Use of a TLC-Ag dressing on 2270 patients with wounds at risk or with signs of local infection: an observational study

Clinical performance and safety of a debridement pad with abrasive and non-abrasive fibres

BACKGROUND

Debridement is key to removing devitalised tissue, debris and biofilm as part of wound-bed preparation. Unlike many other methods of debridement, mechanical debridement with a pad is effective enough to be used independently without an adjunctive method of debridement, while being more accessible than other standalone options.

OBJECTIVE

To explore the clinical performance and safety of a debridement pad with both abrasive and non-abrasive surfaces in daily clinical practice.

METHODS

This was a prospective, non-controlled, non-randomised, single-arm, open-label, multicentred observational evaluation. Inclusion criteria were wounds >4 cm2 covered with at least 30% debris, necrotic tissue or slough in patients aged ≥18 years. The treatment protocol comprised a single application of the debridement pad. The primary outcome measure was the amount of necrotic tissue, slough or debris in the wound bed. Secondary outcomes included the appearance of the wound bed, edges and periwound skin; self-reported pain scores; foreseeable negative impacts; and clinician satisfaction.

RESULTS

A total of 62 participants with a variety of wound types were included in the analysis. Most wounds (87%) had been present for over 3 months and had high or moderate exudate levels (90%). A significant reduction was observed in all three parameters: necrotic tissue (p=0.043), slough (p<0.001) and debris (p<0.001). Necrotic tissue, slough and debris showed mean relative reductions of 40%, 72% and 40%, respectively. Of participants, 84% did not experience an increase in pain during the debridement procedure.

CONCLUSION

This clinical real-world data shows the debridement pad to be an effective and well-tolerated device for debridement and wound bed preparation.

Implementación de buenas prácticas clínicas: serie de casos de heridas de difícil cicatrización con tratamiento en extremidades inferiores

Introducción:

El estándar de manejo de heridas de difícil cicatrización basado en buenas prácticas clínicas incluye la identificación adecuada y el tratamiento de factores de riesgo que influyen en el mal pronóstico de cicatrización de las heridas en los pacientes, como carga microbiana en biopelículas, inflamación crónica y presencia de tejido desvitalizado y senescente.

Objetivo:

Describir el estándar de manejo implementado en un policlínico para tratar usuarios con heridas de difícil cicatrización en extremidades inferiores y evaluar los resultados clínicos de los protocolos utilizados.

Método:

Se identificaron y se analizaron los factores de riesgo presentes en los usuarios. Se utilizó una escala de valoración de pronóstico según la etiología de la úlcera y se valoró integralmente al paciente. Se determinó el objetivo terapéutico a través de la guía TIMERS y se definió el protocolo de tratamiento en el policlínico, que incluyó la limpieza terapéutica de la herida con ácido hipocloroso estabilizado pH 5.5, el uso de apósitos bactericidas-antibiopelícula y distintas estrategias de desbridamiento en heridas con signos de infección. Luego, se instauró un tratamiento local para la disminución de marcadores inflamatorios persistentes a través del uso de apósitos con octasulfato de sacarosa en las heridas sin signos de infección local, y se llevó a cabo un seguimiento de la evolución de las heridas.

Resultados:

Todos los pacientes con heridas de difícil cicatrización derivados al policlínico y tratados con el protocolo actualizado en buenas prácticas clínicas lograron la cicatrización de las heridas. Los tiempos reportados (90–120 días) fueron concordantes con protocolos homólogos reportados en la literatura, y resultaron menores en relación con un grupo de pacientes categorizados en la misma escala de clasificación de pronóstico y gravedad. No se observaron complicaciones durante el tratamiento. Se alcanzó la cicatrización en todos los casos.

Conclusión:

El abordaje sistemático y el uso de estrategias terapéuticas adecuadas pueden promover la cicatrización de heridas en extremidades inferiores, mejorar los resultados clínicos y la calidad de vida de los pacientes.

TLC-Ag dressings: a prospective, multicentre study on 728 patients with wounds at risk of or with local infection

OBJECTIVE

This study aimed to evaluate the management of an unselected cohort of patients with wounds at risk of or with clinical signs of local infection, treated with two antimicrobial contact layers impregnated with silver (TLC-Ag healing matrix), under real-life conditions during the COVID-19 pandemic.

METHOD

A large, prospective, multicentre, observational study with two TLC-Ag dressings (UrgoTul Ag/Silver and UrgoTul Ag Lite Border, Laboratoires Urgo, France) was conducted in Germany between May 2020 and May 2021. The main outcomes included a description of the treated patients and their wound management, the changes in wound infection and wound healing outcomes over a maximum period of four weeks of treatment, as well as the overall clinical assessment of the performance, local tolerance and acceptability of dressings.

RESULTS

A total of 728 patients with wounds of various aetiologies and wound infection status were treated with the evaluated dressings in 39 centres for a mean duration of 26±19 days, with an intermediate visit conducted in 712 (97.8%) patients after a mean period of 12±9 days. At the initial visit, it was established that the majority of patients (60.4%) had a wound infection, while the remaining cohort presented first clinical signs of a local wound infection (25.1%) or were at risk of wound infection (13.2%) (unclear status in 1.2%). Throughout the study period, all the parameters of wound infection continuously decreased, resulting at the final visit in a reduction by 78.9% of the prevalence of local wound infections and by 72.0% of the clinical signs of wound infection, the most rapidly diminished clinical sign being wound deterioration. Concurrently, in terms of the healing process, 92.1% of the wounds healed or improved, 3.2% remained unchanged and 1.7% worsened (data missing for 3.0%), and an improvement of the periwound skin was reported in 65.7% of the patients. Overall, the two dressings were 'very well accepted' by the majority of patients, with no uncomfortable feeling at wearing and no pain at dressing removal, and were assessed by the physicians as 'very useful' in the majority of the cases with a 'very good' efficacy in terms of antimicrobial activity and promotion of the wound healing process. Similar results were reported regardless of the wound type treated or of the TLC-Ag dressing evaluated.

CONCLUSION

These results are consistent with previous clinical evidence on TLC-Ag dressings. They support the good efficacy, good tolerability and usefulness of these antimicrobial dressings in the management of patients with wounds at risk or with clinical signs of local infection, in association with appropriate standard of care.

Silver dressing in the management of an infant's urachal anomaly infected with methicillin-resistant Staphylococcus aureus: A case report

BACKGROUND

Symptomatic urachal anomalies are rare disorders. The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life. However, recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management. In this case, we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well.

CASE SUMMARY

Female baby A, weighing 2.88 kg at 38⁺⁵ wk of gestational age, was referred to the hospital because of a red, swollen umbilicus approximately 2 cm × 2 cm in size with yellow purulent exudate. Through physical and ultrasound examination, the baby was finally diagnosed with a urachal anomaly. We first used oxacillin to prevent infection for 3 d. On the 4^th day, microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing. After 5 d, the symptoms of the umbilicus disappeared, and we discontinued silver dressing application. On the 12^th day, umbilical exudate testing was negative for MRSA. On the 14^th day, the baby's blood testing showed a white blood cell count of 14.7 × 10⁹/L, neutrophil percentage of 27.8%, and C-reactive protein level of 1.0 mg/L, suggesting that the infection had been controlled. We stopped treatment, and the baby was discharged with no complications. In this case, the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods, which was a different course from that of some other urachal remnant cases.

CONCLUSION

Anomalies that do not connect with the bladder can be treated with nonoperative management, including application of conservative antibiotics and local intervention with silver-based dressings. Silver sulfate dressings are absolutely safe for neonates with judicious use, and they play an established role in preventing infection without resistance, which is a common problem with other antibiotics and antiseptics.

Therapeutic index for local infections score (TILI): a new diagnostic tool

OBJECTIVE

Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decision-making on antiseptic therapy or decolonisation.

METHOD

An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections.

RESULTS

The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus.

CONCLUSION

The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe.

Therapeutic Index for Local Infections score validity: a retrospective European analysis

OBJECTIVE

A score to identify local wound infections was developed by a panel of experts from seven European countries. The Therapeutic Index for Local Infections (TILI) score was designed for health professionals who are not specialised in wound care. This study was carried out to test the validity of the TILI score in everyday practice.

METHOD

Content validity was analysed by means of evaluation by a panel of experts, individually and face-to-face, followed by a European multicentred, retrospective, observational study. Participating clinicians sent anonymised copies of completed TILI scores for patients with leg ulcers along with a photograph of the wound for analysis by two blinded reviewers. Concordance (Kappa index) and convergent criterion validity (sensitivity, specificity, accuracy, Youden's J Index and receiver operator characteristic (ROC) or area under the curve (AUC) curve) were calculated to construct validity and reliability.

RESULTS

A total of 307 patients with leg ulcers from seven institutions in five European countries were included in this retrospective analysis. It was shown that the diagnosis of local wound infection could be documented well with five of the six clinical criteria included in the TILI score. By summing up these facultative criteria in comparison with any direct criteria that may be present, there would have been an indication for local antiseptic wound therapy in 22% of patients examined.

CONCLUSIONS

The results show that the TILI score is concordant with the expert assessment of patients and with good diagnostic characteristics. Thus, the easy-to-use TILI score can now be used in the daily routine practice of health professionals to diagnose local wound infections.

Metallic Ions Encapsulated in Electrospun Nanofiber for Antibacterial and Angiogenesis Function to Promote Wound Repair

Electrospun nanofiber is an attractive biomaterial for skin tissue engineering because it mimics the natural fibrous extracellular matrix structure and creates a physical structure suitable for skin tissue regeneration. However, endowing the nanofibrous membranes with antibacterial and angiogenesis functions needs to be explored. In the current study, we aimed to fabricate gelatin/polycaprolactone (GT/PCL) (GT/PCL-Ag-Mg) nanofibers loaded with silver (Ag) and magnesium (Mg) ions for antibacterial activity and pro-angiogenesis function for wound repair. The fabricated GT/PCL membranes had a nanofibrous structure with random arrangement and achieved sustained release of Ag and Mg ions. In vitro results indicated that the GT/PCL-Ag-Mg membranes presented satisfactory cytocompatibility with cell survival and proliferation. In addition, the membranes with Ag demonstrated good antibacterial capacity to both gram-positive and gram-negative bacteria, and the Mg released from the membranes promoted the tube formation of vascular endothelial cells. Furthermore, in vivo results demonstrated that the GT/PCL-Ag-Mg membrane presented an accelerated wound healing process compared with GT/PCL membranes incorporated with either Ag or Mg ions and pure GT/PCL alone. Superior epidermis formation, vascularization, and collagen deposition were also observed in GT/PCL-Ag-Mg membrane compared with the other membranes. In conclusion, a multifunctional GT/PCL-Ag-Mg membrane was fabricated with anti-infection and pro-angiogenesis functions, serving as a potential metallic ion-based therapeutic platform for applications in wound repair.