bluuebunny/crossref_metadata_2025_split huggingface dataset:
The use of proteases as prognostic markers for the healing of venous leg ulcers
Authors: Hoffman R. , Noble J. , Eagle M. 
Published: May 2014

Abnormally high levels of some proteases are associated with pathological changes in the wound bed of venous leg ulcers. This study involved two experiments which measured proteases in wound fluid harvested from leg ulcers in order to predict healing. In the first experiment, neutrophil elastase, a protease, was harvested from wound fluid extracted from the bandages of seven patients with leg ulcers. This was undertaken once a week over a period of up to six weeks. The amount of elastase recovered from the bandages showed wide variation between patients and there was no consistent correlation between the activity of elastase and healing of the ulcers, as determined nine months after sampling for the enzyme. The second experiment determined the stability of neutrophil elastase that was added to bandages for one week. The stability was found to vary from approximately 50% to 100%, depending on the type of bandage used. In addition to the possibility of using protease measurements to predict healing, the procedure was found to be simple, non-invasive and relatively inexpensive, and could be performed routinely in the clinic.
Flap monitoring after head and neck reconstruction: evaluating an observation protocol
Authors: Devine J.C. , Potter L.A. , Magennis P. , Brown J.S. , Vaughan E.D. 
Published: May 2014

This study evaluated the postoperative free-flap monitoring frequency protocol used in a maxillofacial unit for patients receiving free-tissue transfer for reconstruction following orofacial cancer. All free-tissue transfers undertaken in the unit between January 1992 and October 1998 were reviewed retrospectively. Of the 370 patients evaluated, 46 returned to theatre with compromised free flaps. The compromise was purely venous in origin in 37 of these cases, arterial in three and due to a combination of arterial and venous problems in six. Thirty-five of the flaps were successfully salvaged. On average, the clinical manifestation of the problem occurred 25.5 hours postoperatively. However, there was a significant time difference between flaps that were salvaged successfully and those that were not: in the salvaged group the compromise was identified 17.5 hours postsurgery compared with 51 hours for the unsuccessful group. The timing of the return to theatre following the identification of the compromise was a significant factor in the success rate: 71 minutes for those salvaged and 103 minutes for those not salvaged. It is recommended that flaps are monitored hourly for the first 72 postoperative hours and observations recorded on a chart.
Malignant wound management: what dressings do nurses use?
Authors: Wilkes L. , White K. , Smeal T. , Beale B. 
Published: May 2014

This paper reports on the findings from the first part of a three-phase project that aimed to identify nursing strategies used in the management of malignant wounds. The difficulties relating to the management of these wounds and the significant physical and psychological impact on patients are described. A quantitative postal survey aiming to identify the types of dressing used in the care of malignant wounds was sent to specialist nurses working in oncology and palliative care in New South Wales, Australia. Additional qualitative data showed that the major issues were coping with odour and meeting the financial costs of the dressing products. The long list of products compiled for this research demonstrates the complexities nurses face when selecting dressings for the management of malignant wounds. Furthermore, there are no clear recommendations to guide nursing practice. This study provides a framework for subsequent phases of the project and will hopefully lead to the development of guidelines for best practice in malignant wound management.
Nutritional supplementation for diabetic foot ulcers: the first RCT
Authors: Eneroth M. , Larsson J. , Oscarsson C. , Apelqvist J. 
Published: May 2014

Objective: To determine if oral nutritional supplementation improved wound healing in malnourished patients with diabetic foot ulcers when compared with a placebo. Method: This prospective randomised controlled double-blind trial involved patients aged over 60 with diabetes mellitus and a Wagner grade I–II foot ulcer of over four weeks’ duration. Patients received either 400ml (400kcal) oral nutritional supplementation (n=26) or 400ml placebo (n=27) daily for six months. Patients were followed monthly for six months and after one and two years. Results: A third of the patients were classified as having protein-energy malnutrition at inclusion, with no difference between the two groups. Critical leg ischaemia was more common in the intervention group than in the placebo group (p=0.008). Nine patients in the intervention group (35%) and four in the placebo group (15%) dropped out of the study (not significant). Of those who completed the study, the wound had healed at six months in eight out of 23 patients (41%) (placebo) and in seven out of 17 (35%) (intervention) (not significant). Twenty-four per cent of patients with protein-energy malnutrition at inclusion had healed at six months compared with 50% of those without it (not significant). Conclusion: This is the first study to evaluate the possible benefits of nutritional supplementation on diabetic foot ulcers. A third of patients were malnourished. We encountered several methodological problems and were unable to demonstrate an improved wound healing rate in these patients. Declaration of interest: This study was sponsored by a grant from Nutricia AB, Netherlands.
Evaluation of the quality of venous leg ulcer care given in a multidisciplinary specialist centre
Authors: Kjaer M.L. , Sorensen L.T. , Karlsmark T. , Mainz J. , Gottrup F. 
Published: May 2014

Objective:To determine the quality of venous leg ulcer care given in a multidisciplinary, specialist wound-healing centre and to identify problem areas that might affect it.Method:The case records of 90 consecutive patients with venous leg ulcers, diagnosed and treated at the Copenhagen Wound Healing Centre, Denmark, were retrospectively audited by a Scandinavian cross-sectional and multidisciplinary expert panel. Quality of care was audited in each case using implicit criteria. The experts then formulated key recommendations for good clinical practice for patients with venous leg ulcers.Results:Quality of care was satisfactory in 74 patients (82%). The one-year healing rate was 77% (69/90), with a three-month recurrence rate of 12% (11/90). Identified problem areas included the lack of systematic assessment of patients’ suitability for surgery; lack of systematic, duplex-verified diagnoses of venous aetiology; and the lack of systematic examination of distal arterial pressure. The recommendations include the need for venous diagnosis, differential diagnosis, compression therapy, surgery, systemic treatment, access to venous leg ulcer care and better communication.Conclusion:The quality of venous leg ulcer care given in this multidisciplinary centre was satisfactory.Declaration of interest:None.
The impact of warming on pain and wound healing after hernia surgery: a preliminary study
Authors: Melling A.C. , Leaper D.J. 
Published: May 2014

Objective: To determine whether the application of warmth after hernia surgery reduces pain and aids wound healing. Method: Forty-five patients were recruited and randomised to receive either no warming; two hours of warming immediately after surgery; or seven days of warming. Results: Postoperative pain scores were significantly lower after two hours of warming immediately after surgery compared with the non-warmed patients (p<0.05). Pain scores were lower on each of the first seven postoperative days in the warmed groups compared with the non-warmed subjects. Patients in the warmed groups also had lower ASEPSIS wound scores. Conclusion: Warming may allow wounds to heal with fewer complications. In addition, warming for only two hours immediately after surgery may provide similar benefits to seven days of warming. Declaration of interest: This study is part of a research programme part-funded by a competitive research grant from Augustine Medical, which also provided warming equipment at no cost. Since the study was conducted, DJL has become an independent adviser to Arizant (formerly Augustine Medical).
Biophysical effects of repetitive removal of adhesive dressings on peri-ulcer skin
Authors: Zillmer R. , Agren M.S. , Gottrup F. , Karlsmark T. 
Published: May 2014

Objective:To study the effect of repeated removal of four different adhesive dressings on peri-ulcer skin using quantitative non-invasive techniques.Method:Forty-five patients with open (n=29) or healed (n=16) venous leg ulcers were included. Peri-ulcer skin was treated for 14 days with patches of two different hydrocolloid-based adhesive dressings, one polyurethane adhesive and one soft silicone adhesive dressing. Normal skin of the patients’ ventral forearm was also treated identically. Adhesive patches of the dressings were replaced every second day. The skin barrier function was assessed by measuring transepidermal water loss and stratum corneum hydration by measuring electrical conductance.Results:Thirty-nine patients completed the study. The hydrocolloid adhesives increased transepidermal water loss and conductance while the polyurethane and soft silicone adhesives did not influence these parameters significantly compared with adjacent non-treated peri-ulcer skin. For normal forearm skin, similar relative effects among the four adhesives were found.Conclusion:Repetitive treatment with hydrocolloid-based adhesive dressings induced major functional alterations of the stratum corneum. In contrast, a polyurethane adhesive and a soft silicone adhesive dressing did not alter transepidermal water loss or conductance of peri-ulcer skin.Declaration of interest:This study was funded by Mölnlycke Health Care AB, Göteborg, Sweden.
Effect of enzymatic debridement with collagenase on acute and chronic hard-to-heal wounds
Authors: Marazzi M. , Stefani A. , Chiaratti A. , Ordanini M.N. , Falcone L. , Rapisarda V. 
Published: May 2014

Objective: A large retrospective analysis was performed to assess the outcomes of burns and chronic ulcers treated with collagenase in an outpatient setting. No cost comparison was performed. Method: Of 979 patients entered into the analysis, 647 had burns affecting ≤15% body surface area (BSA) and 332 had chronic ulcers of various aetiologies. All were treated with collagenase-based ointments once daily (Noruxol or Iruxol, Smith & Nephew). Treatment was continued until complete healing was achieved. Results: In burns patients the overall average healing time was 17.9 days in the paediatric population and 23.6 days in adults. Burn depth and presence of eschar were the main factors affecting healing probability. The chronic ulcers were predominantly of diabetic, venous and mixed aetiology. Average healing time was 15.4 weeks, with ulcers of mixed aetiology showing the shortest average healing time (9.2 weeks). There was a positive correlation between wound area and healing time. The topical application of collagenase-based ointments was well tolerated by patients and caregivers. Conclusion: This large retrospective analysis shows that collagenase treatments in outpatient clinics are effective and well accepted in patients with burns affecting ≤15% BSA or with chronic ulcers of various aetiologies. Implementation of collagenase treatments in outpatient clinics has the potential to improve wound healing and may also decrease the cost of wound care. Declaration of interest: The statistical evaluation was supported by Smith & Nephew. All materials were hospital acquired and the authors have no conflict of interest.
Effect of placental-extract gel and cream on non-healing wounds
Authors: Tiwary S.K. , Shukla D. , Tripathi A.K. , Agrawal S. , Singh M.K. , Shukla V.K. 
Published: May 2014

Objective: To compare the effects of topical placental-extract gel and cream in the treatment of chronic non-healing wounds with regard to wound healing and discomfort during dressing change. Methods: A sample of 120 patients attending the wound clinic at University Hospital, Varanasi, India, with wounds of more than six weeks’ duration were enrolled into the study. They were alternately allocated to group A (topical application of placental-extract gel) or group B (placental-extract cream). Wound biopsy was performed, and swab culture and sensitivity were taken. Wound size was measured, and visual analogue scale (VAS) scores for pain and discomfort at dressing change were recorded at weekly follow-up in both groups. Biopsy was repeated after two weeks of treatment and sent for histopathological examination for assessment of angiogenesis in 25 cases from each group. Results: One hundred patients completed the study. More than 50% wound healing was observed after eight weeks in 72% of group A patients and 74% of group B patients (p=0.75). Microscopic angiogenesis grading system (MAGS) scores were similar in both groups (not statistically significant, p=0.92). The VAS scores for pain and discomfort were lower in group B (statistically significant, p<0.02). Conclusion: Placental-extract gel and cream are both effective topical agents for chronic non-healing wounds. However, there is less pain and discomfort during dressing change with the placental-extract cream, which we thus recommend for topical application in chronic non-healing wounds. Declaration of interest: None.
The effect of adhesive dressing edges on cutaneous irritancy and skin barrier function
Authors: Dykes P.J. 
Published: May 2014

Objective: To assess the effect of repeated application and removal of adhesive edges from wound- care products on cutaneous irritancy and barrier function in normal volunteer subjects. Method: This was a study using a ‘repeat-insult patch test’. Adhesive edges from six commonly used wound-care products were applied continuously to the same site (six applications over a 14-day period) in 30 normal volunteer subjects. The test sites were assessed clinically before product reapplication using established ranking scales for cutaneous erythema. The cumulative irritancy score (CIS) for each test site was determined by adding the erythema scores at days 3, 5, 8, 10, 12 and 15. At the study end the barrier function of each test site was assessed by measuring transepidermal water loss (TEWL). Results: The CIS showed that the products fall into two distinct groups, with Mepilex, Tielle and Allevyn giving low scores and Biatain, Comfeel and Duoderm higher scores. Statistical analysis indicated significant differences (p<0.05) between Mepilex and Biatain, Mepilex and Comfeel, Mepilex and Duoderm, Tielle and Biatain, Allevyn and Biatain. The mean TEWL values also indicated that the products fall into two distinct groups: Mepilex, Tielle and Allevyn with low mean values close to that of normal adjacent back skin and Biatain, Comfeel and Duoderm with much higher mean values. Statistical analysis indicated that Mepilex, Tielle and Allevyn were not significantly different from normal skin (p<0.05), whereas Biatain, Comfeel and Duoderm were significantly higher than normal skin and the other products tested. Conclusion: The results show clear differences between products; the clinical scores and TEWL measurements indicate that the products fall into two distinct groups. This novel approach seems able to discriminate between adhesive borders and may be useful during product development and in selecting products for clinical trials. Declaration of interest: This study was supported by a research grant from Mölnlycke Health Care AB, Göteborg, Sweden.
The effects of onion extract on hypertrophic and keloid scars
Authors: Hosnuter M. , Payasli C. , Isikdemir A. , Tekerekoglu B. 
Published: May 2014

Objective: To evaluate the therapeutic activity of topical onion extract in gel form on hypertrophic and keloid scars, focusing on problems such as elevation, redness, hardness, itching and pain. Method: This comparative prospective study assigned 60 patients to three groups. Group 1 was treated with onion extract alone, group 2 with silicon gel sheet alone and 3 group with a combination of onion extract and silicon gel sheet. Results: In the group comparisons, a significant difference was observed at the end of six months in the colour parameter between group 1 and group 2 and in the height parameter between group 1 and group 3 (ANOVA post-hoc Tukey’s test, p<0.01 and p<0.05 respectively). The onion extract was more effective in relation to scar colour, while the silicon gel sheet was superior in decreasing the height of scar (paired sample t-test, p<0.001). In addition, the most effective therapeutic results were obtained when the silicon gel sheet treatment was combined with onion extract in group 3. Conclusion: Onion extract improved hypertrophic and keloids scars via multiple mechanisms. However, it was statistically ineffective in improving scar height and itching. For this reason, onion extract therapy should be used in combination with an occlusive silicon dressing to achieve a satisfying decrease in scar height. Declaration of interest: None.
Efficacy, safety and acceptability of a new two-layer bandage system for venous leg ulcers
Authors: Benigni J.P , Lazareth I , Parpex P. , Gerard J.L , Alves M , Vin F , Meaume S , Senet P , Allaert F.A , Sauvadet A , Bohbot S 
Published: May 2014

Objective: To evaluate the efficacy, tolerability and acceptability of a new two-bandage compression system in the local management of venous or mixed aetiology ulcers predominantly of venous origin. Method: This was a prospective non-comparative open label phase III clinical study. Forty-two patients were recruited from 12 centres. Inclusion criteria included ulcers with at least 50% granulation tissue, a surface area of 2–20cm2, an ulcer duration of 1–24 months, an ankle circumference of less than 28cm, and no history of deep vein thrombosis in the three months before enrolment. The primary endpoint was reduction in ulcer surface area, and secondary endpoints were the evolution of leg oedema and patient comfort. During the six-week follow-up, patients underwent weekly clinical assessments and their ulcer surface area was measured by planimetry and photography every alternate week. Results: The mean ulcer surface area at inclusion was 7 ± 6cm2. The mean surface reduction after six weeks was 58.5%, with 24% of the treated wounds healing in a mean time of 25.9 ± 9.46 days. The patients considered that the new compression system had a better effect on quality of life, evaluated by parameters such as pain, heat, itching and general comfort, than the system worn before entry into the study. Patient concordance with the new system was excellent and 86% of leg ulcers improved or healed after six weeks. Local tolerance was considered very good. Conclusion: This new two-bandage compression system is effective and well accepted by patients. Declaration of interest: This study was sponsored by Laboratoires Urgo, Chenôve, France.
Can duplex arterial ultrasonography reduce unnecessary angiography?
Authors: Elgzyri T. , Ekberg G. , Peterson K. , Lundell A. , Apelqvist J. 
Published: May 2014

Objective:To assess the value of arterial duplex ultrasound, which assesses the location and severity of arterial disease, in determining whether invasive vascular intervention is required.Method:A total of 166 consecutive diabetic patients presenting at a multidisciplinary foot clinic with severe peripheral vascular disease, with or without a foot ulcer, were included in this prospective study. The choice of vascular intervention was based on the results of a duplex ultrasound examination. Subjects were followed up for two years, and their clinical management, vascular assessments and interventions given, and patient outcomes were recorded in a specially designed protocol.Results:Based on findings of the duplex ultrasound, it was recommended that 55 patients (33%) should undergo angioplasty (percutaneous transluminal angioplasty [PTA] and/or subintimal recanalisation), 64 patients (39%) diagnostic angiography and 47 patients (28%) medical treatment only, thereby avoiding unnecessary angiography and its potential complications. Diagnostic angiography was recommended when the duplex ultrasound results were inconclusive. Fifty-two of the 55 patients recommended angiography with simultaneous angioplasty had an angiography; of these, 42 (81%) then had an angioplasty. Fifty-seven of the 64 patients with inconclusive results had an angiography. Of these, 23 (40%) subsequently had angioplasty, only 10 (18%) had reconstructive surgery and 24 (42%) had a diagnostic angiography only.Conclusion:Arterial duplex ultrasound may assist evaluations of the need for and type of invasive vascular intervention in patients with an ischaemic diabetic foot. It can thus help avoid diagnostic angiographies that do not result in vascular intervention. However, such decision-making remains at the discretion of the vascular surgeon and radiologist.Declaration of interest:None.
A national prevalence study of pressure ulcers in French hospital inpatients
Authors: Barrois B. , Labalette C. , Rousseau P. , Corbin A. , Colin D. , Allaert F. , Saumet J.L. 
Published: May 2014

Objective: To ascertain pressure ulcer prevalence rate in French hospitals. Method: In 2004, a cross-sectional study was conducted in all French hospitals, except university hospitals. The National Pressure Ulcer Advisory Panel (NPUAP) staging was used. Data were collected using two self-administered questionnaires. Results: A total of 37,307 inpatients in 1170 wards in 1149 hospitals were assessed, representing a response rate of 93.5%. Their mean age was 72.3 years and 62% were females. In all, 3314 patients had at least one pressure ulcer, giving a prevalence rate of 8.9%. A total of 4991 pressure ulcers were recorded; 64% of the patients had only one pressure ulcer. Fifty-five per cent of the patients had at least two concomitant diseases. When patients with only one ulcer were assessed, the most common locations were the heels (53%) and sacrum (29%). Heel pressure ulcers were more common in patients with obliterative arterial disease, and sacral pressure ulcers were more frequent in incontinent (urine, faecal and double incontinence) patients. Patients with multiple pressure ulcers had more severe lesions. Conclusion: These results indicate that the prevalence of pressure ulcers in French hospital inpatients has remained stable since the last prevalence study undertaken 10 years before, when the rate was 8.9%. Such studies should be encouraged in all health-care settings as a means of improving the care provided. Declaration of interest: None.
Are bioploymers potential deodourising agents in wound management?
Authors: Lee G. , Anand S.C. , Rajendran S. 
Published: May 2014

Objective: To investigate the odour-adsorbing properties of biopolymers, with a view to using the findings to develop a novel dressing with odour-adsorbing properties. Method: The odour-adsorbing properties of a selection of biopolymers (aloe vera, tea tree oil, neem oil and manuka honey) and three commercially available dressings containing activated charcoal cloth (ACC) were quantitatively assessed using laboratory test equipment. An aloe vera-containing composite dressing, designed and developed by the authors, was also compared with the ACC dressings. Results: Aloe vera was the most adsorbent of the biopolymers and a 40% dilution had comparable values to those of the ACC dressings. Furthermore, values for the novel composite dressing were similar to those of the ACC dressings. Conclusion: The novel composite dressing may be a potential alternative to ACC dressings, and has the added advantages of having antimicrobial properties as well as the ability to promote a moist wound environment. However, more research is needed. Declaration of interest: The Engineering and Physical Sciences Research Council (EPSRC) and Lantor (UK), Bolton, supported the study. The Surgical Materials Testing Laboratory (SMTL) loaned the test equipment.