bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinical evaluation of the Nimbus 3 alternating pressure mattress replacement system
Authors: Evans D. , Land L. , Geary A.
Published: May 2014

This study assessed the clinical effectiveness of the Nimbus 3 alternating pressure mattress replacement system (APMRS) on pressure ulcer healing and comfort in subjects ≥ 65 years, with at least a Grade 2 ulcer and some mobility problems. Twelve patients in a hospital setting were randomly allocated to the Nimbus 3 or another APMRS, and 20 residents in a nursing home setting to the Nimbus 3 or an alternating pressure mattress overlay. Wound surface area (WSA) (cm2) was recorded twice weekly and comfort once weekly. In the hospital setting, there were no significant differences between groups in the reduction in WSA per day. In the nursing home setting, though subjects on Nimbus 3 had significantly more pressure ulcers at baseline, there were no significant differences between groups in the reduction in WSA per day. Nimbus 3 was statistically more comfortable than control surfaces. The study's sample size has not shown the products were different with regard to clinical effectiveness. However, it might serve as a pilot for a larger, multi-centre RCT aimed at establishing the efficacy of a pressure-relieving (PR)?device on pressure ulcer healing.
The effects of radiotherapy on maxillofacial tissue
Authors: Neal M.S.
Published: May 2014

Radiation therapy for the treatment of maxillofacial tumours can lead to delayed complications. One of the most severe complications is osteoradionecrosis (ORN), which can cause orocutaneous fistulae, exposed to mandible and considerable pain. The condition can occur years after radiotherapy and requires aggressibe prevention and treatment. Hyperbaric oxygen therapy has been found beneficial for patients with maxillofacial ORN, leading to pain relief, fistula closure and bone coverage.
The physics of sub-bandage pressure measurement
Authors: Melhuish J.M. , Clark M. , Williams R. , Harding K.D.
Published: May 2014

Compression therapy is the principal treatment for leg ulcers associated with venous disease. The extent of compression generally can be estimated from the general Laplace equation relating pressure, bandage tension and leg radius. This study aimed to investigate the physical forces under long stretch bandages applied under constant tesnions to cylinders of three defined radii (‘model limbs’). Force expressed as pressure was measured under one, two and three layers of eight long stretch bandages and a plastic film (control) using temperature-compensated, strain-gauge pressure transducers. The bandages were applied at the manufacturers' recommended extensions/tensions and at constant tensions (2–10N) to three rigid plastic tubes of increasing size, covered with a layer of soft foam. Foams of different hardnesses ranging from 20 to 230N were assessed.

The median applied pressure and observed bandage characteristics changed with bandage type. The median applied pressure also changed with tension, number of layers, tube radius adn foam hardness. The inter-layer shear component also tended to increase with the number of layers. An increase in sub-bandage pressure was observed relative to the radius, tension, foam hardness and number of layers but the relationship was not directly proportional. The shear force tended to be associated with increased bandage layers.
Effect of four treatment variants on the functional and cosmetic state of mature scars
Authors: Klopp R. , Niemer W. , Fraenkel M. , von der Weth A.
Published: May 2014

A randomised, intra-individual, comparative study demonstrated that both qualitive improvements and significant changes in skin functional condition can be achieved in the tissue of older, mature scars. Four treatment modalities were studied in an intra-individual comparison involving 12 volunteers with 2.5 to 4-year-old scars. The treatments were: a self-adherent, hydroactive, polyurethane dressing alone; polyurethane plus compression; silicone sheeting plus compression; and compression alone. Evaluation criteria were changes in the microcirculation, roughness and the skin temperature of the scar tissue.

All treatment modalities were found to have significant effects both on the tissue function ad scar tissue surface structure. The most pronounced effects were achieved with the combination of polyurethane dressing plus compression or silicone sheeting plus compression. The positive effect of the polyurethane alone on scar tissue was slighly superior to that of compression therapy alone.
Nurses' views about pain and trauma at dressing changes: results of a national survey
Authors: Hollinworth H. , Collier M.
Published: May 2014

Research findings and professional concerns that patients still experience pain and tissue trauma at dressing changes led specialist nurses to develop a postal questionnaire to elicit the views of 1000 nurses with an interest in wound management. The questionnaire asked practitioners to identify the primary considerations underpinning their approach to pain and tissue trauma at dressing changes, the strategies they adopted, and the factors which determined their treatment choices. The higher than anticipated response rate (37%) illustrates the importance nurses attach to this aspect of practice.

The practitioners' main considerations during dressing changes were the need to prevent trauma to the wound (47%) and to avoid causing the patient pain (34%). Significantly, 81% noticed that patients experienced most pain when dressing products were removed, highlighting the need to re-emphasise the principles of moist wound healing. A total of 225 respondents (60%) were aware of dressings specifically designed to prevent pain and trauma during dressing changes. Practitioners also had the freedom to use the product of choice all (61%) or most (36%) of the time. However, respondents also demonstrated confusion about the properties and availability of many dressings.

Recommendations for practice include reviewing the number of dressings currently available, together with ongoing education and update on all wound management dressing products and related issues.
UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare?
Authors: Kaltenthaler E. , Withfield M.D. , Walters S.J. , Akehurst R.L. , Paisley S.
Published: May 2014

Although prevalence and incidence figures for pressure ulcers vary widely across health-care settings, common trends can be identified. This review examines data from three countries.
Profiling beds versus standard hospital beds: effects on pressure ulcer incidence outcomes
Authors: Keogh A. , Dealey C.
Published: May 2014

Most standard hospital beds are flat based with a pull-out backrest, resulting in a tendency for the patient to slide down the bed. This study aimed to compare the outcome for patients at high risk of developing pressure ulcers nursed on either this type of bed or an electrically operated, multi-sectioned profiling bed.

A total of 100 patients were randomly assigned either to the profiling bed with a pressure-reducing foam mattress (experimental group) or a flat-based bed with an appropriate pressure-redistributing mattress (control group) for a maximum of 10 days. Risk status and pressure damage were assessed daily. Both a patient and a nurse questionnaire were completed. Data from 70 patients who participated in the study for five days or more were included in the analysis.

Pressure ulcer incidence was 0% in both groups. All patients (35) in the experimental group were able to maintain a sitting position compared with only 12/35 in the control group (p=0.0001). While the questionnaire results suggest there were significant differences in postural control and ease of transfer between patients in the two groups, it was not possible to map this to pressure ulcer formation.

Poor recruitment into the study was due to the ‘blocking’ of electric beds by heavily dependent patients who did not meet the inclusion criteria, precluding a significant result in terms of pressure ulcer outcomes. This nurse-led use of the profiling beds was examined alongside the main study to investigate why they were allocated in this way.
Using VAC to treat a vascular bypass site infection
Authors: Demaria R. , Giovannini U.M. , Téot L. , Chaptal P.A.
Published: May 2014

Vacuum-assisted closure is becoming an increasingly popular adjunctive therapy. The following evidence suggests it can be used to treat an infected groin incision over a patent vascular bypass.
Exploring the use of an alginate dressing for diabetic foot ulcers
Authors: Bale S. , Baker N. , Crook H. , Rayman A. , Rayman G. , Harding K.G.
Published: May 2014

Few studies have investigated the use of dressings on patients with diabetic foot ulceration. This paper reports the results of a non-comparative, two-centre study investigating the performance characteristics of SeaSorb dressing in patients with this condition. This was an exploratory study to determine the potential use of this dressing, and not a large randomised control trial. All patients had diabetic foot ulceration of 1cm or more in diameter, classified as Wagner grade I or II, with an ankle brachial pressure index of >0.4. The investigators carried out objective assessments including photography and ulcer tracing as well as subjective assessments of exudate levels, wound bed condition, peri-ulcer skin condition, ease of application and removal of the dressing, dressing conformability, discomfort during dressing application and removal, and clinical signs of infection.

Investigators recruited 41 patients in two sites (31 in site one and 10 in site two). Of these, the findings relating to 39 patients could be evaluated. The patients were treated for a maximum of six weeks or until the ulcer healed. The study found that 28.2% (11/39) of the ulcers healed within the six-week period. Overall, there was a significant reduction in mean ulcer area from 2.8cm2 to 1.02cm2 from week 0 to week six. The relative ulcer area showed a significant decrease from 100% to 33%. For patients who experienced ulcer pain (11 patients), its intensity decreased over the six weeks. Severe maceration was not reported for any patient throughout the study. Six patients required treatment for infection. A total of 12 adverse events were reported: seven mild to moderate and five severe. None were directly attributed to the study dressing.
Do we need to reappraise our method of interpreting the ankle brachial pressure index?
Authors: Carser D.G.
Published: May 2014

This prospective study aimed to investigate if there is a relationship between ankle brachial pressure index (ABPI) and brachial systolic pressure when measured using Doppler ultrasound.

Sixty-two limbs (36 patients) in which arterial disease and diabetes mellitus could be excluded using published blood pressure and flow criteria were included in the study. All measurements were made with a Scimed PVL 50 (Bristol UK) using a revised version of the Whiston method and a one-minute treadmill walk. Statistical analysis was carried out using Pearson's product moment correlation and the t test.

A relationship was found between the ABPI and brachial systolic pressure, with statistical analysis indicating that the ABPI was highest in hypotensive patients and lowest in hypertensive patients (r=−0.385, p<0.01). This may suggest that the current practice of assigning one particular ABPI value as normal (1.00) is not reliable and that the way in which the index is interpreted needs to be reappraised.
Studies that demand caution and respect
Authors: Apelqvist J.
Published: May 2014

Cost-effectiveness studies can help wound-care practitioners to use limited resources to maximum effect. But this will only be achieved if such studies are subjected to rigorous scrutiny, argues Jan Apelqvist.
An exploration of patients' understanding of leg ulceration
Authors: Edwards L.M. , Moffatt C.J. , Franks P.J.
Published: May 2014

Objective:

This study aimed to identify patients' understanding of leg ulceration by examining their knowledge of the disease process and their expectations of their treatment outcomes. It also aimed to identify their attitudes to any patient information provided to them.

Method:

A total of 101 patients (median age: 75 years, range: 23–91; 54% female) with current leg ulceration of 16 months' median duration (range: 1–480) were asked about their understanding of their condition and treatment and their expectations of patient information provided by health-care professionals.

Results:

The majority of patients believed they knew the cause of their ulceration (66%), most frequently attributing it to trauma (28%). The most important part of the treatment was felt to be bandaging (27%) and visiting the clinic (12%). Thirty-nine percent did not know what the term ‘venous' meant. ‘Trauma’ was frequently described as a psychological problem, with only 7% associating the word with a knock or wound. Over half of the patients (64%) expressed an interest in acquiring further information, particularly on how they could assist ulcer healing (51%).

Conclusion:

For patient education to be effective, it must be tailored to the patients' vocabulary using simple concepts and straightforward, unambiguous messages.

Declaration of interest:

None.
Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers
Authors: Meaume S. , Gemmen E.
Published: May 2014

Objectives:

This study set out to define realistic protocols of care for the treatment of chronic venous leg ulcers and pressure ulcers in France and, by developing cost-effectiveness models, to compare the different protocols of care for the two ulcer groups, enabling the calculation of direct medical costs per ulcer healed in a typical French health insurance plan.

Method:

Clinical outcomes and some treatment patterns were obtained from published literature. Validations of different treatment patterns were developed using an expert consensus panel similar to the Delphi approach. Costs were calculated based on national averages and estimates from the UK and Germany. The models were used to measure costs per healed ulcer over a 12-week period.

Results:

For both the pressure ulcer and venous leg ulcer models, three protocols of care were identified. For pressure ulcers and venous leg ulcers, the hydrocolloid DuoDERM (ConvaTec, also known as Granuflex in the UK and Varhesive in Germany) was most cost-effective in France.

Conclusion:

The combination of published data and expert consensus opinion is a valid technique, and in this case suggests that treating pressure ulcers and venous leg ulcers with hydrocolloid dressings is more cost-effective than treating them with saline gauze, in spite of the lower unit costs of the latter.

Declaration of interest:

This study was sponsored by a grant from ConvaTec.
Aeromonas hydrophila wound infection in elective surgery
Authors: Moawad M.R. , Zeiderman M.
Published: May 2014

Patients with diabetes mellitus are subject to wound infection with unusual pathogens. A patient who had colonic surgery developed Aeromonas hydrophila wound infection, which mainly results from contamination by water or soil.
The role of wound-bed preparation in managing chronic pressure ulcers
Authors: Romanelli M. , Mastronicola D.
Published: May 2014

The relatively modern concept of wound-bed preparation draws together elements of current practice, including various methods of ‘maintenance debridement’ and the use of antibiotics and antiseptic agents, to speed up healing of chronic wounds.
From the journals
Authors: Baxter Helena
Published: May 2014

Little objective research has been done to study whether conservative management of hand lacerations produces similar clinical outcomes to wounds that are sutured.
Pressure ulcer care: nutritional therapy need not add to costs
Authors: Schols J.M.G.A. , Kleijer C.N. , Lourens C.
Published: May 2014

A qualitative study was carried out on patients' and nurses' perceptions of pain following toenail avulsion. In part two of her award-winning paper, Brenda King discusses the patients' and nurses' responses to questions on expectations and pain.
How living with a leg ulcer affects people's daily life: a nurse-led study
Authors: Rich A. , McLachlan L.
Published: May 2014

Objective:

This descriptive phenomenological study explored patients' experiences of living with a leg ulcer.

Method:

Eight participants (five female and three male) were recruited from a secondary care leg ulcer clinic in a large UK teaching hospital. All had current venous leg ulceration, lasting between five months and 34 years. Data collection was via in-depth semi-structured interviews. Data categories were: symptoms; treatment; perceptions, emotions and coping strategies; and restrictions.

Results:

Leg ulcers have a significant impact on individuals' lives. The degree to which this occurs varies between each person.

Conclusion:

Patients need consistent treatment that incorporates benchmarking. A support network to address the needs of those living with a leg ulcer should be considered. This study's findings should be promoted to raise awareness among health-care professionals, enabling them to provide more responsive care.

Declaration of interest:

The Band Trust and the Florence Nightingale Foundation provided a scholarship to fund the second year of the lead author's research degree.
Cervicofacial necrotising fasciitis: management with neck dissection and topical negative pressure
Authors: Nouraei S.A.R. , Hodgson E.L.B. , Malata C.M.
Published: May 2014

Copious exudate prevented skin-graft take following a bilateral neck dissection in a case of cervicofacial necrotising fasciitis. The use of topical negative pressure avoided extensive skin excision and complicated reconstructive surgery.
How sedative medication in older people affects patient risk factors for developing pressure ulcers
Authors: Lindquist L.A. , Feinglass J. , Martin G.J.
Published: May 2014

Objective:

This US study set out to examine the relationship between pressure-ulcer risk and sedation. The researchers examined the frequency of sedative use and the severity of pressure ulceration among older patients hospitalised for skin-ulcer treatment. They compared 91 patients who had been sedated before admission to hospital with 101 who had not.

Method:

A retrospective chart-review study was carried out between August 1994 and September 2001 in a tertiary-care metropolitan teaching hospital in the US. A total of 278 patients were identified from computerised discharge records. They were aged 60 years or more and had been discharged with medically treated skin ulcers, skin grafts, debridements or cellulitis. They had a principal or secondary diagnosis of chronic skin ulceration.

Results:

Of the patients with pressure ulcers, 45.5% had been on sedation before admission. They were only slightly more likely to have come from nursing homes and there were no significant differences in prevalence of conditions such as oncological diseases or spinal-cord injury between them and non-sedated patients. However, patients sedated before admission were more likely to be female (67.1%, p=0.04) and had almost a fivefold higher incidence of extremely severe ulceration (p<0.0001).

Conclusion:

Almost half of the older patients hospitalised with pressure ulcers had been taking sedatives before admission. They were more likely to have extremely severe ulcers with necrotic tissue, pressure ulcers in multiple sites, and the largest and deepest ulcers.
A survey of how a region’s A&E units manage pretibial lacerations
Authors: Davis A. , Chester D. , Allison K. , Davison P.
Published: May 2014

Pretibial lacerations are an important cause of morbidity, particularly in elderly patients. When treated inappropriately these wounds may take a long time to heal. For example, primary suture may result in flap necrosis and delayed healing, although the use of adhesive tapes may reduce the mean healing time from 53 to 39 days. De-fatting and laying the pretibial flap back on the wound have been shown to produce a similar mean healing time of 40.7 days. However, conservative management with dressings has been shown to result in an even longer average healing time of 65 days.
Educational intervention in the management of acute procedure-related wound pain: a pilot study
Authors: Gibson, M.C. , Keast D. , Woodbury M.G. , Black J. , Goettl L. , Campbell K. , O’Hara S. , Houghton P. , Borrie M.
Published: May 2014

Objective:

This report describes the pilot testing of an educational intervention to manage acute pain associated with wound care in an outpatient clinic. The intervention included essential elements of pain education identified in the acute pain literature: provision of information; pain measurement; establishing expectations; treatment planning; teaching environment.

Method:

The intervention was tested on five patients attending a wound clinic for scheduled treatment. Patients were aged 65 years or older and had a history of experiencing pain during treatment procedures such as dressing changes and debridement. Before the intervention, the study nurse gave the patients information about the procedure, discussed strategies they could use to make it as comfortable as possible, and explained how they could use a rating scale to denote any physical and emotional distress.

Results:

All patients used the intervention strategies. Three out of five reported reduced pain and/or distress following the intervention.

Conclusion:

The pilot study supported the use of education as a pain control strategy in wound care and illuminated key methodological issues for further research on this topic.

Declaration of interest:

None.
Influence of dressing changes on wound temperature
Authors: McGuiness W. , Vella E. , Harrison D.
Published: May 2014

Objective:

When wound-tissue temperature falls below 33ºC neutrophil, fibroblast and epithelial cell activity decreases. This study examined the influence of dressing changes on wound temperature.

Method:

The wound-bed temperatures of patients with a wound resulting from trauma or surgical debridement were measured immediately before and after dressing changes using a DermaTemp infrared body surface scanning device. The temperature on the surface of the dressing product was measured immediately before the dressing change and then every five minutes it until the pre-procedural temperature was reached.

Results:

A total of 133 dressing episodes were measured, yielding 266 wound-bed temperature measurements and 619 external dressing temperature measurements. Pre-procedural temperatures showed that the wound beds were on average marginally below the 33ºC threshold immediately after dressing takedown (mean: 32.7ºC). This figure dropped two degrees on average as a result of the dressing-change procedure (mean: 29.9ºC). Reapplied wound-dressing products return to the pre-procedural temperature within 30 minutes (mean: 23 minutes).

Conclusion:

This study provides baseline data for future research aimed at promoting maintenance of a normothermic wound bed.

Declaration of interest:

None.
Evaluation of SurePress Comfort: a new compression system for the management of venous leg ulcers
Authors: Polignano R. , Guarnera G. , Boneado P.
Published: May 2014

Objective:

The primary aim was to compare the healing of venous leg ulcers after management with either a new compression stocking (SurePress Comfort, ConvaTec) or a standard short-stretch bandage system (Comprilan, BSN Medical GmbH & Co). Secondary parameters included healing rate, ease of application and removal, comfort during wear, local pain levels and concordance.

Method:

This was a prospective multicentre open-label comparative randomised controlled parallel-group pilot trial of 12 weeks’ duration.

Results:

The proportion of ulcers that healed in 12 weeks (44.4% versus 17.2%, p=0.027) and the average time to healing (72 ±5 days versus 101 ±7 days, p=0.0265) were significantly better with SurePress Comfort than the comparator. All the secondary parameters (except concordance) also showed statistically significant differences for the stocking over the comparator.

Conclusion:

SurePress Comfort stocking system is more effective than a standard short-stretch compression bandage in healing venous leg ulcers and in reducing associated pain. It is well accepted by patients due to its ease of use and comfort, and its safety profile is comparable to that of a standard compression system. It may therefore provide an effective solution for the delivery of graduated compression and has the potential to improve concordance, compared with short-stretch bandages.

Declaration of interest:

This study was sponsored by ConvaTec.
The release of zinc ions from and cytocompatibility of two zinc oxide dressings
Authors: gren M.S. , Mirastschijski U.
Published: May 2014

Objective:

These in vitro studies examined the release of zinc ions from and the response of human dermal fibroblasts to two zinc oxide-medicated dressings: one with zinc oxide in an ointment base and one using polyvinylpyrrolidone (PVP), a hydrophilic polymer for the binding of zinc oxide particles.

Method:

Zinc release from the dressings in buffered-saline (pH 7.4) was studied through a high-pore-density membrane (pore size, 0.40µm) in a two-compartment model at 37°C for three hours. Cytocompatibility of the dressings and 500µmol/l of zinc ions was assessed using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay after exposure to monolayers of confluent normal human dermal fibroblasts to the dressing extracts for four hours.

Results:

The zinc release rate from PVP-bound zinc oxide was more than two-fold higher than from zinc oxide in the ointment. Extract of the zinc oxide ointment, containing 150µmol/l solubilised zinc, elicited a cytotoxic reaction, while the zinc oxide-PVP extract, containing 410µmol/l solubilised zinc, and 500µmol/l zinc chloride were non-cytotoxic to the fibroblasts.

Conclusion:

Zinc release in a simulated wound milieu appears to be inhibited when zinc oxide is incorporated in a lipophilic vehicle. It is hypothesised that the ointment vehicle induced cytotoxicity rather then the solubilised zinc oxide.

Declaration of interest:

None.
Comparing the contractile properties of human fibroblasts in leg ulcers with normal fibroblasts
Authors: Viennet C. , Armbruster V. , Gabiot A.C. , Gharbi T. , Bride J. , Humbert P.
Published: May 2014

Objective:

The tissue contraction phenomenon associated with wound healing is of prime importance for wound closure. Contractile properties of human fibroblasts from chronic venous leg ulcers were compared with those of normal fibroblasts using in vitro models.

Method:

Biopsies were taken from the uninvolved skin of the thigh, the epithelialised ulcer edge and the non-epithelialised ulcer centre in four patients (average age: 78 years). Fibroblasts were obtained by an explant technique and expanded in vitro in Dulbecco’s Modified Eagle’s Medium supplemented with 10% foetal calf serum and used for the assays at their fourth passage. Intracellular alpha-smooth muscle actin expression (αSM-actin) was studied by immunofluorescence labelling of cells cultured in monolayer. Contractile properties were evaluated using three-dimensional collagen lattices.

Results:

Fibroblasts from the ulcer centre were the richest cells in actin filaments. Both populations of venous ulcer fibroblasts contracted more rapidly and to a greater extent than normal fibroblasts. The peak contractile forces developed by fibroblasts from the ulcer centre and the ulcer edge were 30% and 18% greater than normal fibroblasts respectively.

Conclusion:

Some functions of fibroblasts, in particular the generation of contractile forces and the formation of cytoplasmic actin filaments, seem not to be affected in chronic venous ulcers.

Declaration of interest:

This study was supported by the Fondation Coloplast pour la Qualite de la Vie of France.
Clinical usage of honey as a wound dressing: an update
Authors: Molan P. , Betts J.A.
Published: May 2014

Since Molan last covered this topic in Journal of Wound Care, there have been advances in the selection of honey for use in wound care, based on its antibacterial properties, and in clinical protocols for its use. This paper examines woundhealing results achieved with honey in the past fi ve years, the extent of its use and practical issues relating to its clinical use.
Prognostic factors for venous ulcer healing in a non-selected population of ambulatory patients
Authors: Meaume S. , Coullier D. , Vin F.
Published: May 2014

Objective:

To identify wound prognostic indicators in a non-selected patient population with leg ulcers.

Method:

This was a prospective observational survey involving 151 physicians. Ambulatory patients with venous leg ulcers were treated with a non-adherent foam dressing and usual leg ulcer management. At follow-up after three to six weeks, ulcer healing parameters and local treatment tolerability were recorded and concordance with compression therapy was validated.

Results:

A≥40% reduction in the largest wound length was selected as an indicator of a favourable healing outcome. A total of 330 patients were included and seen at follow-up. The mean largest wound length was 4.9 ± 3.6cm. A≥40% decrease in this parameter was noted in 178 patients. Dressing acceptability and tolerability were excellent. Compression therapy, while heterogeneous among physicians, was used regularly and applied correctly (by patients and practitioners) in 81.2% of patients. Predictors for not reaching the main outcome were the presence of an arterial lower limb disease, an ulcer duration of more than three months and an initial ulcer length of 10cm or more. Linear regression showed that old age and a high body mass index were independent predictors of a poor outcome.

Conclusion:

Clinical indicators such as simple ulcer length measurement and ulcer duration may help physicians to detect patients with a prognosis of poor healing.

Declaration of interest:

Sponsored by Laboratoires Coloplast.
Determining pain levels in patients treated with maggot debridement therapy
Authors: Steenvoorde P. , Budding T. , Oskam J.
Published: May 2014

Objective:

Pain as a complication of maggot debridement therapy (MDT) has been a topic of some controversy. This study set out to determine pain levels in patients treated with MDT.

Method:

A retrospective analysis using a visual analogue scale (VAS) was performed: 41 patients were treated with MDT for non-healing wounds (22 men and 19 women; average age: 67 years). Average wound duration was 14 months (range: two weeks to 132 months). Maggots were applied using the contained or the free-range techniques. Paracetamol (1g three times daily) and Durogesic plaster (25µg every three days and 50µg the day before the maggot change) were given for pain relief in the outpatient clinic.

Results:

Diabetic patients experienced the same amount of pain before and during MDT. Eight out of 20 non-diabetic patients experienced more pain during MDT than before; the remaining non-diabetic patients had the same amount of pain before and during the therapy. The difference between diabetic and non-diabetic patients was statistically significant (p<0.05) for all applications combined.

Conclusion:

In 78% of patients (29/37) pain can be adequately treated with analgesic therapy. However, if pain is unmanageable in the outpatient department, we believe that options include hospital admission, using the contained method of application or, in the worst case scenario, cessation of treatment. A standardised but individually tailored pain management protocol is mandatory.

Declaration of interest:

None
A pilot study to determine whether a static magnetic device can promote chronic leg ulcer healing
Authors: Eccles N.K. , Hollinworth H.
Published: May 2014

Objective:

To determine if UlcerCare, a specialised self-securing static magnetic device, can promote the healing of chronic leg ulcers.

Method:

This double-blind placebo-controlled pilot study involved 26 patients with chronic leg ulcers, receiving care consistent with RCN guidelines, who were randomly allocated to receive either UlcerCare leg wrap (treatment) or an identical sham non-magnetic device (control). Wounds were assessed for 12 weeks at four weekly intervals using digital photography, Verge Videometer analysis and patient questionnaires to determine changes in ulcer size, level of pain and function.

Results:

Statistically significant reductions in ulcer measurement were noted in the treatment group when compared with the placebo group.

Conclusion:

The results demonstrate a significant healing effect in the treatment group. A larger randomised controlled study is recommended to investigate the effects on ulcer-associated pain and quality of life.

Declaration of interest:

The study was supported by Magnopulse, Bristol, UK.
Does the use of a cleanser on skin surrounding pressure ulcers in older people promote healing?
Authors: Konya C. , Sanada H. , Sugama J. , Okuwa M. , Kitagawa A.
Published: May 2014

Objective:

To determine whether the use of a skin cleanser on the skin surrounding pressure ulcers helps to promote healing.

Method:

The study was conducted over a two-year period in patients with stage II or more pressure ulcers. All subjects were at least 65 years of age and resident in a long-term care hospital. During the first year, skin was cleansed with normal saline. In year two, a pH-balanced cleanser was used. The healing times for the two methods were then compared.

Results:

Healing time was shorter in the group using the cleanser for every stage of ulcer, with an especially significant difference for stage II ulcers (p=0.002). Analysis using the Cox proportional hazards model found a 1.79-fold improvement in the healing rate of stage II ulcers when the surrounding skin was washed with the cleanser.

Conclusion:

Cleaning the surrounding skin with a cleanser rather than normal saline promotes the healing of pressure ulcers.

Declaration of interest:

None.
Compression and peri-ulcer skin in outpatients’ venous leg ulcers: results of a French survey
Authors: Dereure O. , Vin F. , Lazareth I. , Bohbot S.
Published: May 2014

Objective:

To evaluate concordance with compression therapy in ambulatory patients with venous leg ulcers.

Method:

This was a prospective observational survey conducted in general practice. Consecutive patients with venous leg ulcers about to receive a non-adherent primary dressing and with no contraindication to compression bandaging were selected. At the inclusion visit, size, local aspect of the ulcer and the peri-ulcer skin were scored. Patients were asked about concordance with compression and were given a questionnaire to be completed at home. If patients were seen at a three-week followup visit, ulcer and peri-ulcer characteristics and concordance were reassessed.

Results:

A total of 2842 patients were included, of whom 2532 were re-evaluated at three weeks and 1397 (49%) returned their questionnaire. A compression bandage was already available for 62.9% of these patients, and 62.7% said they used it on a daily basis, 23.3% wore it one or two days per week and 13.7% wore it irregularly or never. There was a statistically significant correlation between concordance with compression and ulcer and peri-ulcer skin severity scores (p<0.001 and p=0.042 respectively). At the follow-up visit, concordance with compression therapy improved (80.1% were wearing it regularly). Ulcer, peri-ulcer skin severity scores and ulcer size were significantly lower (p<0.001) when concordance with compression therapy was good. However, 65.6% of patients considered applying compression very difficult; 45% considered it very unaesthetic and 23% judge wearing it to be very painful, while 9% thought it may worsen their ulcer.

Conclusion:

On a short-term basis, concordance with compression can be substantially improved by simple measures with a clear favourable consequence on both ulcer status and peri-ulcer skin aspect when a non-adherent primary dressing is used. However, the acceptability of compression to patients is poor, and continuous effort is required to convince them of its importance.

Declaration of interest:

This study was sponsored by Laboratories Urgo, France.
Comparison of Allevyn Adhesive and Biatain Adhesive in the management of pressure ulcers
Authors: Amione P. , Ricci E. , Topo F. , Izzo L. , Pirovano R. , Rega V. , Cocci C. , Masina M.
Published: May 2014

Objective:

The primary objective was to assess dressing delamination and the ensuing potential consequences during wear and/or removal, as well as the effect of residue remaining in the ulcer following foam breakdown.

Method:

In this prospective multicentre study, 32 patients with a grade II or III pressure ulcer were randomised to receive either Allevyn Adhesive or Biatain Adhesive dressing. The performance of the dressings was assessed over seven dressing changes or a maximum of six weeks. The primary efficacy variable was the proportion of patients with at least one delaminated dressing (delamination being defined as the falling apart of a dressing during wear or removal, or the presence of residue from the dressing in the ulcer).

Results:

Allevyn Adhesive was significantly less likely to delaminate than Biatain Adhesive: 83% of patients given Biatain Adhesive had a dressing that delaminated compared with 14% for Allevyn Adhesive (p=0.014). Furthermore, a greater proportion of the Biatain Adhesive dressings delaminated compared with the Allevyn Adhesive dressings: 50% versus 4% (p<0.001). Allevyn Adhesive performed significantly better in the following parameters: handling exudate (p=0.044), comfort (p=0.007), ease of application (p=0.004), conformability during application (p=0.003) and removal (p<0.0001), and adherence to the skin during application (p=0.003) and prior to removal (p=0.011). Three patients given Allevyn Adhesive (21%) reported three adverse events; six patients given Biatain Adhesive (33%) reported eight adverse events.

Conclusion:

Allevyn Adhesive is effective and well tolerated in the management of pressure ulcers and less likely to delaminate than Biatain Adhesive.

Declaration of interest:

This study was funded by Smith & Nephew Wound Management Division, Hull, UK.
Role of the wet-to-dry phase of cleansing in preparing the chronic wound bed for dressing application
Authors: Kammerlander G. , Andriessen A. , Asmussen P. , Brunner U. , Eberlein T.
Published: May 2014

Adelay in wound closure can result from poor perfusion, infection, pressure or chronic venous hypertension. How ever, problem wounds are rarely affected by a single factor. To facilitate wound healing, systemic and local factors that may impede healing need to be addressed.
Evaluation of a silver-releasing hydroalginate dressing in chronic wounds with signs of local infection
Authors: Meaume S. , Vallet D. , Nguyen Morere M. , Téot L.
Published: May 2014

Objective:

To evaluate the clinical impact of using a silver-releasing hydroalginate dressing to minimise the risk of local infection in colonised chronic wounds.

Method:

This was a randomised (stratification according to wound type) open-label multicentre comparative two-arm parallel-group study. Thirteen centres recruited 99 patients with either a venous leg ulcer or a pressure ulcer. None of the wounds required systemic antibiotics or were associated with lymphangitis and/or fever, but at least two of the following criteria had to be present: continuous pain; erythema; oedema; heat; and moderate to high levels of serous exudate. Patients were allocated to receive either a silver-releasing hydroalginate dressing (Silvercel, the test group) or a pure calcium alginate dressing (Algosteril, the control group). Wounds were assessed daily over 14 days to complete a modified ASEPSIS index to evaluate risk of infection, and then weekly for two additional weeks. A global wound severity score and area tracings were recorded weekly.

Results:

Fifty-one and 48 patients were randomised in the test and control groups respectively: 28 pressure ulcers and 71 venous leg ulcers. The total mASEPSIS score over 14 days did not differ significantly between groups: 95.4 ± 62.2 and 104.2 ± 72.8 in control and test groups respectively (p=0.791). Of the patients who completed the total four-week study duration, four out of 38 (10.5%) in the control group and none of the 40 in the test group were treated with systemic antibiotics at the final visit (p=0.053). According to the investigators, fewer wounds developed a clinical infection over the four-week follow-up in the test group (33% versus 46%; p=0.223). Overall, the four-week closure rate was statistically greater in the test group (0.32 ± 0.57cm2/day versus 0.16 ± 0.40cm2/day; p=0.024). Compared with baseline, the absolute decrease in wound severity score at week four was higher in the test group (−5.6 ± 3.2 versus −4.1 ± 4.3; p=0.063); this was also true of the percentage reduction (−32 ± 17% versus −23 ± 25%; p=0.034). Poor dressing acceptability and/or tolerability was noted in five out of 48 patients (10.4%) in the control group and in five out of 51 (9.8%) in the test group.

Conclusion:

This study suggests that the use of silver-releasing dressings in the management of wounds at high risk of infection may have a clinically favourable influence on wound prognosis; the dressings also appeared to be well tolerated. However, the evaluation of these advantages in controlled clinical trials is complex and requires potent studies and the development of more specific endpoints than those currently used.

Declaration of interest:

This study was funded by a grant from Johnson and Johnson Wound Management.
Interface pressure measurement during surgery: a comparison of four operating table surfaces.
Authors: Keller B.P.J.A. , Overbeeke J. , van der Werken Chr.
Published: May 2014

Objective:

To compare the pressure-reducing and pressure-redistributing characteristics of four operating room (OR) table mattresses using interface pressure measurements, in two positions adopted for surgical procedures.

Method:

Support surfaces were randomly assigned to 80 patients. These were: an overlay pad filled with fibres (the standard OR mattress), a custom-made viscoelastic polyurethane foam mattress, an inflatable mattress with air-filled cells and a fluid mattress. An XSENSOR full-body pressure-mapping pad was used to record interface pressures of 40 patients in the supine position and 40 patients in the lithotomy position. Measurements were analysed for peak pressure, peak pressure index, total contact surface area and the occurrence of a significant increase in interface pressure during the surgical procedure.

Results:

The highest interface pressures were measured on the standard mattress, in both the supine and lithotomy position. Overall, the fluid mattress showed the best pressure-reducing and pressure-redistributing capacities.

Conclusion:

As long as no reference values are available for interface pressures under which no pressure-related damage will occur, clinical testing of OR table surfaces is still necessary.

Declaration of interest:

The test mattresses were provided free of charge and the companies provided a contribution of €2000 each for the rental of the pressure-mapping system. None of the authors had a financial interest in or link with the companies.
Can transcutaneous oxygen tension measurement determine re-amputation levels?
Authors: Keyzer-Dekker C.M.G. , Moerman E. , Leijdekkers V.J. , Vahl A.C.
Published: May 2014

Objective:

To review the preoperative transcutaneous oxygen tension (TcPO2) measurements in patients having major lower leg amputation, and also consider the re-amputation rate, wound infection and the definitive level of amputation.

Method:

A case-control study was performed in a consecutive cohort of 170 patients (1999–2003). Fifty-two patients underwent preoperative TcPO2 measurements (cases) and 118 patients did not (control). Multiple logistic regression analysis was performed to analyse independent risk factors associated with re-amputations.

Results:

Primary and definitive (in case of a re-amputation) amputation levels were lower in the TcPO2 group, although this did not reach statistical significance. The number of re-amputations in the TcPO2 group was significantly higher: 15 versus 18 patients (p=0.039). Selection of an amputation level with a TcPO2 of 30mmHg resulted in a positive predictive value of re-amputation of 41% and a negative predictive value of 90%. A cut off value of 20mmHg resulted in 41% and 77% respectively.

Conclusion:

The use of TcPO2 measurements for major amputation level selection resulted in an increased rate of re-amputation. However, there was a trend in gaining a more distal definitive amputation level. Selection of an amputation level solely based on a TcPO2 value is unreliable.

Declaration of interest:

None.
An evaluation of polyvinylidene film dressing for treatment of pressure ulcers in older people
Authors: Takahashi, J. , Yokota O. , Fujisawa Y. , Sasaki K. , Ishizu H. , Aoki T. , Okawa M.
Published: May 2014

Objective:

To compare the effectiveness of polyvinylidene (PVL) food wrap as a dressing material versus conventional ointments and gauze dressings for pressure ulcers in patients aged 60 years or over.

Methods:

A prospective open controlled trial was conducted. The severity of pressure ulcers in both groups was evaluated using the DESIGN system. Scores were compared at baseline, four, eight and 12 weeks.

Results:

Twenty-five patients were treated with the PVL film (test) dressings and 24 with the conventional treatment (control). The test group showed greater improvement in DESIGN scores than the control group throughout the observation period, and the difference reached statistical significance at 12 weeks (p<0.05). The incidences of local wound infection in the two groups were not statistically different (p>0.999).

Conclusion:

The PVL film dressing was more effective than conventional treatment in the management of severe pressure ulcers.

Declaration of interest:

This work was partly supported by a research grant from the Zikei Institute of Psychiatry.
Effect of a new silver dressing on chronic venous leg ulcers with signs of critical colonisation
Authors: Jørgensen B. , Bech-Thomsen N. , Gottrup F. , Grenov B.
Published: May 2014

Objective:

To investigate the clinical performance and safety of a new silver-containing wound-contact layer, Physiotulle - Ag (Coloplast), in the treatment of chronic venous leg ulcers with delayed healing and signs of critical colonisation.

Method:

This was an open prospective non-comparative multicentre clinical study. Patients were treated for four weeks with Physiotulle - Ag, which was covered by Alione Hydrocapillary Dressing (Coloplast).

Results:

Thirty patients were recruited into the study. One ulcer healed after three weeks of treatment. The mean relative ulcer area reduced by 55% after four weeks. Over the study period the mean amount of healthy granulation tissue increased from 26% to 62%, and the mean amount of fibrin decreased from 63% to 32%. The ratio of malodorous wounds was 50% at inclusion, 20% after one week and 3% after four weeks. The dressing was considered easy or very easy to apply in 100% and easy to remove in 89% of dressing evaluations. The dressing combination showed good exudate-management properties. Incidence and severity of maceration, erythema and eczema decreased during the study and no device-related adverse events were recorded.

Conclusion:

Physiotulle - Ag is safe and easy to use in chronic venous leg ulcers in which healing is delayed and with signs of critical colonisation.

Declaration of interest:

The study was supported by Coloplast.
Bridging the gap: the impact of patient choice on wound care
Authors: Vowden K. , Vowden P.
Published: May 2014

While the concept of actively involving patients in their disease management and the process of care is an attractive proposition, it is a challenging strategy for practitioners and the health-care system. This paper will attempt to explore some of the issues involved in the relationship between patient and practitioner, define some of the factors that may be responsible for the perceived or actual gap between them, and suggest how we may bridge the divide within the limits of current health-care systems.