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Woo K, Santamaria N, Beeckman D, Alves P, Cullen B, Gefen A, Lázaro-Martínez JL, Lev-Tov H, Najafi B, Sharpe A, Swanson T. Using patient-reported experiences to inform the use of foam dressings for hard-to-heal wounds: perspectives from a wound care expert panel. J Wound Care 2024; 33:814-822. [PMID: 39480734 DOI: 10.12968/jowc.2024.0027] [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: 11/02/2024]
Abstract
Caring for patients with hard-to-heal (chronic) wounds requires a multifaceted approach that addresses their diverse needs, which can contribute to the complexity of care. Wound care providers must have a comprehensive understanding of the patient's comorbid conditions and psychosocial issues to provide personalised and effective treatment. Key quality indicators for effective wound care involves not only selecting appropriate local wound care products, such as foam dressings, but also addressing individual patient experiences of wound-related pain, odour, itch, excessive wound drainage, and self-care needs. The purpose of this review is to inculcate the wound care practice community, research scientists and healthcare industry with a sense of accountability in order to work collaboratively in addressing these unmet care needs.
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Affiliation(s)
- Kevin Woo
- 92 Barrie Street School of Nursing, Queen's University, Kingston, Ontario, Canada
- Toronto Grace Health Center, Toronto, Canada
| | - Nick Santamaria
- School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Campus UZGent, Gent, Belgium
| | - Paulo Alves
- Wounds Research Lab - Centre for Interdisciplinary Research in Health, Catholic University of Portugal, Porto, Portugal
| | | | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - José Luis Lázaro-Martínez
- Director of the Diabetic Foot Research Group, Complutense University and Health Research Institute at San Carlos Teaching Hospital, Madrid, Spain
| | - Hadar Lev-Tov
- University of Miami Hospital Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami, Florida, US
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston TX, US
| | - Andrew Sharpe
- Podiatry Department, Salford Royal NHS Foundation Trust, Salford Care Organisation, Salford, UK
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Gefen A. The complex interplay between mechanical forces, tissue response and individual susceptibility to pressure ulcers. J Wound Care 2024; 33:620-628. [PMID: 39287029 DOI: 10.12968/jowc.2024.0023] [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: 09/19/2024]
Abstract
OBJECTIVE The most recent edition of the International Clinical Practice Guideline for the Prevention and Treatment of Pressure Ulcers/Injuries was released in 2019. Shortly after, in 2020, the first edition of the SECURE Prevention expert panel report, focusing on device-related pressure ulcers/injuries, was published as a special issue in the Journal of Wound Care. A second edition followed in 2022. This article presents a comprehensive summary of the current understanding of the causes of pressure ulcers/injuries (PU/Is) as detailed in these globally recognised consensus documents. METHOD The literature reviewed in this summary specifically addresses the impact of prolonged soft tissue deformations on the viability of cells and tissues in the context of PU/Is related to bodyweight or medical devices. RESULTS Prolonged soft tissue deformations initially result in cell death and tissue damage on a microscopic scale, potentially leading to development of clinical PU/Is over time. That is, localised high tissue deformations or mechanical stress concentrations can cause microscopic damage within minutes, but it may take several hours of continued mechanical loading for this initial cell and tissue damage to become visible and clinically noticeable. Superficial tissue damage primarily stems from excessive shear loading on fragile or vulnerable skin. In contrast, deeper PU/Is, known as deep tissue injuries, typically arise from stress concentrations in soft tissues at body regions over sharp or curved bony prominences, or under stiff medical devices in prolonged contact with the skin. CONCLUSION This review promotes deeper understanding of the pathophysiology of PU/Is, indicating that their primary prevention should focus on alleviating the exposure of cells and tissues to stress concentrations. This goal can be achieved either by reducing the intensity of stress concentrations in soft tissues, or by decreasing the exposure time of soft tissues to such stress concentrations.
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Affiliation(s)
- Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Mathematics and Statistics, Faculty of Sciences, Hasselt University, Hasselt, Belgium
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Ousey K, Woodmansey E, Fitzgerald DJ, Brownhill R. Enhanced exploration of the mode of action of a five-layer foam dressing: critical properties to support wound healing. J Wound Care 2024; 33:708-717. [PMID: 39287030 DOI: 10.12968/jowc.2024.0255] [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: 09/19/2024]
Abstract
OBJECTIVE The aim of this in vitro experimental series was to explore the mode of action of a hydrocellular polyurethane foam dressing (HPFD) and how its advanced features support beneficial interactions with the wound bed to address common barriers to wound healing, thus supporting improved clinical outcomes. METHOD Multiple in vitro microbiological tests were performed, assessing prevention of bacterial ingress, surface removal of bacteria, bacterial sequestration and retention into the dressing in a clinically relevant environment. Odour molecule concentrations were measured using gas chromatography and further assays explored matrix metalloproteinase (MMP)-9 retention in the dressing using enzyme linked immunosorbent assay. RESULTS The HPFD demonstrated marked reductions in bioburden levels across multiple tests. These included prevention of bacterial ingress for seven days, removal of surface bacteria and absorption into the dressing. Further tests identified that most bacteria were sequestered into the hyperabsorbent layer (90.5% for Pseudomonas aeruginosa and 89.6% for meticillin-resistant Staphylococcus aureus). Moreover, the majority of bacteria (99.99% for both test organisms) were retained within the dressing, even upon compression. Additional tests demonstrated a marked reduction of odour molecules following incubation with HPFD and total retention of protease MMP-9 within the dressing. CONCLUSIONS Proactive management of the wound environment with an appropriate advanced wound dressing, such as the HPFD examined in these in vitro investigations, can not only help to minimise the barriers to healing, as observed across this test series by direct interaction with the wound bed, but may, as a result, provide an ideal environment for wound progression with minimal disturbance.
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Affiliation(s)
- Karen Ousey
- 1 Professor of Skin Integrity, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
- 2 Adjunct Professor, School of Nursing, Faculty of Health, Queensland University of Technology, Australia
- 3 Visiting Professor, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Daniel J Fitzgerald
- 5 Research and Development, Advanced Wound Management, Smith & Nephew, Hull, UK
| | - Runi Brownhill
- 5 Research and Development, Advanced Wound Management, Smith & Nephew, Hull, UK
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Pathak D, Mazumder A. A critical overview of challenging roles of medicinal plants in improvement of wound healing technology. Daru 2024; 32:379-419. [PMID: 38225520 PMCID: PMC11087437 DOI: 10.1007/s40199-023-00502-x] [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: 02/01/2023] [Accepted: 12/25/2023] [Indexed: 01/17/2024] Open
Abstract
PURPOSE Chronic diseases often hinder the natural healing process, making wound infections a prevalent clinical concern. In severe cases, complications can arise, potentially leading to fatal outcomes. While allopathic treatments offer numerous options for wound repair and management, the enduring popularity of herbal medications may be attributed to their perceived minimal side effects. Hence, this review aims to investigate the potential of herbal remedies in efficiently treating wounds, presenting a promising alternative for consideration. METHODS A literature search was done including research, reviews, systematic literature review, meta-analysis, and clinical trials considered. Search engines such as Pubmed, Google Scholar, and Scopus were used while retrieving data. Keywords like Wound healing 'Wound healing and herbal combinations', 'Herbal wound dressing', Nanotechnology and Wound dressing were used. RESULT This review provides valuable insights into the role of natural products and technology-based formulations in the treatment of wound infections. It evaluates the use of herbal remedies as an effective approach. Various active principles from herbs, categorized as flavonoids, glycosides, saponins, and phenolic compounds, have shown effectiveness in promoting wound closure. A multitude of herbal remedies have demonstrated significant efficacy in wound management, offering an additional avenue for care. The review encompasses a total of 72 studies, involving 127 distinct herbs (excluding any common herbs shared between studies), primarily belonging to the families Asteraceae, Fabaceae, and Apiaceae. In research, rat models were predominantly utilized to assess wound healing activities. Furthermore, advancements in herbal-based formulations using nanotechnology-based wound dressing materials, such as nanofibers, nanoemulsions, nanofiber mats, polymeric fibers, and hydrogel-based microneedles, are underway. These innovations aim to enhance targeted drug delivery and expedite recovery. Several clinical-based experimental studies have already been documented, evaluating the efficacy of various natural products for wound care and management. This signifies a promising direction in the field of wound treatment. CONCLUSION In recent years, scientists have increasingly utilized evidence-based medicine and advanced scientific techniques to validate the efficacy of herbal medicines and delve into the underlying mechanisms of their actions. However, there remains a critical need for further research to thoroughly understand how isolated chemicals extracted from herbs contribute to the healing process of intricate wounds, which may have life-threatening consequences. This ongoing research endeavor holds great promise in not only advancing our understanding but also in the development of innovative formulations that expedite the recovery process.
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Affiliation(s)
- Deepika Pathak
- Noida Institute of Engineering and Technology (Pharmacy Institute), 19 Knowledge Park-II, Institutional Area, Greater Noida, UP, 201306, India.
| | - Avijit Mazumder
- Noida Institute of Engineering and Technology (Pharmacy Institute), 19 Knowledge Park-II, Institutional Area, Greater Noida, UP, 201306, India
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Marques R, de Lopes MVO, Neves‐Amado JD, Ramos PAS, de Sá LO, da Oliveira IMS, da Amado JMC, de Vasconcelos MJM, Salgado PMF, Alves PJP. Integrating factors associated with complex wound healing into a mobile application: Findings from a cohort study. Int Wound J 2024; 21:e14339. [PMID: 37667542 PMCID: PMC10781894 DOI: 10.1111/iwj.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 09/06/2023] Open
Abstract
Complex, chronic or hard-to-heal wounds are a prevalent health problem worldwide, with significant physical, psychological and social consequences. This study aims to identify factors associated with the healing process of these wounds and develop a mobile application for wound care that incorporates these factors. A prospective multicentre cohort study was conducted in nine health units in Portugal, involving data collection through a mobile application by nurses from April to October 2022. The study followed 46 patients with 57 wounds for up to 5 weeks, conducting six evaluations. Healing time was the main outcome measure, analysed using the Mann-Whitney test and three Cox regression models to calculate risk ratios. The study sample comprised various wound types, with pressure ulcers being the most common (61.4%), followed by venous leg ulcers (17.5%) and diabetic foot ulcers (8.8%). Factors that were found to impair the wound healing process included chronic kidney disease (U = 13.50; p = 0.046), obesity (U = 18.0; p = 0.021), non-adherence to treatment (U = 1.0; p = 0.029) and interference of the wound with daily routines (U = 11.0; p = 0.028). Risk factors for delayed healing over time were identified as bone involvement (RR 3.91; p < 0.001), presence of odour (RR 3.36; p = 0.007), presence of neuropathy (RR 2.49; p = 0.002), use of anti-inflammatory drugs (RR 2.45; p = 0.011), stalled wound (RR 2.26; p = 0.022), greater width (RR 2.03; p = 0.002), greater depth (RR 1.72; p = 0.036) and a high score on the healing scale (RR 1.21; p = 0.001). Integrating the identified risk factors for delayed healing into the assessment of patients and incorporating them into a mobile application can enhance decision-making in wound care.
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Affiliation(s)
- Raquel Marques
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | | | - João Daniel Neves‐Amado
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | - Paulo Alexandre Silva Ramos
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- Unidade de Saúde Familiar Corino de AndradePortoPortugal
| | - Luís Octávio de Sá
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | - Irene Maria Silva da Oliveira
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | - João Manuel Costa da Amado
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
| | | | | | - Paulo Jorge Pereira Alves
- Centre for Interdisciplinary Research in HealthUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
- School of Nursing DepartmentUniversidade Católica Portuguesa, Institute of Health SciencesPortoPortugal
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Holubová A, Chlupáčová L, Krocová J, Cetlová L, Peters LJF, Cremers NAJ, Pokorná A. The Use of Medical Grade Honey on Infected Chronic Diabetic Foot Ulcers-A Prospective Case-Control Study. Antibiotics (Basel) 2023; 12:1364. [PMID: 37760661 PMCID: PMC10525154 DOI: 10.3390/antibiotics12091364] [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: 07/14/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Non-healing wounds are usually colonised and contaminated by different types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical grade honey (MGH). MGH has antioxidant, antimicrobial, anti-inflammatory, and immunomodulatory features. This study aims to evaluate the effect of MGH therapy on infected non-healing wounds, especially for diabetic foot syndrome. Prospective, observational case series (n = 5) of patients with wounds of diabetic foot syndrome are presented. There were five males with an average age of 61.6 years. All wounds were treated with MGH, and the healing trajectory was rigorously and objectively monitored. In all cases, there was a gradual disappearance of odour, pain, and exudation. Moreover, the wound areas significantly reduced within 40 days and there was a decrease in glycated haemoglobin and glycaemia values. All these outcomes resulted in improved quality of life of the patients. Despite bacterial colonisation, antibiotic treatment was not necessary. All wounds were completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in diabetic foot syndrome wounds, does not increase glycated haemoglobin or glycaemia levels, and thus constitutes an effective alternative to the use of antibiotics in the treatment of locally infected wounds.
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Affiliation(s)
- Adéla Holubová
- Faculty of Health and Social Sciences, University of South Bohemia, 370 11 České Budějovice, Czech Republic;
- DiaPodi Care, spol. s r.o., 392 01 Soběslav, Czech Republic;
| | | | - Jitka Krocová
- Department of Nursing and Midwifery, Faculty of Health Studies, University of West Bohemia, 301 00 Pilsen, Czech Republic;
| | - Lada Cetlová
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
| | | | - Niels A. J. Cremers
- Triticum Exploitatie BV, Sleperweg 44, 6222 NK Maastricht, The Netherlands;
- Department of Gynecology and Obstetrics, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Andrea Pokorná
- Department of Health Sciences, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic; (L.C.); (A.P.)
- Department of Health Sciences, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
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Xie H, Guo Z, Cao Q, Ye Y, Chen L, Luo N. Effect of individualized comfortable nursing on prognosis of vacuum sealing drainage in patients with orthopedic trauma. Medicine (Baltimore) 2023; 102:e32903. [PMID: 36800609 PMCID: PMC9936052 DOI: 10.1097/md.0000000000032903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
To explore the effect of individualized comfortable nursing on prognosis of vacuum sealing drainage (VSD) in patients with orthopedic trauma. 110 patients with orthopedic trauma VSD were randomly divided into the control group and the observation group, with 55 patients in each group receiving routine care and comfortable care. The wound healing time, visual analog scale, quality of life score, the level of inflammatory factors, the incidence of complications, and patient satisfaction were compared between the 2 groups. The average time of wound healing in the observation group was significantly lower than that in the control group (P < .01). The satisfaction rate in the observation group was significantly higher than that in the control group (P = .029). Meanwhile, the results showed that visual analog scale and quality of life scores in the observation group was significantly improved than that of the control group after receiving intervention (P < .05). After receiving intervention, the levels of TNF-α and IL-6 of patients in both groups were decreased, and the levels of TNF-α and IL-6 in the observation group were significantly decreased than those in the control group. Moreover, the incidence rate of adverse reaction in the observation group was significantly lower than that in the control group (P < .01). Comfortable nursing can reduce the wound healing time, the postoperative pain level, the incidence of complications, and improve patient satisfaction, which is of great significance for the prognosis of VSD in patients with orthopedic trauma.
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Affiliation(s)
- Huifang Xie
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Zhaodi Guo
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Qin Cao
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Yuan Ye
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Li Chen
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
| | - Na Luo
- Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei, China
- * Correspondence: Na Luo, Department of Hand Surgery, The First People’s Hospital of Jiangxia District, Wuhan city (Union Jiangnan Hospital Huazhong University of Science and Technology), Wuhan, Hubei 430200, China (e-mail: )
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Starace M, Carpanese MA, Pampaloni F, Dika E, Pileri A, Rubino D, Alessandrini A, Zamagni C, Baraldi C, Misciali C, Patrizi A, Bianchi T, Apalla Z, Piraccini BM. Management of malignant cutaneous wounds in oncologic patients. Support Care Cancer 2022; 30:7615-7623. [PMID: 35672478 PMCID: PMC9385755 DOI: 10.1007/s00520-022-07194-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/30/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Neoplastic wounds may develop as a result of primary tumor growth in the skin, due to metastasis, or due to skin invasion by tumors emerging from deeper levels. Malignant wounds may present as a crater-like ulcer, or as raised nodules with a cauliflower-like appearance. They are associated with malodor, necrosis, pain, bleeding, and secondary infection. The aim of our study is to better characterize fungating wounds and their management. METHODS We retrospectively reviewed the database of the Wound Care Unit of the University of Bologna in order to identify individuals affected by neoplastic wound, between January 2019 and February 2021. RESULTS We identified 9 females and 2 males with a mean age of 63 years; all were referred by the Oncology Unit. Management differed depending on the characteristics of the patients and the ulcers. Complete healing of the wound, following the parallel complete remission of the lymphoproliferative neoplasia, was observed in one individual. Among the others, one died because of breast cancer, while cutaneous lesions in 2 individuals deteriorated after 1 year of follow-up. Remission/relapse of the ulcer following the treatment course administered for the lymphoma were observed in one patient. CONCLUSIONS Treatment of malignant fungating wounds is challenging. Considering the neoplastic nature of the wounds, complete healing or improvement cannot be expected with the application of classically prescribed dressing for wounds. A mostly palliative treatment, focusing on maintaining the patient's quality of life, is a reasonable choice.
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Affiliation(s)
- Michela Starace
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Miriam Anna Carpanese
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesca Pampaloni
- Dermatology Unit, Department of Medicine, University of Padova, Via Gallucci 4, 35121, Padua, Italy.
| | - Emi Dika
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandro Pileri
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniela Rubino
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Aurora Alessandrini
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Zamagni
- Addarii Medical Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Tommaso Bianchi
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Zoe Apalla
- Second Dermatology Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Bianca Maria Piraccini
- Dermatology - IRCCS Policlinico Di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
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9
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Sandoz H. An overview of the prevention and management of wound infection. Nurs Stand 2022; 37:75-82. [PMID: 36039670 DOI: 10.7748/ns.2022.e11889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/09/2022]
Abstract
A wound can be defined as infected when the presence and subsequent proliferation of microorganisms leads to a local or systemic response in an individual. Wound infection is associated with delayed healing, wound chronicity, increased risk of hospital admission, loss of limb or digit and increased healthcare costs. The presence of biofilm is also recognised as a challenge in infected wounds and is associated with chronicity and delays in healing. Identifying and managing wound infection early can contribute to faster wound healing, thus reducing the risk of negative outcomes. This article details the pathophysiology, risk factors and signs and symptoms of wound infection. It also outlines various prevention and management options for wound infection.
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Affiliation(s)
- Heidi Sandoz
- Queensway Health Clinic, Hertfordshire Community NHS Trust, Hatfield, England
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10
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Zhao J, Cao Y, Cheng Y, Sun H, Chen T, Zhong Y, Zhang L, Zhou Y, Wang J. Outcomes of present-on-admission pressure injuries at discharge and potential prognostic factors: A historical cohort study in China. J Tissue Viability 2021; 30:576-581. [PMID: 34756551 DOI: 10.1016/j.jtv.2021.10.006] [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] [Received: 01/15/2021] [Accepted: 10/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prevalence of present-on-admission pressure injuries (POA-PIs) is much higher than hospital-acquired pressure injuries (HAPIs). But scant attention has been paid to POA-PIs, especially the healing rate and potential prognostic factors. OBJECTIVE To describe the characteristics of POA-PIs at admission and the outcomes of POA-PIs at discharge, and to explore potential prognostic factors of POA-PIs wound healing. METHODS This study analyzed electronic health records (EHRs) for 838 POA-PIs among 586 patients from a Chinese tertiary hospital in 2018. The outcomes of POA-PIs were identified into four categories by comparing POA-PIs' wound area and exudation amount scores at admission and discharge: deteriorating, stable, improving, and healed. The generalized estimating equation (GEE) was carried out to screen the prognostic factors of POA-PIs wound healing. RESULTS Among this population, 66.38% of the patients were male, 44.03% patients had a Braden Score less than 12 and the median of the Charlson comorbidity index was 5. The most common location of POA-PI wounds was the sacrum and the most common stage of them was Stage II. Nearly half of wounds (45.78%) were larger than 15 cm2, 26.61% were deeper than 0.5 cm, and 61.81% of the wounds were painful. When the patients were discharged, 29.71% wounds were healed, 36.16% were in improving status, 25.78% kept stable, and 8.35% wounds were in deteriorating status. Wound depth was the only independent prognostic factor for POA-PIs wound healing. CONCLUSIONS The healing rate of POA-PIs is quite low, and the only independent prognostic factor of POA-PIs was wound depth.
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Affiliation(s)
- Jing Zhao
- Wound Care Nurse Specialist and Head Nurse, Outpatient Treatment Center, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing, Jiangsu, 210029, PR China
| | - Yinan Cao
- School of Nursing, Nanjing Medical University, No.140 Hanzhong Road, Nanjing, Jiangsu, 210000, PR China
| | - Yang Cheng
- School of Nursing, Nanjing Medical University, No.140 Hanzhong Road, Nanjing, Jiangsu, 210000, PR China
| | - Hang Sun
- School of Nursing, Nanjing Medical University, No.140 Hanzhong Road, Nanjing, Jiangsu, 210000, PR China
| | - Tao Chen
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Yuling Zhong
- Dermatology Hospital, Southern Medical University, No.2 Lujing Road, Guangzhou, Guangdong, 510000, PR China
| | - Liuxin Zhang
- School of Nursing, Nanjing Medical University, No.140 Hanzhong Road, Nanjing, Jiangsu, 210000, PR China
| | - Yufeng Zhou
- School of Nursing, Nanjing Medical University, No.140 Hanzhong Road, Nanjing, Jiangsu, 210000, PR China.
| | - Jie Wang
- School of Nursing, Nanjing Medical University, No.140 Hanzhong Road, Nanjing, Jiangsu, 210000, PR China.
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Hayashida K, Yamakawa S. Topical odour management in burn patients. BURNS & TRAUMA 2021; 9:tkab025. [PMID: 34458382 PMCID: PMC8389170 DOI: 10.1093/burnst/tkab025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/25/2021] [Indexed: 12/31/2022]
Abstract
Preventing microbial colonization or infections that cause offensive smells may lead to odor reduction. As both anaerobic and aerobic bacteria cause the release of malodor from wounds, the most direct way of avoiding or eliminating wound odor is to prevent or eradicate the responsible infection through the debridement of necrotic tissues. However, some burn patients with malodorous wounds are unable to undergo debridement due to systemic conditions, especially in the acute stage. Moreover, the optimal drug doses and dressings to ensure the efficacy and cost-effectiveness of odorous burn wound management is unclear. The purpose of this commentary is to outline the odor management options available for burn patients, focusing on topical strategies. Numerous potential therapies for treating odorous wounds after burn injuries are suggested.
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Affiliation(s)
- Kenji Hayashida
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-0021, Japan
| | - Sho Yamakawa
- Division of Plastic and Reconstructive Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-0021, Japan
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Li S, Renick P, Senkowsky J, Nair A, Tang L. Diagnostics for Wound Infections. Adv Wound Care (New Rochelle) 2021; 10:317-327. [PMID: 32496977 DOI: 10.1089/wound.2019.1103] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Significance: Infections can significantly delay the healing process in chronic wounds, placing an enormous economic burden on health care resources. Identification of infection biomarkers and imaging modalities to observe and quantify them has seen progress over the years. Recent Advances: Traditionally, clinicians determine the presence of infection through visual observation of wounds and confirm their diagnosis through wound culture. Many laboratory markers, including C-reactive protein, procalcitonin, presepsin, and bacterial protease activity, have been quantified to assist diagnosis of infection. Moreover, imaging modalities like plain radiography, computed tomography, magnetic resonance imaging, ultrasound imaging, spatial frequency domain imaging, thermography, autofluorescence imaging, and biosensors have emerged for real-time wound infection diagnosis and showed their unique advantages in deeper wound infection diagnosis. Critical Issues: While traditional diagnostic approaches provide valuable information, they are time-consuming and depend on clinicians' experiences. There is a need for noninvasive wound infection diagnostics that are highly specific, rapid, and accurate, and do not require extensive training. Future Directions: While innovative diagnostics utilizing various imaging instrumentation are being developed, new biomarkers have been investigated as potential indicators for wound infection. Products may be developed to either qualitatively or quantitatively measure these biomarkers. This review summarizes and compares all available diagnostics for wound infection, including those currently used in clinics and still under development. This review could serve as a valuable resource for clinicians treating wound infections as well as patients and wound care providers who would like to be informed of the recent developments.
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Affiliation(s)
- Shuxin Li
- Department of Bioengineering, The University of Texas at Arlington, Arlington, Texas, USA
| | - Paul Renick
- Department of Bioengineering, The University of Texas at Arlington, Arlington, Texas, USA
| | - Jon Senkowsky
- Texas Health Physician's Group, Arlington, Texas, USA
| | | | - Liping Tang
- Department of Bioengineering, The University of Texas at Arlington, Arlington, Texas, USA
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Kuhnke JL, Keast D, Rosenthal S, Evans RJ. Health professionals' perspectives on delivering patient-focused wound management: a qualitative study. J Wound Care 2020; 28:S4-S13. [PMID: 31295076 DOI: 10.12968/jowc.2019.28.sup7.s4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study examined the perspectives of health professionals on the barriers and solutions to delivery of patient-focused wound management and outcomes. METHODS A qualitative, descriptive study design was used. Participants were health-care managers, clinical leaders, nurses and allied health members who are part of wound care services. Open-ended surveys were distributed to participants in a series of learning workshops, and data analysed to identify leading themes. RESULTS A total of 261 participants took part and 194 surveys were returned (response rate: 74%). From the analysis five themes emerged: patient/family wound-related education; health professional wound-related education; implementation of evidence-based wound care and dissemination of evidence-based wound information across professions and contexts; teamwork and respectful communication within teams; and a higher value and priority placed on wound care through collaborative teams by managers, leaders and policymakers. CONCLUSION Findings suggest that ongoing, system-wide education is needed to improve prevention, assessment, treatment and management of four wound types: venous leg ulcer (VLU), diabetic foot ulcer (DFU), pressure ulcer (PU) and surgical wounds. Health professionals are committed to delivering best practice in wound care. Participants identified that effective patient-focused, evidence-based wound care involves having a health-care system with a clear mandate to ensure wound care is a priority. A high value placed on wound care by managers and clinical leadership could transform the present systems. Additionally, effective and widespread dissemination of evidenced-informed practice information is crucial to positive patient outcomes. Education and team commitment for consistent and respectful communication would improve care delivery.
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Affiliation(s)
- Janet L Kuhnke
- Assistant Professor, Nurse Specialist, Ostomy, Wound and Continence, Cape Breton University, Nursing, Grand Lake Road, Sydney, Canada
| | - David Keast
- Wound Care Research Leader, Parkwood Institute Research, Parkwood Institute, London, Ontario
| | - Sue Rosenthal
- Director, Knowledge Mobilization, Wounds Canada, Toronto, Ontario, Canada
| | - Robyn Jones Evans
- Director, Wound Healing Clinic, Women's College Hospital, Canada.,Lecturer, University of Toronto, Toronto, Ontario, Canada
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