Uso tópico de sevoflurano en heridas complejas de miembro inferior / Topical use of sevoflurane in complex lower limb wounds

El dolor crónico asociado a heridas de larga evolución en miembros inferiores constituye una situación de conflicto con características angustiantes que compromete seriamente la calidad de vida e interfiere en el proceso de reparación tisular, estableciendo un cuadro propio en el cual la herida se transforma en un componente más de esta compleja condición y no el motivo en sí de la consulta. Dadas las limitaciones y efectos negativos de las terapias usuales para el alivio del dolor crónico en heridas, se establece una apertura a nuevas propuestas adyuvantes. Motivo de ello es el propósito del presente trabajo, a través del uso de sevoflurano tópico para evaluar el incremento de la analgesia en una población con úlceras en miembro inferior de diverso origen etiológico.

Open-label clinical trial comparing the clinical and economic effectiveness of using a polyurethane film surgical dressing with gauze surgical dressings in the care of post-operative surgical wounds.

Surgical site infection (SSI) is a common postoperative complication and can cause avoidable morbidity and excessive costs for the health service. Novel dressings, designed specifically for postoperative wounds, can help to reduce the risk of SSI and other complications such as blistering. This study compared the use of a new polyurethane film surgical dressing (Opsite Post-Op Visible, Smith & Nephew, Hull, UK) with gauze and tape in the management of postoperative wounds. The results show that the polyurethane film dressing results in a significant reduction in SSI (1·4% versus 6·6%, P = 0·006) as well as a reduction in other postoperative wound complications (e.g. blistering and erythema). Economic analysis conducted alongside the study suggests that these improved outcomes can be achieved at a lower treatment cost than gauze and tape dressings. The modest incremental cost of the polyurethane film surgical dressing is easily offset by the reduction in the costs related to treating SSI and other wound complications associated with gauze and tape dressings.

[Collagenase and devitalized tissue in the framework of the wound bed preparation]. / La colagenasa y el tejido desvitalizado en el contexto de la preparación del lecho de la herida.

We analyze the role of collagenase, as an indispensable resource for the management and control of the devitalized tissue in the framework of the the wound bed preparation. An analysis and discussion of the physiopathological aspects of collagenase has been performed through a bibliographic review.

A prospective, longitudinal study to assess use of continuous and reactive low-pressure mattresses to reduce pressure ulcer incidence in a pediatric intensive care unit.

Pressure between bony prominences and sleep surfaces, as well as pressure from the use of medical devices, put children admitted to pediatric intensive care units (PICUs) at risk of developing pressure ulcers (PUs). To assess the effect of two pediatric-specific, continuous and reactive low-pressure mattresses on the incidence of PUs, an observational, descriptive, prospective, longitudinal (2009-2011) study was conducted among PICU patients. The two pediatric mattresses - one for children weighing between 500 g and 6 Kg and another for children weighing more than 6 Kg - were provided to patients at risk for PUs (Braden-Q ≤16, Neonatal Skin Risk Assessment Scale [NSRAS] ≤13, or per nurse assessment of clinical need). Between 2009 and 2011, 30 children (13 [43.3%] girls and 17 [56.7%] boys), ages 0 to 10 years, at risk of developing PUs (NSRAS risk: n = 14 [13.2 ± 3.03] and Braden-Q risk: n = 10 [10.4 ± 2.4]) were placed on the study mattresses for a median of 4 (range 1 to 25) days. Primary reasons for PICU admission included disorders of the respiratory system (40%), infectious and parasitic diseases (23.3%), and illnesses of the musculoskeletal system and connective tissue (10%). All other PU prevention strategies (eg, repositioning, specialty devices) used as part of standard care protocols also were implemented. Of the 30 participants, only one (3.3%) (confidence interval [CI] 95% = 0.08 -17.2%) developed a nondevice-related PU. No adverse events occurred. A 2008 incidence study in the same PICU, before use of these special surfaces, found a cumulative incidence of 20% nondevice-related PUs. The observed incidence rate of nonmedical device-related PUs in this high-risk population placed on these mattresses is encouraging and warrants future research.

Preventing pressure ulcers on the heel: a Canadian cost study.

An adaptation of a clinical study of 130 patients at risk of developing a pressure ulcer on the heels was performed using Canadian costs. The aim of the study was to compare the cost effectiveness of a specially shaped hydrocellular dressing (Allevyn Heel) versus that of a protective heel bandage (Soffban and gauze) in pressure ulcer prevention over an 8-week period.

The Burden of Pressure Ulcers in Spain.

Pressure ulcers are a serious and debilitating condition treated in all care settings and have a significant impact on both patients and healthcare resources. The objective of this study was to estimate overall treatment costs to the Spanish healthcare system by using a bottom-up costing approach. This study demonstrates that the cost to heal a pressure ulcer increases substantially with the severity of the ulcer, ranging from €24 ([$32.16], Grade I) to €6802 ([$9115], Grade IV) for patients treated in hospitals. Ulcer severity increases overall costs because the time to heal is longer and the incidence of complications is higher in more severe cases. The total cost of pressure ulcer treatment in Spain is approximately €461 million ([$618 million], roughly 5% of total annual healthcare expenditure). Of this, 15% represents the cost of dressings and other materials, while 19% represents the cost of nursing time, and 45% represents the cost of ulcer-related hospital stays.

["Auriga-04" study on the use of a range of Allevyn hydro-cellular dressings in the treatment of bed sores and leg ulcers by primary health care professionals]. / Estudio "Auriga-04".

The objective of this study was to analyze the application and usefulness of a range of Allevyn trademark hydro-cellular dressings during cicatrisation and in the control of exudation and other various characteristics of chronic lesions in real clinical conditions where patients were treated by primary health care professionals. In this study, 441 patients having chronic wounds, either bed sores or leg ulcers, were studied, health care professionals applied a planned program of measures repeated during 20 dressing changes or until cicatrisation was completed if this happened during this interval. The sample population was comprised of elderly patients, the majority of whom were women whose general health could be classified from medium to poor. These patients suffered from these types of wounds: 63% had bed sores, 27.2% had varicose ulcers and 9.8% had leg ulcers caused by another etiology such as mixed ulcers, arterial ulcers or diabetic foot. On average, these lesions were characterized by an evolutionary period of 6.1 months and had a 30.43 square centimetre surface area at the start of the study. 126 lesions, or 28.8%, cicatrized on average of 47.3 days. Among the 315 lesions which had not cicatrized by the end of 20 dressing changes, 90.5% showed evidence of improvement. During the study these lesions showed a significant reduction in their surface area, as well as a significant improvement at the edges of these lesions and the peri-ulceral skin. The health personnel which carried out the treatment using these dressings gave a very favorable evaluation for their use. At the end of this study, in comparison with other dressings previous used, this study showed that in 43.43% of the cases an Allevyn dressing was deemed better in terms of ease in application, in 51.79% of the cases an Allevyn dressing was better in terms of absorption and in 43.23% of the cases an Allevyn dressing was better during removal.

[Prevention of pressure ulcers in heels]. / Prevención de UPP en talones. Impacto clínico y económico en una unidad de medicina interna.

Heels are, for all assistance levels, one of the most frequent locations for the development of pressure ulcers (PU). In this study we deal to investigate in order to determine in patients at risk in an Internal Medicine Unit, the PU incidence on heels, after applying a specific prevention protocol. This protocol particularly designed for pressure ulcers on heels included a combined application of special hydrocellular dressings specially shaped for heels (Allevyn Heel), hyper-oxygenated fatty acids (Mepentol) and special surfaces for pressure management (Aerocare); afterwards, we attempted a comparison of our results with those from previous similar studies. We designed a prospective study which lasted from May 1-2002 until June 30-2003, with a sample of 100 patients without PU included in the study when admitted to the unit. The cumulated incidence established for PU in heels is a 4% which means an incidence rate of 2.06 PU in heels per 1000 persons/day. After observing the results we may affirm that applying the protocol is, under a clinical point of view, as effective as other measures used in previous studies. If we focus on the cost-benefit, the protocol studied represents an option with an excellent cost-efficiency relationship.

[Venous ulcers. Multilayer compression system or crepe bandage? Comparative study on effectiveness, cost, and impact on quality of life]. / Ulceras venosas. Sistema de compresión multicapa o venda de crepé? Estudio comparativo sobre la efectividad, coste e impacto en la calidad de vida.

Treatment for varicose ulcers is based on treating an ulcer as a chronic injury and its primary cause, hypertension in the veins, by means of a system of decreasing and sustained high compression. In Spain patients suffering from varicose ulcers are treated mainly with systems based on the use of crepe bandages which have a low compression effectiveness. In order to bring to light information on this important facet of health care and to generate evidence on this topic, the authors present a comparative study of a standard therapy method utilizing compression on patients suffering from varicose ulcers in Spain, a crepe bandage, against the use of a Profore multi-layer system. The authors studied 30 varicose ulcers on 24 patients who met the criteria to be included in this study; 17 of these, 70.8%, in women and 7, 29.2%, in men. The average treatment period of these lesions with crepe bandages on these lesions was 1045 +/- 2370 (DS) days (mean of 120). At the start of treatment with the multi-layer system, the average lesion surface area reached 10.64 +/- 9.45 (DS) cm2 (mean 7.28). After treatment with this multi-layer system, all these lesions cicatrized entirely. In order for this to happen, an average of 43.73 +/- 27.38 (DS), (mean 34) was required. Based on our results, we can state that the use of the multi-layer system in this study compared to a crepe bandage allowed for the reduction in cicatrisation time, in the number of bandage changes, in the number of visits, in the professional time needed, and reduced by a factor of 20 the cost of the material involved.

[Topical administration of an hyperoxygenated fatty acid compound. Preventive and curative effects on pressure ulcer]. / Aplicación tópica de un compuesto de ácidos grasos hiperoxigenados. Efectos preventivos y curativos en úlceras por presión.

INTRODUCTION: Hyper-oxygenized acidic fats are a very useful topical use product for preventing pressure ulcers and to treat stage I pressure ulcers. Mepentol is a hyper-oxygenized acidic fats product (linoleic acid, gamma linolenic acid, oleic acid, palmitic acid, stearic acid, palmitoleic acid, arachidonic acid and eicosenoic acid) with extracts of Equisetum Avrense and Hypericum Perforatum. It works in three main facets: improve as is possible the epidermis's resistance, repair the damage to the epidermis produced by a prolonged pressure, and restore capillary circulation and counter arrest the effect of oxygen radicals produced during reactive hyperemia which are caused by periods of prolonged pressure. The exclusive formula, based on hyperoxygenized acidic fats and the above referred plant extracts, gives to Mepentol a demonstrated effectiveness, and also special features, like speed of action, great speed of topical absorption and a peculiar fragrance. PATIENTS, MATERIAL AND METHOD: In order to evaluate the tissue level effect of Mepentol, we carried out an experimental research project based on two different objectives: determine the effect at capillary circulation level in heels of healthy volunteers and in patients under risk of developing pressure ulcers, a well as in the treatment of stage I pressure ulcers in patients under high risk of developing pressure ulcers. To do so, the authors determined the capillary blood flow by means of a Doppler laser flow meter. RESULTS: After the application of a hyper-oxygenized acidic fats product, the authors noted an increase of 122.29 +/- 68.74% in flow units related to base values. The authors also observed an increase in microcirculation in heels of patients under high risk of developing pressure ulcers, as well as those who suffer from stage I lesions. These increases remain constant over long periods of time. COMMENTARY: Based on the tests carried out, Mepentol shows an undoubtable effect which improves local circulation in zones under risk of developing pressure ulcers as well as for stage I lesions; this supports the use of this product as a preventive measure against pressure ulcers and as treatment for stage I lesions.

[Heel pressure ulcers. Comparative study between heel protective bandage and hydrocellular dressing with special form for the heel]. / Ulceras por presión en los talones. Estudio comparativo entre el vendaje protector de talones y un apósito hidrocelular con forma especial para los talones.

INTRODUCTION: The heels, together with the sacra area, are one of the most frequent spots where pressure sores appear here in Spain. Any preventive measure against pressure sores on heels needs be oriented towards two main objectives: effective relief of pressure and its compatibility with localized care and skin inspection in order to detect lesions early on at least once a day. PATIENTS, MATERIALS AND METHODS: The authors planned a comparative, multi-centered, open, labeled and controlled study in which patients were assigned to two groups receiving these treatments: one received traditional preventive pressure sore treatment and a protective bandage on their heels while the other used a special Allevyn Heel hydrocellular dressing to protect their heels. The patients took part in this study over an eight week period. The response variable used to determine the effectiveness of the preventive measure in this study was the appearance of pressure sores. RESULTS: At the beginning, 130 patients were included in this study, 65 in each one of the treatment groups. In the bandage group, 50 patients finished this study while 61 in the dressing group finished this study. The appearance of pressure sores in the protective bandage group occurred in 44% of the patients, 22 out of 50, while in the dressing group, the occurrence rate was 3.3%, 2 out of 61 patients with a value of "ji" squared p < 0.001. The risk factor to develop a pressure sore brought us a value of relative risk of 13.42 (IC 95%: 3.31-54.3) in the group wearing the protective bandage compared to the group wearing the dressing. COMMENTS: The results of this study allow us to accept as valid the alternate hypothesis that there exist significant statistical differences between both treatment methods in favor of the Allevyn Heel dressing instead of the protective heel bandage. The use of this dressing, even though it is more expensive a priori than the protective bandage, in terms of unit cost for the product, has proven to be more effective in preventing pressure sores, and cheaper than the protective bandage if we bear in mind these combination of variables: time of usage, application and removal.