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Probst S, Saini C. Microjet wound therapy versus sharp debridement on wound size reduction: a pilot randomised controlled trial. J Wound Care 2024; 33:357-364. [PMID: 38683777 DOI: 10.12968/jowc.2024.33.5.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE There are several methods of treating hard-to-heal (chronic) wounds, each differing in terms of efficiency, selectivity, speed, cost and pain. The objective is to activate a wound to initiate the healing cascade. For this pilot study we assessed the feasibility of a new microjet wound therapy technology compared to standard sharp debridement in wound outcomes. METHOD A randomised, controlled, open-label pilot study was conducted in one outpatient wound clinic in Western Switzerland from March 2022 to May 2023. RESULTS A total of 13 consecutive patients were randomly assigned to receive either microjet wound therapy (n=5) or standard mechanical debridement with instruments (n=8). As a feasibility study, there was insufficient power to detect significant differences between the groups. However, in the intervention group, our analysis may indicate a modestly faster reduction in wound area. Microjet wound therapy appears to alleviate patient anxiety and offer cost savings due to the potential for reduced time, as well as the number of required treatments. This meant fewer overall consultations. CONCLUSION This study highlights a trend that may indicate that microjet therapy holds value in promoting faster healing of hard-to-heal wounds, and it provides a feasibility basis for a sufficiently powered multicentre trial.
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Affiliation(s)
- Sebastian Probst
- HES-SO University of Applied Sciences and Arts Western Switzerland
- Geneva School of Health Sciences, Geneva, Switzerland
- Care Directorate, Geneva University Hospitals, Geneva Switzerland
- College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
- Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Camille Saini
- HES-SO University of Applied Sciences and Arts Western Switzerland
- Geneva School of Health Sciences, Geneva, Switzerland
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Dissemond J, Chadwick P, Weir D, Alves P, Isoherranen K, Lázaro Martínez JL, Swanson T, Gledhill A, Malone M. M.O.I.S.T. Concept for the Local Therapy of Chronic Wounds: An International Update. INT J LOW EXTR WOUND 2024:15347346241245159. [PMID: 38571403 DOI: 10.1177/15347346241245159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Chronic wounds remain a significant clinical challenge both for those affected and for healthcare systems. The treatment is often comprised and complex. All patients should receive wound care that is integrated into a holistic approach involving local management that addresses the underlying etiology and provides for gold standard therapy to support healing, avoid complications and be more cost effective. There have been significant advances in medicine over the last few decades. The development of new technologies and therapeutics for the local treatment of wounds is also constantly increasing. To help standardize clinical practice with regard to the multitude of wound products, the M.O.I.S.T. concept was developed by a multidisciplinary expert group. The M stands for moisture balance, O for oxygen balance, I for infection control, S for supporting strategies, and T for tissue management. Since the M.O.I.S.T. concept, which originated in the German-speaking countries, is now intended to provide healthcare professionals with an adapted instrument to be used in clinical practice, and a recent update to the concept has been undertaken by a group of interdisciplinary experts to align it with international standards. The M.O.I.S.T. concept can now be used internationally both as an educational tool and for the practical implementation of modern local treatment concepts for patients with chronic wounds and can also be used in routine clinical practice.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | | | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, NY, USA
| | - Paulo Alves
- Universidade Católica Portuguesa, Institute of Health Sciences - Wounds Research Lab, Lisboa, Portugal
| | - Kirsi Isoherranen
- Department of Dermatology and Allergology, University of Helsinki and Inflammation center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Terry Swanson
- Wound Education Research Consultancy, Warrnambool, Victoria, Australia
| | - Andrea Gledhill
- Department of Podiatric Surgery, Trauma and Orthopaedics, Great Western Hospital NHSFT, Swindon, UK
| | - Matthew Malone
- Research and Development, Molnlycke Healthcare AB, Gothenburg, Sweden
- Infectious Diseases Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
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3
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Moelleken M, Krimphove SH, Krefting F, Benson S, Rammos C, Cyrek AE, Dissemond J. How effective is simple mechanical wound debridement in reducing bacterial colonisation? Results of a prospective clinical study. Int Wound J 2024; 21:e14824. [PMID: 38512118 PMCID: PMC10956538 DOI: 10.1111/iwj.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND AND AIMS Bacteria in wounds can lead to stagnation of wound healing as well as to local or even systemic wound infections up to potentially lethal sepsis. Consequently, the bacterial load should be reduced as part of wound treatment. Therefore, the efficacy of simple mechanical wound debridement should be investigated in terms of reducing bacterial colonisation. PATIENTS AND METHODS Patients with acute or chronic wounds were assessed for bacterial colonisation with a fluorescence camera before and after mechanical wound debridement with sterile cotton pads. If bacterial colonisation persisted, a second, targeted wound debridement was performed. RESULTS A total of 151 patients, 68 (45.0%) men and 83 (55.0%) women were included in this study. The male mean age was 71.0 years and the female 65.1 years. By establishing a new analysis method for the image files, we could document that the bacterial colonised areas were distributed 21.9% on the wound surfaces, 60.5% on the wound edges (up to 0.5 cm) and 17.6% on the wound surroundings (up to 1.5 cm). One mechanical debridement achieved a significant reduction of bacterial colonised areas by an average of 29.6% in the wounds, 18.9% in the wound edges and 11.8% in the wound surroundings and was increased by performing it a second time. CONCLUSIONS It has been shown that even a simple mechanical debridement with cotton pads can significantly reduce bacterial colonisation without relevant side effects. In particular, the wound edges were the areas that were often most contaminated with bacteria and should be included in the debridement with special attention. Since bacteria remain in wounds after mechanical debridement, it cannot replace antimicrobial therapy strategies, but offer a complementary strategy to improve wound care. Thus, it could be shown that simple mechanical debridement is effective in reducing bacterial load and should be integrated into a therapeutic approach to wounds whenever appropriate.
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Affiliation(s)
- Maurice Moelleken
- Department of Dermatology, Venerology and AllergologyUniversity Hospital of EssenEssenGermany
| | | | - Frederik Krefting
- Department of Dermatology, Venerology and AllergologyUniversity Hospital of EssenEssenGermany
| | - Sven Benson
- University Hospital of Essen, Institute of Medical Psychology and Behavioral Immunobiology, Institute of Medical Education, Centre for Translational Neuro‐ and Behavioral SciencesEssenGermany
| | - Christos Rammos
- Department of Cardiology and AngiologyUniversity Hospital of EssenEssenGermany
| | - Anna Ewa Cyrek
- Division of Vascular and Endovascular Surgery, Department of General, Visceral and Transplant SurgeryUniversity Hospital of EssenEssenGermany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and AllergologyUniversity Hospital of EssenEssenGermany
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4
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Rajhathy EM, Hill MC, Tran DL, Huang RW, Chiu ES, Sibbald RG, Ayello EA. Debridement options for the interprofessional team. Nursing 2024; 54:30-38. [PMID: 38386448 DOI: 10.1097/01.nurse.0001006292.75909.7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
ABSTRACT Debridement is a core component of chronic wound management. Although various debridement methods exist, each carries a unique patient risk level. This article discusses the different normal tissue components that are critical to safe debridement practice, various methods of wound debridement for nurses, and the importance of an interprofessional team and consulting a wound specialist.
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Affiliation(s)
- Erin M Rajhathy
- Erin Rajhathy is a doctoral student at Örebro University, Örebro, Sweden. Mary Hill is an RN in Alberta, Canada. David Tran is a postdoctoral research fellow at the NYU Grossman School of Medicine. Ren-Wen Huang is an attending physician at Linkou Chang Gung Memorial Hospital in Taiwan. Ernest Chiu is a professor of plastic surgery at the NYU Grossman School of Medicine in New York, NY. Gary Sibbald is a professor of medicine and public health at the University of Toronto. Elizabeth Ayello is a faculty emeritus of Excelsior University School of Nursing in Albany, N.Y., and is a member of the Nursing2024 editorial board
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5
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Cardona S, Hernández C, Bohórquez-Tarazona MP, Rubiano AM, Parra DMS. Scalp wound management: a narrative review from a neurosurgical perspective. J Wound Care 2024; 33:127-135. [PMID: 38329834 DOI: 10.12968/jowc.2024.33.2.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article aims to present a narrative review of current literature about the anatomical characteristics of the scalp as well as current practices in the management of surgical, traumatic and pressure injuries in the scalp, which are common in neurosurgery practice. METHOD We searched PubMed for publications and book chapters in English from 2011 to 2021. We also included commonly referenced papers that we considered relevant to the subject with publication before these dates. We used the search terms 'laceration,' and/or 'neurosurgery' and/or, 'pressure injury,' and/or 'craniotomy,' and/or 'surgical incision' in combination with 'scalp,' and/or 'wound care.' We also searched the reference lists of publications identified by the search strategy and selected those that we judged relevant. RESULTS We pre-selected 52 articles that covered various aspects of anatomy, pathophysiology, scalp wound management, or general wound care that we considered applied to the anatomical region of our interest. After abstract review, we selected 34 articles that met our search criteria and were included in our review. CONCLUSION There is limited evidence regarding classification and care of scalp wounds. As a result, many of the current practices for scalp wound management are based on evidence derived from studies involving different anatomical regions, not considering its particular anatomy, vasculature and microbiome. Further research is needed for more comprehensive and effective protocols for the management of scalp injuries. However, this present review proposes responses to the identified gaps concerning the management of scalp wounds.
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Affiliation(s)
| | | | | | - Andrés M Rubiano
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Valle Salud IPS Clinic Network, Colombia
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, UK
| | - Diana Marcela Sánchez Parra
- Meditech Foundation, Barrow Neurological Institute at Phoenix Children's Hospital, US
- Fellow, Global Neurosurgery and Trauma, University of Cambridge, UK
- Fundación Meditech, Cali, Colombia
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Samadian A, Kratochvílová M, Hokynková A, Šín P, Nováková M, Štěpka P, Pokorná A, Babula P. Changes in gene expression in pressure ulcers debrided by different approaches - a pilot study. Physiol Res 2023; 72:S535-S542. [PMID: 38165757 PMCID: PMC10861252 DOI: 10.33549/physiolres.935222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/11/2023] [Indexed: 02/01/2024] Open
Abstract
Pressure ulcers (PUs), also known as pressure injuries, are chronic wounds that represent potential lifelong complications. Pressure ulcers of a deep category (III and IV) are often indicated for surgical treatment - debridement and surgical reconstruction. Sharp surgical debridement is widely used in the debridement of PUs; however, the Versajet® hydrosurgery system is becoming an increasingly popular tool for tangential excision in surgery due to its numerous advantages. This work focused on the expression of selected genes, especially those associated with oxidative stress, in PUs debrided by two approaches - sharp surgical debridement and debridement using Versajet® hydrosurgery system. Expression of following genes was evaluated: NFE2L2, ACTA2, NFKB1, VEGFA, MKI67, HMOX1, HMOX2, HIF1A, and SOD2. ACTB and PSMB were used as housekeeping genes. So far, five patients have been enrolled in the study. Preliminary results suggest no significant difference in gene expression with different pressure ulcer treatment approaches except NFE2L2, despite the macroscopic differences. However, the results revealed correlations between the expression of some genes, namely HIF1A and SOD2, VEGFA and SOD2 and VEGFA and HIF1A. These results may indicate a connection between hypoxia, oxidative stress, pressure ulcer healing processes and angiogenesis.
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Affiliation(s)
- A Samadian
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic, Department of Burns and Plastic Surgery, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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7
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Moelleken M, Erfurt‐Berge C, Ronicke M, Busch D, Hübner UH, Hüsers J, Przysucha M, Dissemond J. Predilection sites of pyoderma gangrenosum: Retrospective study of 170 clearly diagnosed patients. Int Wound J 2023; 20:4227-4234. [PMID: 37528508 PMCID: PMC10681478 DOI: 10.1111/iwj.14323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a non-infectious, neutrophilic dermatosis that was difficult to diagnose in clinical practice. Today, the PARACELSUS score is a validated tool for diagnostics. Based on this score, patients with clearly diagnosed PG were examined with regard to predilection sites. In this retrospective study, the data of patients from the University Hospitals of Essen and Erlangen were analysed in whom the diagnosis of PG could be clearly confirmed using the PARACELSUS score. A total of 170 patients, 49 men (29%) and 121 women (71%) with an average age at first manifestation of 55.5 years, could be included in the analysis. The predilection sites were identified as the lower legs in 80.6% of the patients and the extensor sides in 75.2%. Other localisations of PG were the thighs in 14.1%, mammae and abdomen in 10.0% each, back and gluteal in 7.1% each, feet in 5.9%, arms in 4.7%, genital in 3.5% and head in 2.9%. This retrospective study is the first to identify a collective of PG patients with the highest data quality using the PARACELSUS score. It could be shown that PG can basically occur on the entire integument. However, the predilection sites of PG, which have now been reliably identified for the first time, are the lower legs and in particular the extensor sides.
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Affiliation(s)
- Maurice Moelleken
- Department of Dermatology, Venerology and AllergologyUniversity Hospital of EssenEssenGermany
| | - Cornelia Erfurt‐Berge
- Department of DermatologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐NürnbergErlangenGermany
| | - Moritz Ronicke
- Department of DermatologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐NürnbergErlangenGermany
| | - Dorothee Busch
- Department of DermatologyUniversity Hospital Erlangen, Friedrich‐Alexander University Erlangen‐NürnbergErlangenGermany
| | | | - Jens Hüsers
- Health Informatics Research GroupOsnabrück University of ASOsnabrückGermany
| | - Mareike Przysucha
- Health Informatics Research GroupOsnabrück University of ASOsnabrückGermany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and AllergologyUniversity Hospital of EssenEssenGermany
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8
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Dissemond J, Marzano AV, Hampton PJ, Ortega-Loayza AG. Pyoderma Gangrenosum: Treatment Options. Drugs 2023; 83:1255-1267. [PMID: 37610614 PMCID: PMC10511384 DOI: 10.1007/s40265-023-01931-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 08/24/2023]
Abstract
Pyoderma gangrenosum is a rare neutrophilic dermatosis that leads to exceedingly painful ulcerations of the skin. Although the exact pathogenesis is not yet fully understood, various auto-inflammatory phenomena with increased neutrophil granulocyte activity have been demonstrated. Despite the limited understanding of the pathogenesis, it is no longer a diagnosis of exclusion, as it can now be made on the basis of validated scoring systems. However, therapy remains a major multidisciplinary challenge. Various immunosuppressive and immunomodulatory therapies are available for the treatment of affected patients. In addition, concomitant topical pharmacologic therapy, wound management and pain control should always be addressed. Corticosteroids and/or cyclosporine remain the systemic therapeutics of choice for most patients. However, in recent years, there has been an increasing number of studies on the positive effects of biologic therapies such as inhibitors of tumour necrosis factor-α; interleukin-1, interleukin-17, interleukin-23 or complement factor C5a. Biologics have now become the drug of choice in certain scenarios, particularly in patients with underlying inflammatory comorbidities, and are increasingly used at an early stage in the disease rather than in therapy refractory patients.
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Affiliation(s)
- Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale, Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Philip J Hampton
- Department of Dermatology, Newcastle Dermatology, Newcastle Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science, University, Portland, OR, USA
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Nube VL, Alison JA, Twigg SM. Diabetic foot ulcers: weekly versus second-weekly conservative sharp wound debridement. J Wound Care 2023; 32:383-390. [PMID: 37300856 DOI: 10.12968/jowc.2023.32.6.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Diabetic foot ulcers (DFU) are a serious and costly long-term complication of diabetes, and are one of the most prevalent hard-to-heal (chronic) wound types. Conservative sharp wound debridement (CSWD) is a mainstay of care. It is performed regularly until healing is achieved (when there is adequate blood flow for healing) to support endogenous healing and improve the efficacy of advanced healing therapies. CSWD is supported by evidence-based treatment guidelines, despite a lack of prospective studies. The first prospective randomised study to compare different frequencies of CSWD-the Diabetes Debridement Study (DDS)-showed no difference in healing outcomes at 12 weeks between those ulcers debrided weekly and those debrided every second week. A DFU may require more or less frequent debridement according to individual wound characteristics; however, the new data from DDS can inform clinical decisions and service provision. The implications of weekly versus second-weekly debridement are discussed.
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Affiliation(s)
- Vanessa L Nube
- Royal Prince Alfred Hospital Department of Podiatry, Sydney Local Health District, Australia
- Sydney Medical School (Central), Faculty of Medicine and Health, The University of Sydney, Australia
| | - Jennifer A Alison
- Sydney Local Health District Professorial Unit, Australia
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney
| | - Stephen M Twigg
- Sydney Medical School (Central), Faculty of Medicine and Health, The University of Sydney, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia
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Derwin R, Patton D, Strapp H, Moore Z. The effect of inflammation management on pH, temperature, and bacterial burden. Int Wound J 2023; 20:1118-1129. [PMID: 36251505 PMCID: PMC10031221 DOI: 10.1111/iwj.13970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of this feasibility study was to investigate the impact of inflammation management on wound pH, temperature, and bacterial burden, using the principles of TIME and Wound Bed Preparation. A quantitative non-comparative, prospective, descriptive observational design. Following ethical approval, 26 participants with 27 wounds of varying aetiologies were observed twice weekly for 2 weeks. Wounds were treated with cleansing, repeated sharp debridement, and topical cadexomer iodine. Wound pH (pH indicator strips), temperature (infrared camera), bacterial burden (fluorescence imaging) and size (ruler method) was monitored at each visit. The mean age of all participants was 47 years (SD: 20.3 years), and 79% (n = 19) were male, and most wounds were acute (70%; n = 19) and included surgical and trauma wounds, the remaining (30%; n = 8) were chronic and included vascular ulcers and non-healing surgical wounds. Mean wound duration was 53.88 days (SD: 64.49 days). Over the follow up period, pH values ranged from 6 to 8.7, temperature (centre spot) ranged from 28.4°C to 36.4°C and there was an average 39% reduction in wound size. Inflammation management had a positive effect on pH, temperature, bacterial burden, and wound size. This study demonstrated that it was feasible to practice inflammation management using a structured approach to enhance wound outcomes.
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Affiliation(s)
- Rosemarie Derwin
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- Department of Nursing, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Helen Strapp
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Faculty of Medicine and Health, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Health Sciences, Faculty of Life and Health Sciences Ulster University, Coleraine, UK
- School of Nursing and Midwifery, Cardiff University, Cardiff, UK
- Department of Nursing, Fakeeh College for Medical Sciences, Jeddah, Kingdom of Saudi Arabia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Departmnet of Nursing, Lida Institute, Shanghai, China
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Burian EA, Enevold C, Karlsmark T, Ågren MS. A simplified method for monitoring cytokines in wound fluid. Wound Repair Regen 2023; 31:47-55. [PMID: 36168150 PMCID: PMC10092818 DOI: 10.1111/wrr.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023]
Abstract
Cytokines in wound fluid are used as surrogates for wound healing in clinical research. The current methods used to collect and process wound fluid are noninvasive but not optimal. The aim of this prospective study was to evaluate a method (NovaSwab) by which wound fluid is collected by a surface swab and eluted in a physiological buffer for subsequent cytokine analysis. Wound fluid from 12 patients with leg ulcers was assessed by NovaSwab at the start (Day 0) and at the end of a 23-h collection period of wound fluid retained by foam oblates beneath an occlusive film dressing (Day 1). GM-CSF, IL-1α, IL-1β, IL-6, IL-8, PDGF-AA, TNF-α and VEGF levels were measured by multiplex and electrochemiluminescence assays. IL-1α (2.4×), IL-1β (2.0×) and IL-8 (1.8×) levels increased from Day 0 to Day 1 as detected by NovaSwab, indicating local production of these polypeptides in the wounds. On Day 1, the NovaSwab method yielded higher levels of IL-1α (4.0×), IL-1β (2.7×) and IL-6 (2.7×), and 35% lower levels of VEGF than those in wound fluid accumulated for 23 h in foam oblates (on average, 5 ml of wound fluid). In vitro experiments showed that the investigated cytokines in cell-free wound fluid were recovered in a quantitative manner by the NovaSwab method. We conclude that the method presented here is a promising research tool to study the kinetics of soluble cytokines over the course of wound healing. More studies are needed to determine the interobserver variation and reproducibility of the NovaSwab method.
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Affiliation(s)
- Ewa Anna Burian
- Department of Dermato-Venereology and Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Enevold
- Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, University Hospital, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermato-Venereology and Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Magnus S Ågren
- Department of Dermato-Venereology and Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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12
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Dissemond J. [Diagnostics and treatment of local wound infections]. Z Gerontol Geriatr 2023; 56:48-52. [PMID: 34686916 PMCID: PMC9877047 DOI: 10.1007/s00391-021-01984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 01/29/2023]
Abstract
Local wound infections are a multidisciplinary challenge which should be diagnosed as early as possible and adequately treated. In addition to a stagnation of wound healing, it is in particular the threat of development into systemic infections and even sepsis that represent feared, potentially life-threatening complications. This topic has a particularly high and multidisciplinary significance in the treatment of patients with chronic wounds. Until now, there were no generally accepted criteria for the diagnostics. The newly developed and validated TILI score, as a supplement to vital signs and serological values, enables rapid objectification of local wound infections. In addition, the W.A.R. score can be used to identify patients with an increased risk of infections. With these easy to use tools, the indications for antiseptic wound treatment can be assessed individually, quickly and without problems. For many patients with chronic wounds, polihexanide is then the wound antiseptic of first choice. However, the indications for wound antiseptics should be critically reviewed after a treatment duration of 14 days at the latest.
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Affiliation(s)
- Joachim Dissemond
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122 Essen, Deutschland
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13
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Dayya D, O'Neill OJ, Huedo-Medina TB, Habib N, Moore J, Iyer K. Debridement of Diabetic Foot Ulcers. Adv Wound Care (New Rochelle) 2022; 11:666-686. [PMID: 34376065 PMCID: PMC9527061 DOI: 10.1089/wound.2021.0016] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Diabetic foot ulcerations have devastating complications, including amputations, poor quality of life, and life-threatening infections. Diabetic wounds can be protracted, take significant time to heal, and can recur after healing. They are costly consuming health care resources. These consequences have serious public health and clinical implications. Debridement is often used as a standard of care. Debridement consists of both nonmechanical (autolytic, enzymatic) and mechanical methods (sharp/surgical, wet to dry debridement, aqueous high-pressure lavage, ultrasound, and biosurgery/maggot debridement therapy). It is used to remove nonviable tissue, to facilitate wound healing, and help prevent these serious outcomes. What are the various forms and rationale behind debridement? This article comprehensively reviews cutting-edge methods and the science behind debridement and diabetic foot ulcers.
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Affiliation(s)
- David Dayya
- Division of Undersea and Hyperbaric Medicine, Department of Surgery, Phelps Hospital Northwell Health, Sleepy Hollow, New York, USA.,Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.,Department of Community Medicine, University of Connecticut, Storrs, Connecticut, USA.,Department of Emergency Medicine, SUNY – Upstate Medical University, Syracuse, New York, USA.,Department of Family Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA.,Department of Medicine, Greenwich Hospital, Greenwich, Connecticut, USA.,Department of Medicine, Norwalk Hospital, Norwalk, Connecticut, USA.,Correspondence: Division of Undersea and Hyperbaric Medicine, Department of Surgery, Phelps Hospital Northwell Health, Sleepy Hollow, NY 10591, USA.
| | - Owen J. O'Neill
- Division of Undersea and Hyperbaric Medicine, Department of Surgery, Phelps Hospital Northwell Health, Sleepy Hollow, New York, USA.,Department of Emergency Medicine, SUNY – Upstate Medical University, Syracuse, New York, USA.,Department of Medicine, New York Medical College, Valhalla, New York, USA
| | - Tania B. Huedo-Medina
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.,Department of Community Medicine, University of Connecticut, Storrs, Connecticut, USA
| | - Nusrat Habib
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA.,Department of Community Medicine, University of Connecticut, Storrs, Connecticut, USA
| | - Joanna Moore
- Department of Medicine, Norwalk Hospital, Norwalk, Connecticut, USA
| | - Kartik Iyer
- Department of Medicine, Norwalk Hospital, Norwalk, Connecticut, USA
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Joergensen B, Blaise S, Svensson AS. A randomised, open-label, parallel-group, multicentre, comparative study to compare the efficacy and safety of Exufiber® with Aquacel® Extra™ dressings in exuding venous and mixed aetiology leg ulcers. Int Wound J 2022; 19 Suppl 1:22-38. [PMID: 36111589 PMCID: PMC9478964 DOI: 10.1111/iwj.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
The performance and safety of Exufiber® gelling fibre and Aquacel® Extra™ Hydrofiber® wound dressings were compared for the management of chronic, exuding leg ulcers. The 6‐week study (≤ 24 weeks in a subgroup of subjects) was a randomised, open‐label, parallel‐group, multicentre, non‐inferiority design. Adults (n = 248, 30–97 years of age) were randomised to either Exufiber® or Aquacel® Extra™ dressing. The dressings were applied at baseline and evaluations of wound condition and performance of the dressing were recorded at 1, 2, 3, 4, and 6 weeks. The primary efficacy endpoint was the percentage reduction in wound area at 6 weeks relative to baseline, in the per protocol (PP) population. A median relative reduction of 50% for Exufiber® (n = 100) vs 42% for Aquacel® Extra™ (n = 107) was demonstrated in the PP population (P = 0.093) and confirmed in the intention‐to‐treat population. As the mean and 95% confidence interval for the difference in relative wound area reduction between groups at 6 weeks was −29.4% (−63.5; 3.2), and the lower limit did not exceed 12%, non‐inferiority of Exufiber® was concluded. Both dressings were well tolerated and no safety concerns were identified in both groups. Clinicians' satisfaction with the dressings was higher for Exufiber® than for Aquacel® Extra™ in terms of ease of use and management of exudate, slough, and blood.
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Affiliation(s)
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, Grenoble, France
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15
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Tettelbach WH, Cazzell SM, Hubbs B, Jong JLD, Forsyth RA, Reyzelman AM. The influence of adequate debridement and placental-derived allografts on diabetic foot ulcers. J Wound Care 2022; 31:S16-S26. [PMID: 36113857 DOI: 10.12968/jowc.2022.31.sup9.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the role of debridement when patients are using placental-derived allografts (PDAs), data from two prospective, multicentre, randomised controlled trials (RCTs) were evaluated for the quality or adequacy of debridement on diabetic foot ulcers (DFUs) treated with PDAs. Results were compared with real-world findings via a retrospective analysis of 2015-2019 Medicare claims for DFUs. METHOD Debridement adequacy in the prospective RCTs was adjudicated by three blinded wound care specialists. Treatments included two PDAs, dehydrated human amnion/chorion membrane (DHACM, n=54) or dehydrated human umbilical cord (DHUC, n=101), compared with standard of care (SOC, n=110). The key outcome was the influence of adequate debridement on rates of complete closure within 12 weeks. Additionally, a retrospective analysis of 2015-2019 Medicare claims for DFUs that received routine debridement at intervals ranging from every 1-7 days (18,900 total episodes), 8-14 days (35,728 total episodes), and every 15 days or greater (34,330 total episodes) was performed. RESULTS Within the RCTs, adequate debridement occurred in 202/265 (76%) of patients, 90/110 (82%) SOC ulcers, 45/54 (83%) of DHACM-treated ulcers, and in 67/101 (66%) of DHUC-treated ulcers. Complete closure occurred in 150/202 (74%) of adequately debrided ulcers, and in only 13/63 (21%) of ulcers without adequate debridement, p<0.0001. Debridement was the most significant factor for closure even when controlling for other clinical characteristics. Within the Medicare claims data 21% (18,900/88,958) of episodes treated with SOC only had debridement intervals of ≤7 days. Short debridement intervals in combination with the use of DHACM demonstrated statistically significant better outcomes than SOC including: 65% fewer major amputations (p<0.0001), higher DFU resolution rates (p=0.0125), 42% fewer emergency room visits (p<0.0001) and reduced usage of other hospital resources (admissions and readmissions). CONCLUSION Prospectively collected data examining the quality of debridement and retrospectively analysed data examining the frequency of debridement supports routine adequate wound debridement, particularly at intervals of seven days, as an essential component of wound care. Optimal use of placental-derived allografts improves outcomes and lowers the use of healthcare resources.
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Affiliation(s)
- William H Tettelbach
- MIMEDX Group, Inc., GA, US.,College of Podiatric Medicine, Western University of Health Sciences.,Duke University School of Medicine, Department of Anesthesiology, NC, US.,American Professional Wound Care Association, LA, US.,Association for the Advancement of Wound Care, PA, US.,Western Peaks Specialty Hospital, UT, US
| | | | | | | | - R Allyn Forsyth
- MIMEDX Group, Inc., GA, US.,Department of Biology, San Diego State University, San Diego, CA, US
| | - Alexander M Reyzelman
- Department of Medicine California School of Podiatric Medicine at Samuel Merritt University, CA, US.,Co-Director, UCSF Center for Limb Preservation and Diabetic Foot Center for Clinical Research, San Francisco, CA, US
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16
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Abstract
Debridement of devitalised tissue and wound biofilm is vital to promote healing. This article introduces an innovative debridement product, ChloraSolv Wound Debridement Gel, which is as effective as a blade but also selective, atraumatic and fast-acting and does not require specialist training. Its ease of use makes it suitable for all settings and staff.
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Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust and University of Huddersfield
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17
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Atkin L. Foreword. J Wound Care 2022; 31:S4. [PMID: 35994429 DOI: 10.12968/jowc.2022.31.sup8a.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Leanne Atkin, Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust and University of Huddersfield.
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Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust and University of Huddersfield
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18
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DE’ LORENZI ROSSI C. Le medicazioni idrocolloidi nella cura delle lesioni croniche. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.21.04738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Executive Summary: Debridement: Canadian Best Practice Recommendations for Nurses Developed by Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC). J Wound Ostomy Continence Nurs 2021; 48:516-522. [PMID: 34781306 DOI: 10.1097/won.0000000000000822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Debridement is described in the literature as having a high level of clinical risk and may result in patient harm when performed by untrained nurses. As a result, specialized knowledge, skills, and competencies are required to initiate, direct, and perform safe and effective debridement. This executive summary provides an overview of Debridement: Canadian Best Practice Recommendations for Nurses from the Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC). The primary objective of these recommendations is to positively influence patient outcomes and enhance safety. The 12 recommendations place the safety of the patient and nurse at the forefront and highlight the educational, competency, certification, preceptor/mentorship, and legal requirements for nurses to initiate, direct, and perform all methods of debridement. We designed these recommendations to be circulated and implemented widely by nurses of various professional levels across the continuum of care and advocate for organizations and government agencies to clearly define debridement in their policies and legislative regulations.
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20
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Vanhoudt A, Hesseling J, Nielen M, Wilmink J, Jorritsma R, van Werven T. M-score and wound healing assessment of two nonantibiotic topical gel treatments of active digital dermatitis lesions in dairy cattle. J Dairy Sci 2021; 105:695-709. [PMID: 34635353 DOI: 10.3168/jds.2021-20613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/23/2021] [Indexed: 11/19/2022]
Abstract
This open-label, randomized clinical trial with positive control compared the treatment of active digital dermatitis (DD) lesions (stages M1, M2, and M4.1) on dairy cattle hind feet with an enzyme alginogel or a copper and zinc chelate gel (coppergel). Upon recruitment (d 0), active DD lesions were cleaned, photographed, treated, and bandaged. This procedure was repeated on d 3 and d 7, with treatment and bandaging discontinued for those lesions that had transitioned to the M0, M3, or M4 stage on d 7. Day 10 was considered the end of the treatment trial, and all recruited feet were cleaned and photographed. Treatment effect of the 2 products was assessed not only using the M-score but also using general wound healing progress criteria. Improvement of M-score was defined as transition to M0, M3, or M4 stages, or to lesions with a smaller ulcerative area (e.g., M2 stage to M1 stage). Lesions with improved wound healing had at least one of the following criteria when compared with the previous observation: decreased defect size, healthier granulation tissue color (pink-red instead of purple-grayish), more regular aspect of granulation tissue surface, wound contraction, or epithelization starting from the surrounding skin. Both primary outcomes were assessed using a multivariable logistic regression analysis. Lesions treated with the enzyme alginogel had a decreased adjusted odds ratio for M-score improvement (aOR: 0.04; 95% confidence interval: 0.01-0.11). Lesions treated with the coppergel mostly transitioned to chronic lesions, whereas lesions treated with the enzyme alginogel mostly remained active lesions. The wound healing progress of almost 70% of the lesions treated with coppergel could not be scored, for the greater part due to the presence of crust materials. With these unscorable lesions classified as "improved," there was no treatment effect on wound healing progress (aOR: 0.99; 95% confidence interval: 0.34-3.05), whereas with unscorable lesions classified as "not improved," the enzyme alginogel outperformed the coppergel with regard to wound healing progress (aOR: 2.48; 95% confidence interval: 1.07-5.79). None of the products used in our study achieved high cure rates (transition to the M0 stage) for active DD lesions. Low cure rates of topical treatment of DD, together with the important role of chronic lesions in the epidemiology of DD, indicate that future research should investigate how to achieve successful wound management of DD lesions, thereby mitigating pain associated with the lesions and reducing both transmission and prevalence of DD within herds.
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Affiliation(s)
- A Vanhoudt
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL, Utrecht, the Netherlands.
| | - J Hesseling
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL, Utrecht, the Netherlands
| | - M Nielen
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL, Utrecht, the Netherlands
| | - J Wilmink
- Woumarec, 6705 CT, Wageningen, the Netherlands
| | - R Jorritsma
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL, Utrecht, the Netherlands
| | - T van Werven
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL, Utrecht, the Netherlands; University Farm Animal Practice, 3481 LZ, Harmelen, the Netherlands
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21
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Nube VL, Alison JA, Twigg SM. Frequency of sharp wound debridement in the management of diabetes-related foot ulcers: exploring current practice. J Foot Ankle Res 2021; 14:52. [PMID: 34384453 PMCID: PMC8359122 DOI: 10.1186/s13047-021-00489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background Conservative sharp wound debridement (CSWD) is fundamental to wound bed preparation. Evidence-based practice guidelines strongly recommend frequent CSWD of diabetes-related foot ulcers (DFU) based on expert opinion and observational studies which suggest that more frequent debridement is associated with better healing outcomes. Aim To document current practice with regards to CSWD of DFU and whether this is performed at every visit, how often and what factors determine debridement frequency. Method Survey data were collected and managed using REDCap electronic data tools, a secure, web-based application. The survey was distributed through podiatry managers and relevant clinical networks between October 2017 and February 2018. Results One hundred clinicians opened the survey and seventy-five surveys were completed by n = 53 NSW Health (Australia) employed podiatrists (representing 41% of all NSW Health podiatrists), 11 privately practicing podiatrists, and 11 nurses. Most (n = 47) worked in metropolitan areas versus regional/remote (n = 28). CSWD was the most frequently used debridement method, performed at every visit by most (84%) of podiatrists. Callus, slough and infection presence were the top 3 most important determinants of frequency, with staff time (a limiting factor) ranking 4th. Regional/remote podiatrists practiced less frequent debridement compared with those in metropolitan areas (debridement every 2 weeks or less = 71% regional podiatrists versus 45% metropolitan podiatrists) (p = 0.024). Conclusion and clinical implications CSWD was the predominant form of debridement used with debridement occurring at every treatment visit for most of the clinicians surveyed. Debridement frequency was determined by clinical wound indications and staffing resources, with regional/remote podiatrists providing debridement less often than their metropolitan colleagues. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-021-00489-1.
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Affiliation(s)
- Vanessa L Nube
- Department of Podiatry, Royal Prince Alfred Hospital, Sydney, Missenden Rd, Camperdown, NSW, 2050, Australia. .,Faculty of Medicine and Health, Sydney Medical School (Central), The University of Sydney, Camperdown, Australia.
| | - Jennifer A Alison
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, Australia.,Allied Health, Sydney Local Health District, Camperdown, Australia
| | - Stephen M Twigg
- Faculty of Medicine and Health, Sydney Medical School (Central), The University of Sydney, Camperdown, Australia.,Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Camperdown, Australia
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22
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Holubová A, Chlupáčová L, Cetlová L, Cremers NAJ, Pokorná A. Medical-Grade Honey as an Alternative Treatment for Antibiotics in Non-Healing Wounds-A Prospective Case Series. Antibiotics (Basel) 2021; 10:antibiotics10080918. [PMID: 34438968 PMCID: PMC8388796 DOI: 10.3390/antibiotics10080918] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 02/06/2023] Open
Abstract
Non-healing wounds are usually colonised by various types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical-grade honey (MGH), which favourably affects the healing process with its antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory properties. The objective of this study was to evaluate the effect of MGH therapy on the healing process of non-healing wounds of various aetiologies and different wound colonisations. Prospective, observation–intervention case studies (n = 9) of patients with wounds of various aetiologies (venous leg ulcers, diabetic foot ulcers, surgical wound dehiscence) are presented. All wounds were treated with MGH and the healing trajectory was rigorously and objectively monitored. In all cases, pain, odour, and exudation were quickly resolved, which led to an improvement in the quality of life of patients. Despite the proven bacterial microflora in wounds, antibiotic treatment was not necessary. The effects of MGH alleviated the signs of local infection until their complete elimination. In eight out of nine cases, the non-healing wound was completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in wounds of various aetiologies and forms an effective alternative for the use of antibiotics for treating locally infected wounds.
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Affiliation(s)
- Adéla Holubová
- Faculty of Health and Social Sciences, University of Bohemia, 370 11 České Budějovice, Czech Republic
- DiaPodi Care spol. s r.o., 392 01 Soběslav, Czech Republic;
- Correspondence: ; Tel.: +420-774-672-220
| | | | - Lada Cetlová
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
| | | | - Andrea Pokorná
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
- Department of Nursing and Midwifery, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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Abstract
The treatment of patients with chronic wounds is a multiprofessional challenge. Based on a comprehensive diagnosis and integrated into a causal treatment concept, patients should always be treated with a modern wound therapy. This wound therapy should try to take into account many different factors such as the wound healing phases, infection status, exudate levels, but also individual patient wishes. Especially in the case of chronic wounds of the lower extremities and edema, compression therapy is also very important for therapy and recurrence prophylaxis. In addition, the pain, which is usually very distressing, should be recorded and adequately treated or avoided. Modern moist wound therapy can then support the healing of patients with chronic wounds, reduce complications and thus improve their quality of life.
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Eliasson B, Fagerdahl AM, Jönsson A, Apelqvist J. Debriding effect of amino acid-buffered hypochlorite on hard-to-heal wounds covered by devitalised tissue: pilot study. J Wound Care 2021; 30:455-464. [PMID: 34121441 DOI: 10.12968/jowc.2021.30.6.455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Wounds such as lower extremity ulcers are serious, costly and frequently hard to heal. Guidelines conclude that new dressings and treatments generally fail to show superiority compared with standard of care. Several mechanisms are probably responsible for impaired healing of hard-to-heal wounds, including inflammation and infection. Amino acid-buffered hypochlorite has presumed antiseptic and antibacterial properties and has been shown to be useful in the treatment of diabetic foot ulcers (DFUs). We evaluated the debriding effect of amino acid-buffered hypochlorite (ChloraSolv) on full skin hard-to-heal lower extremity ulcers covered with devitalised tissue (≥50%), with six applications over 5 weeks and follow-up at 12 weeks. METHOD This was an open-label, single-arm, multicentre, pre-market pilot investigation. We recruited subjects with a lower extremity ulcer, covered with devitalised tissue (≥50%), who were candidates for cleansing and debridement/desloughing. There was a weekly application of the investigational device for five weeks. Follow-up for wound status evaluation was performed at 12 weeks from baseline. RESULTS We evaluated 57 subjects (33 males, 24 females, median age 73 years, range 51-90 years) (intention-to-treat). Of these, 61.4% had a leg ulcer and 38.6% a foot ulcer. The median wound size at baseline was 7.7cm2 (range 2.1-52cm2) with devitalised tissue coverage of 76.5%. After 5 weeks, a decrease of 72.7% in devitalised tissue was seen, and 71.4% of the subjects showed a decrease in devitalised tissue of ≥50% (evaluated independently using PictZar). At 12 weeks' follow-up the decrease in devitalised tissue was 84.4%. Wound-related pain was reported by ten subjects, resulting in 17 adverse events (AEs). Among these, 12 AEs from eight subjects were recorded as possibly or probably related to the investigational device and one AE was reported to have a causal relationship with the investigational device. CONCLUSION This clinical study suggests that amino acid-buffered hypochlorite can be effective and well tolerated in the treatment of hard-to-heal lower extremity ulcers to dissolve and remove devitalised tissue.
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Affiliation(s)
- Björn Eliasson
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset and Wound Centre, Södersjukhuset, Stockholm, Sweden
| | - Anders Jönsson
- Department of Orthopaedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Sweden
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25
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Vallejo A, Wallis M, McMillan D, Horton E. Use of low-frequency contact ultrasonic debridement with and without polyhexamethylene biguanide in hard-to-heal leg ulcers: an RCT protocol. J Wound Care 2021; 30:372-379. [PMID: 33979219 DOI: 10.12968/jowc.2021.30.5.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this research is to investigate the effect of low-frequency contact ultrasonic debridement therapy (LFCUD) in hard-to-heal wounds with suspected biofilm, and compare the effect with or without a surfactant antimicrobial on bacterial colony counts and wound healing rates. METHOD A single-blinded randomised controlled trial (RCT) will investigate the combination of LFCUD and the antiseptic polyhexamethylene biguanide with a surfactant betaine (referred to in this paper as PHMB) as a topical solution post-treatment and in a sustained dressing, compared with use of LFCUD alone. Potential participants from a community wound clinic (n=50) will be invited to take part in the 12-week trial. Wound swabs and tissue samples will be analysed for bacterial type and quantity, before and after treatments, using traditional culture techniques and advanced molecular methods. Wound healing, pain, quality of life and biofilm (via a specifically designed tool) will also be measured. DISCUSSION Bacteria have the potential to cause a hard-to-heal wound, particularly when antibiotics are too frequently and unnecessarily prescribed, resulting in antibiotic-resistant microorganisms. Appropriate care is vital when caring for hard-to-heal wounds to avoid these scenarios. With no simple laboratory method available to identify or treat wound biofilm, clinicians rely on their expertise in wound management. This study aims to provide in vivo evidence on the effectiveness of PHMB, to prevent the reformation of biofilm when applied after LFCUD. The aim is to provide evidence-based and more cost-effective wound care.
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Affiliation(s)
- Alison Vallejo
- Wound Solutions Clinic, School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Locked Bag 4, Maroochydore, QLD 4558, Australia
| | - Marianne Wallis
- School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Locked Bag 4, Maroochydore, QLD 4558, Australia
| | - David McMillan
- INFLAME Biomedical Research Cluster, School of Health and Sports Sciences, The University of the Sunshine Coast, Maroochydore, QLD 4558, Australia
| | - Eleanor Horton
- School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Locked Bag 4, Maroochydore, QLD 4558, Australia
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Burnett J, Kerr A, Morrison M, Ruston A. An audit to assess the impact of prescribing a monofilament fibre debridement pad for patients with unhealed wounds after six months. J Wound Care 2021; 30:381-388. [PMID: 33979215 DOI: 10.12968/jowc.2021.30.5.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A monofilament fibre debridement pad has been found to be a rapid and effective mechanical method of removing dry skin, biofilm and debris from acute and chronic wounds with minimal patient discomfort. Evidence of its impact on prescribing and wound healing, however, has been more limited. The aim of this audit was to show evidence of the monofilament fibre debridement pad's impact on wound treatment costs through an analysis of NHS wound-care prescribing data in England. A dataset for 486 uniquely identified patients who had been newly prescribed the monofilament fibre debridement pad was obtained from the NHS Business Services Authority. All data were anonymised. Costs were identified for the six months before and six months after the month of first prescription of the monofilament fibre debridement pad. The total cost of wound-care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 (n=486) after. These results indicate that use of the monofilament fibre debridement pad could reduce prescribing costs and the use of antimicrobial and negative pressure therapies. Further research is warranted to investigate the clinical role of the monofilament fibre debridement pad in wound healing.
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Affiliation(s)
| | - Andrew Kerr
- Lower Limb Consultancy Services Ltd, UK.,Sandwell and West Birmingham Hospitals NHS Trust, UK
| | | | - Abbe Ruston
- Lohmann & Rauscher, Burton on Trent, Staffordshire, UK
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27
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González-de la Torre H, Verdú-Soriano J, Quintana-Lorenzo ML, Berenguer-Pérez M, Lavín RS, Soldevilla-Ágreda J. Specialised wound care clinics in Spain: distribution and characteristics. J Wound Care 2020; 29:764-775. [PMID: 33320747 DOI: 10.12968/jowc.2020.29.12.764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. METHOD This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. RESULTS A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). CONCLUSION The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.
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Affiliation(s)
- Héctor González-de la Torre
- Complejo Hospitalario Materno-Infantil Insular de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Spain
| | - María L Quintana-Lorenzo
- Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas de Gran Canaria, Spain
| | - Miriam Berenguer-Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Spain
| | - Raquel Sarabia Lavín
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Cantabria, Santander, Spain
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Abbade LPF, Frade MAC, Pegas JRP, Dadalti-Granja P, Garcia LC, Bueno Filho R, Parenti CEF. Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:1-18. [PMID: 33371937 PMCID: PMC7772605 DOI: 10.1016/j.abd.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
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Affiliation(s)
- Luciana Patricia Fernandes Abbade
- Department of Infectious Diseases, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Marco Andrey Cipriani Frade
- Department of Internal Medicine (Dermatology Division), Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - José Roberto Pereira Pegas
- Dermatology Service, Hospital Padre Bento de Guarulhos, Guarulhos, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Universidade da Cidade de São Paulo, São Paulo, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Jundiaí, SP, Brazil
| | - Paula Dadalti-Granja
- Department of Clinical Medicine (Discipline of Dermatology), Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Roberto Bueno Filho
- Dermatology Service, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Axel K. Case for wound cleansing. J Wound Care 2020; 29:S3-S4. [PMID: 33016849 DOI: 10.12968/jowc.2020.29.sup10a.s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kramer Axel
- Consultant Clinical Microbiology and Infection Control, Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
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Kotronis G, Vas PRJ. Ultrasound Devices to Treat Chronic Wounds: The Current Level of Evidence. INT J LOW EXTR WOUND 2020; 19:341-349. [DOI: 10.1177/1534734620946660] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic wounds cause considerable morbidity and utilize significant health care resources. In addition to addressing wound etiology and treating infection, regular debridement is a key component of wound care with a proven ability to accelerate healing. In this regard, a significant innovation in wound care has been the development of ultrasound debridement technology. The purpose of this review is to evaluate the current evidence behind the technology with an emphasis on noncontact low-frequency (NCLF) ultrasound. A number of studies, especially those evaluating NCLF technology, have demonstrated the potential of ultrasound debridement to effectively remove devitalized tissue, control bioburden, alleviate pain, and expedite healing. However, most of the studies are underpowered, involve heterogeneous ulcer types, and demonstrate significant methodological limitations making comparison between studies difficult; there is a paucity of data on cost-effectiveness. Future clinical trials on ultrasound debridement technology must address the design issues prevalent in current studies, and report on clinically relevant endpoints before adoption into best-practice algorithms can be recommended.
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Affiliation(s)
| | - Prashanth R. J. Vas
- King’s College Hospital NHS Foundation Trust, London, UK
- King’s Health Partners’ Institute of Diabetes, Endocrinology and Obesity, London, UK
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31
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Moelleken M, Jockenhöfer F, Benson S, Dissemond J. Prospective clinical study on the efficacy of bacterial removal with mechanical debridement in and around chronic leg ulcers assessed with fluorescence imaging. Int Wound J 2020; 17:1011-1018. [PMID: 32289211 PMCID: PMC7948916 DOI: 10.1111/iwj.13345] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/01/2023] Open
Abstract
Bacterial colonisation in wounds delays healing, mandating regular bacterial removal through cleaning and debridement. Real-time monitoring of the efficacy of mechanical debridement has recently become possible through fluorescence imaging. Red fluorescence, endogenously produced during bacterial metabolism, indicates regions contaminated with live bacteria (>104 CFU/g). In this prospective study, conventional and fluorescence photos were taken of 25 venous leg ulcers before and after mechanical debridement, without use of antiseptics. Images were digitally segmented into wound bed and the periwound regions (up to 1.5 cm outside bed) and pixel intensity of red fluorescence evaluated to compute bacterial area. Pre-debridement, bacterial fluorescence comprised 10.4% of wound beds and larger percentages of the periwound area (~25%). Average bacterial reduction observed in the wound bed after a single mechanical debridement was 99.4% (p<0.001), yet periwound bacterial reduction was only 64.3%. On average, across bed and periwound, a single mechanical debridement left behind 29% of bacterial fluorescence positive tissue regions. Our results show the substantial effect that safe, inexpensive, mechanical debridement can have on bacterial load of venous ulcers without antiseptic use. Fluorescence imaging can localise bacterial colonised areas and showed persistent periwound bacteria post-debridement. Fluorescence-targeted debridement can be used quickly and easily in daily practice.
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Affiliation(s)
- Maurice Moelleken
- Department of Dermatology, Venerology and AllergologyUniversity of EssenEssenGermany
| | - Finja Jockenhöfer
- Department of Dermatology, Venerology and AllergologyUniversity of EssenEssenGermany
| | - Sven Benson
- Institute of Medical Psychology and Behavioral ImmunobiologyUniversity of EssenEssenGermany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and AllergologyUniversity of EssenEssenGermany
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Holloway S, Pokorná A, Janssen A, Ousey K, Probst S. Wound Curriculum for Nurses: Post-registration qualification wound management-European qualification framework level 7. J Wound Care 2020; 29:S1-S39. [PMID: 32857627 DOI: 10.12968/jowc.2020.29.sup7a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Holloway
- Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales, UK
| | - A Pokorná
- Professor, Masaryk University,Faculty of Medicine, Dept. of Nursing and Midwifery, Brno, Czech Republic Institute of Health Information and Statistics of the Czech Republic, Department of quality of care assessment, Head of Department, Prague, Czech Republic
| | - A Janssen
- Health & Social Care, Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands
| | - K Ousey
- Professor and Director, Institute of Skin Integrity and Infection Prevention Huddersfield, UK, Visiting Professor, School of Nursing, Faculty of Health at the Queensland University of Technology, Brisbane, Australia; Visiting Professor, Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland; Director, Institute of Skin Integrity and Infection Prevention Huddersfield, UK
| | - S Probst
- Professor of tissue viability and wound care, HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland
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Leypold T, Schäfer B, Boos AM, Beier JP. Plastic Surgery Reconstruction of Chronic/Non-Healing Wounds. Surg Technol Int 2020; 38:65-71. [PMID: 33370841 DOI: 10.52198/21.sti.38.wh1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In western countries, approximately 1 % of individuals are affected by chronic wounds during their lifetime. Due to changing demographics, this incidence will likely increase in the future. Additionally, the high prevalence is accompanied by substantial treatment expenditures. Therefore, it is of global interest to find effective treatment algorithms. In this article, we present up-to-date solutions for treating chronic / difficult to heal and complex wounds by means of plastic and reconstructive surgery. We outline the principles of chronic wounds and how to perform an appropriate diagnosis. Close cooperation and interdisciplinary exchange are important for optimizing treatment. We report the principles of wound debridement and the role of negative pressure wound therapy. Moreover, we discuss the state of the art of defect reconstruction by means of skin grafting, with or without acellular dermal matrices, local tissue transfers and free tissue transfers. In very complex cases, the local macrovascular blood flow is greatly reduced and there are few, if any, recipient vessels for free flap reconstruction. We discuss the role of arteriovenous loops to overcome this problem.
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Affiliation(s)
- Tim Leypold
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Benedikt Schäfer
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Anja M Boos
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Justus P Beier
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
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Hughes M, Alcacer-Pitarch B, Allanore Y, Baron M, Boin F, Bruni C, Chung L, Del Galdo F, Denton CP, Matucci-Cerinic M. Digital ulcers: should debridement be a standard of care in systemic sclerosis? THE LANCET. RHEUMATOLOGY 2020; 2:e302-e307. [PMID: 38273475 DOI: 10.1016/s2665-9913(19)30164-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 01/02/2023]
Abstract
Digital ulcers are a serious, recurrent complication in patients with systemic sclerosis. They are often slow to heal and exquisitely painful. Local wound care, such as debridement of the wound bed, is an essential component in the management of digital ulcers in systemic sclerosis. However, digital ulcer debridement is not a standard of care, and there is substantial international variation in the use of this approach. In this Viewpoint, we discuss the assessment of the wound bed and different methods of debridement using the model of tissue management, infection and inflammation, moisture control, and wound edge or epidermal advancement, known as TIME. We highlight the challenges in standard practice and the need for research into local wound care for this type of ulceration, before suggesting a potential roadmap to develop a standardised approach to support ulcer debridement in systemic sclerosis. Debridement might be the missing component in optimising the management of digital ulcers and we propose that the approach should be rigorously investigated as a standard of care in this common complication of systemic sclerosis.
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Affiliation(s)
- Michael Hughes
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK; Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Begonya Alcacer-Pitarch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Biomedical Research Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Yannick Allanore
- Department of Rheumatology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Murray Baron
- Division of Rheumatology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Francesco Boin
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Cosimo Bruni
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine and Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; NIHR Biomedical Research Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Christopher P Denton
- Department of Rheumatology, Royal Free Hospital, University College London, London, UK
| | - Marco Matucci-Cerinic
- Division of Rheumatology, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, de Ceniga MV, Weir D, Wolcott R, Ĉernohorská J, Ciprandi G, Dissemond J, James GA, Hurlow J, Lázaro MartÍnez JL, Mrozikiewicz-Rakowska B, Wilson P. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care 2020; 29:S1-S26. [DOI: 10.12968/jowc.2020.29.sup3b.s1] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Christine Murphy
- Vascular Nurse Specialist, The Ottawa Hospital Limb Preservation Centre, Ottawa, Canada
| | - Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust and University of Huddersfield, UK
| | - Terry Swanson
- Nurse Practitioner, Wound Management, Warrnambool, Victoria, Australia
| | - Masahiro Tachi
- Professor, Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Yih Kai Tan
- Director of Vascular Services, Consultant Vascular and Endovascular Surgeon, Changi General Hospital, Singapore
| | - Melina Vega de Ceniga
- Consultant Angiologist, Vascular and Endovascular Surgeon, Galdakao-Usansolo Hospital, Bizkaia, Spain
| | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, US
| | | | | | - Guido Ciprandi
- Chief Wound Care Surgical Unit, Division of Plastic and Maxillofacial Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Joachim Dissemond
- Professor of Dermatology and Venerology, University of Essen, Germany
| | - Garth A James
- Associate Research Professor of Chemical and Biological Engineering, Director, Medical Biofilms Laboratory, Center for Biofilm Engineering, Montana State University, Bozeman, Montana, US
| | - Jenny Hurlow
- Wound Specialized Advanced Practice Nurse, Advanced Wound Care, Southaven, Mississippi and West Memphis, Arkansas, US
| | | | - Beata Mrozikiewicz-Rakowska
- Associate Professor, Diabetology and Metabolic Diseases Department, Medical University of Warsaw, Warsaw, Poland
| | - Pauline Wilson
- Clinical Specialist Podiatrist, St James's Hospital, Dublin, Republic of Ireland
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36
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Multicentre study of pressure ulcer point prevalence in a Portuguese region. J Tissue Viability 2020; 29:12-18. [DOI: 10.1016/j.jtv.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 08/20/2019] [Accepted: 11/09/2019] [Indexed: 01/10/2023]
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Kashkouli MB, Khademi B, Erfanian-Salim R, Eshraghi B, Karimi N, Maleki M. Pressure ulcer following circumferential head dressing. Orbit 2020; 39:350-356. [PMID: 31997678 DOI: 10.1080/01676830.2020.1719521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report four patients with forehead pressure ulcer (PU) following encircling head dressing and review the literature. METHODS Uneventful endoscopic forehead lift procedure was performed with moderate skin elevation in three patients. Left upper eyelid crease incision was made to remove the sub-brow dermoid cyst uneventfully in one patient. All procedures were performed under general anesthesia. Mixed topical antibiotic and steroid ointments were placed on the incision sites before putting the encircling forehead dressing (using gauze and elastic bandage). The dressing was then removed on the first postoperative examination. RESULTS Forehead and eyebrow PUs were observed on the first follow-up visit (16-72 h) after removing the dressing. Patients were otherwise healthy. They did not have significant pain or burning postoperatively. Management included pressure release, wound debridement, daily dressing, topical antibiotic and steroid, and silicone-based anti-scar cream. None had infected ulcer and all except one ended up with atrophic scar in the last follow-up (2-14 months). External pressure and shearing forces were assumed to be the main causative factors, even though reperfusion injury could contribute in the development of PU. CONCLUSION Encircling head dressing can cause PU and result in scar formation in healthy immunocompetent patients. If there is a low risk of postoperative hematoma, encircling dressing should be avoided. Early loosening of the dressing and frequent examination of the skin are the best preventive and diagnostic measures. Treatment includes pressure removal, daily debridement, and topical medications.
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Affiliation(s)
- Mohsen Bahmani Kashkouli
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences , Tehran, Iran
| | - Behzad Khademi
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences , Tehran, Iran
| | | | - Bahram Eshraghi
- Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | - Nasser Karimi
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences , Tehran, Iran
| | - Meysam Maleki
- Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences , Tehran, Iran
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Eberlein T, Wiegand C, Andriessen A, Roes C, Abel M. Use of a monofilament debridement pad in the treatment of acne vulgaris. J Wound Care 2019; 28:780-783. [PMID: 31721661 DOI: 10.12968/jowc.2019.28.11.780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Acne vulgaris (acne) presents with increased oil-sebum secretion and subsequent formation of comedones, papules, pustules and nodules. Skin cleansing is part of the daily routine to improve skin condition. A monofilament debridement pad has shown to be effective when used for wound debridement and skin cleansing in dermatological conditions. The pad may offer benefits when used for acne affected skin. METHODS The in vitro cleansing capacity of the monofilament fibre pad was analysed and compared with commercially available cosmetic pads. For this purpose, a sebum model consisting of glass plates coated with an oil-red-stained layer of artificial sebum was used. To gain clinical experience a case series evaluated cleansing efficacy of the monofilament debridement pad in combination with polyhexanide and sodium-hypochlorite based solutions. Over a period of four months, seven individuals suffering from retentive moderate facial acne who visited the dermatology clinic for their acne used the pad as necessary, ranging from twice weekly to daily, dependent on the sensitivity of the patient's skin condition. RESULTS The in vitro study exhibited a significantly better cleansing efficacy of the monofilament debridement pad compared with the cosmetic pads. After single use of the pad subject scores on sebum reduction revealed excellent/very good in 42.9% and acceptable in 57.1% of cases. After repeated use of the monofilament pads scores on sebum reduction of excellent/very good were given in 85.7% and acceptable in 14.3% of cases. Subject scored handling of the pad and comfort during use also received favourable ratings. CONCLUSION These initial results show the potential of the monofilament debridement pad for cleansing of acne-prone and acne affected skin. More robust studies are needed to confirm these results.
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Affiliation(s)
- Thomas Eberlein
- Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Cornelia Wiegand
- Department of Dermatology, University Hospital Jena, Erfurter Str. 25, 07743 Jena, Germany
| | - Anneke Andriessen
- UMC St Radboud, Nijmegen & Andriessen Consultants, Malden, The Netherlands
| | - Claas Roes
- Lohmann & Rauscher GmbH & Co. KG, Westerwaldstrasse 4, 56579 Rengsdorf, Germany
| | - Martin Abel
- Lohmann & Rauscher GmbH & Co. KG, Irlicher Str. 55, 56567 Neuwied, Germany
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Viviana Serna González C, Thum M, de Oliveira Ramalho A, Beloto Silva O, Franco Coelho M, Medeiros da Silva Queiroz W, Maria Sebba Tosta de Souza D, Cristina Nogueira P, Lúcia Conceição Gouveia Santos V. Análise da “1a Recomendação Brasileira para o Gerenciamento do Biofilme em Feridas Crônicas e Complexas”. ESTIMA 2019. [DOI: 10.30886/estima.v17.783_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivos: Analisar criticamente a “1ª Recomendação brasileira para o gerenciamento de biofilme em feridas crônicas e complexas”. Método: Realizou-se revisão da literatura atual às informações nele contidas. Resultados: Observou-se que a publicação carece de metodologia compatível com o título, existem lacunas nas recomendações quanto à classificação das evidências e com ausência de fundamentação a partir de importantes consensos internacionais para o tratamento das feridas complexas com suspeita de biofilme, publicados nos últimos três anos. Conclusão: Conclui-se que o manuscrito não deve ser usado como guia de recomendações clínicas, mas como revisão bibliográfica sobre o tema.
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Viviana Serna González C, Thum M, de Oliveira Ramalho A, Beloto Silva O, Franco Coelho M, Medeiros da Silva Queiroz W, Maria Sebba Tosta de Souza D, Cristina Nogueira P, Lúcia Conceição Gouveia Santos V. Analysis of “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds”. ESTIMA 2019. [DOI: 10.30886/estima.v17.783_in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Analyze critically the “1st Brazilian Recommendation for Biofilm Management in Chronic and Complex Wounds” (from Portuguese, “1a Recomendação Brasileira para o Gerenciamento de Biofilme em Feridas Crônicas e Complexas”). Method: Reviewing information contained in said document according to current literature. Results: The publication was showed to lack methodology compatible with its title; gaps in the recommendations were perceived regarding evidence classification, as well as an absence of grounding from important international consensus, published in the last three years, about treatment of complex wounds with suspected biofilm. Conclusion: The document was concluded to be inadequate for use as a clinical guideline, being considered only a bibliographic review about the theme.
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Assadian O, Kammerlander G, Geyrhofer C, Luch G, Doppler S, Tuchmann F, Eberlein T, Leaper D. Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds. J Wound Care 2019; 27:S10-S16. [PMID: 30307816 DOI: 10.12968/jowc.2018.27.sup10.s10] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE: The influence of different irrigation solutions, in conjunction with wet-to-moist cleansing, on the reduction of sessile, non-planktonic bacteria which colonise wounds, has not been investigated. In this study, the antibacterial effect of different irrigation solutions, during a 20-minute wet-to-moist cleansing, has been evaluated in chronic wounds. METHODS: This study was designed as a prospective cohort study with 12 study arms and was conducted between June 2011 and April 2016. Patients with chronic wounds present for more than three months, irrespective of previous treatments, were recruited into this study. Quantitative wound swabs were obtained before and after a 20-minute, wet-to-moist cleansing, using different wound irrigation solutions. Sterile 0.9% saline served as a control. RESULTS: We recruited 308 patients, of which 260 patients with 299 chronic wounds were eligible for analysis. Staphylococcus aureus was the most common recovered (25.5%) microorganism, of which 8% were meticillin-resistant Staphylococcus aureus (MRSA) strains. Although 0.9% saline supported cleansing of the wound bed, it did not significantly reduce the bacterial burden. The highest reduction of bacterial burden was achieved with an aqueous solution containing betaine, zinc and polyhexamethylene biguanide (polihexanide; ln RF=3.72), followed by a 3% saline solution containing 0.2% sodium hypochlorite (ln RF=3.40). The most statistically significant reduction of bacterial burden, although not the highest, was achieved with povidone-iodine (ln RF=2.98; p=0.001) and an irrigation solution containing sea salt 1.2% and NaOCl 0.4% (ln RF=2.51; p=0.002). CONCLUSION: If a reduction of bacterial burden is warranted, wound irrigation solutions containing a combination of hypochlorite/hypochlorous acid, or antiseptics such as polihexanide, octenidine or povidone-iodine, ought to be considered.
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Affiliation(s)
- Ojan Assadian
- Department for Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. and Institute for Skin Integrity & Infection Prevention, School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Claudia Geyrhofer
- CWM Academy, Zurich, Switzerland, WCC Wound Competence Centre, Linz, Austria
| | - Gerlinde Luch
- CWM Academy, Zurich, Switzerland, WCC Wound Competence Centre, Linz, Austria
| | - Stefan Doppler
- Kepler University Hospital, Neuromed Campus, Department of Pathology & Microbiology, Linz, Austria
| | - Felix Tuchmann
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Eberlein
- CWM Academy, Zurich, Switzerland, WCC Wound Competence Centre, Linz, Austria
| | - David Leaper
- Emeritus Professor of Surgery, University of Newcastle upon Tyne, Visiting Professor, Imperial College, London, UK
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Roes C, Calladine L, Morris C. Biofilm management using monofilament fibre debridement technology: outcomes and clinician and patient satisfaction. J Wound Care 2019; 28:608-622. [PMID: 31513491 DOI: 10.12968/jowc.2019.28.9.608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: Best practice in wound bed preparation and biofilm-based wound management includes debridement to create a clean wound bed and to assist in minimising the redevelopment of biofilm. Biofilm that is not removed inhibits healing and redevelops if not prevented from doing so with topical antimicrobial agents. Monofilament fibre debriding technology (MFDT) is used for effective and rapid mechanical debridement of loose material, slough and biofilm. The objective of this evaluation was to determine the clinical effect and consequential levels of health professional and patient satisfaction with the results of a biofilm pathway that included MFDT to achieve debridement. Methods: This non-comparative, open label evaluation was conducted in static and non-static wounds that required debridement. MFDT was used to debride in a two-week evaluation of a biofilm pathway. Wounds were debrided three times in week one and twice in week two. Each debridement was followed by treatment with an antimicrobial dressing. Other care included secondary dressings and compression delivered according to local practice, guidelines and formularies. After the clinical evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with the biofilm pathway. Results: There were 706 health professionals who provided answers to the survey questions. Wound types evaluated were leg ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%). Of the wounds, 9% were reported as non-static despite the eligibility criteria. Not all wounds followed the pathway. The most frequently-used antimicrobial was silver. Non-antimicrobial products used included all-in-one dressings, other secondary dressings and compression. There was a change in 77% of wounds overall after two weeks. Change was reported almost equally for both static and non-static wounds. Health professionals who did or did not follow the pathway were ‘completely satisfied’ or ‘satisfied’ with the overall clinical outcome 96% and 95%, respectively. Of the patients, 77% were ‘completely satisfied’ or ‘satisfied’ with healing after following the pathway, as reported by the treating health professional. Conclusion: The biofilm pathway that includes MFDT appears effective. Wounds managed on the pathway were debrided effectively and healing progressed to the satisfaction of both health professionals and patients.
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Affiliation(s)
- Claas Roes
- 1 Scientific Support Manager, Lohmann & Rauscher GmbH & Co. KG, Global Scientific Support, Rengsdorf, Germany
| | - Leanne Calladine
- 2 Communications and Events Manager, Lohmann & Rauscher, Burton on Trent, Staffordshire, UK
| | - Clare Morris
- 2 Senior Clinical Services Manager, Lohmann & Rauscher, Burton on Trent, Staffordshire, UK
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Ousey K, Walker A, Brace J, Duteille F, Probst A, Hughes M, Milne C, Cole W. A multipurpose dressing: A clinical review of the absorption, debridement and healing properties of Aquacel Foam. J Wound Care 2019; 28:S1-S23. [DOI: 10.12968/jowc.2019.28.sup9a.s1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention – University of Huddersfield Department of Nursing and Midwifery; Adjunct Professor – School of Nursing, Faculty of Health at the Queensland University of Technology, Australia; Visiting Professor, Royal College of Surgeons, Dublin, Republic of Ireland
| | - Angela Walker
- Podiatry Lead, Clinical Specialist, Birmingham Community Healthcare NHS Foundation Trust, UK
| | | | - Franck Duteille
- Professor of Plastic Surgery, Burn Centre, Centre Hospitalier Universitaire (CHU) de Nantes, France
| | - Astrid Probst
- Advanced Nurse Practitioner, Kreiskliniken Reutlingen, Germany
| | - Maria Hughes
- Independent Tissue Viability Consultant; Head of Medical Services and Wellbeing, and Queens Nurse, North Wales Police, UK
| | - Cathy Milne
- Advanced Practitioner, Wound Ostomy and Continence Nursing, Connecticut Clinical Nursing Associates, US
| | - Windy Cole
- Adjunct Professor and Director of Wound Care, Medical Director, UH Ahuja Wound Center, US
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Roes C, Calladine L, Morris C. Rapid debridement with monofilament fibre debridement technology: clinical outcomes and practitioner satisfaction. J Wound Care 2019; 28:534-541. [DOI: 10.12968/jowc.2019.28.8.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To determine the clinical effect and consequential levels of health professionals and patient satisfaction with the results of debridement episodes of wounds with visible slough and/or scaly skin using monofilament fibre debridement technology. Methods: This was a non-comparative, open label evaluation conducted in static/non-healing acute and chronic wounds with visible slough and/or scaly skin that required debridement. Monofilament fibre debridement technology was applied in 1–2 sequential treatment episodes during normal clinical practice which followed local practice, guidelines or formularies. Following the clinical phase of the evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with them. Results: Survey questions were answered by 1129 health professionals. Wounds managed using the monofilament fibre debridement technology during this evaluation included leg ulcers (63%), pressure ulcers (10%), dehisced surgical wounds (3%), diabetic foot ulcers (8%) and other wounds (13%). ‘Other’ wound types included acute dirty wounds, burns, cellulitis, psoriasis, diabetic amputation wounds, dry flaky skin, moisture wounds, trauma, varicose eczema. Of the wounds, 12% were reported as non-static. There was visible change in the wound and/or skin after first use of the monofilament fibre debridement technology in a high proportion of all wound types, and a further increase in the proportion of wounds with visible change after the second use. The visible difference was significant for both static and non-static wounds. User and patient satisfaction with all clinical outcomes were high, whether or not the user and patient had previous experience of monofilament fibre debridement technology. Conclusion: Monofilament fibre debridement technology provides rapid, visible and effective debridement of slough and scaly skin after one application and further visible improvement after two applications in static and non-static wounds. Health professionals and patients report high levels of satisfaction with outcomes following application of the monofilament fibre debridement technology.
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Affiliation(s)
- Claas Roes
- Scientific Support Manager, Lohmann & Rauscher GmbH & Co. KG, Global Scientific Support, Rengsdorf, Germany
| | - Leanne Calladine
- Communications and Events Manager, Lohmann & Rauscher, Burton on Trent, Staffordshire, UK
| | - Clare Morris
- Senior Clinical Services Manager, Lohmann & Rauscher, Burton on Trent, Staffordshire, UK
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Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjö M, Piaggesi A, Probst A, Vowden P. EWMA Document: Negative Pressure Wound Therapy. J Wound Care 2019; 26:S1-S154. [PMID: 28345371 DOI: 10.12968/jowc.2017.26.sup3.s1] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1 NPWT has been described as a effective treatment for wounds of many different aetiologies2,3 and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4-6 dehisced sternal wounds following cardiac surgery7,8 and as a valuable agent in complex non-healing wounds.9,10 Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11 While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12-14 The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents15-19 with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
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Affiliation(s)
- Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, 205 02 Malmö, Sweden and Division for Clinical Sciences, University of Lund, 221 00 Lund, Sweden
| | - Christian Willy
- Department of Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Bundeswehr Hospital Berlin, Research and Treatment Center for Complex Combat Injuries, Federal Armed Forces of Germany, 10115 Berlin, Germany
| | - Ann-Mari Fagerdahl
- Department of Clinical Science and Education, Karolinska Institutet, and Wound Centre, Södersjukhuset AB, SE-118 83 Stockholm, Sweden
| | - Marco Fraccalvieri
- Plastic Surgery Unit, ASO Città della Salute e della Scienza of Turin, University of Turin, 10100 Turin, Italy
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, Pisa University Hospital, 56125 Pisa, Italy
| | - Astrid Probst
- Kreiskliniken Reutlingen GmbH, 72764 Reutlingen, Germany
| | - Peter Vowden
- Faculty of Life Sciences, University of Bradford, and Honorary Consultant Vascular Surgeon, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom
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Hodgson H, Davidson D, Duncan A, Guthrie J, Henderson E, MacDiarmid M, McGown K, Pollard V, Potter R, Rodgers A, Wilson A, Horner J, Doran M, Simm S, Taylor R, Rogers A, Rippon MG, Colgrave M. A multicentre, clinical evaluation of a hydro-responsive wound dressing: the Glasgow experience. J Wound Care 2019; 26:642-650. [PMID: 29131748 DOI: 10.12968/jowc.2017.26.11.642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Our aim was to assess the effectiveness of hydro-responsive wound dressing (HRWD) in debridement and wound bed preparation of a variety of acute and chronic wounds that presented with devitalised tissue needing removal so that healing may proceed. METHOD This was a non-comparative evaluation of acute and chronic wounds that required debridement as part of their normal treatment regimen. Clinicians recorded wound changes including a subjective assessment level of devitalised tissue and wound bed preparation, presence of pain, wound status (e.g., wound size) and periwound skin condition. Data was also collected from clinicians and patients to provide information on clinical performance of the dressing. RESULTS We recruited 100 patients with a variety of wound types into the study. Over 90% of the clinicians reported removal of devitalised tissue to enable a healing response in both chronic and acute wounds. Specifically, over the course of the evaluation period, levels of devitalised tissue (necrosis and slough) reduced from 85.5% to 26.3%, and this was accompanied by an increase in wound bed granulation from 12.0% to 33.7%. Correspondingly, there was a 40% reduction in wound area, hence a clinically relevant healing response was seen upon treatment with HRWD. It is also noteworthy that this patient population included a significant proportion of chronic wounds (51.4%) that showed no signs of wound progression within <4 weeks before study inclusion. Of these chronic wounds, 93% demonstrated wound progression upon treatment with HRWD. Despite reported pain levels being low pre- and post-dressing change, overall wound pain improved (reduced) in 48% of patients. Periwound skin condition showed a tendency towards improvement, and the fluid management capabilities of the HRWD was reported as good to excellent in the majority of cases. Wound infections were reduced by at least 60% over the evaluation period. A simple cost-effective analysis demonstrated significant savings using HRWD (£6.33) over current standard practice regimens of a four-step debridement process (£8.05), larval therapy (£306.39) and mechanical pad debridement (£11.46). CONCLUSION HRWD was well tolerated and was demonstrated to be an efficient debridement tool providing rapid, effective and pain free debridement in a variety of wound types.
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Affiliation(s)
- H Hodgson
- Lead Investigator, Lead Nurse Tissue Viability, Tissue Viability Acute and Partnerships, Glasgow
| | - D Davidson
- Vascular Nurse Specialist, Inverclyde Royal Hospital, Greenock
| | - A Duncan
- Vascular Nurse Specialist, Queen Elizabeth University Hospital, Glasgow
| | - J Guthrie
- Tissue Viability Specialist Nurse, Tissue Viability Acute and Partnerships, Glasgow
| | - E Henderson
- Tissue Viability Nurse Specialist, Glasgow Royal Infirmary, Glasgow
| | - M MacDiarmid
- Tissue Viability Clinical Nurse Specialist, Queen Elizabeth University Hospital, Glasgow
| | - K McGown
- Tissue Viability Nurse, Queen Elizabeth University Hospital, Glasgow
| | - V Pollard
- Tissue Viability Nurse, Inverclyde Royal Hospital, Greenock
| | - R Potter
- Tissue Viability Clinical Nurse Specialist, Tissue Viability Specialist Nurses (Partnerships Glasgow)
| | - A Rodgers
- Paediatric Tissue Viability Nurse, Royal Hospital for Children, Glasgow
| | - A Wilson
- Tissue Viability Nurse Specialist, Royal Alexandra Hospital, Paisley
| | - J Horner
- Tissue Viability Personal Assistant, Tissue Viability Acute and Partnerships, Glasgow
| | - M Doran
- Tissue Viability Personal Assistant, Tissue Viability Acute and Partnerships, Glasgow
| | - S Simm
- Clinical Development Manager, Hartmann Wound Care, Haywood, Lancashire
| | - R Taylor
- Nurse Advisor (North), Hartmann Wound Care, Haywood, Lancashire
| | - A Rogers
- Medical Communications, Flintshire, North Wales
| | - M G Rippon
- Visiting Clinical Research Fellow, Huddersfield University, Queensgate, Huddesfield
| | - M Colgrave
- Freelance Medical Writer, Molecular Cell Research, Lincoln
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Abstract
The European Wound Management Association (EWMA) has just finalised the first curriculum in a series of several curricula intended for use in levels 5-7 of the European Qualifications Framework (EQF)1. The aim of these is to support a common approach to post-registration qualification in wound management for nurses across Europe. EWMA hopes and will work towards a close collaboration with European nurse organisations as well as educational institutions to implement these common curricula.
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Affiliation(s)
- Andrea Pokorná
- Associate Professor, Senior lecturer, Medical Faculty, Masaryk University, Dept. of Nursing, Brno, Czech Republic, Institute of Health Information and Statistics of the Czech Republic, Department of quality of care assessment (Head of Department)
| | - Samantha Holloway
- Senior Lecturer, Centre for Medical Education, School of Medicine, Cardiff University, Wales, UK
| | - Robert Strohal
- Head of Department, Dept. of Dermatology and Venerology, Federal University Teaching, Hospital Feldkirch, Austria (Head of Department)
| | - Ida Verheyen-Cronau
- Manager, Anerkennungs- und Zertifizierstelle ICW e.V./PersCert TÜV, Initiative Chronische Wunde (ICW), Germany
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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Jepson RE, Cardwell JM, Cortellini S, Holm L, Stevens K, Walker D. Cutaneous and Renal Glomerular Vasculopathy: What Do We Know so Far? Vet Clin North Am Small Anim Pract 2019; 49:745-762. [PMID: 30961997 DOI: 10.1016/j.cvsm.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cutaneous renal glomerular vasculopathy (CRGV), colloquially named "Alabama rot," is an emerging condition in the United Kingdom, previously reported from the United States and Germany. The cause of CRGV is not yet determined; no definitive link to an infectious agent has been made. Dogs diagnosed with CRGV initially develop cutaneous lesions, and a proportion of these dogs go on to manifest acute kidney injury, which may result in oligoanuric acute renal failure. Antemortem diagnosis is challenging given the lack of a specific diagnostic test, and confirmation of CRGV is therefore currently dependent on identification of thrombotic microangiopathy on renal histopathology.
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Affiliation(s)
- Rosanne E Jepson
- Department of Clinical Science and Services, Royal Veterinary College, Queen Mother Hospital for Animals, Hawkshead Lane, North Mymms, Herts, London AL9 7TA, UK.
| | - Jacqueline M Cardwell
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Herts, London AL9 7TA, UK
| | - Stefano Cortellini
- Department of Clinical Science and Services, Royal Veterinary College, Queen Mother Hospital for Animals, Hawkshead Lane, North Mymms, Herts, London AL9 7TA, UK
| | - Laura Holm
- Anderson Moores Veterinary Specialists, The Granary, Bunstead Barns, Poles Lane, Hursley, Winchester SO21 2LL, UK
| | - Kim Stevens
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Herts, London AL9 7TA, UK
| | - David Walker
- Anderson Moores Veterinary Specialists, The Granary, Bunstead Barns, Poles Lane, Hursley, Winchester SO21 2LL, UK
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50
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Baczako A, Fischer T, Konstantinow A, Volz T. [Chronic wounds]. MMW Fortschr Med 2019; 161:48-56. [PMID: 30887314 DOI: 10.1007/s15006-019-0006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Andrea Baczako
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland
| | - Tatjana Fischer
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland
| | - Alexander Konstantinow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland
| | - Thomas Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, D-80802, München, Deutschland.
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