be sensitive to the silver alginate dressing. The average corrected zone of inhibition was 6.9mm at pH 7, compared with 8mm at pH 5.5. For MRSA and Staphylococcus aureus, it ranged from 4.5mm to 7.5mm at pH 7. When the pH was decreased to 5.5, the corrected zone of inhibition increased. Conclusion: This study demonstrates the activity of a silver alginate dressing on a wide range of burn isolates, including antibiotic-resistant bacteria, isolated from three different burn centres in the US. It also highlights the possible importance of pH and its potential effects on antimicrobial performance and microbial susceptibility. However, more extensive testing is required to substantiate this. Conflict of interest: SLP is employed by Advanced Medical Solutions Ltd.
Prevention and treatment of radiodermatitis using a nonadhesive foam dressing
Authors: Lupiáñez Pérez Y. , Medina J. A. , Lupiáñez Pérez I. , Mata García C.
Published: May 2014

Objective: To validate the efficacy of a radiodermatitis management protocol (which involves preventive measures, the application of preventive creams and the use of a non-adhesive, foam dressing with a silicone contact layer) at a radiation oncology department in southern Spain. Method: An observational study was carried out on consecutive patients undergoing radiation therapy for sarcomas, ear nose and throat, breast, cervix and lung cancers, excluding patients with other tumours and those who stopped radiation treatment, or who died during its course. variables that were assessed included: average healing time, general progression of the injury, degree of trauma caused by removing the dressing, convenience and comfort, patient's aesthetic perception, ease of use for health professionals, adaptability, and the length of time for which the dressing stays in place. Results: 20 patients were included in the study and radiodermatitis was resolved in 100% (20/20). optimal progression of all lesions was observed. No infections occurred, and the average total healing time ranged from one to two weeks, even during radiation therapy Patients reported a high level of satisfaction with the dressing, which scored highly in terms of convenience and comfort, atraumatic dressing, ease of use, adaptability, patients' aesthetic perception and adhesive durability. Conclusion: our action protocol is effective in the prevention and treatment of radiodermatitis. We achieved optimal results in the current study, which supports the continued use of the test dressing in our department. Conflict of interest: None.
Case report: doxycycline instillation used to treat a high-output lymphatic fistula secondary to needle puncture
Authors: Singh K. , Wang M.L. , Rubinshteyn V. , Sticco C. , Deitch J.
Published: May 2014

Previous reports have documented the use of doxycycline as a sclerosing agent in the treatment of recurrent pleural effusion and pneumothoracies. However, little is currently known of its use in the closure of lymphatic fistulae. This paper presents a case in which an infusion of doxycycline was used in a patient who had developed the unusual complication of a high-output lymphatic fistula, following a femoral needle puncture. As no standard of care has been established in the treatment of this problem, we embarked on a minimally-invasive course of action, using doxycycline as a sclerosing agent. We found this treatment to be effective, with no complications.
The dissemination of wound management guidelines: a national survey
Authors: Gethin G. , Mclntosh C. , Cundell J.
Published: May 2014

Objective: In 2009, the Health Service Executive (Ireland) launched the first national guidelines for wound management. The Wound Management Association of Ireland (WMAI) participated in their development and dissemination. This study aimed to determine how aware of the guidelines members of the WMAI were, how they became aware of them, and if they had disseminated them further. Method: 130 members of the WMAI were surveyed. The questionnaire was developed using previous questionnaires assessing dissemination as a reference and was reviewed by the executive panel for face and construct validity. Results: The response rate was 55% (72/130). Fifty-seven per cent (n=41) had attended education sessions in which the guidelines were on the agenda. These included WMAI local events (43%), work events (16%), industry sponsored events (10%) and college course (7%). Fifty-one per cent had heard about the guidelines from the WMAI national conference. Eighty-five per cent had informed others of the guidelines, 70% had given a copy to others. Seventeen per cent (n=12) had given a presentation about the guidelines. Of these, five had given one presentation; two had given four and two had given five. Seventy-five per cent of which were at work. Currently, 56% of people are working on implementation. While full-text, ‘hard’ copies were not printed, people still requested these and 47% downloaded the full-text for their own use. Conclusion: Clinical practice guidelines are vital for the provision of evidence based health care. However, they are ineffective unless disseminated and implemented. Wound care organisations are able to play a key role in dissemination and feedback from this survey suggests that this has been achieved. Conflicts of interest: None
The role of disgust emotions in predicting self-management in wound care
Authors: Gaind S. , Clarke A. , Butler P.E.M.
Published: May 2014

Objective: An observation study, employing a nominal questionnaire, was conducted to explore the relationship between disgust emotions, response to surgical wounds and engagement in wound management. Method: A total of 101 patients were recruited at the Royal Free Hospital plastic surgery dressing clinic, following a variety of elective or emergency surgical procedures. Participants were asked to complete the Haidt Disgust Sensitivity Questionnaire and a Wound Management Questionnaire. Participants were observed during the consultation to assess characteristics of the wound and indicators of disgust. Data were analysed using analysis of variance (ANoVA) and Z-test, with the primary outcome measure being engagement in care, as rated by the dressing nurses. Results: Mean disgust sensitivity was significantly higher in females and in those who were observed to avert their gaze or appeared tearful during the consultation. Sensitivity was lower in participants who felt able to help the nurse with their dressing, those able to clean their wound, and those able to do their own dressing at home and who were not worried about the appearance of their scar. Wound size and severity were also found to have a significant impact on engagement in care. Conclusion: Both biomedical factors, such as size and severity of a wound, and psychological factors, such as disgust sensitivity, are important in wound care. Screening for disgust sensitivity pre-operatively, in association with the modified Wound Management Questionnaire, has the potential to identify patients who are at risk of avoidant behaviour and to develop psychological interventions to promote wound self management. Conflict of interest: none
Wound dressings and other topical treatment modalities in bioburden control
Authors: White R.
Published: May 2014

This is a chapter taken from the book Microbiology of Wounds, published by CRC Press in 2010. Reduction of wound bioburden has traditionally been achieved by the use of topical antimicrobial agents, such as bactericidal antiseptics or antibiotics. This has worked well for many years, however, concerns about toxicity and resistance have prompted research into other mechanisms. There are various means of removing bacteria from the wound, without recourse to chemical agents; for example, larvae (maggots) ingest bacteria, together with the devitalised tissue of the wound, while the control of exudate restricts the availability of free water, impeding the growth of water-loving bacteria. The discovery that some materials selectively adsorb, or sequester, bacteria has led to the development of bacteriostatic dressing materials, which do not rely on antiseptics for their action. These are designed to physically remove microorganisms, such as bacteria, from the wound, thus reducing bioburden. However, this still demands validation as a clinically relevant mechanism. Until that time, it remains a fascinating theoretical concept.
An overview of the evidence on the efficacy of silver dressings
Authors: Leaper David
Published: May 2014

While there is a plethora of clinical and anecdotal evidence on the efficacy of silver dressings, there is no rigorous RCT data to support this. This has led procurement managers to defer the inclusion of silver dressings on wound formularies, despite its clinical popularity. This article gives an overview of the evidence on topical antimicrobials, in order to determine whether there is a case for such a stance
An open label non-comparative case series on the efficacy of an enzyme alginogel
Authors: Durante C.M.
Published: May 2014

Objective:

To evaluate the efficacy of an enzyme alginogel in outpatients with chronic or acute wounds left to heal by secondary intention.

Method:

This evaluation was a single-centre, single-arm, case series involving 23 patients with wounds of diverse aetiologies treated with the enzyme alginogel (Flaminal; Flen Pharma). The product was applied in accordance with the manufacturer's instructions and wounds were covered with secondary dressings. Treatment was based on a scheduled protocol and patients were assessed at days 14, 30 and 60.

Results:

Median baseline dimensions for the wounds were surface area 2.6cm2 and volume 2.8cm3. Median wound duration before application of the enzyme alginogel was 292 days, with 16 chronic wounds (78%). Three wounds were clinically infected at baseline; two were negative by day 14 and the third by day 30. after 2 months, wound surface area and volume had decreased, as could be expected. Two adverse events were reported: an allergic reaction in the skin surrounding the wound and transient maceration.

Conclusion:

The enzyme alginogel facilitated healing in chronic and acute wounds of diverse aetiologies. additional research is warranted to confirm the clinical utility of the dressings in the management of chronic or acute wounds left to heal by secondary intention.

Declaration of interest:

The author has no conflict of interest to declare. There were no external sources of funding for this evaluation.
Randomised, controlled pilot to compare collagen and foam in stagnating pressure ulcers
Authors: Piatkowski A. , Ulrich D. , Seidel D. , Abel M. , Pallua N. , Andriessen A.
Published: May 2014

Objective:

To compare the clinical efficacy of a collagen dressing covered with a foam dressing with the same foam used as a primary dressing in stagnating granulating pressure ulcer patients.

Method:

Patients were randomised to receive either a foam dressing (Suprasorb P; Lohmann & Rauscher) as a primary dressing (group A), or a combination of a collagen dressing (Suprasorb C; Lohmann & Rauscher) covered with the same foam dressing (group B). Wound fluid was collected and evaluated prior to treatment (day 0), and on days 3, 7, 14 and 21. The level and expression of matrix metalloproteinases (MMPs) MMP-2 and MMP-9, and tissue inhibitors of metalloproteinases (TIMPs) TIMP-1 and TIMP-2, as well as elastase content in wound fluid and angiogenesis, were evaluated, comparing results on day 0 and day 21. Time to ulcer healing, reduction in ulcer area, safety of treatment, patient-reported ulcer pain and comfort of the dressing regimen were evaluated as secondary outcomes. Patients received standard preventive measures, in line with the pressure ulcer prevention guidelines.

Results:

Ten patients were included in the pilot; five were treated with the foam dressing (group A) and five patients received the collagen dressing, using the foam as a secondary dressing (group B). Wound fluid from group B displayed a significant positive effect on angiogenesis (p < 0.05) compared with group A. In the collagen and foam group TIMP-1 and -2 increased faster and levels were higher than in group A. Furthermore, MMP-2, MMP-9 (p < 0.04) and elastase in group B showed faster and greater decrease in levels, compared with group A, indicating a faster and superior reduction of inflammation. In both groups the ulcers started to heal, with a faster onset of healing for group B.

Conclusion:

The results of this pilot support published data on the use of collagen dressings compared with foam for stagnating wounds, shown in clinical studies.

Declaration of interest:

This study was supported with an educational grant by Lohmann & Rauscher GmbH. Apart from Dr Abel, the sponsors had no role in the design or conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript. Dr Abel gave input to the study design from a scientific perspective. None of the authors received administrative, technical or material support for the conduct of this study. The authors have no other relevant financial interests to declare.
Linear scar reduction using silicone gel sheets in individuals with normal healing
Authors: Maher S.F. , Dorko L. , Saliga S.
Published: May 2014

• Objective:

To examine the application of silicone gel sheets on linear scars due to surgical procedures.

• Method:

Ten individuals, with scars less than 1 year old, participated in the study. The Participant and Observer Scar Assessment Scale (POSAS) was used to evaluate scars on seven characteristics rated by visual analogue scales (VAS). Participants applied silicone gel sheets to half of their scar for 6 months, and every 2 weeks POSAS data forms were completed. Linear mixed-effects analysis of variances (ANOVA) were used to determine if significant differences occurred between groups (treated and untreated scar sides) across the 6 months of data collection. To see if differences were found from the initial evaluation to final visit, Mann-Whitney U tests analysed between-group changes (treated and untreated scar sides), while Wilcoxon signed ranks tests compared within-group changes (evaluation of each scar side over time).

• Results:

No significant differences in VAS ratings were observed when the two scar sides were compared, with the exception of overall opinion of the scar, as rated by an observer. For each group, significant changes from baseline to study end were observed for colour, stiffness and irregularities, as rated by the participant. Significant improvements for the treated versus untreated group were observed for pliability and pigmentation, as rated by the observer scale.

• Conclusion:

There was no evidence for improved healing when using silicone gel sheets. The results do not support using silicone gel sheets on linear scars for individuals with no history of abnormal scarring.

• Declaration of interest:

Funding for this study was provided by a grant from Oakland University Honors College. However, the authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
Workload and prevalence of open wounds in the community: French Vulnus initiative
Authors: Meaume S. , Kerihuel J.C. , Fromantin I. , Téot L.
Published: May 2014

Objective: To calculate the prevalence of open cutaneous wounds presented on a routine working day in community settings in metropolitan France, and to estimate the workload associated with the care of these wounds by nurses, GPs and specialists (dermatologists, diabetologists and phlebologists). Method: a transversal epidemiological survey was conducted on a randomly selected sample of the above practitioners between June and July 2008. The percentage of patients presenting on a routine working day with open a cutaneous lesion of any origin, location, size and duration was assessed. all local and systemic care performed on the patient during that day because of the wound was also recorded. Results: In total, 475 GPs, 453 specialists and 238 nurses participated (n=1166) and saw a total of 29 663 patients, of whom 3037 presented with one or more cutaneous wound. The overall non-weighted prevalence of patients with a wound was 10.2% (95%CI: 9.9%;10.6%). This prevalence was similar for GPs (6.0%) and for specialists (6.9%), but was higher for nurses (22.0%). Forty-three per cent of all wounds had a duration of over 6 weeks. These chronic wounds were predominantly leg ulcers, diabetic foot ulcers or pressure ulcers, but also included wounds of all aetiologies. For 33% of all patients with wounds, the impact on their health status was serious to severe. The overwhelming majority of wounds (95%) required local care, including in 65% of cases cleansing and debridement. Conclusion: Despite its limitations, this initiative, the first of its type in France, strongly suggests that wound care constitutes an important part of routine care given by health professionals in the community, and for a substantial number of these patients, wounds represent a serious morbidity. Declaration of interest: The non-profit organisation ‘association vivre avec une Plaie’ financially supported this study. This association received unrestricted grants from the French Wound Healing Society (SFFPC) and a consortium of private companies (main sponsors: ConvaTec, Genevrier, Hartmann, KCI, Mölnycke, Smith & nephew, urgo; minor sponsors: Coloplast, Covidien, HNE) to fund the costs incurred by the methodological process and statistical analysis but had no input into the findings. The national Health Insurance organisation provided non-financial support to this initiative. J.C. Kerihuel received support for the submitted work from ‘association vivre avec une Plaie’. S. Meaume, I. Fromantin and l. Téot have no financial relationship with ‘association vivre avec une Plaie’, for either this or any work submitted in the previous 3 years. The authors have no non-financial interests that may be relevant to the submitted work, and their spouses, partners, or children have no financial relationships that may be relevant to the submitted work.
Resynthesis of sternal dehiscence with autologous bone graft and autologous platelet gel
Authors: Lusini M. , Di Martino A. , Spadaccio C. , Rainer A. , Chello M. , Fabbrocini M. , Barbato R. , Denaro V. , Covino E.
Published: May 2014

Postoperative management of sternal dehiscence requires the organised effort of a multidisciplinary medical team, including orthopaedic surgeons, plastic surgeons, microbiologists, critical care nurses and rehabilitation experts. Clinical care of this complication impacts heavily on health-care costs, length of hospital stay, and the time to full recovery and return to regular work activity. There are various surgical approaches to sternal resynthesis, but they are often unsuccessful. In this paper, we describe the case of a 67-year-old male complaining of chronic pain due to sternal dehiscence after coronary artery bypass grafting surgery. We first report a technique for sternal resynthesis, performed in the cardiac surgery setting, using a combination of autologous bone graft and autologous platelet-derived gel (APG), and describe its postoperative management and outcome. The four-month follow-up was uneventful and a CT scan confirmed full healing of the nonunion site with solid bridging bone.
Disposable NPWT device to facilitate early patient discharge following complex DFU
Authors: Khanbhai M. , Fosah R. , Oddy M.J. , Richards T.
Published: May 2014

Negative pressure wound therapy (NPWT) is a valuable tool in complex wound management. Despite its popularity, NPWT therapy systems can have drawbacks, including reduced mobility and cost; therefore, NPWT is predominantly hospital based. The advent of a new, lightweight and disposable system may aid early discharge and permit outpatient treatment. This case report describes how one such system facilitated early discharge in a patient with a complex diabetic foot ulcer
Dehydrated amniotic membrane allografts for the treatment of chronic wounds: a case series
Authors: Forbes J. , Fetterolf D.E.
Published: May 2014

A retrospective case series demonstrating the use of dehydrated human amniotic membrane (dHAM) allografts in the treatment of wounds of various aetiologies. Amniotic membrane was applied to a series of chronic wounds referred to a formal wound clinic for aggressive management, after prior, traditional treatment methods were found ineffective, over a period of 1 month. In each case, failure of traditional therapy was followed by placement of a dehydrated amniotic membrane allograft and the healing time course was documented with charted measurements. Wounds treated with the amniotic membrane allograft demonstrated improved healing, with a change in the healing trajectory from that previously noted. Dehydrated human amniotic membrane represents a potentially effective addition to existing wound care therapies, with further formal clinical studies indicated.
Eutectic mixture of local anaesthetics (EMLA) 5% cream as a primary dressing on a painful lower leg ulcer
Authors: Purcell A. , Marshall A. , King J. , Buckley T.
Published: May 2014

Patients living with chronic leg ulceration may frequently experience moderate to severe wound-related pain, which may not be alleviated by oral analgesics alone. Poorly controlled leg ulcer pain can prevent timely and effective wound management strategies being implemented, and increase wound healing times. Furthermore, patients with poorly controlled leg ulcer pain can experience continuous pain, which significantly affects quality of life. This case report introduces an innovative way of using the eutectic mixture of local anaesthetics (EMLA) 5% cream to reduce wound-related pain, reduce oral analgesic intake, and improve health-related quality of life for a patient with a painful, chronic lower leg ulcer.
A novel surgical approach to calcinosis cutis using a collagen-elastin matrix
Authors: Piombino L. , Pallara T. , Soltani A.M. , Langella M. , Persichetti P.
Published: May 2014

Calcinosis cutis is a cutaneous disorder characterised by abnormal deposition of calcium in the dermis. Treatment of this condition has variable success rates and includes medical, topical and surgical management. Here we describe a case of a woman with a painful calcinosis lesion on the buttocks, treated with excision and application of a bovine collagen-elastin dermal regeneration template, a thin, porous membrane consisting of a native bovine type I, II and V collagen-fibre template coated with elastin hydrolysate. The patient's wound healed without complication and without the use of a skin graft. She remains recurrence free at 10-month follow up, with satisfactory outcome.
More effective cell-based therapy through biofilm suppression
Authors: Wolcott R.D. , Cox S.
Published: May 2014

Objective:

To determine if targeted biofilm suppression of a specific wound improves the efficacy of cell-based therapy (CBT).

Method:

A retrospective study designed to compare a cohort of patients who received CBT in conjunction with biofilm-based wound management with published outcomes from randomised controlled trials in the literature, utilising standard care and CBT. Biofilm-based wound management is the use of multiple simultaneous strategies to suppress wound biofilm, specifically targeting the individual wound's bioburden with agents and methods to suppress the wound biofilm and improve wound-bed preparation.

Results:

A Kaplan-Meier analysis shows that all wound aetiologies receiving biofilm-based wound care and CBT showed better healing than published outcomes at 3 months and 6 months. Overall wound closure for all wound types combined was 79% at 3 months (versus 56% for the literature) and 92% at 6 months (compared with 63–78% in the literature). All wounds that failed to heal showed some improvement with therapy.

Conclusion:

With adequate biofilm suppression, the entire graft material was observed to remain intact on the surface of the wound and wounds healed faster than reported in the literature. The relationship between improvement of wound biofilm suppression and less degradation of the graft suggests that the wound microbiota plays a significant role in the degradation of applied bioengineered skin.

Declaration of interest:

There were no external sources of funding for this study. The author has no financial or commercial conflicts of interest to declare.
Stem cell application in acute burn care and reconstruction
Authors: Lewis C.J.
Published: May 2014

Burn injuries have a consistently high rate of mortality and morbidity, principally due to sepsis and systemic inflammation. Furthermore, wound closure is often troubled by a limited supply of autologous skin graft availability. Researchers are now looking at augmenting alternative sources for tissues engineering, including stem cells in the bone marrow, fat and hair follicles. Many studies suggest that the ability of stem cells to augment the clinical care of thermally-injured patients shows great potential; however, while our understanding of stem-cell biology has expanded dramatically over the last two decades, significant insight is still required so the full potential of these cells can be safely harnessed and transferred to patient care. This article provides a commentary on the evidence supporting a role for stem-cell therapy in acute burn care and tissue reconstruction, with particular reference to those in the bone marrow, adipose tissue and hair follicle.
Electrical stimulation as adjuvant treatment for chronic leg ulcers of different aetiology: an RCT
Authors: Magnoni C. , Rossi E. , Fiorentini C. , Baggio A. , Ferrari B. , Alberto G.
Published: May 2014

Objective:

To investigate the effectiveness of an innovative electrical stimulation (ES) therapy as adjuvant treatment for chronic wounds of various aetiology, in terms of pain and ulcer healing.

Method:

Patients with chronic limb ulcers were enrolled for the study and randomised into the intervention or control group. The intervention group received conventional treatment plus ES therapy (FREMS; Lorenz Lifetech) while the control group received only conventional treatment. Each ES treatment cycle consisted of 12 sessions performed in 4 weeks (three sessions/week). All patients were treated until full wound healing occurred, or for a maximum of 9 ES cycles, with a 2-week rest between each cycle.

Results:

A total of 60 patients were enrolled in the study and randomised into the two groups: the intervention group (n=30) and the control group (n=30). During follow-up, some patients terminated the protocol because they reached the ulcer closure before the maximum of 9 cycles. The analysis of the effect of ES on pain and ulcer healing was performed on all patients who underwent at least two consecutive clinical evaluations (two cycles), in order to reach a compatible sample size with the primary objective (one patient withdrew). In both groups, there was a significant reduction of pain compared with baseline (p < 0.05), starting from T6 visit in the first cycle. In particular, there was a significant reduction of pain in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle. Similarly, there was a significant reduction of PUSH tool score in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle.

Conclusion:

Data collected in this study support data in the literature. Analysis of longitudinal data analysed by simple models and complex models suggest that the ES therapy had a positive and significant effect on pain reduction (VAS) and on the improvement of ulcer healing process in terms of the PUSH tool total index compared with conventional treatment, and may have induced a significant acceleration of the wound-healing process.

Declaration of interest:

There were no external sources of funding for this trial. The authors have no financial, commercial or social conflicts of interest to declare regarding the article or its content.
The impact of compression therapy with Unna's boot on the functional status of VLU patients
Authors: de Lima E.L. , Salomé G.M. , de Brito Rocha M.J.A. , Ferreira L.M.
Published: May 2014

Objective:

To assess disability in patients with venous leg ulcers treated with compression therapy with Unna's boot.

Method:

A descriptive analytic case control study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in interior Brazil. Fifty patients of both sexes, aged 18 years or above, who had had a venous leg ulcer for more than 1 year and a Doppler ankle-brachial index of 0.8–1.0 were selected for the study. Patients were treated with wound dressings and Unna's boot. Disability was assessed using the 20–item Stanford Health Assessment Disability Scale (HAQ–20). Statistical analysis was performed using the Student's t-test, the Kruskal-Wallis test and the chi-square test of independence, all at a significance level of 0.05 (p<0.05).

Results:

The mean overall HAQ score at inclusion (baseline) was 2.98, indicating impaired functional capacity. After 8 and 12 months of compression treatment with Unna's boot, the mean overall HAQ scores were 1.35 and 1.0, respectively, indicating good functional capacity.

Conclusion:

Patients with venous leg ulcer reported severe difficulty or serious disability in their daily functioning at baseline; after 8 months of treatment with Unna's boot, these patients were able to perform activities of daily living.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare with regard to the manuscript of its contents.
Degloving injuries of the abdominal wall
Authors: Veena P.W , Babu R. , Venkatesh M.S. , Udayashankar  , Deepak K.L.
Published: May 2014

Objective:

To stress the local, regional and global impact of degloving injuries of abdominal wall based on which the surgeon can design the management protocol.

Method:

A retrospective series of seven cases who met with high velocity run-over accidents between the year 2002 to 2007. All patients were clinically examined and the findings confirmed radiologically, which guided the management.

Results:

Out of the seven patients treated, six survived. All patients had open degloving injury of abdominal wall and in different areas of the lower limbs, while three had an additional closed degloving in the back, thighs and gluteal regions. All of them had pelvic fractures of various types. Three patients had peritoneal injury, of whom one had additional diaphragmatic injury. None of them had hollow viscus perforation or injury to solid viscera despite the varied severity of injuries to the abdominal wall, pelvic bone and diaphragm.

Conclusion:

Degloving injuries of the abdominal wall are rarely encountered in our practice. The associated morbidity and mortality are very high. However, the prognosis can be improved by successful revival and rehabilitation of these patients, which is possible by early resuscitation, recognition of all bony and soft tissue injuries, early debridement and coverage.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare with regard to the manuscript or its content.
NPWT or HRT-dressing? Results of an expert panel and a Delphi panel analysis
Authors: Hermans M. H. E. , Cutting K.
Published: May 2014

Objective:

To investigate the similarities and differences between Hydration response Technology (HRT) and negative pressure wound therapy (NPWT) with regard to wound bed preparation, and to devise a set of recommendations for their use on the basis of the opinion of two panels.

Method:

An expert panel that analysed in vitro and clinical data as well as the similarities and differences between the two modalities was established. This culminated in a series of recommendations on which modality to use for which indication. These recommendations were presented to a Delphi panel, consisting of users of both NPWT and HRT-dressing. The panel was then asked to produce its own recommendations.

Results:

The outcomes and recommendations of both panels were reported. NPWT is the preferred treatment modality for abdominal dehisced wounds, and to a lesser extent, for surgical wound healing by secondary intention. For all other indications, the treatment modalities are at least equal, with HRT-dressing often being the superior mode to treat wounds such as venous leg ulcers, arterial ulcers and vasculitis.

Conclusion:

In the opinion of the expert panel and the Delphi panel, both modalities share a number of clinical and non-clinical properties. However, because of the numerous advantages of HRT technology, HRT dressing has the potential to replace NPWT in a number of indications, where the patient, healthcare providers and institutions may benefit.

Declaration of interest:

This study was sponsored by Sorbion GmbH & Co, Senden, Germany. Authors M. Hermans and K. Cutting are consultants to Sorbion GmbH & Co, Senden, Germany.
Maximising the secondary beneficial effects of larval debridement therapy
Authors: Pritchard D.I. , Nigam Y.
Published: May 2014

Laboratory-based clinical investigations have shown that maggots and their secretions promote, among other activities, fibroblast motogenesis and angiogenesis. These events would contribute to re-granulation if translated to the wound environment. Maggot secretions also have ascribed antibacterial actions and may exhibit anti-inflammatory effects. Many of these biological events would be lost in the presence of necrotic tissue, making debridement a prerequisite for the release of larval-secreted secondary beneficial effects on the wound. We argue that Larval Debridement Therapy (LDT) should be considered as a primary and secondary treatment in wound management, with the primary application designed to debride the wound, and with subsequent applications to the debrided wound targeted to cellular events that promote healing. This review lends support to a re-evaluation of larval application protocols, in order to optimally harness the potential secondary beneficial clinical effects of larval therapy.