Limpieza de úlceras de etiología venosa. Una revisión sistemática / Cleansing venous leg ulcers. A systematic review

Objetivo: Evaluar los efectos de la limpieza, así como las soluciones y técnicas utilizadas, para el tratamiento de las úlceras de etiología venosa. Metodología: Se realizó una revisión sistemática siguiendo las últimas recomendaciones de la declaración PRISMA. La búsqueda se realizó en 3 bases de datos (PubMed, CINAHL, Cochrane), limitándose por idioma (inglés/español) y por año (de enero de 2011 a diciembre de 2021). Siguiendo el diagrama PRISMA, se realizó la depuración y evaluación de calidad de los estudios por pares, utilizando las normas de la Red EQUATOR, y seleccionando únicamente ensayos clínicos aleatorizados y revisiones sistemáticas de calidad media o alta. Resultados: Se identificaron un total de 790 artículos, de los cuales se eliminaron 58 por estar duplicados, 700 tras la revisión por título y resumen, y 25 en el cribado por texto completo. De los 7 artículos restantes, se incluyeron 5 al presentar alta calidad metodológica (cumplieron > 70% de los ítems), 3 con diseño de estudio clínico aleatorizado y 2 revisiones sistemáticas. Conclusiones: Actualmente, no se dispone de evidencias científicas sólidas que den valor a la limpieza dentro del tratamiento integral de las heridas. Se necesitan más estudios que permitan orientar a los profesionales en la toma de decisiones para realizar una práctica segura y una optimización de los recursos existentes, considerando a la persona, sus necesidades y su satisfacción en el proceso del cuidado de las lesiones (AU)

Objectives: To evaluate the effects of cleansing venous ulcers on the healing, as well as wound cleansing solutions available and wound cleansing techniques used. Methodology: A systematic review has been made following the PRISMA statement recommendations. This research used 3 databases (PubMed, CINAHL, Cochrane), filtering by language (English/Spanish) and by date (from January 2011 to December 2021). Diagram PRISMA was the base for filtering and evaluating the peer review quality, using the EQUATOR Network and selecting only the randomised clinical trial (RCT) and high or medium quality systematic reviews (SR). Results: A total of 790 articles were identified, of which 58 were eliminated as duplicates, 700 after reviewing by title and abstract, and 25 after screening by full text. Of the 7 remaining articles, 5 of them were included as they were of high methodological quality (more than 70% of the items were accomplished), 3 with an RCT design and 2 SR. Conclusions: Currently, there is no solid scientific evidence that gives credence that cleansing injuries, adds value, within the comprehensive treatment of wounds. More studies are needed, to give professionals decision-making guidelines for providing safe practices and optimising existing resources, considering the state of the patient, their needs and their comfort during the process of injury care (AU)

Knowledge, attitude, and practice study on animal bite, rabies, and its prevention in an urban community.

INTRODUCTION: Rabies is a neglected zoonotic tropical disease that usually affects the poorest communities. Rabies is 100% fatal and at the same time 100% preventable. A huge proportion of death due to rabies occurs in Asia and Africa, and India is reported to have the highest incidence of rabies. AIMS: To assess the knowledge, attitude, and practice related to animal bites, rabies, and its prevention and utilization of health services for this purpose in the study population. METHODS: A community-based cross-sectional study done in an urban area among the age group 20 and above of both gender to assess and statistically highlight the knowledge, attitude, and practice related to animal bites, rabies, and its prevention and utilization of health services for this purpose in the study population. The sample size was estimated to be 350 and a simple random sampling technique was used for the selection of samples. RESULTS: About 76% had heard about rabies. Among them only 63.5% knew it is a fatal disease, only 37.6% knew animals other than dogs can also cause rabies, only 37.3% of the study participants knew about appropriate first aid. Only 37.5% of the animal bite victims washed their wound with soap and running water and 35% had a full course of vaccination. Education had been an important factor that created a significant difference in the knowledge level of the participants. CONCLUSIONS: Improved community awareness, forestalling animal rabies, and better access to affordable and potent human rabies vaccines are essential for the elimination of human rabies.

Evaluation of effectiveness of a new treatment method for healing infected wounds: an animal model.

OBJECTIVE: To evaluate the effectiveness of a new treatment method in healing superficial infected wounds compared with surgical debridement with chlorhexidine solution. METHOD: In this animal model, two wounds were created on the back of 10 male adult rabbits. Wounds treated by Method 1 were debrided using 0.02% chlorhexidine aqueous solution and an antibiotic topical ointment. Wounds treated by Method 2 wounds were treated using a newly developed device which enabled visual monitoring of the wound as it was treated with various pharmacological solutions (including antiseptic, antiseptic oxidant and an osmotically active agent) specifically formulated for each wound healing stage. Wound area size (using digital planimetry) and time taken to clean the wound were recorded, and biopsies were taken, at the beginning of the study and at various timepoints throughout. RESULT: It was observed that both wound cleaning and wound healing were accelerated by treatment with method 2 compared with method 1 (by 43.8% and 36.7%, respectively). There were also a significantly smaller number of complications in these wounds [p=0.0044] due to the positive ratios of neutrophils and fibroblasts in the wound cavities (from the third to the fourteenth day after wound modelling). CONCLUSION: Wounds treated with the new device in method 2 had a shorter wound healing time than wounds treated with a traditional method. The automated influx-outflow of solutions removed any fragments of necrotic tissue from the wound surface. Wounds were able to be monitored without the need to remove dressings. The transparent, airtight film, which allowed for wound monitoring without the need to remove dressings, meant that suturing was not required. This resulted in no complications in the wounds treated by this new method.

Fatty acid potassium improves human dermal fibroblast viability and cytotoxicity, accelerating human epidermal keratinocyte wound healing in vitro and in human chronic wounds.

Effective cleaning of a wound promotes wound healing and favours wound care as it can prevent and control biofilms. The presence of biofilm is associated with prolonged wound healing, increased wound propensity to infection, and delayed wound closure. Anionic potassium salts of fatty acids are tested with commonly used anionic surfactants, such as sodium laureth sulphate (SLES) and sodium lauryl sulphate/sodium dodecyl sulphate (SLS/SDS). The normal human dermal cells demonstrated significantly greater viability in fatty acid potassium, including caprylic acid (C8), capric acid (C10), lauric acid (C12), oleic acid (C18:1), and linoleic acid (C18:2), than in SLES or SLS after a 24-hour incubation. Cytotoxicity by LDH assay in a 5-minute culture in fatty acid potassium was significantly lower than in SLES or SLS. in vitro wound healing of human epidermal keratinocytes during the scratch assay in 24-hour culture was more significantly improved by fatty acid treatment than by SLES or SLS/SDS. In a live/dead assay of human epidermal keratinocytes, C8K and C18:1K demonstrated only green fluorescence, indicating live cells, whereas synthetic surfactants, SLES and SLS, demonstrated red fluorescence on staining with propidium iodide, indicating dead cells after SLES and SLS/SDS treatment. Potassium salts of fatty acids are useful wound cleaning detergents that do not interfere with wound healing, as observed in the scratch assay using human epidermal keratinocytes. As potassium salts of fatty acids are major components of natural soap, which are produced by natural oil and caustic potash using a saponification method, this may be clinically important in wound and peri-wound skin cleaning. In human chronic wounds, natural soap containing fatty acid potassium increased tissue blood flow based on laser speckle flowgraphs after 2 weeks (P < .05), in addition to removing the eschars and debris. Wound cleansing by natural soap of fatty acid potassium is beneficial for wound healing.

Application of pulsatile lavage in wound healing of diabetic foot ulcer patients / 中国实用护理杂志

Objective@#To explore the effect of pulsatile lavage on wound healing in diabetic foot ulcer patients.@*Methods@#The random number table method was used to divide 86 patients of diabetic foot ulcers into two groups with 43 patients in each group. The control group disinfected and cleaned the wound by routine methods, while the experimental group received closed pulse irrigation with sewage collection unit. The two groups were debridement, dressing selection and wound dressing in a unified way. The frequency of dressing change, time of dressing change, efficacy, cost of dressing changes, score of wound pain and wound healing were observed.@*Results@#The frequency of dressing change, dressing change time, wound healing time and total effective rate of the experimental group were (10.42±1.92) times, (12.19±2.37) min, (32.53±6.91) d and 86.04% (37/43), respectively, while those of the control group were (19.47±3.13) times, (21.65±3.99) min, (43.17±13.72) d and 51.16% (22/43), with statistically significant differences (t values were 4.545-16.127, χ2 value was 13.214, all P < 0.01). However, the cost of dressing change in the experimental group was (3 278.78±220.92) yuan, and that in the control group was (3 195.75±206.54) yuan. There was no significant difference between the two groups (t value was -1.814, P > 0.05). The pain scores were (1.47±1.09), (0.57±0.72), (0.06±0.23), (0.003±0.01) points in the experimental group at the 2nd week,the 4th week,the 6th week and the 8th week after intervention, and they were (3.83±1.16), (2.73±1.41), (1.92±1.06), (1.43±0.70) points respectively in the control group, the differences were statistically significant (Ftime=390.663, Fintergroup=76.011, Finteraction=4.210, all P < 0.01). The wound healing rates were (49.34±9.34)%, (86.26±13.33)%, (95.01±8.56)%, (97.28±3.62)% respectively in the experimental group in the 2nd week,the 4th week,the 6th week and the 8th week after intervention,while in the control group they were (26.64±5.19)%, (50.37±10.53)%, (64.84±12.27)% and (72.04±12.96)%. The differences between the two groups were statistically significant (Ftime=354.487, Fintergroup= 921.230, Finteraction =23.154, all P < 0.01).@*Conclusions@#Pulsatile lavage can effectively clean the wound, reduce the frequency of dressing change, shorten the time of dressing change and wound healing, reduce the wound pain, improve the wound healing rate of diabetic foot ulcers, and did not increase the economic burden of patients, which was worthy of clinical application.

How to administer lidocaine in wounds.

RATIONALE AND KEY POINTS: Before a wound can be cleaned and/or closed, the use of a local anaesthetic such as lidocaine is often required to enable the nurse to assess the wound thoroughly and plan the optimal method of repair. This article explains how to administer lidocaine safely and effectively, including how to infiltrate a wound with lidocaine before cleaning or suturing. There are potentially serious consequences associated with the use of local anaesthesia, but careful preparation will ensure patient safety and contribute towards a positive patient experience. REFLECTIVE ACTIVITY: How to articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of.

Surfactants and their role in wound cleansing and biofilm management.

Surfactants are widely used as detergents, emulsifiers, wetting agents, foaming agents and dispersants in the cosmetics, hygiene, food and oil industries. Their use in a clinical setting is also common, particularly within the field of wound care. Many wound cleansers contain surfactants and subsequently there is available data that shows the growing potential of these wound cleansers in the enhancement of wound closure. The presence of microorganisms in wounds has been recognised as a significant factor that delay healing. In complex or chronic wounds that are complicated by biofilms, persistent inflammation or the production of non-viable tissue and slough, the use of surfactants has been shown to aid in the removal of these barriers to wound healing. The use of concentrated surfactant(poloxamer) based wound dressings represent an important component of wound management. Consequently, this article will discuss the effect of clinically used surfactants, with specific focus on a concentrated poloxamer for use against wound biofilm.