Portable Negative Pressure Wound Therapy: A Case Study of a Patient Treated in the Community in Jersey.

The aim of this case study is to describe the authors' experience with the use of portable negative pressure wound therapy (pNPWT) in a non-NHS community health care environment. In this context, wound care products are funded by the individual patient. Nurses struggle to reconcile best practice and current evidence-based care when cost implications limit treatment options. In this case, funding for pNPWT was provided by a local charity. This afforded the patient the opportunity to receive best-practice wound care, and significant wound healing, pain reduction and improved patient satisfaction were achieved. Further investigation is required around the suitability of developing a strategic plan to facilitate delivery of pNPWT within the authors' community nursing service.

A clinically effective primary wound dressing that supports self-care for chronic and acute wounds.

Wound care forms a large component of the ever-increasing workload of district and community nurses. The need for a cost-effective product that can be used on a variety of wounds and that meets multiple requirements (e.g. protease modulation, anti-microbial, peri-wound skin protection, maceration control and barrier function) is well recognised. The plethora of wound dressings available today all fulfil some, although not all, of these requirements. Choosing the correct dressing decreases healing time, provides cost-effective care and improves patient quality of life. This article looks at the important properties of wound care products, investigates the need to release nurse time and describes how patients with wounds can engage in effective self-care, with a focus on 1 Primary Wound Dressing® (1PWD), a cost effective, easy-to-use product that has already demonstrated clinical efficacy. Case studies showing the successful use of 1PWD are also presented to highlight the clinical application of this novel product.

Tecnologia da espuma de poliuretano com prata iônica e sulfadiazina de prata: aplicabilidade em feridas cirúrgicas infectadas / Tecnología con sulfadiazina de plata y plata iónica de espuma de poliuretano: aplicación en heridas quirúrgicas infectadas / Polyurethane foam technology with ionic silver and silver sulfadiazine: applicability in infected surgical wounds

The objective of the research is to describe the healing process of infected surgical wounds with the use of polyurethane foam with ionic silver and silver sulfadiazine. This is an observational, descriptive, prospective series type of data held in a curative clinic of a public hospital in the city of Rio de Janeiro. Four survey participants had wound infection. Data collection occurred from March to May 2016. The data collection instrument was the PUSH. The results showed that all study participants followed from beginning to end of treatment showed significant changes in relation to the size of the lesion with fast healing process, decreasing the amount of exudates and appearance of granulation and epithelial tissues. The foam showed better results by having all the properties of an ideal dressing.

O objetivo da pesquisa é descrever o processo cicatricial de feridas cirúrgicas infectadas com a utilização de espuma de poliuretano com prata iônica e sulfadiazina de prata. Trata-se de estudo observacional, descritivo, prospectivo do tipo série de dados, realizada em um ambulatório de curativos de um hospital público no município do Rio de Janeiro. Os 4 participantes da pesquisa possuíam infecção de ferida operatória. A coleta de dados ocorreu de março a maio de 2016. O instrumento de coleta de dados foi o PUSH. Os resultados evidenciaram que todos os participantes do estudo acompanhados do início ao término do tratamento apresentaram alterações significativas em relação ao tamanho da lesão com rápido processo de cicatrização, diminuição da quantidade de exsudato e surgimento dos tecidos de granulação e epitelial. A espuma apresentou melhores resultados por apresentar todas as propriedades de um curativo ideal.

El objetivo de la investigación es para describer el proceso de curación de las heridas quirúrgicas infectadas con el uso de espuma de poliuretano conplata iónica y sulfadiazina de plata. Se trata de un tipo prospectivo observacional, descriptivo, serie de los datos contenidos en una clínica curativa de un hospital público en la ciudad de Río de Janeiro. 4 participantes de la encuesta habían infección de la herida. Los datos fueron recolectados entre marzo y mayo de 2016. El instrumento de recolección de datos fue el empujón. Los resultados mostraron que todos los participantes en el estudio seguido de principio a fin del tratamiento mostraron cambios significativos en relación con el tamaño de la lesión con proceso de curación rápida, disminuyendo la cantidad de exudado y la apariencia de la granulación y tejidos epiteliales. La espuma mostró mejores resultados al tener todas las propiedades de un apósito ideal.

Treatment of Dehisced, Thoracic Neonatal Wounds With Single-Use Negative Pressure Wound Therapy Device and Medical-Grade Honey: A Retrospective Case Series.

PURPOSE: The purpose of this study was to report on our experience with a portable, single-use negative pressure wound therapy device used in combination with activated active Leptospermum honey (ALH) in the treatment of colonized or infected, dehisced, thoracic wounds in neonates with complex congenital heart disease. DESIGN: Retrospective, descriptive study. SUBJECTS AND SETTING: We reviewed medical records of 18 neonates and reported on findings from 11; the remaining 7 were not included secondary to incomplete records, transfer to a different institution prior to wound healing, or death. The median age of our patients was 12 days (range, 2 days to 5 weeks); their mean gestational age was 34 weeks. All of the neonates had acquired postoperative wound dehiscence that were colonized or infected and were treated in the neonatal intensive care unit (NICU) at Cohen Children's Medical Center (New Hyde Park, New York), a regional perinatal center with a level 4 NICU. METHODS: Wound cultures were obtained on all patients prior to treatment commencement. All cultures were repeated on day 4 of treatment. Systemic antibiotics were administered as necessary. No complications were observed related to the use of negative pressure wound therapy device and ALH. All patients were followed until discharge home or transfer to another facility. The pain scores during placement and removal were acceptable (between 1 and 3; median = 2) using the Neonatal Infant Pain Scale. Staff and parents indicated that the combination of ALH and the negative pressure wound therapy device did not interfere with daily care and parental bonding. CONCLUSIONS: Use of ALH and a single-use negative pressure wound therapy device was successful in this series of 11 neonates with complex congenital heart disease.

Surgical wound dehiscence in an Australian community nursing service: time and cost to healing.

OBJECTIVE: Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. METHOD: Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. RESULTS: Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. CONCLUSION: SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be 'at risk'. DECLARATION OF INTEREST: The authors declare they have no competing interests.

Resultados de dez anos de atendimento ambulatorial a pacientes com ferida cirúrgica / Ten-years of out patient service of patients with surgical wound

Identificar a taxa de cicatrização de ferida cirúrgica complexa e caracterizar esses pacientes. Método: Estudo tipo descritivo exploratório e retrospectivo, realizado em um serviço ambulatorial de um hospital de grande porte de 2003 a 2013, com amostra de 138 pacientes com idade igual ou superior a 18 anos e ferida localizada na região da mama e abdome. Resultados: A taxa de cicatrização foi de 71,745, com tempo médio de tratamento de 3 meses. A maioria era do sexo feminino, de cor parda, casada, com média de idade 47,4 anos e baixa escolaridade. O câncer foi o principal motivo para a cirurgia. Coclusão: A maioria dos pacientes recebeu alto com com a ferida cicatrizada. O conhecimento produzido com o estudo poderá contribuir para o fortalecimento da prática clínica dos enfermeiros quanto à importância da avaliação os pacientes com ferida cirúrgica e tempo esperado para a cicatrização das mesmas...

A Skin-stretching Wound Closure System to Prevent and Manage Dehiscence of High-tension Flap Donor Sites: A Report of 2 Cases.

Tension on the suture line of flap donor sites raises the risk of delayed healing and wound dehiscence. Closing a large flap donor site without a skin/flap graft is a major surgical challenge. Recently, the authors started using a skin-stretching wound closure system designed to harness both mechanical creep and stress-relaxation principles for the management of a variety of surgically closed wounds, including flap donor sites. The system consists of a pair of attachment plates connected by a long, flexible approximation strap that can be invasively (sutured) or noninvasively (by adhesion) secured to the skin wound edges and gradually tightened. The care and outcomes of 2 of the 41 patients whose wounds were managed with this system at the authors\'92 plastic/reconstructive and wound repair center during a period of 7 months are described. The first case involved a 20-year-old patient with a 16 cm x 8 cm deep inferior epigastric perforator flap to reconstruct a malignant tumor resection of the groin. The second patient required a 10 cm x 8 cm anterolateral thigh free-flap to repair a traumatic dorsal skin, soft tissue defect. Wounds were assessed and tension adjusted every 2 or 3 days. Both lesions healed by primary intention and with a good cosmetic outcome. Controlled clinical studies are needed to examine the effectiveness, efficacy, indications, complications, and cost effectiveness of this closure system.

The influence of the initiation of an exercise programme on seroma formation and dehiscence following breast cancer surgery.

AIMS AND OBJECTIVES: To verify whether early (first post-operative day) or late initiation (after removal of the continuous suction drain) of a functional rehabilitation exercise programme influences the incidence of seroma formation and dehiscence for women after breast cancer surgery. BACKGROUND: Benefits of early implementation of an exercise programme initiated with women in the first days following breast cancer surgery are widely known. However, the safe initiation of the exercises is still a controversial issue and some authors correlate early initiation of the exercises with an increase in seroma formation. DESIGN: A prospective, randomised, controlled clinical trial. METHODS: Seventy-seven women were randomly assigned to initiate the programme on post-operative day 1 (early group = 40) or after removal of the drain (late group = 37) and were monitored until the 45th post-operative day. Patients in the early group were instructed to perform the exercises daily at home, beginning on post-operative day 1, while those of the late group began the exercises after the drain was removed. The assessment for seroma formation and dehiscence was performed on post-operative days 7 and 45. RESULTS: There was no statistically significant difference regard to seroma formation between early group and late group. Also there was no association between the presence of dehiscence and early exercises. CONCLUSION: The early initiation of the exercises for women, following breast cancer surgery, constitutes a safe practice for the rehabilitation. However, these findings need to be further explored and confirmed in a larger sample. RELEVANCE TO CLINICAL PRACTICE: Studies showing evidence that early functional rehabilitation process is a safe practice for women having surgery for breast cancer, as well as the present research, are of interest to health professionals who care for these patients and contribute to the wider global clinical community.

[Clinical approach in vulvar cancer surgery]. / Démarche clinique dans la chirurgie du cancer de la vulve.

Vulva cancer is rare. It is mainly treated through surgery. Recurrent scarring complications can prolong the period of hospitalisation. To reduce scar dihiscence, the nursing team of the Oscar Lambret Centre in Lille treats scars by negative pressure as a preventative measure. It also integrates into its clinical approach the prevention of pain and malnutrition.

Assessment of surgical wounds in the home health patient: definitions and accuracy with OASIS-C.

The number of surgical patients receiving home care continues to grow as hospitals discharge patients sooner. Home health clinicians must gain knowledge of the wound healing stages and surgical wound classification to collect accurate data in the Outcome and Assessment Information Set-C (OASIS-C). This article provides the information clinicians need to accurately assess surgical wounds and implement best practices for improving surgical wounds in the home health patient.

The role of community nurses in providing a seamless patient pathway.

Every day, community nursing teams deliver evidence-based practice and use their expertise to oversee complex care pathways. However, much of the valuable work community nurses undertake remains invisible or tacit as practitioners concentrate on managing their patients' needs rather than raising the profile of the service they offer. This case study demonstrates the crucial role a community nursing team played in coordinating services, risk management and delivering evidence-based care. This enabled an individual to heal his problematic abdominal wound and quickly regain his former quality of life. When community nursing teams apply their experience and clinical expertise, they can facilitate dramatic improvements in patients' health and recovery times. Nursing teams need to highlight and promote the valuable role they play in care pathways to the commissioners of community services. Patients can then continue to be supported by professionals with the experience and skills to assist them in managing complex clinical situations.

Development of abdominal wound dehiscence after a colectomy: a nursing challenge.

Abdominal wound dehiscence is associated with prolonged hospitalization, high morbidity and mortality rates, an increase in health care costs, and risk of further surgery. A case of wound dehiscence in a patient following major abdominal surgery is reviewed and a framework for understanding wound complication as a challenge to nursing care is provided.

[Living with a chronic abdominal wound--the patients' perspective]. / Leben mit einer chronischen Bauchwunde--Die Erfahrung Betroffener und ihre Erwartungen an die betreuenden Fachpersonen.

Chronic abdominal wounds lead to prolonged hospital stays. However, no data exist that describe the experience of persons living with a chronic abdominal wound. The aim of this qualitative study was to explore the experience of persons living with chronic abdominal wounds and elicit their expectations in health professionals. Narrative interviews were conducted with five women and four men. Using content analysis techniques, five categories with one to four subcategories emerged from the data. "Returning to everyday life without a wound" represents the main goal of the participants and is driven by their hope to achieve this outcome. "Everyday life with the wound" illustrates the reality of participants' lives, which is affected by suffering. "The patients' work" demonstrates the component that patients contribute to managing their wound. "The work of primary support persons" shows the importance of the work of people close to the patient. "The work of professionals" includes the expectations that patients have in their caregivers. Teamwork between professionals, patients and primary support persons seems to be an essential condition for the successful healing of an abdominal wound.

A utilização de curativos no tratamento de evisceração: relato de caso / The use of wound dressings in treatment of disembowelment: case report

A evisceração é caracterizada como projeção das vísceras para fora da cavidade abdominal ocorrendo simultaneamente à deiscência de sutura ou durante sua evolução. O objetivo deste trabalho é relatar a utilização de curativo com gaze não aderente embebida em petrolatum associada ao hidrogel e posteriormente o uso de Ácidos Graxos Essenciais (AGE), no tratamento de um paciente com deiscência abdominal e evisceração. Trata-se de um estudo de caso na modalidade qualitativa que foi realizado no Hospital de Base de São José do Rio Preto. Concluiu-se que os produtos utilizados apresentaram resultado satisfatório, pois a cicatrização completa da lesão ocorreu em aproximadamente três meses.