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BACKGROUND: CSG dressing is water-soluble and helps to hydrate the wound, control exudate, and provide gentle debridement by virtue of a high concentration of surfactant micelles. The primary objective of this retrospective case series is to report on the feasibility of CSG use in pediatric wounds and its mechanism of action. The secondary aim was to measure pain during application and removal of CSG. METHODS: Eight pediatric patients ranging in age from newborn to a few months old with wounds requiring medical intervention were treated with CSG. The CSG dressing was applied twice daily at initiation of treatment in some patients, but mostly once daily. NIPS was utilized for pain measurements. RESULTS: Near-complete healing of wounds was observed by the end of treatment duration, which was only a few days. The calm temperament of these patients during dressing changes and objective NIPS suggested minimal to no pain. None of the patients experienced any adverse events related to the use of this dressing. CONCLUSION: The CSG dressing could be the dressing of choice in this population to enhance debridement and maintain moist healing and support granulation, either proactively or if other treatments fail.
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Vendajes , Tensoactivos , Cicatrización de Heridas , Humanos , Cicatrización de Heridas/efectos de los fármacos , Lactante , Estudios Retrospectivos , Masculino , Femenino , Vendajes/normas , Vendajes/estadística & datos numéricos , Tensoactivos/uso terapéutico , Tensoactivos/farmacología , Recién Nacido , Geles/uso terapéutico , Heridas y Lesiones/terapia , Heridas y Lesiones/tratamiento farmacológicoRESUMEN
INTRODUCTION: Diabetic foot ulcers (DFUs) are commonly contaminated with pathogenic organisms and precede most diabetes-related amputations. Antimicrobial dressings are used in the treatment of DFUs; however, recent guidelines do not support their use. There are no data describing the experience of antimicrobial dressing use among podiatrists in Aotearoa New Zealand (AoNZ). This study aimed to (i) determine which antimicrobial dressings podiatrists in AoNZ use for the management of diabetic foot ulcers; and (ii) determine what factors influence AoNZ podiatrists' use of antimicrobial dressing when managing DFUs. METHODS: An anonymous cross-sectional web-based survey was undertaken. Participants were AoNZ registered podiatrists who managed DFUs in their practice. The survey included questions relating to personal and professional demographic characteristics and DFU management and dressing practices. Descriptive statistics were computed to address the research aims. RESULTS: Responses from 43 AoNZ podiatrists were included. Participants reported both cadexomer iodine and silver dressings were the most common antimicrobial dressings used, with honey dressings being the least frequently used. The most influential factors in choosing antimicrobial dressings when managing DFUs were the presence of current infection, ulcer exudate and ability to prevent future infection. The least influential factors in choosing antimicrobial dressings when managing DFUs were patient preferences, cost of dressings and comfort of dressing/pain on removal. CONCLUSIONS: AoNZ podiatrists managing DFUs primarily use antimicrobial dressings containing cadexomer iodine or silver as active ingredients, while lower-cost options, such as honey and povidone iodine are less often used. Current recommendations highlight the lack of evidence to support positive outcomes from any particular antimicrobial dressing over another and advocate that exudate control, comfort and cost be prioritised in decision-making. As cost has been an increasing burden to our healthcare funding, clinicians and organisations may consider this before purchasing and stocking expensive dressings.
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Vendajes , Pie Diabético , Podiatría , Pautas de la Práctica en Medicina , Humanos , Pie Diabético/terapia , Pie Diabético/tratamiento farmacológico , Nueva Zelanda , Estudios Transversales , Vendajes/economía , Vendajes/estadística & datos numéricos , Podiatría/estadística & datos numéricos , Masculino , Femenino , Pautas de la Práctica en Medicina/estadística & datos numéricos , Persona de Mediana Edad , Antiinfecciosos/uso terapéutico , Antiinfecciosos/economía , Encuestas y Cuestionarios , Adulto , MielRESUMEN
OBJECTIVE: this study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries. METHOD: the study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5. RESULTS: significant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (-7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (-0.3 AU) with MPF. CONCLUSIONS: The findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies.
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Talón , Microclima , Humanos , Femenino , Masculino , Persona de Mediana Edad , Brasil , Anciano , Temperatura Cutánea/fisiología , Vendajes/normas , Vendajes/estadística & datos numéricos , Poliuretanos , AdultoRESUMEN
Bioactive dressings are usually produced using natural or synthetic polymers. Recently, special attention has been paid to ß-glucans that act as immunomodulators and have pro-healing properties. The aim of this research was to use ß-1,3-glucan (curdlan) as a base for the production of bioactive dressing materials (curdlan/agarose and curdlan/chitosan) that were additionally enriched with vitamin C and/or hydrocortisone to improve healing of chronic and burn wounds. The secondary goal of the study was to compressively evaluate biological properties of the biomaterials. In this work, it was shown that vitamin C/hydrocortisone-enriched biomaterials exhibited faster vitamin C release profile than hydrocortisone. Consecutive release of the drugs is a desired phenomenon since it protects wounds against accumulation of high and toxic concentrations of the bioactive molecules. Moreover, biomaterials showed gradual release of low doses of the hydrocortisone, which is beneficial during management of burn wounds with hypergranulation tissue. Among all tested variants of biomaterials, dressing materials enriched with hydrocortisone and a mixture of vitamin C/hydrocortisone showed the best therapeutic potential since they had the ability to significantly reduce MMP-2 synthesis by macrophages and increase TGF-ß1 release by skin cells. Moreover, materials containing hydrocortisone and its blend with vitamin C stimulated type I collagen deposition by fibroblasts and positively affected their migration and proliferation. Results of the experiments clearly showed that the developed biomaterials enriched with bioactive agents may be promising dressings for the management of non-healing chronic and burn wounds.
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Ácido Ascórbico/farmacología , Quemaduras/tratamiento farmacológico , Fibroblastos/efectos de los fármacos , Hidrocortisona/farmacología , Queratinocitos/efectos de los fármacos , Cicatrización de Heridas , beta-Glucanos/farmacología , Antiinflamatorios/farmacología , Antioxidantes/farmacología , Vendajes/estadística & datos numéricos , Quemaduras/etiología , Quemaduras/patología , Colágeno Tipo I/metabolismo , Quimioterapia Combinada , Fibroblastos/metabolismo , Humanos , Queratinocitos/metabolismo , Sefarosa/metabolismoRESUMEN
Topical silver sulfadiazine (SSD) is an effective antimicrobial therapy used to prevent burn wound infection and promote healing, but the frequency of application has not been previously examined. This study compares once versus twice daily dressing changes with SSD, focusing on development of wound infections, incidence of hospital acquired complications, patient pain scores, and length of stay. The objective of this study was to evaluate whether a once-daily or twice-daily application of SSD impacts burn wound healing outcomes. Our institution maintained a twice-daily dressing change standard of care until January 1, 2019. Patients admitted after that date had their dressing changed once daily. We performed a noninferiority analysis which indicated that a sample size of 75 per group would be sufficient to detect a significant difference with a power of 0.80. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after. Our main outcomes recorded are wound infection, average pain scores, average daily narcotic requirements, and length-of-stay. Results from 75 pre-change-of-practice and 75 post-change-of-practice patients showed slightly better outcomes in the post-change-of-practice group. The wound-infection rates were the same for both groups (pre = 5.33%, post = 5.33%), average daily pain levels for the pre-change group were slightly higher but the difference was negligible and not statistically significant (pre = 5.27, post = 5.25), hospital-related complication rates (unrelated to wound care) were higher pre-change (pre = 10.67%, post = 6.67%), and length-of-stay, was longer in the pre-change group (pre = 11.97, post = 10.31). The amount average amount of SSD (g/day) used per patient per hospital stay was higher as well (pre = 320.14, post = 202.12). Further statistical analysis of the results, particularly in the distribution of burn type, age, and burn depth showed no discrepancy and a generalized decreased length-of-stay with once-daily SSD dressing change. Our results show that once-daily dressing changes of SSD in burn wounds have no negative impact on wound outcomes. However, it is associated with a decreased length-of-stay, decreased pain levels, and less hospital-acquired complications. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. In addition, less hospital-acquired complications result in better patient recovery. Since the difference in wound outcomes is negligible and statistically insignificant, changing the standard-of-care to once daily could prove beneficial.
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Antiinfecciosos Locales/administración & dosificación , Quemaduras/tratamiento farmacológico , Sulfadiazina de Plata/administración & dosificación , Infección de Heridas/prevención & control , Adulto , Antibacterianos/administración & dosificación , Antiinfecciosos Locales/efectos adversos , Vendajes/estadística & datos numéricos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sulfadiazina de Plata/efectos adversos , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
OBJECTIVE: To investigate the protective effect of a hydrocolloid nasal dressing on the incidence and severity of nasal injury and continuous positive airway pressure (CPAP) failure in preterm infants receiving nasal CPAP (N-CPAP). METHODS: A randomized controlled trial was conducted over 4 months in 2019 at level 3 neonatal ICUs in two hospitals affiliated with Isfahan University of Medical Sciences, Iran. Eighty eligible infants were born at 32 weeks of gestation or younger and/or with a birth weight of 1,500 g or less and had received between 4 and 72 hours of CPAP. Infants were randomly assigned to two groups; the intervention group used a protective dressing, and the control group received routine care. Data collection tools included a demographic questionnaire and nasal injury assessment score chart. MAIN OUTCOME MEASURES: The incidence and severity of nasal injury in preterm infants undergoing N-CPAP. RESULTS: Infants in the intervention group had a significantly lower incidence and severity of nasal injury compared with the control group: 15 of 40 (37.5%) versus 37 of 40 (92.5%; P < .001). Overall, the injuries identified in this study were mostly mild and moderate, with only three severe injuries in the intervention group and five in the control group. No significant differences were detected in CPAP failure (P > .05). CONCLUSIONS: The studied nasal barrier dressing is a safe and convenient solution to reduce nasal injury in preterm infants receiving N-CPAP.
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Vendajes/normas , Presión de las Vías Aéreas Positiva Contínua/estadística & datos numéricos , Falla de Equipo/estadística & datos numéricos , Heridas y Lesiones/etiología , Vendajes/estadística & datos numéricos , Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Presión de las Vías Aéreas Positiva Contínua/métodos , Femenino , Humanos , Incidencia , Recién Nacido , Recien Nacido Prematuro/fisiología , Unidades de Cuidado Intensivo Neonatal/organización & administración , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Irán/epidemiología , Masculino , Síndrome de Dificultad Respiratoria/epidemiología , Síndrome de Dificultad Respiratoria/terapia , Heridas y Lesiones/epidemiologíaRESUMEN
BACKGROUND: Global studies indicate that surgical site infections (SSIs) are a major healthcare challenge within hospitals and can have a profound impact on patient quality of life and healthcare costs. Closed-incision negative-pressure therapy (ciNPT) has been reported to provide positive clinical benefits for patients with various incisions, including those following colorectal surgeries. METHODS: Investigators performed a prospective, randomized, multicenter trial to evaluate complications of surgical incisions in patients who received a ciNPT dressing versus a conventional surgical dressing (control) over their closed incision following colorectal surgery. The incidence of SSI was determined at 7, 15, and 30 days postsurgery. RESULTS: A total of 148 patients participated in the study. Results showed that the SSI rate on day 7 was lower in the ciNPT group versus the control group (10/75 [13.3%] vs 17/73 [23.3%]), but this difference was not statistically significant. On day 15, the SSI rate was 12/75 (16.0%) in the ciNPT group versus 21/73 (28.8%) in the control group; however, this difference was only marginally statistically significant (P = .0621). At 1 month, the SSI rate remained lower in the ciNPT group (13/75 [17.3%] vs 21/73 [28.8%], P = .0983) compared with the control group. CONCLUSIONS: Future studies with larger population sizes are necessary to determine the impact of ciNPT on patients' incisions after colorectal surgery.
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Vendajes/normas , Neoplasias Colorrectales/cirugía , Terapia de Presión Negativa para Heridas/normas , Herida Quirúrgica/terapia , Anciano , Anciano de 80 o más Años , Vendajes/estadística & datos numéricos , Neoplasias Colorrectales/complicaciones , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/estadística & datos numéricos , Estudios Prospectivos , Herida Quirúrgica/fisiopatologíaRESUMEN
Pavement burns are common in a dry high heat climate. This study reviews the etiology, management, and outcome pavement burns in children. All patients age <18 who sustained contact burns from hot pavement from January 1, 2014 to December 31, 2019 were reviewed for mechanism, medical history, treatment course, and outcome. The high ambient temperature on each date and zip code of each injury were extracted from Weather Underground (www.wunderground.com). In this study, 45 patients met criteria and were reviewed 27 patients (60%) were male. Average age was 3.29 years (SD 0.69), made up two discrete age groups: age 3 years and under (n = 40, 89%) and older patients 14 years of age and up (n = 5, 11%). Thirty-eight patients (84%) had no known medical history. All had second-degree burns and one patient (2%) also had third-degree burns. Mean TBSA was 2.5% (SD 1.4%, range 0.75%-5.5%). Burn etiology included 31 patients (69%) who were walking barefoot on pavement, six (13%) who fell onto pavement, one (2%) seizure, and other/unknown etiology for the remaining seven patients (16%). Thirty patients (67%) had injuries on the plantar aspect of the bilateral feet, two (4%) to bilateral palms of hands, four (9%) to other parts of upper extremities, and 10 (22%) to other parts of lower extremities. Thirty-four patients (76%) were managed without any hospitalization. Those that were hospitalized had an average length of stay of 2.72 days (range 1-9 days). All burns were managed nonoperatively with topical therapy alone. Thirty-four patients (76%) were managed initially with silver sulfadiazene alone and six (13%) with bacitracin alone. Aquacel dressing was utilized in 10 patients at a follow-up visit (22%). Three patients (6.7%) were treated with collagenase enzyme therapy at some point in their care. One patient developed a superficial infection requiring oral antibiotic therapy. There were no mortalities in this group. High ambient temperature on date and location of each injury was 102.1°F (SD 5.4°F, range 89-111°F). Of the 30 patients that continued to follow up in clinic the average time to the burn being 95% healed was 10.50 days (SD 8.97 days, range 2-40 days). Pavement burns in children are partial thickness and are safely managed with topical therapy alone with good outcomes. Patients age 3 and under are at high risk.
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Antiinfecciosos Locales/uso terapéutico , Quemaduras/terapia , Calor/efectos adversos , Sulfadiazina de Plata/uso terapéutico , Atención Ambulatoria , Vendajes/estadística & datos numéricos , Niño , Preescolar , Femenino , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Cicatrización de HeridasRESUMEN
AIM OF THE STUDY: The aim of the current study was to develop collagen-based bi-layered composite dressings with antibacterial property and evaluate the efficiency for wound healing. MATERIALS AND METHODS: A bi-layered composite wound dressing was fabricated using two marine biomacromolecules (collagen and chitosan or carboxymethyl chitosan). Non-crosslinked and N-Ethyl-N'-(3-dimethylaminopropyl) carbodiimide/N-Hydroxy succinimide (EDC/NHS) cross-linked collagen sponges fabricated by vacuum freeze-drying technology was used as the inner layer. The medical spun-laced nonwoven coated with chitosan and carboxymethyl chitosan was used as the outer layer. The antibacterial activities against E. coli and S. aureus were evaluated by the inhibition zone assay. Deep second-degree scald model was performed to evaluate the efficiency of bi-layered composite dressings for wound healing. RESULTS: In view of comprehensive evaluation of appearance and in vitro antibacterial activity, medical spun-laced nonwoven coated with 3% of chitosan solution was chosen to be used as the optimized preparation conditions to produce the outer layer of composite dressing, which acted as a barrier against microorganisms and provided mechanical support. Furthermore, the results of wound closure and histopathological analysis indicated that EDC/NHS cross-linked collagen-based bi-layered composite dressing was superior to non-crosslinked and commercial products, which stimulated the wound healing process and accomplished deep second-degree scalded skin healing within a time span of 28 days. CONCLUSION: The EDC/NHS cross-linked collagen-based bi-layered composite dressing had immense potential to be applied for an ideal wound dressing for more efficient and faster wound healing. Therefore, the findings provided the essential theoretical basis for great potential of collagen-based composite dressing used in wound healing applications.
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Antibacterianos/normas , Vendajes/normas , Colágeno/farmacología , Cicatrización de Heridas/efectos de los fármacos , Análisis de Varianza , Animales , Antibacterianos/administración & dosificación , Vendajes/estadística & datos numéricos , Colágeno/uso terapéutico , Modelos Animales de Enfermedad , Ratas , Ratas Sprague-Dawley , Factores de TiempoRESUMEN
Although silver is an efficient antimicrobial and is a widely used antiseptic in wound healing, previous studies have reported the cytotoxic in vitro effects of silver dressings. Moreover, few studies have addressed the distribution of silver in chronic wounds. The study compares the healing of chronic wounds treated with a standard-of-care silver dressing (Ag-CMC) and a dressing containing antiseptic octenidine (OCT-HA). Biopsies were taken from two wound areas before the commencement of treatment (baseline), after 2 weeks and after 6 weeks (the end of the study). We analyzed the histopathologic wound-healing score, silver distribution, and expression of selected genes. The wound-healing score improved significantly in the wounded area treated with OCT-HA after 2 weeks compared to the baseline and the Ag-CMC. The Ag-CMC wound areas improved after 6 weeks compared to the baseline. Moreover, collagen maturation and decreases in the granulocyte and macrophage counts were faster in the OCT-HA parts. Treatment with OCT-HA resulted in less wound slough. The silver, visualized via autometallography, penetrated approximately 2 mm into the wound tissue and associated around capillaries and ECM fibers, and was detected in phagocytes. The metallothionein gene expression was elevated in the Ag-CMC wound parts. This exploratory study determined the penetration of silver into human chronic wounds and changes in the distribution thereof during treatment. We observed that silver directly affects the cells in the wound and elevates the metallothionein gene expression. Octenidine and hyaluronan dressings provide a suitable alternative to silver and carboxymethyl cellulose dressings without supplying silver to the wound.
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Antiinfecciosos/farmacología , Vendajes/estadística & datos numéricos , Quemaduras/tratamiento farmacológico , Piridinas/farmacología , Plata/farmacología , Cicatrización de Heridas/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Iminas , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To determine the ability of 0.2% polyhexamethylene biguanide (PHMB)-impregnated gauze to inhibit the growth of bacteria isolated from equine infected sites. STUDY DESIGN: In vitro study. METHODS: Nine bacterial isolates were obtained from cultures submitted from equine patients presenting with penetrating injuries of the hoof (n = 4), septic osteitis (n = 1), synovial sepsis (n = 1), wounds (n = 2), and incisional infection following laparotomy (n = 1). Two standardized strains were also included. A standard inoculum of each isolate was placed on 12 Muller-Hinton agar plates. Squares (2.5 cm × 2.5 cm) of 0.2% PHMB-impregnated (n = 6) and nonimpregnated control gauze (n = 6) were placed on inoculated agar plates. Bacterial growth under each gauze square was assessed after a 24-h incubation period and areas of inhibition were measured to a standardized scale, using image-processing software. Mean ± SD growth inhibition (%) using 0.2% PHMB-impregnated gauze was compared to the nonimpregnated gauze for each isolate using Student's t test (p < .05). RESULTS: The 0.2% PMHB-impregnated gauze inhibited the growth of Staphylococcus spp. (n = 4) by 33%-83.1% and that of Escherichia coli spp. (n = 4) by 6.5%-37%. There was no inhibition of growth of Pseudomonas aeruginosa or either Enterococcus spp. CONCLUSION: The 0.2% PHMB-impregnated dressing tested here inhibited the growth of staphylococcal and E. coli isolates, but the magnitude of inhibition varied between strains. CLINICAL RELEVANCE: These results justify in vivo studies to evaluate the ability of the dressing to reduce the bacterial growth of common equine bacterial pathogens in clinical practice.
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Vendajes/estadística & datos numéricos , Biguanidas/farmacología , Desinfectantes/farmacología , Infecciones por Escherichia coli/veterinaria , Enfermedades de los Caballos/prevención & control , Infecciones Estafilocócicas/veterinaria , Infección de la Herida Quirúrgica/veterinaria , Animales , Escherichia coli/efectos de los fármacos , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/prevención & control , Enfermedades de los Caballos/microbiología , Caballos , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/prevención & control , Staphylococcus/efectos de los fármacos , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
The use of prophylactic dressings to help prevent intraoperatively acquired pressure injuries (IAPIs) merits further study. PURPOSE: To examine how the use of a soft silicone foam dressing affects the development of IAPIs in patients undergoing spinal surgery to obtain baseline data supporting evidence-based nursing care. METHODS: Using a self-controlled study design, 64 patients requiring thoracic or lumbar surgery on a Wilson frame at a hospital in Seoul, South Korea, were recruited between February 12 and September 1, 2018; 50 patients were eligible. Basic demographic, health, and surgical data were obtained. Before surgery, the left or right side chest and iliac crest areas were randomly assigned to be covered with a soft silicone foam dressing. The areas were assessed at 2 time points: immediately after and 30 minutes after surgery. If an IAPI was present at 30 minutes after surgery, all sites were reevaluated after 7 days. RESULTS: The majority of participants were male (26 participants, 52%). Average patient age was 62.54 (± 13.83) years, with a body mass index of 24.32 (± 4.23) kg/m2. Average length of surgery was 218.4 (± 137) minutes. Immediately after surgery, 26 IAPIs were observed and there was a significant difference between dressed and non-dressed chest areas for the number of IAPIs (4% vs. 28%; P = .002). After 30 minutes, the total number of IAPIs was 20 and the difference between IAPIs in the iliac crest area was significant between dressed and non-dressed areas (0% vs. 14%; P = .012). After 1 week, there were no chest or iliac crest IAPIs in the areas that had been covered by a dressing; however, 8 chest (61.5%) and 4 iliac crest (30.8%) area IAPIs remained when no dressing had been applied. The majority of IAPIs were stage 1 at all assessment times. After 1 week, 1 IAPI had evolved into a stage 3 injury. CONCLUSIONS: The results of this study show that many stage 1 IAPIs do resolve over time and that use of soft silicone foam dressings during spinal surgery can significantly reduce IAPI rates. Additional longitudinal studies are needed to help guide postoperative skin assessment intervals and increase the understanding about the evolution of stage 1 IAPIs.
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Vendajes/normas , Procedimientos Neuroquirúrgicos/efectos adversos , Úlcera por Presión/etiología , Geles de Silicona/uso terapéutico , Médula Espinal/cirugía , Anciano , Vendajes/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Úlcera por Presión/terapia , Seúl , Médula Espinal/fisiología , Médula Espinal/fisiopatología , Cicatrización de Heridas/efectos de los fármacosRESUMEN
BACKGROUND: Pain is an important symptom in wound management, and the choice of treatment directly affects the patient's quality of life. Pain assessment (PA) is essential for quality wound care and, in Italy, mandatory by law. OBJECTIVE: To administer a dedicated learning survey to obtain a better sense of current PA practices, ensure more training, improve procedures, and reduce malpractice. METHODS: A 16-month learning survey of nurses based on a validated questionnaire developed for this project. RESULTS: The survey sample comprised 512 questionnaires. Of respondents, 78% were female, 56.1% were older than 40 years, 94% were RNs, and 6% were wound care specialist nurses. Participants performed a range of dressing changes per week (1-5, 46.3%; 6-20, 34.4%; >21, 19.3%). Although 93% of respondents considered PA important, only 26% recognized it as a vital parameter, and barely one-quarter (25.4%) were aware of current legislation mandating PA. The majority (95.3%) believed that PA is not consistent with pain perceived by the patient. Further, 87.3% stated that they did not have adequate knowledge to conduct a PA, 91.4% did not consider themselves up-to-date on PA, and 81% did not document PA results. However, specific wound care training leads to significantly better PA (P < .001): 71.9% of wound care specialist nurses recognized pain as a vital parameter, and 59.4% were aware of current legislation regarding PA; further, 81.3% consistently evaluated pain, 59.4% documented PA results, and 50% communicated the outcome to the physician in charge. CONCLUSIONS: The results illustrate the lack of sensitivity, training, and education that Italian RNs have regarding PA in wound care.
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Vendajes/estadística & datos numéricos , Manejo del Dolor/enfermería , Dimensión del Dolor/enfermería , Heridas y Lesiones/enfermería , Adulto , Femenino , Humanos , Italia , Masculino , Personal de Enfermería en Hospital/normas , Calidad de Vida , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: Major trauma is the leading cause of death in people aged < 45 years. Patients with major trauma usually have lower-limb fractures. Surgery to fix the fractures is complicated and the risk of infection may be as high as 27%. The type of dressing applied after surgery could potentially reduce the risk of infection. OBJECTIVES: To assess the deep surgical site infection rate, disability, quality of life, patient assessment of the surgical scar and resource use in patients with surgical incisions associated with fractures following major trauma to the lower limbs treated with incisional negative-pressure wound therapy versus standard dressings. DESIGN: A pragmatic, multicentre, randomised controlled trial. SETTING: Twenty-four specialist trauma hospitals representing the UK Major Trauma Network. PARTICIPANTS: A total of 1548 adult patients were randomised from September 2016 to April 2018. Exclusion criteria included presentation > 72 hours after injury and inability to complete questionnaires. INTERVENTIONS: Incisional negative-pressure wound therapy (n = 785), in which a non-adherent absorbent dressing covered with a semipermeable membrane is connected to a pump to create a partial vacuum over the wound, versus standard dressings not involving negative pressure (n = 763). Trial participants and the treating surgeon could not be blinded to treatment allocation. MAIN OUTCOME MEASURES: Deep surgical site infection at 30 days was the primary outcome measure. Secondary outcomes were deep infection at 90 days, the results of the Disability Rating Index, health-related quality of life, the results of the Patient and Observer Scar Assessment Scale and resource use collected at 3 and 6 months post surgery. RESULTS: A total of 98% of participants provided primary outcome data. There was no evidence of a difference in the rate of deep surgical site infection at 30 days. The infection rate was 6.7% (50/749) in the standard dressing group and 5.8% (45/770) in the incisional negative-pressure wound therapy group (intention-to-treat odds ratio 0.87; 95% confidence interval 0.57 to 1.33; p = 0.52). There was no difference in the deep surgical site infection rate at 90 days: 13.2% in the standard dressing group and 11.4% in the incisional negative-pressure wound therapy group (odds ratio 0.84, 95% confidence interval 0.59 to 1.19; p = 0.32). There was no difference between the two groups in disability, quality of life or scar appearance at 3 or 6 months. Incisional negative-pressure wound therapy did not reduce the cost of treatment and was associated with a low probability of cost-effectiveness. LIMITATIONS: Owing to the emergency nature of the surgery, we anticipated that some patients who were randomised would subsequently be unable or unwilling to participate. However, the majority of the patients (85%) agreed to participate. Therefore, participants were representative of the population with lower-limb fractures associated with major trauma. CONCLUSIONS: The findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to the lower limbs. FUTURE WORK: Our work suggests that the use of incisional negative-pressure wound therapy dressings in other at-risk surgical wounds requires further investigation. Future research may also investigate different approaches to reduce postoperative infections, for example the use of topical antibiotic preparations in surgical wounds and the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12702354 and UK Clinical Research Network Portfolio ID20416. FUNDING: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 38. See the NIHR Journals Library for further project information.
WHAT DID THE TRIAL FIND?: We found no evidence of a difference in the rate of surgical site infection between those patients randomised to negative-pressure wound therapy and those patients randomised to standard wound dressings. There was no difference in the rate of other wound healing complications or in the patients' self-report of disability, health-related quality of life or scar healing. Negative-pressure wound therapy is very unlikely to be cost-effective for the NHS. In conclusion, and contrary to previous reports, the findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to their legs.
Major trauma is the leading cause of death worldwide in people aged < 45 years and a significant cause of short- and long-term health problems. In 85% of major trauma patients, the injury involves broken bones. Surgery to fix broken bones in the lower limbs is complicated and has risks, one of the main ones being wound infection. In these patients, rates of wound infection have been reported to be as high as 27%. One factor that may affect the risk of infection is the type of dressing applied after surgery. In this trial, we compared standard wound dressings with a new treatment called incisional negative-pressure wound therapy. Negative-pressure wound therapy is a special type of dressing whereby gentle suction is applied to the surface of the wound. A total of 1548 patients from 24 specialist trauma hospitals in the UK agreed to take part and were assigned at random to receive either a standard wound dressing or negative-pressure wound therapy after their surgery. We reviewed the recovery of the patients for 6 months. We recorded how many had an infection in the surgical wound and asked the patients to rate the extent of their disability, their quality of life and the scar healing. We also collected information about the cost of treatment.
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Vendajes , Fracturas Abiertas/cirugía , Terapia de Presión Negativa para Heridas , Infección de la Herida Quirúrgica , Cicatrización de Heridas/fisiología , Adulto , Vendajes/economía , Vendajes/estadística & datos numéricos , Femenino , Humanos , Extremidad Inferior/lesiones , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/economía , Terapia de Presión Negativa para Heridas/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Reino Unido/epidemiologíaRESUMEN
Purpose: To compare, in a masked manner, a novel cross-linked hyaluronic acid ocular bandage gel (OBG) versus standard-of-care bandage contact lens (BCL) plus artificial tears with respect to safety and effectiveness in healing epithelial defects created for photorefractive keratectomy (PRK). Methods: This was a randomized, reading center-masked, exploratory study. Forty-five patients (myopic without significant anisometropia) scheduled for bilateral PRK (9-mm epithelial defect) were randomized post-PRK to treatment with OBG 8 times daily for 3 days, followed by 4 times daily for 11 days (Group 1); OBG 4 times daily for 14 days (Group 2); or BCL and artificial tears (Control). A masked reading center used image analysis of digital slit lamp photos of the fluorescein-stained cornea to evaluate defect size during the 14-day postoperative follow-up period. Effectiveness endpoints were (1) time to complete closure of the corneal defect and (2) proportion of patients with complete healing on day 3 postoperatively, whose defect remained closed. Safety assessments included findings for adverse events and vision, Standard Patient Evaluation of Eye Dryness (SPEED™) Questionnaire, slit lamp, intraocular pressure, and fundus examinations. Results: The proportion of patients with complete healing at 3 days was 73.3%, 86.7%, and 66.7% of patients in Groups 1, 2, and Control, respectively. On day 2, the mean wound size was 6%-26% smaller in Groups 1 and 2 compared with Control. No safety concern arose. SPEED scores were not significantly different across groups. Conclusion: OBG offers a well-tolerated and effective therapy for quickly reepithelializing the cornea following trauma, disease, or surgery.
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Adyuvantes Inmunológicos/farmacología , Vendajes/efectos adversos , Ácido Hialurónico/farmacología , Miopía/cirugía , Queratectomía Fotorrefractiva/métodos , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/efectos adversos , Adulto , Vendajes/estadística & datos numéricos , Estudios de Casos y Controles , Lentes de Contacto/efectos adversos , Córnea/diagnóstico por imagen , Córnea/patología , Femenino , Fluoresceína/metabolismo , Humanos , Ácido Hialurónico/administración & dosificación , Ácido Hialurónico/efectos adversos , Gotas Lubricantes para Ojos/administración & dosificación , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/estadística & datos numéricos , Estudios Prospectivos , Repitelización/efectos de los fármacos , Seguridad , Lámpara de Hendidura , Resultado del Tratamiento , Agudeza Visual/efectos de los fármacos , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: The Ponseti method of serial manipulation and casting revolutionized the treatment of one of the most common congenital orthopaedic conditions-clubfoot-resulting in less surgical morbidity and better functional results. Several studies have examined aspects of nonoperative treatment but none have explored the effect of different types of undercast padding. METHODS: The authors performed a randomized controlled trial comparing cotton Stockinette and Webril undercast padding using the Ponseti method. They included 56 patients under the age of 6 months who had an untreated idiopathic clubfoot. For treatment, the padding was randomized to double-layer Stockinette (29 patients) or standard 2- to 3-layer Webril (27 patients). The primary analysis consisted of a 2-sample t test comparing the mean number of casts required for correction in each group. Secondary outcomes included initial and final standardized clubfoot scores (Pirani and Dimeglio scores) and adverse events. RESULTS: Baseline demographics were not statistically different between groups, with respect to mean age, sex, and side being treated, nor were the baseline Dimeglio and Pirani scores. The primary outcome analysis revealed an equivalent number of casts (about 4) required before tenotomy. The secondary analysis on complications did not show any significant difference, with 10 events documented in the Webril group and 9 in the Stockinette group (P=1.00). At the end of the study, the mean Dimeglio (3.9±2.1 vs. 3.9±1.8, P=0.99) and Pirani (2.1±0.8 vs. 2.2±0.8, P=0.70) scores were not significantly different. Subjectively, parents and doctors indicated a substantially more positive experience for the Stockinette group. CONCLUSIONS: Webril and Stockinette paddings provide equivalent clubfoot deformity correction while applying a similar number of casts before tenotomy. Although minor skin complications were observed, these were not significantly different between groups.
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Vendajes/estadística & datos numéricos , Moldes Quirúrgicos , Pie Equinovaro/terapia , Femenino , Humanos , Lactante , Masculino , Enfermedades Musculoesqueléticas , Tenotomía , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the safety and efficacy of a new topical skin ointment with natural ingredients (aloe vera, honey, and peppermint) for dressing skin graft donor sites. DESIGN: A double-blind, placebo-controlled, randomized clinical trial. PATIENTS AND INTERVENTION: Researchers enrolled patients who were referred for split-thickness skin graft after burns or surgical wounds on the scalp or face area. For each patient, a thin layer of skin (depth, 0.04 mm; approximate size, less than 15 × 7 cm) was harvested from the thigh by a plastic surgeon with an electric or manual dermatome. The donor sites were divided and randomized to receive either natural ointment or petroleum jelly as a topical agent to dressing. Topical agents were applied on donor site wounds on days 0, 4, 7, and 14. MAIN OUTCOME MEASURES: Wound size, pain, erythema, pruritus, patient discomfort, complications, and physician satisfaction were evaluated at each visit. MAIN RESULTS: Among 28 patients, there was no significant difference between the two treatment agents regarding the rate of wound healing (P = .415), pain (P = .081), pruritus (P = .527), and patient discomfort (P = .616). The ointment was superior to petroleum jelly in reducing wound erythema (P = .001) and was associated with significantly better treatment satisfaction (P < .001). CONCLUSIONS: The natural topical ointment investigated in this study may be an acceptable alternative to petroleum jelly in caring for split-thickness donor skin graft donor site wounds to effectively promote wound healing, prevent infection and scarring, reduce pain, and comfort the patient.
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Quemaduras/terapia , Pomadas/uso terapéutico , Vaselina/uso terapéutico , Preparaciones de Plantas/uso terapéutico , Administración Tópica , Adulto , Vendajes/estadística & datos numéricos , Quemaduras/tratamiento farmacológico , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Piel , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
GENERAL PURPOSE: To provide wound care information that considers the specific physiology of neonates. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Differentiate the use of hydrocolloids, hydrogels, foam dressings, and barrier creams in the neonatal population.2. Identify issues related to the use of solvents, alginates, collagen dressings, and negative-pressure wound therapy in neonates. ABSTRACT: OBJECTIVETo discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. DATA SOURCES: Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. STUDY SELECTION: Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. DATA EXTRACTION: Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. DATA SYNTHESIS: Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. CONCLUSION: This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.
To discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.
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Cicatriz/prevención & control , Desbridamiento/enfermería , Fármacos Dermatológicos/uso terapéutico , Cuidados de la Piel/enfermería , Cicatrización de Heridas/fisiología , Heridas y Lesiones/enfermería , Adolescente , Vendajes/estadística & datos numéricos , Niño , Humanos , Recién Nacido , Terapia de Presión Negativa para Heridas/métodos , Pomadas/uso terapéuticoRESUMEN
Objective of this study was to evaluate the efficacy of the autolytic debridement promoted by hydrogel with sodium alginate enriched with fatty acids and vitamins A and E in the healing of foot wounds in diabetic patients. A clinical study was conducted at an outpatient clinic of medical specialties. The sample comprised 8 patients supervised for a 3-month period, from April to July 2017, by means of a clinical history, photographic record, planimetry, and classification of the wound severity by the Pressure Ulcer Scale for Healing (PUSH) system. Of the 8 patients supervised, 1 dropped out and 7 were followed up for 12 weeks. Only 2 had complete wound healing, but all presented a reduction of the lesion area of approximately 22.2% and PUSH score of 9.8 to 6.6. This study found that hydrogel showed good results for the treatment of diabetic feet, reducing the area and overall PUSH score of the wounds.
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Alginatos/farmacología , Diabetes Mellitus/tratamiento farmacológico , Hidrogeles/farmacología , Cicatrización de Heridas/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Alginatos/uso terapéutico , Vendajes/normas , Vendajes/estadística & datos numéricos , Diabetes Mellitus/fisiopatología , Femenino , Humanos , Hidrogeles/uso terapéutico , Masculino , Persona de Mediana Edad , Cicatrización de Heridas/fisiologíaRESUMEN
Venous Leg Ulcers cost Australia's healthcare system millions yearly, as they are underdiagnosed, and possibly undertreated. Most Venous Leg Ulcers are seen in general practice. However, it is currently unknown as to what treatment actions are most common in these contexts. Understanding how they are managed in these settings can improve healthcare delivery and patient outcomes. Using cross-sectional general practitioner patient encounter data collected April 2006 to March 2016 from the Bettering the Evaluation and Care of Health program, a continuous national study of general practice clinical activity in Australia, we aimed to describe the characteristics of venous leg ulcer management by general practitioners in Australia. Among the 972 100 general practitioner-patient encounters recorded, 3604 (0.34%) involved management of VLU. Male general practitioners managed Venous Leg Ulcers significantly more often than female general practitioners. Most Venous Leg Ulcers were treated via dressings (76%) and/or pharmacological treatments (25.7%), with few patients receiving the best practice treatment of medical compression (2.1%) or referral (4.9%). Patients with new (first visit) Venous Leg Ulcers were more likely to receive pharmacological treatments and to be referred elsewhere, and less likely to receive dressings than patients receiving follow-up care. There appears to be a large gap between best practice guidelines and actual Venous Leg Ulcers treatments, as referrals and appropriate treatment was low. Further longitudinal studies are needed to determine the effectiveness of care for people with Venous Leg Ulcers who are managed by general practitioners.