[Management of patients with haemorrhage malignant wounds]. / Prise en charge des patients porteurs de plaies tumorales hémorragiques.

Patients with tumor wounds have many symptoms that impair their quality of life and their general condition. Hemorrhaging is one of them. It can be a challenge for the caregivers and the medical team and will have an impact on the patient. There is no consensus on the management of this symptom, but the literature provides some food for thought. Simple measures can be easily implemented depending on the patient's risk factors, the wound and the oncological context.

Acellular fish skin matrix on thin-skin graft donor sites: a preliminary study.

OBJECTIVE: Surgery for head and neck cancer often requires free flap reconstructions, whose harvesting site often requires a thin-skin graft. Wounds from the thin-skin donor site are comparable to an intermediate or deep second-degree burn. This is uncomfortable and can lead to complications such as a long healing time, local infections and pain. Since they are reproducible, these wounds may serve as a model for an objective assessment of new healing medical devices. The acellular fish skin matrix is a new medical device designed to improve healing quality and time. METHODS: We compared the outcomes between standard procedure and the use of this matrix placed on the split-thickness skin graft (STSG) donor site, in patients operated on in our centre for radial forearm free flap reconstruction for head and neck wounds. RESULTS: There were 21 patients included. The healing time was halved when using the acellular fish skin matrix, from 68 to 32 days on average. Acellular fish skin matrix reduced pain levels and local infection. The visual analogue pain scale (VAS) was ≥3 at five days (p=0.0034) and infection rate reduced from 60% to 0% (p=0.0039). CONCLUSION: These results are extremely encouraging. However, it is important to take into account the relatively high cost of this matrix for its future indications. A larger study including an overall cost estimation and an assessment on different wound types would be interesting, to better target the indications of the acellular fish skin matrix.

Frequency and Management of Hemorrhagic Malignant Wounds: A Retrospective, Single-Center, Observational Study.

CONTEXT: The prevalence of bleeding episodes in malignant wounds (MW) is poorly documented, with no distinction between minor and potentially severe bleedings. This affects the quality of care. OBJECTIVES: Assessing the frequency and management of hemorrhagic malignant wounds at Institut Curie hospital, an anti cancer center. METHODS: Retrospective study conducted from the medical records of patients followed up by the Research and Wound Care Unit from Curie Institute (Paris, France), between 2017 and 2018. Patients >18 years of age, seen at least once by the Unit, and with an MW > 10 cm2 were included. RESULTS: Ninety patients were included, 74.4% female and 25.6% male, with a median age of 64 years (32-92). The most frequent etiologies were breast cancer (52.2%), sarcomas (12.2%), squamous cell carcinoma ear, nose and throat (11%), and pelvic cancer (8.9%). The median survival of patients after their first consultation was 5.6 months (95% CI: 4.6-8.4). Minor bleedings were observed in 38.9% of situations. Bleedings were significantly higher in malignant fungating wounds (P < 0.01). They were treated by the application of alginate or nonadherent dressings. The presence of at least one minor bleeding significantly increased the risk of more severe bleedings (P < 0.001). Hemorrhagic episodes were reported in 18.9% of patients, and 2.2% of patients died as a result of these bleeding episodes. Hemorrhages were fully controlled by hemostatic dressings in 70.6% of cases. The appearance of bleeding (minor or hemorrhagic) was significantly associated with survival (P < 0.001). CONCLUSION: MWs with bleedings appear to be associated with a poor prognosis and could be a reason for early palliative care even if the patient's general condition is preserved. Palliative care must incorporate wound care skills to provide the most appropriate solutions to this anxiety-provoking symptom.

[Using negative pressure therapy to prevent and treat wounds]. / Prévenir et traiter les plaies par pression négative.

The offer of Negative Pressure Wound Therapy (NPWT) has considerably increased these last years. Nowadays, one can choose between different tools such as motorised systems - or not - like pumps; devices which are particularly portables; automated therapies allowing regular instillations; or finally systems adapted to specific indications like "open abdominal wounds". This diversity of devices implies more than ever that prescriptions from the medical doctor be detailed and a good trackability of the nursing follow-up.

[Neutral and impregnated dressings and products]. / Les pansements et produits neutres et imprégnés.

Dressings without active ingredients are adapted to each stage of healing, depending on their degree of moisture, their absorption capacity and their non-traumatic character. Impregnated and mechanical dressings are also available. They are indicated for preventing or treating a symptom or a complication, or for "boosting" healing, in the form of a sequential treatment. Understanding their composition enables their indications to be better targeted thereby improving the efficacy of the overall wound management.

[Long-term intravenous devices, continuity of care from the specialist doctor to the nurse]. / Gestion des risques des dispositifs intraveineux de longue durée.

Long-term intravenous devices have become an essential tool in the treatment of patients requiring the administration of medication over more than one month. The choice of device must be established through consultation between the nursing team and the patient. Several types of complications can be observed immediately after the insertion of the device and during treatment. Protocols in the community and at hospital are therefore necessary in order that doctors, nurses, specialists and experts work together. Clinical and translational research should enable the incidence of certain complications, notably infections and thrombosis, to be further reduced.

[Malignant wounds in palliative care]. / Les plaies tumorales en soins palliatifs.

In the alsence of effective cancer treatment, malignant wounds evolve. The decisions taken by the multi-disciplinary team with regard to their care vary depending on whether the patient is in the initial, advanced or terminal phase of palliative care. Modern dressings can be used to control bleeding, odours and drainage. The aim is to control the symptoms and improve the quality of life, until its end.

[Management of the cutaneous side effects of chemotherapies and targeted therapies]. / Gestion des effets secondaires cutanés des chimiothérapies et thérapies ciblées.

The treatments used in oncology cause frequent cutaneous side effects. The different types of cutaneous toxicities depend on the class of anti-tumour therapies and can involve the skin, mucosa, nails and hair. Effectively managing these cutaneous toxicities requires adapted preventive and curative measures in order to reduce their impact, notably on patients' quality of life.