ABSTRACT
Treatment of infected wounds remains a major challenge for clinicians. Antimicrobial stewardship is an important pillar in wound treatment and, as the role of bacteria in wound repair is not well understood, new treatment options and products are constantly being developed to tackle local infection and biofilm. This case report describes a case of antibiotic-resistant Burkholderia cepacia skin infection and subsequent leg ulceration in an 86-year-old man during the COVID pandemic in Italy, which was successfully treated in a conservative way using 1% acetic acid and silver oxysalts in conjunction with compression bandage.
Subject(s)
Burkholderia cepacia , Skin Ulcer , Male , Humans , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Skin , Wound HealingABSTRACT
The Burden of Wounds Study estimated the cost of wound care across the UK to be £5.3 billion, with £3 billion associated with hard-to-heal wounds. This article looks at potential cost savings of managing hard-to-heal leg ulcers in a specialist wound care service using a multidisciplinary team (MDT) approach. This unique approach includes: a consultant dermatologist; a podiatrist specialising in mobility and gait; a clinical psychologist; clinical nurse specialists; and allied health professionals from tissue viability and lymphoedema services. Bringing together specialists from supporting disciplines provides a one-stop service for the patient. We conducted a retrospective analysis (over 365 days) of wound healing in patients attending the service for management of leg ulcers with differing aetiologies, including venous and atypical leg ulceration. Many of the patients referred to the service had a long wound history, between two and nine years, with a duration up to 25 years in the most complex cases. Within this complex cohort of patients, higher levels of focused compression was required (Accelerate Strapping, Accelerate, UK) for retromalleolar ulceration and management of foot oedema needing toe bandaging or garments. Wound healing was achieved in 72% of patients across all wound aetiologies, demonstrating the impact that a specialist MDT team can have on positive healing outcomes, and which can result in cost savings to the health economy and an improved quality of life for the patient.
Subject(s)
Quality of Life , Varicose Ulcer , Cost-Benefit Analysis , Humans , Retrospective Studies , Specialization , Varicose Ulcer/therapyABSTRACT
Significance: A systematic approach to develop experts-based recommendations could have a favorable impact on clinical problems characterized by scarce and low-quality evidence as heel pressure ulcers. Recent Advances: A systematic approach was used to conduce a formal consensus initiative. A multidisciplinary panel of experts identified relevant clinical questions, performed a systematic search of the literature, and created a list of statements. GRADE Working Group guidelines were followed. An independent international jury reviewed and voted recommendations for clinical practice. Consent was developed according to Delphi rules and GRADE method was used to attribute grade of strength. Critical Issues: The extensive search of the literature retrieved 42 pertinent articles (26 clinical studies, 7 systematic reviews or meta-analysis, 5 other reviews, 2 consensus-based articles, and 2 in vitro studies). Thirty-five recommendations and statements were created. Only 1 of 35, concerning ankle-brachial pressure index reliability in diabetic patients, was rejected by the panel. No sufficient agreement was achieved on toe brachial index test to rule out the orphan heel syndrome, removing dry eschar in adult patients without vascular impairment, and using an antimicrobial dressing in children with infected heel pressure injuries. Eleven recommendations were approved with a weak grade of strength. Experts strongly endorsed 20 recommendations. Offloading, stages I and II pressure injuries, and referral criteria were areas characterized by higher level of agreement. Future Directions: We believe that the results of our effort could improve practice, especially in areas where clear and shared opinions emerged. Barriers and limits that could hinder implementation are also discussed in the article.
Subject(s)
Evidence-Based Medicine/methods , Heel/injuries , Pressure Ulcer/therapy , Pressure/adverse effects , Adult , Ankle Brachial Index/methods , Anti-Infective Agents/therapeutic use , Bandages , Cardiology/methods , Child , Consensus , Diabetic Foot/physiopathology , Female , Heel/microbiology , Heel/pathology , Humans , Infant, Newborn , Interdisciplinary Research/ethics , Practice Guidelines as Topic/standards , Pressure Ulcer/diagnosis , Pressure Ulcer/pathology , Reproducibility of ResultsABSTRACT
This article introduces a simple approach to adopt in the treatment of sickle cell disease (SCD) related ulcerations based on the acronym SICKLE, standing for Skin assessment, Infection control, Compression, Keep moving keep debriding, Local strapping and Endless support. This case report explains and describes each step used in the treatment of this challenging disease in a 24-year-old patient, achieving complete healing in 6 months in long-lasting SCD ulceration previously treated without results with many other treatments. It has been replicated in further patients with excellent results. The SICKLE approach is an attempt to deliver a holistic way of treating patients with SCD-related leg ulcers. More studies are needed to better define the scientific validity of this method or to demonstrate any inconsistencies.
