Hydrogel dressings for venous leg ulcers

Updating Wound Care Algorithms: A Systematic, Focused Review

PURPOSE

The purpose of this project was to update the underlying evidence base for basic wound care in the Solutions Wound Care Algorithms and revise this resource as needed.

METHODS

The 14 major algorithm goals, guidelines, and outcomes of patient care and 34 detailed qualifying assessment and management statements/steps were reconstructed to encompass 21 qualifying statements/steps and aligned with their most recent (2013) levels of evidence. Next, a systematic, focused review of the literature was conducted to update the evidence levels using the Strength of Recommendation Taxonomy.

SEARCH STRATEGY

An English language search of CINAHL, Medline, Cochrane Library, and Joanna Briggs Institute (JBI) electronic databases was conducted for the years 2015-2023. For each wound type, the following search terms were used: meta-analysis, systematic review, randomized controlled trial, clinical practice guideline, clinical trial, and wound care/healing and dressings. Publications not focused on the patient population or qualifying statements were excluded.

FINDINGS

The search retrieved 59 elements that met the predetermined criteria for analysis and leveling. All qualifying statements and steps remain evidence-based. Higher quality evidence became available for nutritional status assessment, exercise to reduce risk factors for various types of lower extremity ulcers, using tap water to cleanse wounds; that delayed wound healing may be a sign of infection, and that silver-containing dressings are effective when used appropriately. No basic patient and wound care steps have the highest level of evidence (level 1) and strength of recommendation (A).

CONCLUSION

Compared to previous updates, we found fewer clinical trials indicating a need for research to improve evidence levels for various steps of basic wound assessment and care processes.

The (dis)organization of leg ulcer care: A realist synthesis

BACKGROUND

Venous leg ulcers affect 1.5% of the UK adult population. Leg ulcers are painful, can be malodourous and are associated with poor quality of life. Leg ulcers are predominantly cared for by nurses in the community. Frequently, patients receive suboptimal treatment through unwanted variations in care and simple ulcers deteriorate to become hard-to-heal wounds. It is important to understand the current UK system of care and how nurses and patients navigate through it.

AIM

The aim of this paper was to understand how, when, for whom and in what context leg ulcers are cared for in the United Kingdom and specifically, the current system of care, the nurses' role and the patients' experience in this system of care.

DESIGN

A realist synthesis of the literature was undertaken, reported following the RAMESES publication standards: Realist syntheses.

DATA SOURCES

An iterative literature search was conducted across three recognized health collections from January 2010 to January 2022 that included descriptive studies as well as primary research.

RESULTS

73 papers were included.

CONCLUSION

In the absence of UK national guidance that recommends how leg ulcer care is organized and delivered, care is commissioned locally, with variable outcomes. Patients with venous leg ulcers would like to be looked after by knowledgeable, skilled and confident nurses, in well-equipped and staffed clinics; nurses who have the ability to make clinical judgements to alter their treatment when necessary and are empowered to refer to specialist centres when further support is required.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This synthesis offers guidance to commissioners and providers to change how leg ulcer care is organized.

PATIENT OR PUBLIC CONTRIBUTION

The views of a patient and public group was sought at each stage of the synthesis.

Pyolytics as a product of the physical–chemical repurposing of antiseptics and an alternative to larval therapy for chronic wounds

The traditional treatment of chronic wounds involves daily cleansing of the wound surface from purulent necrotic masses using mechanical and medicinal methods, accompanied by regular replacement of wound dressing. In this case, medicinal wound cleansing lasts 10–15 mins from the time of replacement of the old wound dressing with the new one. According to established practice, medicinal sanitation of infected and purulent wounds during dressing involves irrigation of the wound surface with cleansing solutions, antiseptics, and/or antibiotics. In severe cases, the above therapy is supplemented with live larvae of the necrophage fly, which are injected into purulent necrotic masses and left in them under wound dressing until wounds are completely cleansed from pus. Nevertheless, the generally accepted course of treatment of chronic wounds remains ineffective. The use of pyolytics and their supplementation with wound dressings in the form of warm wet compresses, which create a local greenhouse effect in wounds, was reported to accelerate the healing of chronic wounds. Pyolytics are a group of antiseptics developed in Russia. They are warm alkaline solutions of hydrogen peroxide; when they interact with purulent necrotic masses, these solutions dissolve very quickly and foam them. Because of the interaction with pyolytics, thick purulent masses immediately turn into fluffy oxygenated foam. Pyolytics have been developed because of the physicochemical repurposing of aqueous solutions of sodium hydrogen carbonate and hydrogen peroxide. To accelerate the healing of chronic wounds, a recommendation was to irrigate the surface of chronic wounds with 3% hydrogen peroxide and 2–10% sodium bicarbonate solutions, heated to 37–45°C, which have alkaline activity at pH 8.4–8.5 and are enriched with dissolved carbon dioxide or oxygen (due to excess pressure of 0.2 atm). This study presented the importance of treating chronic wounds using politics and treatment outcomes using pyolytics along with warm moist dressing compresses, demonstrating a wound-healing effect. Consequently, physical and chemical reprofiling of antiseptics may make them effective pyolytics, and the combination of pyolytics with warm wound dressings such as warm moist compresses, which create a local greenhouse effect on wounds, accelerates the healing of chronic wounds.

Determining the measurement accuracy in assessing the progress of wound healing

Introduction

Wound management is a challenge in terms of the way, duration and cost of treatment both for the patient and health providers. The healing of skin wounds is a highly multi-step coordinated process. Objective monitoring of treatment at every stage is necessary to assess the applied therapy.

Aim

To show the possibility of using the AutoCad software (ACS) as a tool with a slight measurement error for accurate measurement of the venous leg ulcers on the lower limbs.

Material and methods

To determine the error of the measurement method Circle Templates For Drafting for four different sizes were used as ulcer models. Seventy-six wounds of various sizes from patients with venous leg ulcers (VLUs) were photographed and outlined with a marker on a transparent foil. The wounds were measured both using ACS and digital planimetry with C-Geo software (CGS). Data were analysed using Wilcoxon test, intraclass correlation coefficient (ICC) and Bland-Altman analysis.

Results

The mean relative error of the surface wound model area measured by the ACS was 0.30 ±0.31% (range: 0.004-1.25) and a median of 0.18%. Areas and perimeters measured with ACS were higher than areas and perimeters measured with CGS, and the difference was statistically significant.

Conclusions

The analysis of the wound images obtained in the ACS showed a very high potential of the software in terms of the accuracy of the analysed areas, which significantly increases the possibility of the analysis and reduces the measurement error in relation to planimetry using a digital digitizer.