bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and microbiological efficacy of MDT in the treatment of diabetic foot ulcers
Authors: Tantawi T.I , Gohar Y.M , Kotb M.M , Beshara F.M , El-Naggar M.M 
Published: May 2014

Objective: To assess the clinical and microbiological efficacy of maggot debridement therapy (MDT) in the management of diabetic foot ulcers unresponsive to conventional treatment and surgical intervention. Method: Consecutive diabetic patients with foot wounds presenting at the vascular surgery unit and the diabetic foot unit of Alexandria Main University Hospital were selected for MDT. Lucilia sericata medicinal maggots were applied to the ulcers for three days per week. Changes in the percentage of necrotic tissue and ulcer surface area were recorded each week over the 12-week follow-up period. Semiquantitative swab technique was used to determine the bacterial load before and after MDT. Results: The sample comprised 10 patients with 13 diabetic foot ulcers. The mean baseline ulcer surface area was 23.5cm2 (range 1.3–63.1), and the mean percentage of necrotic tissue was 74.9% (range 29.9–100). Complete debridement was achieved in all ulcers in a mean of 1.9 weeks (range 1–4). Five ulcers (38.5%) were completely debrided with one three-day MDT cycle. The mean reduction in ulcer size was significant at 90.2%, and this occurred in a mean of 8.1 weeks (range 2–12). The mean weekly reduction in ulcer size was 16.1% (range 8.3–50). Full wound healing occurred in 11 ulcers (84.6%) within a mean of 7.3 weeks (range 2–10). The bacterial load of all ulcers reduced sharply after the first MDT cycle to below the 105 threshold, which facilitates healing. Conclusion: The results highlight the potential benefits of MDT in diabetic wound care in developing countries. MDT was proved to be a rapid, simple and efficient method of treating these ulcers. Declaration of interest: None.
Phase 2 study of a new Hydrofiber dressing for superficial chronic or acute wounds
Authors: Faucher N. , Ehrler S. , Vin F. , Dugré T. 
Published: May 2014

Objective: To evaluate the safety and performance of Medicel Tulle Dressing (MTD) in subjects with chronic or acute wounds left to heal by secondary intention. Method: This 28-day, multi-centre, single-arm clinical study was conducted at seven sites in France. Thirty patients with a chronic (n=20) or acute wound (n=10) were treated with MTD and gauze as a secondary dressing. Study treatment lasted 28 days or until healing. Results: Mean baseline wound area was 14.8cm2. There were 103 clinic dressing changes and 220 home dressing changes. Seven adverse events were reported in five subjects, including one treatment-related adverse event of dry scab. No adherence was reported for 66% of clinic dressing changes and 53% of home dressing changes. No trauma was reported for 96% of clinic dressing changes. Mean reduction in wound size was 7.0cm2. Conclusion: In this study, MTD demonstrated good safety results. Additional study is warranted to confirm the clinical utility of MTD in the management of chronic or acute wounds left to heal by secondary intention. Declaration of interest: This study was supported by ConvaTec, a division of ER Squibb & Sons, New Jersey, US.
Pulse oximetry index: a simple arterial assessment for patients with venous disease
Authors: Bianchi J. , Zamiri M. , Loney M. , McIntosh H. , Dawe R.S. , Douglas W.S. 
Published: May 2014

Objective:To provide additional safety data comparing ankle brachial pressure index (ABPI) and pulse oximetry (Lanarkshire Oximetry Index, LOI) as measures of arterial circulation in patients with venous disease of the leg.Method:A total of 107 (195 legs) attending hospital leg ulcer clinics participated in this prospective open study. We attempted to measure brachial and foot arterial pressures in all patients using both the handheld Doppler method (ABPI) and pulse oximeter method (LOI). Features of patients with limbs in which either the ABPI or LOI could not be assessed were documented. ABPI and LOI values were compared, and agreement between the two assessment methods was assessed.Results:We found the LOI measurement to be a simpler technique than Doppler ABPI measurement, with an endpoint less prone to the subjective variability associated with the Doppler method. Of the 195 legs assessed, we obtained LOI in 10 in which an ABPI could not be recorded. LOI could not be recorded in only one leg. There was a linear association (p<0.001) and fair agreement (?=0.303) between LOI and ABPI in the 184 legs in which both ratios could be measured. There was no evident tendency for LOI to read either low or high compared with ABPI.Conclusion:Pulse oximetry LOI is a simple alternative to Doppler ABPI in the screening of patients for arterial disease that could be a contraindication to, or require modification of, compression therapy. It can be measured in some legs that cannot be assessed by Doppler ultrasound.Declaration of interest:None.
Split-skin graft in the management of diabetic foot ulcers
Authors: Mahmoud S.M. , Mohamed A.A. , Mahdi S.E.I. , Ahmed M.E. 
Published: May 2014

Objective: To compare the effects of split-thickness skin grafts versus a conservative wound dressing on the healing times of diabetic foot ulcers and the length of hospital stay. Method: In this prospective case-controlled study, 50 patients consented to skin grafting (graft group) and 50 preferred to be managed by conservative dressings (control group). Wound management in both groups was standardised with regard to the dressing materials (which comprised a multilayer dressing including paraffin gauze and diluted povidone-iodine soaked gauze), wound care and surgeon involvement. Graft take, ulcer recurrence rate and donor-site morbidity were assessed. Healing times and the length of hospital stay were compared between the two groups. Results: A 100% skin graft take was recorded in 84% of the patients on the fifth postoperative day and in 62% on weeks 3 and 8. All patients in the graft group healed completely, but 8% had an ulcer recurrence and 4% a superficial infection within the following year. The mean healing time and mean length of hospital stay were significantly less in the graft group compared with the control group (p<0.001), reflecting results of similar studies. Conclusion: Split-skin grafting is an effective method of managing diabetic foot ulcers as, compared with the conservative dressings used in this study, it reduced healing times and the length of hospital stay, while donor-site morbidity was minimal. Declaration of interest: None.
Prevalence of wounds in a community care setting in Ireland
Authors: McDermott-Scales L. , Cowman S. , Gethin G. 
Published: May 2014

Objective: To establish the prevalence of wounds and their management in a community care setting. Method: A multi-site, census point prevalence wound survey was conducted in the following areas: intellectual disability, psychiatry, GP practices, prisons, long-term care private nursing homes, long-term care, public nursing homes and the community/public health (district) nursing services on one randomly selected day. Acute services were excluded. Formal ethical approval was obtained. Data were collected using a pre-piloted questionnaire. Education was provided to nurses recording the tool (n=148). Descriptive statistical analysis was performed. Results: A 97.2% response rate yielded a crude prevalence rate of 15.6% for wounds across nursing disciplines (290/1,854 total census) and 0.2% for the community area (290/133,562 population statistics for the study area). Crude point prevalence ranged from 2.7% in the prison services (7/262 total prison population surveyed) to 33.5% in the intellectual disability services (72/215 total intellectual disability population surveyed). The most frequent wounds recorded were pressure ulcers (crude point prevalence 4%, 76/1,854 total census; excluding category l crude point prevalence was 2.6%, 49/1,854 total census), leg ulcers (crude point prevalence 2.9%, 55/1,854 total census), self-inflicted superficial abrasions (crude point prevalence 2.2%, 41/1,854 total census) and surgical wounds (crude point prevalence 1.7%, 32/1,854 total census). Conclusion: These results support previous international research in that they identify a high prevalence of wounds in the community. The true community prevalence of wounds is arguably much higher, as this study identified only wounds known to the nursing services and excluded acute settings and was conducted on one day. Declaration of interest: None.
The PREPARE pilot RCT of home-based progressive resistance exercises for venous leg ulcers
Authors: Jull A. , Parag V. , Walker N. , Maddison R. , Kerse N. , Johns T. 
Published: May 2014

Objective: To establish the feasibility of conducting a home-based progressive resistance exercise programme to improve calf muscle pump function in community-based patients with venous leg ulcers. Method: Participants were randomised to receive a 12-week progressive resistance exercise programme using heel raises in addition to compression. The control was usual care in addition to compression. Randomisation was stratifi ed by ulcer duration and ulcer size. Air plethysmography was used to determine changes in calf muscle pump function from baseline. Changes in ulcer parameters were measured using the SilhouetteMobile device. Results: Forty participants were randomised. There were significantly greater improvements in ejection fraction of the calf muscle in the exercise group compared with the control (usual care) group (mean difference 18.5%, 95% CI 0.03 to 36.6%, p<0.05). Other parameters improved in the exercise group but the mean differences were not significant. Adherence with prescribed exercises was 81% and there was no significant difference in the numbers reporting adverse events. There were also no significant differences in ulcer healing parameters (change in area, percentage change in area, number healed at 12 weeks, time to healing). Conclusion: A community-based randomised trial of progressive resistance exercise is feasible. The prescribed exercises appeared to increase ejection fraction, but the effect of exercise on ulcer healing requires further investigation. Declaration of interest: The study was funded by the Health Research Council of New Zealand. ARANZ Medical provided access to a SilhouetteMobile device.
Using a novel wound model to investigate the healing properties of products for superficial wounds
Authors: Wigger-Alberti W. , Kuhlmann M. , Ekanayake S. , Wilhelm D. , Buettner H. , Callaghan T. , Wilhelm K.P. 
Published: May 2014

Objective:To establish a new wound model that can induce uniform abrasions and use it to assess the healing properties of a range of products commonly applied to these wounds.Method:Ten healthy volunteers were enrolled into an open-label, randomised, intra-individual comparison pilot study. Five standardised, superficial abrasions were induced on their forearms by repeatedly scrubbing the skin with a surgical brush until the first signs of uniform glistening and punctuate bleeding were observed. Three products that promote a moist wound environment (polyurethane, hydrocolloid, hydrogel) and two standard plasters were randomly allocated to the test areas.Results:Evaluation of wound healing on days 2, 5, 8 and 14 ±1 showed best results for the polyurethane and hydrocolloid plasters. Visible re-epithelialisation was recorded on days 5 and 8. More than 50% of the wound area had closed. Video microscope images support these findings. The investigator and volunteers assessed cosmetic outcomes on day 31 ±2. Best results were obtained for the polyurethane and hydrocolloid products, which had high mean scores close to the maximum of 10. Histological examination of biopsies taken from the abrasions of two volunteers showed the dermis remained intact, making the model highly suitable for the study of superficial wounds.Conclusion:Uniform and identical standardised wounds created using an abrasive brush technique can be used to reliably detect differences in the performance of plasters intended for superficial wounds. In general, products that promote a moist wound environment produced better results than those that promote a dry wound environment, with an earlier onset of healing and better healing outcomes. Superficial cutaneous wounds treated with polyurethane or hydrocolloid products demonstrated superior rates of re-epithelialisation and overall cosmetic outcomes.Declaration of interest:This study was funded by Beiersdorf AG. Neither author has any interest in the sponsor's commercial activities.
The resource costs of wound care in Bradford and Airedale primary care trust in the UK
Authors: Vowden K. , Vowden P. , Posnett J. 
Published: May 2014

Objective: To estimate the resource costs of providing wound care for the 488,000 catchment population of the Bradford and Airedale primary care trust (PCT). Method: A wound survey was carried out over a one-week period in March 2007 covering three hospitals in two acute trusts, district nurses, nursing homes and residential homes within the geographical area defined by the PCT. The survey included information on the frequency of dressing change, treatment time and district nurse travel time. The resource costs of wound care in the PCT were estimated by combining this information with representative costs for the UK National Health Service and information on dressing spend. Results: Prevalence of patients with a wound was 3.55 per 1000 population. The majority of wounds were surgical/trauma (48%), leg/foot (28%) and pressure ulcers (21%). Prevalence of wounds among hospital inpatients was 30.7%. Of these, 11.6% were pressure ulcers, of which 66% were hospitalacquired. The attributable cost of wound care in 2006–2007 was £9.89 million: £2.03 million per 100,000 population and 1.44% of the local health-care budget. Costs included £1.69 million spending on dressings, 45.4 full-time nurses (valued at £3.076 million) and 60–61 acute hospital beds (valued at £5.13 million). Conclusion: The cost of wound care is significant. The most important components are the costs of wound-related hospitalisation and the opportunity cost of nurse time. The 32% of patients treated in hospital accounted for 63% of total costs. Putting in place care pathways to avoid hospitalisation and avoiding the development of hospital-acquired pressure ulcers and other wound complications are important ways to reduce costs. Declaration of interest: John Posnett is an employee of Smith & Nephew.
Laboratory findings on the exudate-handling capabilities of cavity foam and foam-film dressings
Authors: Thomas S. 
Published: May 2014

Objective To compare the fluid-handling properties of a range of commonly used absorbent foam dressings. Results were analysed to generate broad estimates of wear time, using previously published data for the rate at which exudate is produced by various wound types. Method Test data were produced by an independent, accredited test facility using a series of standard test systems, and submitted to the author for review and interpretation. Results Absorbency values for the cavity foam dressings tested ranged from 11 to 16 grams per 10cm2 sample under the specified test conditions. The increase in dressing volume ranged from 71% to 206%, although this did not always correlate directly with absorbency values. Foam-film dressing tests revealed large variations in product performance. The total fluid handling capacity of dressings (the sum of absorbency and evaporative loss) ranged from approximately 7 to 26 grams per sample. These differences are largely due to variations in permeability of the film backing layer, which ranged from approximately 2000 to 20 000g/m2/24h. Compression reduced the absorbency of most dressings but it appeared to enhance the performance of one product (possibly through ensuring contact between the test sample and the simulated wound bed). 9 of the 11 sheet dressings tested were estimated to be capable of managing normal levels of wound exudate for 48 hours, based solely on their absorbency figures. Considering the additional effects of moisture vapour permeability, theoretical wear time increases to five days in a number of instances. Conclusion The laboratory data suggest considerable differences in the clinical performance of dressings. Making a number of assumptions as stated in the text, predicted values for clinical performance were generated. These estimates show marked differences between dressings. Declaration of interest This report was produced by the author for a professional fee, from BSN, as a medical device consultant and medical writer using test data generated independently by an accredited laboratory. The author had no involvement either with the choice of test methods, or the range of dressings included in the study, and has no fi nancial interests in any of the products concerned.
Manuka honey as an effective treatment for chronic pilonidal sinus wounds
Authors: Thomas M. , Hamdan M. , Hailes S. , Walker M. 
Published: May 2014

Objective: A retrospective study to investigate the effectiveness of topical manuka honey in the treatment of chronic or recurrent pilonidal sinus disease (PSD), assessing the ability of this simple dressing technique to achieve complete wound healing, the time taken to achieve healing and the recurrence rate. Method: All patients who received manuka honey dressing therapy following surgical intervention for chronic or recurrent PSD were identified over a 4-year period. In a retrospective review of case notes, data were collected on patient sex, age, nature of surgical procedures performed, time to achieve complete wound healing, and recurrences after completion of honey therapy. Results: Seventeen patients were eligible for inclusion in the study. Mean time to commence honey therapy post-surgery was 93 days (5–517 days; median 33 days); 15 patients achieved complete wound healing, in a mean time of 65 days (14–264 days; median 49 days). Honey was discontinued in one patient due to an adverse event, and two patients experienced recurrence several months after completing honey therapy. Conclusion: Manuka honey dressing therapy provides an effective topical treatment for chronic/recurrent PSD. Further research is necessary to determine the optimum dressing protocol. Declaration of interest: The authors have no conflicts of interest to declare. There were no external sources of funding for this study.
Fact or myth? Pain reduction in solvent-assisted removal of adhesive tape
Authors: van Schaik R. , Rovekamp M.H. 
Published: May 2014

•Objective: To determine if solvent-assisted tape removal reduces pain when compared with dry tape removal. •Method: A double-blinded comparative study was performed, in which commonly used solvents, namely water, alcohol, peanut oil, sunflower oil, and Leukotape remover (BsN medical), were applied to six zinc oxide adhesive tapes (Leukoplast, BsN medical), 10cm long, 2.5cm wide that had been placed on the volar side of each forearm of adult volunteers. One tape was left dry. Pain was measured using a visual analogue scale (vAs) and statistically analysed. •Results: There were no statistically significant differences in vas pain scores between the used substances when compared with the dry tape (p=0.39). The use of oil (peanut and sunflower) caused remains of adhesive to occur significantly more often (p < 0.05). •Conclusion: Applying substances to ease pain associated with the removal of adhesive tapes does not lead to a reduction of pain when compared with dry tape. •Conflict of interest: none.
Extended leg infection of diabetic foot ulcers: risk factors and outcome
Authors: Adam K.M. , Mahmoud S.M. , Mahadi S.I. , Widatalla A.H. , Shawer M.A.G. , Ahmed M.E. 
Published: May 2014

Objective: To identify the risk factors for extension of infection to the leg in diabetic foot ulcers (DFU) and to evaluate its role as a prognostic measure regarding limb salvage and healing time. Method: This retrospective case-control study took place in Jabir Abu Eliz Diabetic (JADC) during 2006–2008. Forty-eight patients diagnosed with a diabetic foot ulcer (DFU) with the infection extending to the leg (case group) were compared with an equal number of patients with a DFU without extension (control group). risk factors for extension were identified by univariate analysis and both groups were compared with regard to limb salvage and healing time. Results: Previous history of toe amputation was more frequent in the case group (p=0.004). the case group patients were significantly more likely to present with fever (p=0.01), pallor (p=0.02), confusion (p=0.04), and necrosis (p=0.004). Ulcers located in the heel were more frequent in the case group when compared with controls (p=0.0001) while more toes ulcers were found in the control group (p=0.001). A significant number of patients in the case group had an ulcer of more than 5cm diameter compared with those in the control group (p=0.001). the total number of patients presented with severe disease (Wagner grade 3–5) was significantly more in the case group compared with controls (p=0.004). patients with severe infection (grade 4) were more in the case group compared with the controls (p=0.04). there were no significant differences between the two groups with regard to major and minor amputation rate. the case group had a longer duration of healing when compared with the controls. seventy-five per cent of the controls healed by 6 months (n=31) compared with 22% in the case group (n=8; p=0.001). Conclusion: Toe amputation, wound located in the heel, wound size more than 5cm and advanced Wagner grade (3–5) and severe sepsis, grade 4, may be considered as risk factors for extension of infection to the leg in DFU. However, this extension did not carry a poor prognostic value to the final outcome if adequate therapeutic measures were followed. Conflict of interest: None.
Case series of sural island flaps used for soft-tissue defects of the distal-third lower extremity
Authors: Steffner R.J. , Spiguel A. , Ranieri J. , Suk M. , Yoo B.J. 
Published: May 2014

Objective: To establish the sural island fasciocutaneous flap as an initial consideration for distal third lower-extremity soft tissue coverage and to provide non-plastic surgeons with a procedure they can perform on their own. Method: Literature on reverse sural island fasciocutaneous flaps was reviewed and summarised. We then assessed our case series of sural island flaps from 2008–2011 and looked to provide our operative technique and patient outcomes. Results: Nine patients, aged 12–70 years old, with greater than 1 year follow-up, were reviewed. Five patients had diabetes, peripheral vascular disease, or smoked tobacco. All patients healed their soft tissue coverage with minimal complication and were able to accommodate normal footwear. Conclusion: Reverse sural island flaps are resilient flaps that should be considered as an alternative to free muscle transfer, for distal third lower extremity coverage. Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.