Wound bed preparation: an overview.

Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community.

Preliminary Experience with Conservative Sharp Wound Debridement by Nurses in the Outpatient Management of Diabetic Foot Ulcers: Safety, Efficacy, and Economic Analysis.

Background: Treatment of diabetes costs the United States an estimated $245 billion annually; one-third of which is related to the treatment of diabetic foot ulcers (DFUs). We present a safe, efficacious, and economically prudent model for the outpatient treatment of uncomplicated DFUs. Methods: 77 patients (mean age = 54 years, range 31 to 83) with uncomplicated DFUs prospectively enrolled from September 2008 through February 2012. All patients received an initial sharp debridement by one of two orthopaedic foot and ankle fellowship trained surgeons. Ulcer dressings, offloading devices, and debridement procedures were standardized. Patients were evaluated every two weeks by research nurses who utilized a clinical management algorithm and performed conservative sharp wound debridement (CSWD). Results: Average time to clinical healing was 6.0 weeks. There were no complications of CSWD performed by nurses. The sensitivity for the timely identification of wound deterioration was 100%, specificity = 86.49%, PPV = 68.75% and NPV = 100% with an overall accuracy of 89.58%. The estimated cost savings in this model by having nurses perform CSWD was $223.26 per encounter, which, when extrapolated to national estimates, amounts to $1.56 billion to $2.49 billion in potential annual savings across six to ten-week treatment periods, respectively. Conclusion: CSWD of DFUs by nurses in a vertically integrated multidisciplinary team is a safe, effective, and fiscally responsible clinical practice. This clinical model on a national scale could result in significant healthcare savings. Surgeons and other licensed independent practitioners would have more time for evaluating and treating more complex and operative patients; nurses would be practicing closer to the full extent of their education and training as allowed in most states.Level of Evidence: III.

Wound Healing and Wound Care in Neonates: Current Therapies and Novel Options.

GENERAL PURPOSE: To provide wound care information that considers the specific physiology of neonates. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Differentiate the use of hydrocolloids, hydrogels, foam dressings, and barrier creams in the neonatal population.2. Identify issues related to the use of solvents, alginates, collagen dressings, and negative-pressure wound therapy in neonates. ABSTRACT: OBJECTIVETo discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. DATA SOURCES: Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. STUDY SELECTION: Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. DATA EXTRACTION: Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. DATA SYNTHESIS: Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. CONCLUSION: This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.

To discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.

Active debridement of venous leg ulcers: a literature review to inform clinical practice.

Community nurses often care for patients with sloughy venous leg ulcers. Slough is viewed as a potential infection source and an impediment to healing, but it is unclear if active debridement of slough promotes healing. Using a clinical scenario as a contextual basis, this literature review sought research evidence to answer this clinical question. A strategy based on the '4S' approach was used to identify research evidence. The retrieved evidence included one systematic review, three clinical guidelines and six qualitative and quantitative studies. The analysis suggested that there is no robust evidence to support the routine practice of active debridement of venous leg ulcers to promote healing, and that debridement is associated with increased pain. Since autolytic debridement can be achieved through the application of graduated compression therapy, active debridement may offer no additional benefit.

Técnica y cuidados complejos de urostomía necrosada en abdomen catastrófico: combinación de recursos / No disponible

La eventración paraestomal (EP) es la complicación tardía más frecuente del estoma quirúrgico. Solo se interviene un tercio de éstas, hecho que en parte se explica por el alto índice de recidivas observadas tras la reparación.Se presenta el caso de un paciente portador de cistoprostatectomía radical y derivación tipo Bricker, sometido a reparación de EP. Se describen complicaciones postoperatorias que requieren un abordaje de alta complejidad y técnica depurada para la resolución de necrosis en la urostomía más abdomen catastrófico por pérdida de pared.El empleo de dispositivos adecuados, accesorios y terapia de presión negativa, junto con la coordinación entre la estomaterapeuta y el enfermero de práctica avanzada, asegura una correcta evolución del paciente y favorece que pueda marchar de alta en las mejores condiciones posibles

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Asociación entre olor y aislamiento social en pacientes con heridas tumorales malignas: estudio piloto / Associação entre odor e isolamento social em pacientes com feridas tumorais malignas: estudo piloto / Association between odor and social isolation in patients with malignant tumor wounds: pilot study

Objetivo: Analizar las asociaciones entre olores y aislamiento social en pacientes con heridas tumorales malignas.Material y método: Estudio piloto con corte transversal realizado con nueve pacientes con heridas tumorales malignas atendidas en un hospital universitario en el período de 2014 a 2016. Se recogieron datos por medio de aplicación de escala likert de cinco puntos para evaluación del aislamiento social relacionado con el olor de las heridas tumorales malignas durante las consultas de enfermería. Se analizaron los datos por estrategia estadística inferencial con cálculo de coeficiente de Spearman al nivel de significancia del 5% (α = 0,05).Resultados: Se constató correlación con significancia estadística entre el olor y las dimensiones psicosociales: constreñimiento y limitación en frecuentar locales públicos.Conclusión: El olor es el principal síntoma que genera constreñimiento y limita la convivencia social, favoreciendo el aislamiento social y la degradación de la calidad de vida de los pacientes oncológicos

Objetivo: Identificar as associações entre odor e isolamento social em pacientes com feridas tumorais malignas. Material e método: Estudo piloto com corte transversal realizado com nove pacientes com feridas tumorais malignas atendidos em um hospital universitário no período de 2014 a 2016. Coletaram-se dados por meio de aplicação de escala likert de cinco pontos para avaliação do isolamento social relacionado ao odor de feridas tumorais malignas, durante as consultas de enfermagem. Analisaram-se os dados por estratégia estatística inferencial com cálculo de coeficiente de Spearman ao nível de significância de 5% (α = 0,05). Resultados: Constatou-se correlação com significância estatística entre o odor e as dimensões psicossociais: constrangimento e limitação em frequentar locais públicos. Conclusão: O odor é o principal sintoma que gera constrangimento e limita a convivência social, favorecendo o isolamento social e a degradação da qualidade de vida dos pacientes oncológicos

Objective: To analysis associations between odor and social isolation in patients with malignant tumor wounds.Material and method: This is a cross-sectional pilot study performed with nine patients with malignant tumor wounds treated at a university hospital from 2014 to 2016. Data were collected using a five-point Likert scale for the evaluation of social isolation related to odor of malignant tumor wounds during nursing consultations. Data were analyzed by inferential statistical strategy with Spearman's coefficient at the significance level of 5% (α = 0.05).Results: Correlation was found with statistical significance between odor and psychosocial dimensions: constraint and limitation in attending public places.Conclusion: Odor is the main symptom that causes embarrassment and limits social coexistence, favoring social isolation and degradation of the quality of life of cancer patients

Valoración y manejo de una quemadura de espesor parcial en atención primaria / Evaluation and management of a partial thickness burn in primary care

Las quemaduras son heridas que presentan un aspecto muy diverso. Además, pueden comportar niveles de gravedad muy distintos, tratándose de heridas leves que evolucionan favorablemente en algunos casos (quemaduras «menores»), o causando graves lesiones cutáneas y trastornos sistémicos en otros (quemaduras graves o grandes quemados). Las quemaduras graves deberán ser derivadas de inmediato a unidades de quemados, mientras que las quemaduras «menores», se pueden manejar en atención primaria. No obstante, pueden presentarse algunas complicaciones, que deben prevenirse o detectarse precozmente para evitar secuelas mayores. A propósito de este caso, se mencionan algunos aspectos importantes sobre el manejo de estas lesiones en atención primaria, citando algunos errores que suelen cometerse frecuentemente y la forma de evitarlos. Destacaremos los beneficios que aportan algunos materiales modernos, que contribuyen al cierre más rápido de la herida, con lo que se obtiene un mejor resultado estético y funcional de la cicatriz resultante

Burns are wounds that have a very different appearance. In addition, they can behave very different levels of severity, in the case of minor wounds that progress favorably in some cases («minor» burns), or causing severe skin lesions and systemic disorders in others (severe burns or large burns). Serious burns should be immediately referred to burn units, while «minor» burns can be handled in primary care. However, some complications can occur, which must be prevented or detected early to avoid major sequelae. Regarding this case, some important aspects of the management of these injuries in primary care are mentioned, citing some errors that are frequently committed and how to avoid them. We will highlight the benefits provided by some modern materials, which contribute to the faster closure of the wound, which results in a better aesthetic and functional outcome of the resulting scar

Uso de apósitos con tecnología alveolar gelificante para cura de úlceras por presión / Usage of dressings with gelifying alveolar technology for pressure ulcer healing

Objetivo: Describir el proceso de cicatrización de dos úlceras por presión con el uso de apósitos con tecnología alveolar gelificante. Metodología: aplicación de las guías vigentes de tratamiento de las úlceras por presión. Resultados: Ambas úlceras evolucionaron progresivamente de manera favorable hasta conseguir su cicatrización a los 3 meses del inicio del tratamiento. Conclusiones: El uso de apósitos con tecnología alveolar gelificante, unido a la aplicación de las medidas preventivas, posturales e higiénico-dietéticas recomendadas en las guías de tratamiento de las úlceras por presión, fueron determinantes para el buen desarrollo del proceso de cicatrización de las lesiones

Aim: The aim was to describe the healing process of two pressure ulcers with the usage of dressings with gelifying alveolar technology. Methodology: Application of the current guidance about pressure ulcers treatment. Results: Both ulcers evolved progressively and favorably until reach their healing in three months from the beginning of the treatment. Conclusions: The usage of dressing with gelifying alveolar technology along with the application of preventive, postural and hygienicdietetic measures recommended by the guidance of pressure ulcers treatment, were essential for the good development of the healing process

Efectividad de una nueva propuesta Clean & Close en el tratamiento de heridas de evolución tórpida / Clean and Close: an effective new treatment proposal for wounds with torpid evolution

Las heridas de evolución tórpida y compleja suponen un desafío para las enfermeras por su multicausalidad. Asimismo, la diferencia de criterios entre las profesionales podría generar una falta de continuidad en los tratamientos que comprometería su resolución. Por ello, es necesario unificar criterios para su prevención, diagnóstico y tratamiento con el fin de mejorar la continuidad de los cuidados. La curación de estas heridas es un proceso complejo y dinámico que implica la modificación del entorno de la herida según el estado de salud del paciente. El tratamiento local se basa en los principios de cura en ambiente húmedo (CAH) y en la preparación del lecho. El objeto de este artículo es describir los resultados de la aplicación de la propuesta Clean & Close, basada en la aplicación secuencial de dos nuevos apósitos, que, por un lado, estimulan el desbridamiento del tejido necrótico húmedo y el control de la infección (Kytocel: apósito de fibras de Quitosán) y, por otro, estimulan la producción de tejido de granulación y el proceso de angiogénesis, acelerando la cicatrización de las heridas (Trionic(R): apósito bioactivo con carga iónica). Consideramos que pueden ser una alternativa efectiva en el tratamiento de este tipo de heridas

Complex wounds with torpid evolution represent a challenge for nursing professionals due to their multicausality. Differences of criteria among professionals could eventually lead to treatment discontinuities compromising wound healing. It is therefore necessary to unify criteria for complex wound prevention, diagnosis and treatment in order to improve continuity of care. The healing of chronic wounds involves a complex and dynamic process, which requires modulating wound environment depending on the patient's state of health. Local treatment is based on the principles of moist wound healing (MWH) and wound bed preparation. The purpose of this article is to describe the results of the new Clean & Close treatment proposal. It is based on the sequential application of two new dressings which, on the one hand, stimulate the debridement of slough tissue and favor infection control (Kytocel: chitosan fibers dressing), and on the other, stimulate the production of granulation tissue and the process of angiogenesis, accelerating wound healing (Trionic(R): bioactive ionic dressing). We consider that the Clean & Close proposal can be an effective alternative treatment for these types of complex, chronic, hard-to-heal wounds

Caso clínico: pie diabético complicado / Clinical case: complicated diabetic foot ulcer

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[A new cleansing technique for complex wounds]. / Une nouvelle technique de détersion pour les plaies complexes.

Fast, effective and pain-free cleansing is essential in the management of wounds, in order to favour the formation of the granulation tissue and the filling of the cavity. Faced with a chronic wound which was not progressing from the inflammatory phase, caregivers put in place a technique combining negative pressure therapy and instillations of sodium bicarbonate and oxygenated water. The initial results are promising, with the patient benefiting from effective and pain-free cleansing.

Wound bed preparation: a survey of general nurses' understanding.

This article will discuss the clinician's knowledge of wound assessment based on electronic voting responses gathered at the Journal of Wound Care conference, ''Wound Expo', held in September 2015. Data were gathered on aspects such as demographic data, experience and opinions. Each workshop lasted 45 minutes and they were designed purposely to be interactive and inclusive. The session was repeated ten times over the 2-day period. A total number of 196 delegates participated in the voting and amongst the questions posed they were asked to consider which term most suited their skill set and understanding, that of 'debridement' or 'desloughing'. Of the respondents, 91% stated that they felt most confident in desloughing.

Análise da prevalência de desbridamento cirúrgico de úlcera por pressão em um hospital municipal / Análisis de la prevalencia del desbridamiento quirúrgico de las úlceras por presión en un hospital municipal / Analysis of the prevalence of surgical debridement of pressure ulcers in a municipal hospital

This study aimed to assessing the prevalence of surgical debridement of Pressure Ulcer (PU), describe the socio-demographic, clinical profile and anatomical location of the PU. Method: This was a retrospective study with a quantitative analysis of the data obtained in the period from August 2011 to June 2013 made with 416 records of surgical clinic of a general hospital, where 47 patients underwent surgical debridement. Results: The prevalence of 11,29 % of surgical debridement related to UPP, of these, 59,57% male, comorbidities 38,02%, Hypertension 26,76% Diabetes Mellitus. The anatomical locations of the UPP were 40,74% sacrococcygeal, 24,69% calcaneus and 19,75% trochanter. Conclusion: The prevalence of debridement of PU was high in the elderly, from the home, with comorbidities, which corroborated the need to implement prevention PU program integrated continuum of care for these patients and reference strengthen home care protocols for reducing these injuries...

Avaliar a prevalência de desbridamentos cirúrgicos de Úlcera por Pressão (UPP), descrever o perfil sociodemográfico, clínico e localização anatômica das UPP. Método: Estudo retrospectivo, com análise quantitativa dos dados obtidos no período de agosto de 2011 a junho de 2013, realizado com 416 prontuários da clínica cirúrgica de um hospital geral, onde 47 pacientes foram submetidos ao desbridamento cirúrgico.Resultados: Encontrou-se prevalência de 11,29% de desbridamento cirúrgico relacionado à UPP, destes,59,57% eram do sexo masculino, comorbidades 38,02%, Hipertensão Arterial Sistêmica 26,76% Diabetes Mellitus. As localizações anatômicas das UPP foram 40,74%, sacrococcígea, 24,69% calcâneo e 19,75% trocanteres. Conclusão: A prevalência de desbridamento de UPP foi elevada em idosos provenientes do domicílio, com comorbidades associadas, o que corroborou a necessidade de implementação de protocolos de prevenção de UPP, programa de cuidados continuados integrados para referência desses pacientes e fortalecimento da assistência domiciliar para redução desses agravos...

Estudio retrospectivo, exploratorio que tuvo como objetivo evaluar la prevalencia de desbridamiento quirúrgico relacionado con úlcera por presión (UPP) en un Hospital General, describiendo el perfil socio-demográfico y clínico de la localización anatómica de las úlceras por presión. Método: Se llevó a cabo con 416 registros clínicos del centro quirúrgico, los datos obtenidos mediante el análisis de los registros fueron procesados utilizando el software de Microsoft Office Excel 2007. Resultados: Los resultados mostraron prevalencia de 11,29% en el desbridamiento quirúrgico relacionado con UPP, de estos, 59,57% sexo masculino, 53,19 % tienen entre 60 a 79 años, el 19,14 % de 80 años y más. Las comorbilidades más prevalentes fueron la hipertensión arterial y la diabetes mellitus 38,02% y 26,76 %. Como las ubicaciones de la UPP fueron sacrococcígea 40,74 %, 24,69% calcáneo, trocánter 19,75%. Conclusión: Se sugieren nuevos estudios que involucran el tema y hay una necesidad de implementar el programa de prevención de UPP continuo integrado de atención para estos pacientes y referencia fortalecer los protocolos de atención a domicilio para reducir estas lesiones...

Terapia larval. Caso clínico en atención domiciliaria / Maggot therapy: case study in home care

Introducción. La terapia larval es un método de preparación del lecho de la herida de utilización ancestral. Su uso quedó relegado con la aparición de los antibióticos, hasta nuestros días, donde está resurgiendo como opción en el tratamiento de heridas crónicas. Metodología. Presentamos un caso clínico, donde una herida en pie diabético de seis meses de evolución tórpida y con varios cambios de tratamiento poco efectivos mejora en 3-4 días tras la utilización de terapia larval en el domicilio. El lecho de la herida queda preparado para el proceso de granulación. Resultados. Se puede apreciar cómo, tras cuatro días de tratamiento con la terapia larval, el lecho de la herida queda libre de esfacelos y disminuye también el exudado y el edema. Se consigue una herida en óptimas condiciones para la cicatrización. Se objetivó, aplicando la escala EVA, una clara disminución del dolor tras la terapia. Se demostró que la terapia larval puede utilizarse en atención domiciliaria o comunitaria sin inconvenientes. Conclusión. La terapia larval es un método de desbridamiento rápido, efectivo y seguro, que se puede aplicar en el domicilio del usuario (AU)

Introduction. Maggot therapy is a wound bed preparation method of ancestral use. Its use was relegated with the emergence of antibiotics, until today, where is reemerging as an option in the treatment of chronic wounds. Methodology. We report a case study where a six months wound in diabetic foot with torpid evolution and with several changes of ineffective treatment, improved in 3-4 days after the use of maggot therapy at home; leaving the wound bed prepared for the process of granulation. Results. As could see, after four days from the application of maggot therapy, the wound bed was free of slough, also decreasing exudation and edema. Leaving the optimal conditions for wound healing. It was assessed by the VAS scale decreased pain after dressing changes. It was demonstrated that maggot therapy can be used in home or community care without inconvenience. Conclusion. The maggot therapy is a method of debridement fast, effective and safe, this method can be used in home care (AU)

Slough and biofilm: removal of barriers to wound healing by desloughing.

The presence of non-viable tissue in a chronic wound presents a barrier against effective wound healing, hence removal facilitates healing and reduces areas where microorganisms can attach and form biofilms, effectively reducing the risk of infection. Wound debridement is a necessary process in those wounds that have evidence of cellular debris and non-viable tissue. As slough is a form of non-viable tissue we hypothesise that it will support the attachment and development of biofilms. Biofilms are entities that have serious implications in raising the risk of infection and delaying wound healing. In those wounds that contain only slough, high-risk debridement methods are not considered necessary for its removal. The use of mechanical techniques for removing the slough is regarded as posing a much lower risk to the patient and the wound bed. The process of removing slough from a wound is referred to as 'desloughing'. We propose that mechanical desloughing is a low-risk method of debridement to aid the specific removal of slough. Slough in a wound is a recurrent issue for a large majority of patients. Consequently, desloughing should not be deemed a one-off process but an on-going procedure referred to as 'maintenance desloughing'. Maintenance desloughing will help to achieve and maintain a healthy wound bed and aid the removal of wound biofilms, facilitating wound healing.

Wound care considerations in neonates.

Wound care management is a complex issue when caring for the neonate. An understanding of the anatomy and physiology of neonatal skin is necessary to recognise and prevent any potential problems. Effective wound care is a dynamic process based on accurate assessment and the setting of realistic goals. Knowledge of the specific characteristics of neonatal skin and the wound healing process is required when determining appropriate treatment and selecting wound care products.

Understanding methods of wound debridement.

Autolytic debridement describes the body's natural method of wound-bed cleansing, helping it to prepare the wound bed for healing. In acute wounds, autolytic debridement occurs automatically and often does not require intervention, as during the inflammatory stage of a wound, neutrophils and macrophages digest and removes devitalised tissue, cell debris and contaminants, clearing the wound of any cellular barriers to healing. In chronic wounds, by contrast, healing is often delayed, frequently because of inadequate debridement. The autolytic process becomes overwhelmed by high levels of endotoxins released from damaged tissue (Broadus, 2013). Therefore wound debridement becomes an integral part of chronic-wound management and practitioners involved in wound care must be fully competent at wound-bed assessment and have an awareness of the options available for debridement. This article will review wound-bed assessment, highlighting variations in devitalised tissue, and explore options available for wound debridement, taking into consideration patients' pain and quality of life.

Are community nurses prepared for wound debridement?

Debridement is an essential component of wound care. However, autolysis remains a frequently used method of debridement, despite recent recommendations from the European Wound Management Association and the National Institute for Health and Care Excellence. Community nurses are recognised as front-line clinicians participating in debridement interventions. It is essential that community nurses are able to deliver the most appropriate debridement method regardless of their current skill set. This will require community nurses to revisit the evidence base for debridement, reflect on their current methods of debridement and expand their skill set when required. Guidance exists to ensure community nurses are able to offer appropriate and safe debridement to clients with non-viable tissue which is delaying the wound healing process.

[Negative pressure therapy and acute wounds]. / La thérapie par pression negative et les plaies aiguës.

Negative pressure therapy medical techniques constitute a revolution in wound care, notably with acute wounds.The latter, often surgical, are treated as an emergency