bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of a two-component compression system for the therapy of venous leg ulcers
Authors: Escaleira R. , Cardoso M. , Rego J. , Macedo P. , Midões A. 
Published: May 2014

Objective:The performance of a two-component compression system in daily practice was assessed in an outpatient clinic where patients with a wide variety of comorbidities and wound characteristics are treated.Methods:In the single-centred observational study, patients with venous leg ulcers (VLUs) on one or both legs were treated with a two-component compression system for up to 12 months or until the ulcer healed. The only exclusion criteria were an ABPI <0.8, immobilisation and limited ankle joint fl exibility. Study assessment parameters included ulcer size on entry into the study, the presence of skin irritations, occurrence of adverse events and ulcer recurrence. The primary outcome measure was the mean time to healing.Results:In total, 136 patients with VLUs were included. Baseline median ulcer duration was 7.5 months and the baseline median size was 4.3cm2. The average reduction in total ulcer surface was 2.9 ± 5.5cm2per month. Of the wounds, 90.4% healed after 12 months; the mean healing time was three months (Kaplan-Meier, CI 95%: 3–4). The baseline wound size had a significant influence on mean healing time (Cox proportional hazards model; p<0.0001), wounds >4.3cm2healed within a mean of five months, while wounds <4.3cm2healed within a mean of two months (log rank test: p<0.00001).Conclusion:Healing results were encouraging and suggest a good applicability in the daily practice of VLU therapy. Further studies will include systematic assessment of patient concordance.Declaration of interest:None.
Transcutaneous oxygen tension: a useful predictor of ulcer healing in critical limb ischaemia
Authors: Ruangsetakit C. , Chinsakchai K. , Mahawongkajit P. , Wongwanit C. , Mutirangura P. 
Published: May 2014

Objective To investigate the threshold of transcutaneous oxygen tension (TcPO2) values in predicting ulcer healing in patients with critical limb ischaemia in a prospective study. Method 50 patients suffering from critical limb ischaemia with chronic ischemic ulcers or gangrenous toes were enrolled in this study between January and December 2008. Their demographic data and ankle brachial pressure index (ABPI) were collected. Baseline ulcers were measured with a wound measurement system (Visitrak, Smith & Nephew). TcPO2 was measured at rest in the supine position and with 30° leg elevation. The patients with infective and ischemic ulcers underwent debridement and gangrenous toes were amputated. Ulcer outcome was classifi ed as either: (1) A healing ulcer, showing good epithelialisation or granulation at both base and edges, or a decrease in ulcer area during the study; or (2) A non-healing ulcer, showing poor granulation tissue formation or a pale base and necrotic edges, or deterioration in an ischaemic ulcer. Results The mean age of the patients was 67.6 ± 10.8 years. The most common risk factor was hypertension (90%). Mean ABPI was 0.75 ± 0.39. 13 patients (26%) had a TcPO2 of less than 20mmHg, of which none showed any improvement in ulcer healing (p<0.001). 15 patients (30%) had a TcPO2 of more than 40mmHg, of which all progressed to complete ulcer healing (p<0.001). In the borderline group (20–40mmHg, 22 patients, 44%), 10 patients (45%) had a TcPO2 drop of <10mmHg with 30° leg elevation, of which 8 achieved complete ulcer healing (p<0.001). 12 patients (55%) had a TcPO2 drop of >10mmHg with 30° leg elevation, of which 11 showed no ulcer healing (p<0.001). Conclusion TcPO2 measurement is an accurate, non-invasive, and good predictor of ischemic ulcer healing, for cut-off TcPO2 values of less than 20mmHg and more than 40mmHg. In addition, the leg elevation method for TcPO2 might provide an important adjunct in the assessment of patients with borderline values. Declaration of interest None.
Testing wound dressings using an in vitro wound model
Authors: Lipp C. , Kirker K. , Agostinho A. , James G. , Stewart P. 
Published: May 2014

Objective To determine whether or not there are any significant differences in the effects of wound dressings on bacterial bioburden. Method A selection of non-occlusive, non-adhesive dressings was tested for their effect on bacterial bioburden. The dressings selected included two dressings with antimicrobial properties (one containing silver and one containing PHMB), a cotton-based dressing enclosed in a perforated sleeve of poly(ethylene terephthalate), a carboxymethyl cellulose-based dressing, a fibre-free alginate dressing, and a 12-ply 100% cotton gauze. Using the colony-drip flow reactor (DFR) model, a meticillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa biofilm was grown underneath a dressing sample. Biofilm growth was examined via plate counts, fluorescent microscopy and scanning electron microscopy. Results The dressings containing antimicrobial agents had the greatest effect on bacterial load. In the MRSA experiments, both antimicrobial dressings produced lower bacteria counts than the other dressings (p≤0.001), while in the P. aeruginosa experiments, only the silver-containing sample had fewer bacteria (p≤0.0001). However, neither antimicrobial dressing was able to completely eradicate the bacteria when testing with either microorganism. Conclusion The results presented herein illustrate that bacteria can grow unchallenged within the dressing environment and that an antimicrobial dressing can limit this bacterial growth. Declaration of interest None.
Human skin allografts as a useful adjunct in the treatment of purpura fulminans
Authors: Gaucher S. , Stéphanazzi J. , Jarraya M. 
Published: May 2014

Objective The aim of this report is to discuss the role of human skin allografts in surgical coverage procedures for patients with purpura fulminans. Method We describe cases of purpura fulminans in three adults and one infant treated at our burns unit between October 2006 and January 2008. Results The application of cryopreserved human skin allografts allowed us to obtain immediate wound closure after necrosis excision and enabled our team to subsequently perform autografts on favourable graft recipient sites. Conclusion Recourse to human skin allografts must be considered a pertinent therapeutic option in patients with purpura fulminans. Conflict of interest None.
Quality of nursing care from the perspective of patients with leg ulcers
Authors: Törnvall E. , Wilhelmsson S. 
Published: May 2014

Objective To investigate and analyse the quality of nursing care in a primary care setting from the perspective of patients with leg ulcers and determine the subjective importance that patients attach to various aspects of quality of care. Method All of the patients with leg ulcers at 15 primary care centres in the south east of Sweden were invited to participate. They were given the short version of the Quality from the Patient's Perspective questionnaire (QPP) to fill in. This included a number of closed and open questions relating to their perceptions of the quality of their nursing care and the importance of this care to them. Results Overall, the patients in this study perceived that the quality of nursing care was high. However, important areas for improvement were revealed, including the need for an increase in patient-focused care, continuity of care and better pain relief. Conclusion To address the weak points highlighted by the study, we recommend that nurses explore patient perceptions of pain in greater detail and invite patients take a more active role in the management of their leg ulcers. Conflict of interest None. This study was funded by the county council of Östergötland and by Linköping University, Sweden.
Use of ultrasound in assessment of necrotic tissue in pressure ulcers with adjacent undermining
Authors: Ueta M. , Sugama J. , Konya C. , Matsuo J. , Matsumoto M. , Yabunaka K. , Nakatani T. , Tabata K. 
Published: May 2014

Objective: To reveal the specific ultrasonic imaging findings of non-visible necrotic tissue in pressure ulcers (PUs) with undermining and describe the images objectively. The predictive validity of the specific images of the undermined necrotic tissue was also determined. Method: Using digital ultrasonography (12mHz linear transducer, mylab25; Hitachi medical Corporation), we imaged PUs with undermining every 2 weeks. PUs were also monitored by DESIGN-R, a PU assessment tool, at the same time. Results: Ten patients had 11 PUs with undermining and all ulcers were located in the sacral region. The necrotic tissue showed high echogenicity with no layers, unclear borders and an uneven gray level (cloud-like image). Granulation tissue appeared as a low echoic image which had no layers, was of coarse resolution and an even gray level. There were significant differences between the pixel uniformity of the necrotic tissue (84.0) and granulation tissue (53.9) compared with uninjured tissue (65.5; p=0.000 and 0.005, respectively). The sensitivity, specificity, and positive and negative predictive values of cloud-like image were 87.5%, 91.7%, 77.8% and 95.6%, respectively. Conclusion: The results suggest that cloud-like image is the most useful diagnostic indicator for non-visible necrotic tissue in PUs with undermining and is the best prognostic indicator for PU healing. Declaration of interest: The authors have no conflicts of interest to declare. There were no external sources of funding for this study.
Gauze-based negative pressure wound therapy as an adjunct to collagen-elastin dermal template resurfacing
Authors: Goutos I. , Ghosh S.J. 
Published: May 2014

Objective: To report the first case series of gauze-based negative pressure wound therapy (NPWT) as an adjunct to collagen-elastin dermal template resurfacing and provide a brief overview of the current knowledge and controversies regarding NPWT in association with dermal templates. Method: In this prospective study, patients undergoing single stage resurfacing with Matriderm (Dr Suwelack Skin & Health Care, Germany) between September 2007 and September 2008 at Stoke Mandeville Hospital were identified and followed up. A gauze-based NPWT system (V1STA) was used to secure the dermal template and split skin graft to the wound bed. Rates of epithelialisation, the patients’ analgesic requirements and patient concordance with the device were all recorded. Results: In the 10 patients studied (7 males and 3 females) this modality of vacuum therapy was found to be effective in all cases for bolstering single stage collagen-elastin dermal templates onto wounds, and contributed to excellent rates of epithelialisation (mean: 94%, range: 70–100%). Additionally, patient concordance with the device was excellent and the costs associated with its use were much lower compared with foam-based NPWT. Conclusion: We recommend the consideration of gauze-based NPWT as cost-effective alternative to foam based modalities in association with the use of dermal templates. Conflict of interest: None.
An open label non-comparative case series on the efficacy of an enzyme alginogel
Authors: Durante C.M. 
Published: May 2014

Objective: To evaluate the efficacy of an enzyme alginogel in outpatients with chronic or acute wounds left to heal by secondary intention. Method: This evaluation was a single-centre, single-arm, case series involving 23 patients with wounds of diverse aetiologies treated with the enzyme alginogel (Flaminal; Flen Pharma). The product was applied in accordance with the manufacturer's instructions and wounds were covered with secondary dressings. Treatment was based on a scheduled protocol and patients were assessed at days 14, 30 and 60. Results: Median baseline dimensions for the wounds were surface area 2.6cm2 and volume 2.8cm3. Median wound duration before application of the enzyme alginogel was 292 days, with 16 chronic wounds (78%). Three wounds were clinically infected at baseline; two were negative by day 14 and the third by day 30. after 2 months, wound surface area and volume had decreased, as could be expected. Two adverse events were reported: an allergic reaction in the skin surrounding the wound and transient maceration. Conclusion: The enzyme alginogel facilitated healing in chronic and acute wounds of diverse aetiologies. additional research is warranted to confirm the clinical utility of the dressings in the management of chronic or acute wounds left to heal by secondary intention. Declaration of interest: The author has no conflict of interest to declare. There were no external sources of funding for this evaluation.
Randomised, controlled pilot to compare collagen and foam in stagnating pressure ulcers
Authors: Piatkowski A. , Ulrich D. , Seidel D. , Abel M. , Pallua N. , Andriessen A. 
Published: May 2014

Objective: To compare the clinical efficacy of a collagen dressing covered with a foam dressing with the same foam used as a primary dressing in stagnating granulating pressure ulcer patients. Method: Patients were randomised to receive either a foam dressing (Suprasorb P; Lohmann & Rauscher) as a primary dressing (group A), or a combination of a collagen dressing (Suprasorb C; Lohmann & Rauscher) covered with the same foam dressing (group B). Wound fluid was collected and evaluated prior to treatment (day 0), and on days 3, 7, 14 and 21. The level and expression of matrix metalloproteinases (MMPs) MMP-2 and MMP-9, and tissue inhibitors of metalloproteinases (TIMPs) TIMP-1 and TIMP-2, as well as elastase content in wound fluid and angiogenesis, were evaluated, comparing results on day 0 and day 21. Time to ulcer healing, reduction in ulcer area, safety of treatment, patient-reported ulcer pain and comfort of the dressing regimen were evaluated as secondary outcomes. Patients received standard preventive measures, in line with the pressure ulcer prevention guidelines. Results: Ten patients were included in the pilot; five were treated with the foam dressing (group A) and five patients received the collagen dressing, using the foam as a secondary dressing (group B). Wound fluid from group B displayed a significant positive effect on angiogenesis (p < 0.05) compared with group A. In the collagen and foam group TIMP-1 and -2 increased faster and levels were higher than in group A. Furthermore, MMP-2, MMP-9 (p < 0.04) and elastase in group B showed faster and greater decrease in levels, compared with group A, indicating a faster and superior reduction of inflammation. In both groups the ulcers started to heal, with a faster onset of healing for group B. Conclusion: The results of this pilot support published data on the use of collagen dressings compared with foam for stagnating wounds, shown in clinical studies. Declaration of interest: This study was supported with an educational grant by Lohmann & Rauscher GmbH. Apart from Dr Abel, the sponsors had no role in the design or conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript. Dr Abel gave input to the study design from a scientific perspective. None of the authors received administrative, technical or material support for the conduct of this study. The authors have no other relevant financial interests to declare.
Linear scar reduction using silicone gel sheets in individuals with normal healing
Authors: Maher S.F. , Dorko L. , Saliga S. 
Published: May 2014

• Objective: To examine the application of silicone gel sheets on linear scars due to surgical procedures. • Method: Ten individuals, with scars less than 1 year old, participated in the study. The Participant and Observer Scar Assessment Scale (POSAS) was used to evaluate scars on seven characteristics rated by visual analogue scales (VAS). Participants applied silicone gel sheets to half of their scar for 6 months, and every 2 weeks POSAS data forms were completed. Linear mixed-effects analysis of variances (ANOVA) were used to determine if significant differences occurred between groups (treated and untreated scar sides) across the 6 months of data collection. To see if differences were found from the initial evaluation to final visit, Mann-Whitney U tests analysed between-group changes (treated and untreated scar sides), while Wilcoxon signed ranks tests compared within-group changes (evaluation of each scar side over time). • Results: No significant differences in VAS ratings were observed when the two scar sides were compared, with the exception of overall opinion of the scar, as rated by an observer. For each group, significant changes from baseline to study end were observed for colour, stiffness and irregularities, as rated by the participant. Significant improvements for the treated versus untreated group were observed for pliability and pigmentation, as rated by the observer scale. • Conclusion: There was no evidence for improved healing when using silicone gel sheets. The results do not support using silicone gel sheets on linear scars for individuals with no history of abnormal scarring. • Declaration of interest: Funding for this study was provided by a grant from Oakland University Honors College. However, the authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
More effective cell-based therapy through biofilm suppression
Authors: Wolcott R.D. , Cox S. 
Published: May 2014

Objective: To determine if targeted biofilm suppression of a specific wound improves the efficacy of cell-based therapy (CBT). Method: A retrospective study designed to compare a cohort of patients who received CBT in conjunction with biofilm-based wound management with published outcomes from randomised controlled trials in the literature, utilising standard care and CBT. Biofilm-based wound management is the use of multiple simultaneous strategies to suppress wound biofilm, specifically targeting the individual wound's bioburden with agents and methods to suppress the wound biofilm and improve wound-bed preparation. Results: A Kaplan-Meier analysis shows that all wound aetiologies receiving biofilm-based wound care and CBT showed better healing than published outcomes at 3 months and 6 months. Overall wound closure for all wound types combined was 79% at 3 months (versus 56% for the literature) and 92% at 6 months (compared with 63–78% in the literature). All wounds that failed to heal showed some improvement with therapy. Conclusion: With adequate biofilm suppression, the entire graft material was observed to remain intact on the surface of the wound and wounds healed faster than reported in the literature. The relationship between improvement of wound biofilm suppression and less degradation of the graft suggests that the wound microbiota plays a significant role in the degradation of applied bioengineered skin. Declaration of interest: There were no external sources of funding for this study. The author has no financial or commercial conflicts of interest to declare.
Electrical stimulation as adjuvant treatment for chronic leg ulcers of different aetiology: an RCT
Authors: Magnoni C. , Rossi E. , Fiorentini C. , Baggio A. , Ferrari B. , Alberto G. 
Published: May 2014

Objective: To investigate the effectiveness of an innovative electrical stimulation (ES) therapy as adjuvant treatment for chronic wounds of various aetiology, in terms of pain and ulcer healing. Method: Patients with chronic limb ulcers were enrolled for the study and randomised into the intervention or control group. The intervention group received conventional treatment plus ES therapy (FREMS; Lorenz Lifetech) while the control group received only conventional treatment. Each ES treatment cycle consisted of 12 sessions performed in 4 weeks (three sessions/week). All patients were treated until full wound healing occurred, or for a maximum of 9 ES cycles, with a 2-week rest between each cycle. Results: A total of 60 patients were enrolled in the study and randomised into the two groups: the intervention group (n=30) and the control group (n=30). During follow-up, some patients terminated the protocol because they reached the ulcer closure before the maximum of 9 cycles. The analysis of the effect of ES on pain and ulcer healing was performed on all patients who underwent at least two consecutive clinical evaluations (two cycles), in order to reach a compatible sample size with the primary objective (one patient withdrew). In both groups, there was a significant reduction of pain compared with baseline (p < 0.05), starting from T6 visit in the first cycle. In particular, there was a significant reduction of pain in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle. Similarly, there was a significant reduction of PUSH tool score in the intervention group compared with the control group after 14 days, and this reduction continued until the end of the second cycle. Conclusion: Data collected in this study support data in the literature. Analysis of longitudinal data analysed by simple models and complex models suggest that the ES therapy had a positive and significant effect on pain reduction (VAS) and on the improvement of ulcer healing process in terms of the PUSH tool total index compared with conventional treatment, and may have induced a significant acceleration of the wound-healing process. Declaration of interest: There were no external sources of funding for this trial. The authors have no financial, commercial or social conflicts of interest to declare regarding the article or its content.
The impact of compression therapy with Unna's boot on the functional status of VLU patients
Authors: de Lima E.L. , Salomé G.M. , de Brito Rocha M.J.A. , Ferreira L.M. 
Published: May 2014

Objective: To assess disability in patients with venous leg ulcers treated with compression therapy with Unna's boot. Method: A descriptive analytic case control study was conducted from June 2010 to May 2011 in an outpatient wound care clinic in interior Brazil. Fifty patients of both sexes, aged 18 years or above, who had had a venous leg ulcer for more than 1 year and a Doppler ankle-brachial index of 0.8–1.0 were selected for the study. Patients were treated with wound dressings and Unna's boot. Disability was assessed using the 20–item Stanford Health Assessment Disability Scale (HAQ–20). Statistical analysis was performed using the Student's t-test, the Kruskal-Wallis test and the chi-square test of independence, all at a significance level of 0.05 (p<0.05). Results: The mean overall HAQ score at inclusion (baseline) was 2.98, indicating impaired functional capacity. After 8 and 12 months of compression treatment with Unna's boot, the mean overall HAQ scores were 1.35 and 1.0, respectively, indicating good functional capacity. Conclusion: Patients with venous leg ulcer reported severe difficulty or serious disability in their daily functioning at baseline; after 8 months of treatment with Unna's boot, these patients were able to perform activities of daily living. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare with regard to the manuscript of its contents.