New techniques for wound management: A systematic review of their role in the management of chronic wounds.

Debridement is a crucial component of wound management. Recent technologies such as hydrosurgery (Versajet), ultrasound therapy (the MIST therapy device), or plasma-mediated bipolar radio-frequency ablation therapy (Coblation) seem to represent interesting alternatives for wound debridement. The purpose of this systematic review was to describe, evaluate, and compare these three recently developed methods for the management of chronic wounds. In January 2016, an electronic database search was conducted of MEDLINE, PubMed Central, and Embase for articles concerning these three innovative methods for the management of chronic wounds. A total of 389 references were identified by our search strategy, and 15 articles were included. We extracted data regarding the number and age of patients, indications, operating time, number of procedures, costs, wound healing time, decrease in exudation, perioperative blood loss, bacterial load, and the occurrence of complications. The 15 articles included studies that involved 563 patients who underwent hydrosurgery (7 studies), ultrasound therapy (6 studies), or Coblation (2 studies). Six randomized controlled trials were included that compared the use of a scalpel or curette to hydrosurgery (2 studies) or ultrasound therapy (6 studies). Hydrosurgery, in addition to being a very precise and selective tool, allows significantly faster debridement. Ultrasound therapy provides a significant reduction of exudation, and improves the wound healing time. No comparative study dedicated to Coblation was identified. Despite the obvious clinical interest of the topic, our review of the current literature revealed a lack of prospective randomized studies comparing these devices with each other or with standard techniques, particularly for Coblation and hydrosurgery.

Leech management before application on patient: a nationwide survey of practices in French university hospitals.

Background: Leech therapy in plastic/reconstructive microsurgery significantly improves a successful outcome of flap salvage but the drawback is a risk of severe infection that results in a drop of the salvage rates from 70-80% to below 30%. We report the results of a national survey conducted in all the French university hospitals to assess the current extent of use of leech for medical practices in the hospital and to investigate maintenance, delivery practices and prevention of the risk of infection. Methods: Data concerning conditions of storage, leech external decontamination, microbiological controls, mode of delivery and antibiotic prophylaxis were collected from all the French university hospitals in practicing leech therapy, on the basis of a standardized questionnaire. Results: Twenty-eight of the 32 centers contacted filled the questionnaire, among which 23 practiced leech therapy, mostly with a centralized storage in the pharmacy; 39.1% of the centers declared to perform leech external decontamination and only 2 centers recurrent microbiological controls of the water storage. Leech delivery was mostly nominally performed (56.5%), but traceability of the leech batch number was achieved in only 39.1% of the cases. Only 5 centers declared that a protocol of antibiotic prophylaxis was systematically administered during leech therapy: either quinolone (2), sulfamethoxazole/trimethoprim (2) or amoxicillin/clavulanic acid (1). Conclusions: Measures to prevent infectious complications before application to patient have to be better applied and guidelines of good practices are necessary.

[Infection of chronic wounds in elderly patients]. / Infection de plaies chroniques : particularités chez la personne âgée.

Chronic wounds infection in the elderly patients presents the risk of functional decompensation, or irreversible worsening of a wound. The diversity of clinical situations, the absence of data from clinical trials in the literature and a certain fatalism in view of the poor prognosis of these conditions should not be allowed to delay the early preparation of a patient-centred care plan (aiming at complete scarring, remission or symptomatic relief). Diagnostic and therapeutic strategies must be flexible, to take account not only of functional issues, constraints and special features relating to the patient but also of the resources and technical means available. Antibiotic therapy is widely used and must be reduced. It needs, however, to be considered for inclusion in a care plan that must be comprehensive and multidisciplinary.

L'infection de plaies chroniques chez le patient âgé fait peser le risque d'une décompensation fonctionnelle ou d'une aggravation irréversible de la plaie. L'hétérogénéité des situations cliniques, l'absence de données issues d'essais cliniques et un certain fatalisme devant le pronostic précaire de ces affections ne doivent pas retarder l'élaboration d'un projet de soins adapté au patient (traitement visant à une cicatrisation complète, une rémission ou alors purement symptomatique). La stratégie de prise en charge doit s'adapter de façon dynamique aux enjeux fonctionnels, aux contraintes et particularités liées au patient mais aussi aux ressources et moyens techniques à disposition. Par ailleurs, l'emploi de l'antibiothérapie doit être maîtrisé et ne doit pas éluder une prise en charge globale et pluridisciplinaire.

[Smartphone applications for choosing dressings, a survey of private practice nurses]. / Applications smartphone pour le choix du pansement, enquête auprès d'infirmiers libéraux.

Nurses are often on the frontline regarding the choice of dressing for chronic wounds. In this age of connected health, numerous tools are available to help them or guide them in their choices. A study was carried out in 2015 to assess the perceptions and practices of private practice nurses with regard to the use of smartphone applications to help them choose a dressing when treating chronic wounds.

[Treatment of pubic osteomyelitis secondary to pressure sores]. / Le traitement des ostéites du bassin secondaires aux escarres.

There is no consensus regarding the diagnostic and therapeutic strategy for pubic osteomyelitis secondary to pelvic pressure sores. Diagnosis is often difficult and bone biopsies with microbiological and anatomical-pathological examination remain the gold standard. The rate of cicatrisation of pressure sores is low. Cleansing and negative pressure treatment are key elements of the treatment. Optimising the care management with medical-surgical collaboration is being studied in the Ostear protocol.