bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the use of low-level laser influence wound healing in chronic venous leg ulcers?
Authors: Kopera D. , Kokol R. , Berger C. , Haas J. 
Published: May 2014

Objective: Venous leg ulcer treatment often requires months or years of regular wound care by trained staff. It has been suggested that low-level laser irradiation has a biostimulative and wound healing effect, but this has not been clinically verified by controlled studies. This study aimed to compare the effectiveness of low-level laser irradiation with that of a placebo ‘light source’. Method: Forty-four patients were assigned to two treatment groups (laser and placebo) or a third group (standardised treatment only) to quantify the effect of the laser therapy. Patients in all three groups received standardised wound care (disinfection, a hydrofibre dressing and compression bandaging). Ulcer size was measured at baseline (day 1), at the end of therapy (day 28) and then two months later (day 90). The relative difference in wound size was evaluated. Results: The difference in the reduction in wound size was not statistically significant in all three groups. A positive effect of using the non-laser device (placebo effect) was demonstrated in some patients. Conclusion: These study results suggest that low-level laser does not stimulate wound healing in venous leg ulcers. Further controlled studies are needed to clarify the efficacy of low-level laser treatment as a wound-healing stimulant. Declaration of interest: None.
Evaluating dressing materials for the prevention of shear force in the treatment of pressure ulcers
Authors: Ohura N. , Ichioka S. , Nakatsuka T. , Shibata M. 
Published: May 2014

Objective: Shear force is believed to affect pressure ulceration. Therefore, dressing materials that reduce shear force may prevent ulceration and facilitate healing. Method: We measured the following three properties: the coefficient of friction between the outer layer of the dressings and the patient’s clothes; the degree of adhesiveness between the inner layer of the dressing and the patient’s skin; the transmissibility of shear force of the dressing. Results: The coefficients of static friction were 1.01 for hydropolymer, 0.72 for hydrofoam and 0.48 for hydrocolloid. Adhesiveness was tested by rolling different sized ball bearings down a slope and over the adhesive lining under both wet and dry conditions. Under dry conditions, the heaviest ball bearing that stopped rolling for five seconds was 111.9g for both hydrofoam and hydrocolloid. Under wet condition, it was 11.9g for hydrofoam and under 1g for hydrocolloid. Tests showed the very low transmissibility (1N buffer) of shear force for hydrofoam, with significant differences between the dressings. Clinical observation has identified good results for hydrofoam when used under highly exuding conditions and for hydrocolloid when used with relatively slight or decreased exudate. Conclusion: Existing dressing materials are being developed and evaluated for wound healing. However, if innovations in the raw materials from which dressings are manufactured could lead to a reduction in shear force and the prevention of pressure ulcers, then dressing materials could be discussed from a viewpoint that is quite different from wound healing. Declaration of interest: None.
Determining venous incompetence: a report from a specialised leg ulcer clinic
Authors: Bjellerup M. 
Published: May 2014

Objective:To analyse the diagnosis, treatment and prognosis in patients attending a specialised leg ulcer clinic at a dermatology department.Method:In total, 345 patients were investigated and 332 registered and followed up prospectively. All patients had their arterial and venous circulation assessed with a hand-held Doppler ultrasound.Results:The most frequent diagnosis was venous ulceration (153 patients, 46%) followed by hydrostatic ulceration (70 patients, 21%). Venous incompetence was classified as isolated superficial (n=86) or deep venous incompetence (n=57) in 143 out of the 153 patients. Previous deep vein thrombosis (DVT) was more frequent in patients with deep venous incompetence. Of patients with venous ulcers, 38 (25%) healed within 92 days, 77 (50%) within 155 days and 115 (75%) within 329 days. Healing time was influenced by patient age, ulcer duration and ulcer area, but not by type of venous incompetence or ankle brachial pressure index. After healing, 19% of venous patients (28/144), dominated by those with superficial disease, were subject to venous vascular surgery.Conclusion:Classification of venous insufficiency should be mandatory in patients with venous ulcers since it determines suitability for venous surgery.Declaration of interest:This study has been made possible by generous grants from the Gorthon Foundation, Helsingborg, Sweden.
Management of bioburden with a burn gel that targets nociceptors
Authors: Martineau L. , Dosch H-M. 
Published: May 2014

Aim: To assess the effectiveness of RescuDerm, an amorphous, water-soluble burn gel in controlling Pseudomonas aeruginosa growth in rat full-thickness wounds contaminated with 103, 105 or 107 CFU/g tissue. Method: Wounds were treated daily for 72 hours with a placebo gel, a 5% w/w mafenide acetate gel (Maf), or with four modalities of RescuDerm application. Results: All RescuDerm treatments were equally effective within 24 hours in preventing further Pseudomonas aeruginosa growth in wounds contaminated with 103 CFU/g tissue. Pseudomonas aeruginosa levels remained at or below this baseline count for 72 hours in all but one of the RescuDerm treatments. The bioburdens in Maf-treated wounds were negligible, averaging 0.14 ± 0.09 log10 CFU/g tissue. While RescuDerm and Maf remained bacteriostatic in wounds contaminated with 105 CFU/g tissue, this property disappeared at higher bioburdens. Conclusion: RescuDerm can be used for the management of cutaneous injuries sustained in environments deemed marginally or moderately contaminated. Heavily contaminated wounds would require irrigation prior to application to reduce their bioburden below 105 CFU/g tissue. Declaration of interest: This work was partly supported by NociPharm. Defence Research and Development Canada (DRDC) Toronto designed all the experimental protocols. The findings of this study were not constrained by the sponsoring body, and have never been presented at a scientific meeting or in another public context.
Use of topical corticosteroids on chronic leg ulcers
Authors: Hofman D. , Moore K. , Cooper R. , Eagle M. , Cooper S. 
Published: May 2014

Objective: Topical corticosteroids are widely used in the management of chronic wounds, yet there is little evidence to support this. This pilot study aimed to identify current practice by three specialist nurses and to assess the efficacy of topical corticosteroids. Method: Data on healing, pain relief, exudate reduction and control of hypergranulation tissue were collected on 34 patients whose wounds were treated with topical corticosteroids prospectively in three centres over a three-month period. Results: Twenty-seven patients (79%) benefited from the application of topical corticosteroid either in terms of healing, pain relief, exudate reduction or the control of hypergranulation tissue. Two wounds deteriorated and treatment was immediately withdrawn. Conclusion: Suppression of inflammation plays an important role in healing and pain relief. Applying topical corticosteroids to the wound can accelerate healing and reduce pain in certain cases. However, careful monitoring is essential as there is a risk of sensitisation with prolonged use as well as a potential increased risk of infection. Declaration of interest: None.
Safety and efficacy of a new honey ointment on diabetic foot ulcers: a prospective pilot study
Authors: Abdelatif M. , Yakoot M. , Etmaan M. 
Published: May 2014

Objective: To study the effectiveness and safety of PEDYPHAR ointment (a new ointment prepared from natural royal jelly and panthenol in an ointment base) in the treatment of patients with limb-threatening diabetic foot infections. Method: Sixty patients presenting with limb-threatening diabetic foot infection were categorised into three groups, based on the severity of the lesions. Group 1: full-thickness skin ulcer (Wagner grades 1 and 2); group 2: deep tissue infection and suspected osteomyelitis (grade 3); group 3: gangrenous lesions (grades 4 and 5). They were treated with PEDYPHAR ointment after irrigation and cleansing with normal saline, and surgical debridement if required. The lesions were covered with dressings and patients were followed up for six months or until full healing occurred. No other specific treatment was given apart from insulin treatment to control the diabetes. The primary endpoint was the clinical response at weeks 3, 9 and 24 from the start of treatment. Results: Ninety-six per cent of the patients in groups 1 and 2 responded well, with a complete cure, defined as ‘complete closure of the ulcer without signs of underlying bone infection’ by the end of week 9 and for the duration of the six-month follow-up period. All of the ulcers in group 1 healed, as did 92% of those in group 2. All patients in group 3 healed following surgical excision, debridement of necrotic tissue and conservative treatment with PEDYPHAR ointment. Conclusion: We can conclude from our pilot study that PEDYPHAR ointment may be a promising, safe conservative local treatment. However, further double-blind randomised controlled studies are needed to confirm this. Declaration of interest: Pharco Pharmaceutical supported us in the preparation of the ointment by supplying the raw materials.
Pain-relieving properties of topically applied morphine on arterial leg ulcers: a pilot study
Authors: Jansen M.M. , van der Horst J.C. , van der Valk P.G. , Kuks P.F. , Zylicz Z. , van Sorge A.A. 
Published: May 2014

Objective: To assess whether topical morphine is pharmacologically effective in relieving pain from ulcers caused by arterial insufficiency and identify whether this effect is centrally or peripherally mediated. Method: The analgesic effect of a topically applied hydrogel containing 0.5% of morphine was evaluated in a double-blind, placebo-controlled, three-way crossover pilot study involving nine patients with painful arterial leg ulcers. All patients had a baseline pain intensity of at least 5 on a 10-point numeric rating scale. They received the following three treatments in random order: morphine hydrogel plus a subcutaneous (SC) placebo infusion; placebo gel plus a SC infusion of 5mg morphine over six hours and a placebo gel plus a SC placebo infusion. Each treatment lasted one day. Pain was assessed during the first 24 hours after application of the hydrogel and the start of the subcutaneous infusion. Results: There was a statistically significant difference between average baseline pain scores and those reported during treatment, but this difference was not clinically relevant. The three treatments did not differ in terms of the pain relief provided. Conclusion: Topical morphine does not have a clinically relevant analgesic effect in patients with painful arterial leg ulcers. Further research should focus on ulcers of other aetiology. Declaration of interest: None. The Graseby syringe drivers were supplied by Smith & Nephew.
Effectiveness of topical application of amino acids to chronic wounds: a prospective observational study
Authors: Cassino R. , Ricci E. 
Published: May 2014

Objective: To evaluate whether the topical application of an amino acid dressing, Vulnamin, aids the management of chronic wounds. Method: A total of 160 patients with non-infected cutaneous chronic wounds were recruited. Before treatment, wound size was assessed using digital planimetry. Treatment lasted for a maximum of six weeks. Wound area measurements were repeated two and six weeks after starting treatment. Results: There was a significant reduction in the mean wound area after two weeks (7.4 ± 8.7cm2) and six weeks (4.6 ± 6.3cm2) of treatment, when compared with baseline (11.2 ± 12.1cm2, p<0.01). At the final follow up, 23% of patients (n=36) healed and 34% (n=54) achieved a greater than 60% reduction in wound size. Seventy-six per cent (n=120) achieved positive outcomes (defi ned as a greater than 40% reduction in the ulcer size). Conclusion: Although further investigations on the potential effects of this product on chronic wound healing are required, these data suggest it may promote healing in venous, pressure and diabetic ulcers. Declaration of interest: This study was sponsored by Professional Dietetics, Milan (Italy).
Pinch grafting of chronic leg ulcers: a retrospective analysis of 104 patients with 169 ulcers
Authors: Hjerppe A. , Sane M. , Huhtala H. , Vaalasti A. 
Published: May 2014

Objective:To compare healing rates of inpatients and outpatients with chronic leg ulcers treated with pinch grafting and to define which of these patients would benefit most from the therapy.Method:This retrospective analysis reports the healing rates of 104 patients with 169 ulcers treated with pinch grafting during 1997–2007 at the Department of Dermatology, Tampere University Hospital.Results:These relate to 17 outpatients with 18 pinch-grafted ulcers and 95 inpatients with 151 ulcers. Nine ulcers (50%) in the outpatient and 95 (62.9%) in the inpatient group healed completely. Median healing times were five and eight weeks for the outpatient and inpatient groups respectively. For the sample as a whole, 61.5% of the ulcers healed.Conclusion:This retrospective study found that pinch grafting is an efficient method of treating chronic leg ulcers, with an overall healing rate over 60%. Patients who complied with compression therapy were most likely to benefit from this therapy.Declaration of interest:None.
In vivoeffect of sustained-release silver sulphadiazine foam on bioburden and wound closure in infected venous leg ulcers
Authors: Lantis J.C. , Gendics C. 
Published: May 2014

Objective:To determine the in vivo effect of a sustained-release silver sulphadiazine powder foam dressing on the bacterial burden of venous leg ulcers (VLUs), with a view to correlating the wound closure rate with the degree of bioburden and to assess other markers of its progression towards healing.Method:Patients attending a tertiary care wound practice were screened for a VLU bacterial count of >105colony forming units (cfu/g) per gram of tissue. Patients were treated with the above topical dressing plus multilayer compression bandaging for 12 weeks. Quantitative cultures were taken at weeks 0, 2, 4 and 8. Wounds were assessed at each weekly visit using photography and planimetry.Results:Twenty-four of the 33 screened patients met the inclusion criteria. The average baseline wound size was 12.3cm2. At week 8, the bioburden had reduced to <105cfu/g in 54.2% of patients, with 41.7% achieving this reduction by week 2. At week 8, the median reduction was 0.7log10(p<0.001). The median percentage reductions in bioburden were 50.5%, 56.8% and 80.4% at weeks 2, 4 and 8 respectively. Over the study period, 79.2% of the patients had >75% wound area reduction and 45.8% achieved ulcer closure in a median of 80.5 days.Conclusion:Although the wound size and bacterial counts reduced significantly, there was no statistical correlation between the two. Nevertheless, the in vivo data show that this active antimicrobial dressing was associated with a very high healing rate in these hard-to-heal wounds.Conflict of interest:This research was supported by a grant from Smith & Nephew, Hull, UK. In addition, the principal investigator receives other grants from Smith & Nephew, Hull, UK.
The effect of wound dressings on the pH stability of fuids
Authors: Uzun M. , Anand S.C. , Shah T. 
Published: May 2014

Objective: To investigate and evaluate the effect of 20 commercial wound dressings on the pH values of selected fluids upon contact, over a period of 7 days. Method: The effect of the dressings on the pH of two different solutions, solution a (2.298g sodium chloride [NaCl], 0.368g calcium chloride [CaCl2] dihydrate added to 1 litre of de-ionised water) and distilled water, was investigated over a period of 7 days. Two different methods for contacting fluid with the dressings were used, to simulate wounds with different levels of exudate: i) immersing the dressing in 35ml fluid, and ii) adding 5ml drop-wise onto the dressing's absorbent pad on a daily basis. Results: on immersion of the dressings, the pH values of the fluids changed quite appreciably over time, with similar results for both methods. The lowest pH values were found with the hydrocolloid dressings, for both solution a and distilled water. The foam dressings had an alkaline effect on the fluids; in most cases, they increased the fuid's pH significantly. The non-woven dressings reduced the pH of both fluids to a lesser extent than the hydrocolloid dressings. The hydroactive dressings decreased the pH value of solution a and increased the pH of distilled water. Conclusion: This study demonstrates that the pH values of the fluids are not constant, likely due to the complicated nature of the dressings’ chemical structures and designs. Thus, optimisation of pH level to meet the requirements of any specific wound types and healing processes must consider the complex nature of the dressing. The increase in pH value of the wound over time needs to be minimised in order to maximise the effectiveness of the healing therapy. Declaration of interest: This work was supported by a financial grant from the Turkish Council of Higher education in collaboration with Marmara university, Turkey and the university of Bolton, UK. The authors have no conflict of interest to declare.
The impact of atraumatic vs conventional dressings on pain and stress
Authors: Upton D. , Solowiej K. 
Published: May 2014

Objective: To compare the pain and stress experiences of patients with chronic wounds being treated with atraumatic vs conventional dressings at dressing change. Method: This exploratory study adopted an independent samples design to identify any differences between reported levels of pain and stress associated with the use of atraumatic and conventional dressings used in treatment regimens of patients with chronic wounds. Physiological and psychological assessments of pain and stress were recorded at dressing change (including numerical ratings, heart rate, blood pressure, respiration rate, GSR, salivary cortisol and the Perceived Stress Scale (PSS) and State Trait anxiety Inventory (STAI) questionnaire surveys). Results: In total, 49 patients with chronic wounds took part in the study. Fifty-three percent of patients were male (n=26) and 47% were female (n=23). Patients were aged 38–95 years, with a mean age of 69.11 ± 14.08 years. overall, 10 patients were receiving atraumatic dressings with Safetac technology as part of their routine wound treatment and 39 were receiving conventional dressings. Patients receiving atraumatic dressings reported significantly lower numerical pain and stress ratings and experienced significantly lower GSR at dressing change. Mean heart rate, blood pressure, salivary cortisol were also lower for patients with atraumatic dressings. However, patients' PSS (atraumatic=24.60, conventional=22.72) and STAI (atraumatic=34.90, conventional=33.21) scores were similar for both dressing type groups. Conclusion: This study provides a basis for understanding how different dressing types can impact pain and stress at dressing change. acute episodes of pain and stress were much lower in patients receiving atraumatic dressings;0 however factors associated with the overall experience of living with a chronic wound may be contributing to underlying and ongoing feelings of stress and anxiety. The impact of these implications on selection of dressings and cost of care are also discussed. Declaration of interest: This research was commissioned by Mölnlycke Health Care. None of the authors work for Mölnlycke Health Care or have any financial interests with the company. There are no additional conflicts of interest to declare.
The use of larval therapy to reduce the bacterial load in chronic wounds
Authors: Blueman D. , Bousfield C. 
Published: May 2014

Objective: To ascertain the effect of larval therapy against bacteria associated with infected chronic wounds, and determine if larvae therapy actively reduces the bacterial load in chronic wounds. Method: An extended literature review was undertaken using online databases: Athens, Medline, EMBASE, British Nursing Index and Allied and Complementary Medicine via OVID and Cumulative Index to Nursing and Allied Health. Key terms were searched worldwide from 1950 to 2011. Results: Four themes emerged: Gram-positive and Gram-negative bacteria, MRSA, quorum sensing: biofilm consideration and bacterial burden. This suggests larvae debridement therapy is differentially effective against both Gram-positive and Gram-negative bacterial strains, namely Staphylococcus aureus, Pseudomonas aeruginosa and meticillin-resistant Staphylococcus aureus. Conclusion: The evidence supports the use of antimicrobial properties of larvae therapy against the bacteria of infected chronic wounds. Declaration of interest: There were no external sources of funding for this literature review. This paper is based on an independent study submitted as part of the BSc Health Care Studies, (Tissue Viability), University of Nottingham, UK. The authors have no competing or financial interest to declare and ethical approval and funding were not required to undertake the study.
Use of acellular dermal regeneration template combined with NPWT to treat complicated extremity wounds in children
Authors: Hutchison R.L. , Craw J. R. 
Published: May 2014

Objective: The treatment of open wounds with exposed bone, tendon, or nerve is a challenging reconstructive problem, especially in children. The purpose of this study is to evaluate the safety and effectiveness of using acellular dermal templates combined with negative pressure wound dressings in the treatment of complicated paediatric soft tissue extremity wounds. Method: A retrospective review of eight patients treated with acellular dermal templates for closure of complicated extremity wounds was performed. After debridement, all patients were treated with a template and a negative pressure wound treatment (NPWT) system. Results: The average age was 8.8 years with 4 females and 4 males. Four wounds were at the foot/ankle, with tendon exposed in all 4, nerve in 2, and bone in 3. There were 3 lower leg wounds, all with exposed bone. One patient had arm/hand wounds with exposed tendon. The size of the wounds and dermal graft averaged 86cm2 and 57cm2. The average time to wound closure was 65 days. The majority of the treatment was received as an outpatient, including NPWT. For inpatient and outpatient care, the average number of sponge system changes was 2.6 compared to 4.6, and time between changes was 3.5 compared to 6.8 days. Each patient had only one procedure each for application of the dermal substitute and later one skin grafting procedure. Complications were minimal, and all patients healed their wounds without the need of flaps. One patient required wound revision. Conclusion: Our study demonstrates that a dermal template combined with NPWT can safely and effectively be used to treat complicated wounds in children. Closure was obtained without flaps, the majority of the treatment time was spent in the outpatient setting, and the complication rate was low. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.