bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a nanocrystalline silver dressing on lymphatic ulcers in patients with chronic lymphoedema
Authors: Forner-Cordero I. , Navarro-Monsoliu R. , Muñoz-Langa J. , Alcober-Fuster P. , Rel-Monzó P. 
Published: May 2014

Objective: A prospective evaluation to explore the effect of treating patients with chronic lower limb lymphoedema and lymphatic ulcers using a nanocrystalline dressing and multilayer bandaging. Method: Ulcers were cleansed and dressed with a nanocrystalline silver dressing, an alginate dressing and a hydrocellular dressing, followed by multilayer short-stretch compression bandages. A digital planimetry system was used to calculate the ulcer surface area. In cases of multiple ulcers, the areas were added together. Results: Eight patients with chronic lower limb lymphoedema plus ulcers were included. Median age was 53.7 years (range 39.2–72.3). Mean ulcer size was 10.5cm2 (range: 0.8–33.8). All ulcers completely healed after one to nine weeks of treatment. Conclusion: This protocol has been effective in healing lymphatic ulcers and was well accepted by patients. There were no adverse effects or withdrawals. Further studies with larger numbers of patients are required to support these results. Declaration of interest: Smith & Nephew Spain supported this study by supplying a measuring device. They did not provide any dressings or bandages.
Topical diphenylhydantoin sodium can improve healing in a diabetic incisional animal wound model
Authors: Chan F.C , Kennedy C , Hanson R.P , O’Sullivan B , Kelly J , Bouchier-Hayes D 
Published: May 2014

Objective: Anecdotally, topical application of diphenylhydantoin sodium (DpH) (phenytoin) has been shown to aid wound healing. We previously reported improved healing following topical infiltration of DpH in a healthy animal wound model. This study evaluates its effect on an incisional wound model in diabetic animals. Method: Twenty-five male Sprague-Dawley rats were rendered diabetic by a single intraperitoneal injection of streptozotocin. Two caudal and two cephalad wounds were made on the dorsal surface. A polyvinyl alcohol sponge was placed in a subcutaneous pocket created proximal to both cephalad wounds. Each wound was either treated topically with 10mg DpH in a 200µl carrier or an equal volume of the saline vehicle (control) on the day of wounding and days 3 and 6 post-incision. The animals were sacrificed on day 10. The breaking strength of fresh and fixed wounds was determined by tensiometry, and the hydroxyproline content was determined spectrophotometrically. Results: There was a significant overall increase in both fresh (24%) and fixed (18%) wound-breaking strength of the DpH-treated wounds when compared with the controls (p<0.05). This was associated with an increase in collagen synthesis as indicated by the increased hydroxyproline content in the DpH-infiltrated sponges when compared with the controls. Conclusion: Our data suggest that topical DpH improves healing in a diabetic wound model. Topical administration of DpH has the potential to accelerate diabetic wound healing and should be evaluated in human diabetic wounds. Declaration of interest: None.
Wound healing activity ofPersea americana(avocado) fruit: a preclinical study on rats
Authors: Nayak B.S. , Raju S.S. , Chalapathi Rao A.V. 
Published: May 2014

Objective:Avocado (Persea americana) oil is rich in nutrient waxes, proteins and minerals, as well as vitamins A, D and E. It is an excellent source of enrichment for dry, damaged or chapped skin. This study aimed to evaluate the wound-healing activity of fruit extract of Persea americana in rats.Method:The effect of topical and oral administration of Persea americana fruit extract (300mg/kg/day) on excision and dead space wound models was evaluated. The rats used in the excision wound model were divided into four groups of five each and received either topical or oral treatment. The rats used in the dead space wound model were divided into two groups of five each and were treated orally. Healing was assessed by the rate of wound contraction, period of epithelialisation, granulation tissue weight and hydoxyproline content.Results:In the excision wound model, complete healing (full epithelialisation) was observed on average on day 14 in the rats who receive oral or topical treatment. In contrast, the controls took approximately 17 days to heal completely. The extract-treated wounds were found to epithelialise faster than the controls (p<0.001). Wet and dry granulation tissue weight and the hydroxyproline content of the tissue obtained from extract-treated animals used in the dead space wound model were significantly higher (p<0.05) compared with the controls.Conclusion:Rate of wound contraction, epithelialisation time together with the hydroxyproline content and histological observations support the use of Persea americana in the management of wound healing.Declaration of interest:None.
A randomised controlled trial on the effectiveness of an advanced wound dressing used in Iran
Authors: Kordestani S. , Shahrezaee M. , Tahmasebi M.N. , Hajimahmodi H. , Ghasemali D. Haji , Abyaneh M.S. 
Published: May 2014

Objective:To compare the wound healing rate and incidence of infection in wounds treated with either a bioactive dressing (containing hydrophilic mucopolysaccharide, chitosan) or conservative treatment (gauze).Method:Eighty-five patients with diabetic foot ulcers, pressure ulcers or leg ulcers were randomised to receive either the bioactive study dressing (n=33 patients, 45 wounds) or the control dressing (n=52 patients, 53 wounds) for 21 days. Wound size, stage where appropriate and the presence of infection were recorded at each dressing change. Thirty-one of these 85 patients dropped out of the study during the three-month post-treatment follow-up, when wound size and grade were assessed on a monthly basis. Data were therefore analysed on 54 patients, of whom 32 (34 wounds) were in the treatment group and 22 (26 wounds) in the control group.Results:In the control group, four pressure ulcers healed, but the remaining wounds all deteriorated and became infected, requiring antibiotics. In contrast, in the treatment group 29/34 wounds healed completely, and none became infected; the remaining five wounds healed during the follow-up period. The difference between the two groups in the number of wounds that healed was statistically significant (p<0.001), as was that for the number of healed pressure ulcers p<0.05.Conclusion:Use of a moist bioactive wound dressing significantly increased the healing rate when compared with the traditional dressings used in the participating hospitals. This will in turn bring significant cost savings.Declaration of interest:This study was sponsored by ChitoTech.
The impact of topical phenytoin on recalcitrant neuropathic diabetic foot ulceration
Authors: El-Nahas M. , Gawish H. , Tarshoby M. , State O. 
Published: May 2014

Objective: To study the impact of topical phenytoin on the healing of recalcitrant neuropathic diabetic foot ulcers in patients with no clinical evidence of ischaemia or infection, and to evaluate its antibacterial effect. Method: Thirty-two patients were enrolled into the study. Topical phenytoin in the form of 2% aerosol powder was applied once daily in addition to the patient's usual treatment (weekly sharp debridement, offloading and use of a gauze dressing) for eight weeks. The primary outcome was change in ulcer area over time, measured by grid tracing. Secondary outcomes were the ability of topical phenytoin to eradicate bacterial isolates, and the occurrence of adverse events. Results: Topical phenytoin significantly improved healing of recalcitrant neuropathic diabetic foot ulcers. Baseline wound area was 319.3 ± 340.4mm2, reducing to 286.1 ± 341.1mm2 and 269.1 ± 341.2mm2 after four and eight weeks respectively. However, the overall reduction in ulcer size was only 18.3% ± 27.5% and 25.7% ± 38.6 % respectively. Topical phenytoin therapy over eight weeks did not eradicate any of the bacterial wound isolates (Staphylococcus spp., Proteus spp. or Pseudomonas spp.). Of the 32 patients evaluated, only eight (25%) achieved more than 50% reduction in ulcer size after eight weeks of treatment. Conclusion: Topical phenytoin can enhance wound healing in recalcitrant neuropathic diabetic foot ulcers, although only one-quarter of patients achieved more than 50% reduction in ulcer size after eight weeks of therapy. Further research is needed to characterise those patients who will satisfactorily respond to such therapy. Declaration of interest: None.
Comparison of interface pressures of three compression bandaging systems used on healthy
Authors: Jünger M. , Ladwig A. , Bohbot S. , Haase H. 
Published: May 2014

Objective: To compare changes in interface pressures of three compression systems (four layer, two layer and short stretch) recorded over seven days in healthy volunteers in different positions: supine, sitting, active standing and working pressure during exercise. Method: Twenty-four volunteers were bandaged with one of the three compression systems on both legs. Interface pressures were measured at inclusion (day 0) and on days 1, 3 and 7 using an air sensor system, with the sensor placed in the medial B1 position above the inner ankle. In addition, the volume of the lower legs were also measured on days 0 and 7 using a three-dimensional imaging system. Comfort and tolerability were also assessed. Results: The performance, based on the loss of interface pressure compared with baseline, of the two-layer system was partially better than that of the short-stretch system for maximal working pressure and loss of volume. The two-layer system and short-stretch system had similar results for the supine, sitting and active standing positions. No difference was observed between the two-layer system and the four-layer system for the maximal working pressure. However, the two-layer system compared better than the two other systems for comfort and tolerability: 25% of the patients treated with the four-layer system discontinued the treatment after three days because of pain. Conclusion: The two-layer bandage system maintained, over one week, a similar level of sub-bandage pressure similar to a four-layer system and was partially better than short-stretch bandaging. However, the volunteers found the two-layer system more comfortable and tolerable than the other two systems. Declaration of interest: The investigators received an education grant from Urgo for the study. However, Urgo had no infl uence on the data analysis or interpretation.
Malignant fungating wounds: an analysis of the lived experience
Authors: Piggin C. , Jones V. 
Published: May 2014

Objective: The current understanding of living with a malignant fungating wound is derived from professionals' rather than the patient's perspective. An appreciation of the lived experience may assist in the development of more empathetic support approaches. This paper reports upon a study that aimed to illuminate the meaning and experience of living with a malignant fungating wound. Method: A Heideggerian hermeneutic phenomenological approach was used as the philosophical framework. Unstructured interviews were conducted with a purposive sample of five participants. Content hermeneutic analysis was adopted to analyse the data. Result: Four themes were identified: representing the worst part of the patient's cancer; living within a body that cannot be trusted; a changing relationship with the patient's family and friends; and a loss of identity while continuously striving to be normal, yet feeling different. Conclusion: Health care professionals must possess a heightened awareness of: the importance of the impact of the wound upon day-to-day living, identity and purpose; the value of adopting the phrase used by the patient to describe their wound; and to focus more upon the subjective meaning of a visibly changing wound rather than objective measurement. Declaration of interest: None.
An in-vitro model for comparing the efficiency of wound-rinsing solutions
Authors: Kaehn K. 
Published: May 2014

Objective: To develop an in-vitro model to evaluate the efficiency of wound-rinsing solutions in removing adherent, hydrophobic, denatured proteins. We hypothesised that saline solutions would be less effective than surfactant-containing solutions in removing denatured proteins. Method: Prepared slides containing dried blood plasma or fibrin were incubated for up to one hour in histological troughs filled with one of four test solutions: physiological saline solution, Ringer's solution, a surfactant-containing solution and an antiseptic. The concentration of dissolved proteins was measured using a modified Biuret test. Results were analysed by plotting protein concentration against the incubation time. Results: During the incubation period, the protein concentration increased in all of the test solutions, with the lowest concentration reported in the two saline-based solutions. These stayed clear, while the surfactant-containing solution become opaque, indicating that the surfactant had encased hydrophic substances, such as denatured proteins. Conclusion: Ringer's solution and saline are inappropriate solvents for adhering wound coatings. A sterile, surfactant-containing wound rinsing solution contains the essential properties for thorough and gentle cleansing of chronic wounds. Declaration of Interest: None.
An in vitro evaluation of the cell toxicity of honey and silver dressings
Authors: Du Toit D. F. , Page B. J. 
Published: May 2014

Objective: To establish whether honey and silver-impregnated dressings used by wound-healing practitioners are cytotoxic in vitro to human skin keratinocytes and dermal fibroblasts. Method: Human keratinocyte and fibroblast tissue cultures were established in vitro. Untreated cultures served as controls (group I). Small dressing implants of monofloral, medicinal honey (L-Mesitran) (group 2) and nanocrystalline silver (Acticoat) (group 3) were placed in test wells and cocultured with each of the two cell lines. Morphological changes, including cell toxicity, were assessed using inverted microscopy, trypan blue staining and the Rosdy and Clauss cell toxicity scoring system. Results: Untreated cultures consisting of both keratinocytes and fibroblasts (group 1) were established in 90% of all cases. In group 2, cultures with honey-impregnated implants, cell proliferation remained present at two and four months. Cell viability remained intact and cell toxicity was not evident at four months after continuous tissue culture. In group 3, marked toxicity was observed with high non-viability staining and cell-scoring counts compared with groups 1 and 2 (p<0.05). This demonstrates that the silver interfered with epidermal cell proliferation and migration, implying that it contains cytotoxic material. Conclusion: The honey-based product showed excellent cytocompatibility with tissue cell cultures compared with the silver dressing, which demonstrated consistent culture and cell toxicity. Further studies are needed to assess if these comparative in-vitro findings should influence a clinician's choice of wound dressing. Declaration of interest: None.
Mood disorders in patients with acute and chronic wounds: a health professional perspective
Authors: Upton D. , Hender C. , Solowiej K. 
Published: May 2014

Objective: This exploratory study surveys a group of practitioners to discover their perspectives on the prevalence of stress, anxiety and mood disorders among their patients with acute and chronic wounds. Method: a questionnaire survey was sent to an convenience sample of 81 health professionals. The questionnaire included items about the health professionals’ perceptions of the prevalence of mood disorders among their patients, and their perceptions of potential contributory factors and treatments. Results: Thirty-nine health professionals (48%), including tissue viability nurses, nurses and podiatrists, responded to the survey. The majority of respondents believed that 50–75% of their patients with chronic wound were suffering from mood problems related to their condition. Despite this, most practitioners believed that few of their patients were actually receiving treatment for these mood-related problems. one quarter of patients with acute wounds were considered to have related problems with mood. Practitioners believed anxiety and feeling helpless were the most common mood problems among their patients, while chronic pain/discomfort of the wound and inability to complete everyday tasks were potential contributory factors to these problems. Conclusion: The findings suggest that the health professionals who responded to the survey were aware of behavioural signs of stress, anxiety and mood problems in their patients with chronic wounds. Furthermore, the majority of practitioners did not feel that their patients were receiving help or treatment for these problems. It is therefore suggested that increased awareness of the behavioural signs of stress, anxiety and mood problems among patients with wounds could help to improve the patient's experience of wound care, as acknowledgement of mood problems could lead to the most appropriate form of treatment or help for individual patients. Declaration of interest: This study was commissioned by Mölnlycke Health Care. none of the authors work for Mölnlycke or have any financial interests with the company. There are no additional conflicts of interest to declare.
Management of diabetic foot ulcers with a TLC-NOSF wound dressing
Authors: Richard J.L. , Martini J. , Faraill M.M. Bonello , M’Bemba J. , Lepeut M. , Truchetet F. , Ehrler S. , Schuldiner S. , Sauvadet A. , Bohbot S. 
Published: May 2014

Objective: To evaluate the efficacy, tolerance and acceptability of UrgoStart Contact (Laboratoires Urgo), a new wound dressing impregnated with NOSF, as an MMP regulator in the management of neuropathic diabetic foot ulcers. Method: A multicentre, pilot, prospective, non-controlled open-label clinical trial. Adult patients with type 1 or 2 diabetes mellitus, who had a grade 1A (Texas classification), uninfected, neuropathic foot ulcer, 1–15cm2 in size and of 1–20 months' duration (mean 6.7±5.2 months) were included in the study. The primary endpoint was the relative reduction of the wound surface area (%) at the end of the study. Secondary endpoints included rate of complete healing, and tolerability and acceptability of the dressing. The wound dressing was changed regularly at the investigator's discretion, in accordance with the wound status and exudate level. Patients were followed up every 2 weeks for a 12-week period. At each visit, patients underwent clinical assessments, and ulcer surface area was measured by planimetry and photographs. Results: Thirty-four diabetic patients with a neuropathic foot ulcer were included but only 33 cases were analysed, as data were completely lost for one patient. At baseline, mean surface area was 2.7±2.4cm2. At the 12-week follow-up, the median surface area reduction was 82.7% (mean reduction 62.7±49.9%) and in 10 of the 33 analysed patients (30%) the wound was healed. Only two of the seven documented local adverse events were deemed to be dressing related. According to the nursing staff, acceptability was considered very satisfactory, particularly in term of conformability and ease of use. Conclusion: This pilot study indicates that use of the new UrgoStart Contact dressing, combined with offloading and debridement,may help promote the healing process of the neuropathic diabetic foot ulcers, and was well tolerated and accepted. Declaration of interest: This study was supported by grants from Laboratoires URGO pharmaceutical company. S. Bohbot is an employee of Laboratoires URGO; J.L. Richard has received monetary compensation as a consultant and speaker for Laboratoires URGO. Data management and statistical analysis were carried out by StatMed (Villemoirieu, France).
An RCT to compare a bio-cellulose wound dressing with a non-adherent dressing in VLUs
Authors: Alvarez O.M. , Phillips T.J. , Menzoian J.O. , Patel M. , Andriessen A. 
Published: May 2014

Objective: To compare the efficacy of a bio-cellulose dressing (BWD) versus a non-adherent wound contact layer in venous leg ulcer (VLU) outpatients. Method: In a prospective, randomised, controlled multicentre study, 48 VLU patients were randomised to receive compression bandages and either standard care (non-adherent dressing; n=23) or a BWD (Suprasorb X; n=25). VLUs were evaluated for debridement efficacy, time to 75-100% granulation and ≥ 50% re-epithelialisation, reduction of ulcer size and patient-reported ulcer pain, comparing the status at day 0 and weekly, over a 12-week study treatment period. Results: Thirty-three patients (n=18 BWD and n=15 control dressing) were included in the analysis. Autolytic debridement was significantly faster in the BWD group, with an 84% removal of yellow tissue compared with 26% in the control group, over the 12-week period (p < 0.0001). A median of 25 days were required to achieve 75-100% granulation in the BWD group vs 36 days for controls. A median of 36 days was taken to achieve ≥ 50% re-epithelialisation in the BWD group vs 50 days for controls. Patient-reported ulcer pain reduced significantly faster in the BWD group (p < 0.05), by week 7, 100% of patients reported no pain, compared with 63% of controls. Conclusion: Autolytic debridement was faster and more effective in the BWD group compared with standard care, as was pain reduction. Although the time to healing was shorter with the BWD vs standard care, the difference was not statistically significant. Declaration of interest: This study was supported by Xylos Corporation. The study product was called X-Cell at the time, and is now available as Suprasorb X (Lohmann & Rauscher). Each principal investigator (Alvarez, Phillips, Menzoian, Etris-Brown) and respective clinical centre received funding for the conduct of the study. Each site executed a clinical study agreement independently with the sponsor. The sponsors had no role in the design and conduct of the study, in the collection, analysis, or interpretation of data, or in the preparation of the manuscript, review, or approval of the manuscript. None of the authors received administrative, technical or material support for the conduct of this study. The authors have no relevant financial interest in this article.
Meeting the challenges of wound care in Danish home care
Authors: Jørgensen S.F. , Nygaard R. , Posnett J. 
Published: May 2014

Objective: To evaluate a community-based educational intervention to improve wound-care practice, and thereby reduce the costs of care, in four communities in Denmark. Method: Annual wound care audits recorded patients’ ages, the number and types of wounds being treated, wound duration (days unhealed), frequency of dressing changes and nurse time per dressing change. Data were available at year 1 and year 3 post-intervention. A statistical analysis was performed, testing for changes in a range of variables between these years. Results: In the post-intervention period, significant reductions were found in the proportion of chronic wounds, the proportion of wounds requiring a daily dressing change, mean frequency of dressing change, mean nurse time spent in wound care per week, and the total cost of wound care per week. Conclusion: These results suggest that it is possible to improve wound-care practice and reduce the resource costs of wound care through a systematic programme of education and training, tailored to suit the needs of local communities. Declaration of interest: S.F. Jørgensen and R. Nygaard are partners of KvaliCare ApS. J. Posnett was commissioned by KvaliCare ApS to undertake the analysis of audit data.