A clinically effective primary wound dressing that supports self-care for chronic and acute wounds.

Wound care forms a large component of the ever-increasing workload of district and community nurses. The need for a cost-effective product that can be used on a variety of wounds and that meets multiple requirements (e.g. protease modulation, anti-microbial, peri-wound skin protection, maceration control and barrier function) is well recognised. The plethora of wound dressings available today all fulfil some, although not all, of these requirements. Choosing the correct dressing decreases healing time, provides cost-effective care and improves patient quality of life. This article looks at the important properties of wound care products, investigates the need to release nurse time and describes how patients with wounds can engage in effective self-care, with a focus on 1 Primary Wound Dressing® (1PWD), a cost effective, easy-to-use product that has already demonstrated clinical efficacy. Case studies showing the successful use of 1PWD are also presented to highlight the clinical application of this novel product.

Portable Negative Pressure Wound Therapy: A Case Study of a Patient Treated in the Community in Jersey.

The aim of this case study is to describe the authors' experience with the use of portable negative pressure wound therapy (pNPWT) in a non-NHS community health care environment. In this context, wound care products are funded by the individual patient. Nurses struggle to reconcile best practice and current evidence-based care when cost implications limit treatment options. In this case, funding for pNPWT was provided by a local charity. This afforded the patient the opportunity to receive best-practice wound care, and significant wound healing, pain reduction and improved patient satisfaction were achieved. Further investigation is required around the suitability of developing a strategic plan to facilitate delivery of pNPWT within the authors' community nursing service.

Treatment of Dehisced, Thoracic Neonatal Wounds With Single-Use Negative Pressure Wound Therapy Device and Medical-Grade Honey: A Retrospective Case Series.

PURPOSE: The purpose of this study was to report on our experience with a portable, single-use negative pressure wound therapy device used in combination with activated active Leptospermum honey (ALH) in the treatment of colonized or infected, dehisced, thoracic wounds in neonates with complex congenital heart disease. DESIGN: Retrospective, descriptive study. SUBJECTS AND SETTING: We reviewed medical records of 18 neonates and reported on findings from 11; the remaining 7 were not included secondary to incomplete records, transfer to a different institution prior to wound healing, or death. The median age of our patients was 12 days (range, 2 days to 5 weeks); their mean gestational age was 34 weeks. All of the neonates had acquired postoperative wound dehiscence that were colonized or infected and were treated in the neonatal intensive care unit (NICU) at Cohen Children's Medical Center (New Hyde Park, New York), a regional perinatal center with a level 4 NICU. METHODS: Wound cultures were obtained on all patients prior to treatment commencement. All cultures were repeated on day 4 of treatment. Systemic antibiotics were administered as necessary. No complications were observed related to the use of negative pressure wound therapy device and ALH. All patients were followed until discharge home or transfer to another facility. The pain scores during placement and removal were acceptable (between 1 and 3; median = 2) using the Neonatal Infant Pain Scale. Staff and parents indicated that the combination of ALH and the negative pressure wound therapy device did not interfere with daily care and parental bonding. CONCLUSIONS: Use of ALH and a single-use negative pressure wound therapy device was successful in this series of 11 neonates with complex congenital heart disease.

Surgical wound dehiscence in an Australian community nursing service: time and cost to healing.

OBJECTIVE: Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. METHOD: Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. RESULTS: Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. CONCLUSION: SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be 'at risk'. DECLARATION OF INTEREST: The authors declare they have no competing interests.

The influence of the initiation of an exercise programme on seroma formation and dehiscence following breast cancer surgery.

AIMS AND OBJECTIVES: To verify whether early (first post-operative day) or late initiation (after removal of the continuous suction drain) of a functional rehabilitation exercise programme influences the incidence of seroma formation and dehiscence for women after breast cancer surgery. BACKGROUND: Benefits of early implementation of an exercise programme initiated with women in the first days following breast cancer surgery are widely known. However, the safe initiation of the exercises is still a controversial issue and some authors correlate early initiation of the exercises with an increase in seroma formation. DESIGN: A prospective, randomised, controlled clinical trial. METHODS: Seventy-seven women were randomly assigned to initiate the programme on post-operative day 1 (early group = 40) or after removal of the drain (late group = 37) and were monitored until the 45th post-operative day. Patients in the early group were instructed to perform the exercises daily at home, beginning on post-operative day 1, while those of the late group began the exercises after the drain was removed. The assessment for seroma formation and dehiscence was performed on post-operative days 7 and 45. RESULTS: There was no statistically significant difference regard to seroma formation between early group and late group. Also there was no association between the presence of dehiscence and early exercises. CONCLUSION: The early initiation of the exercises for women, following breast cancer surgery, constitutes a safe practice for the rehabilitation. However, these findings need to be further explored and confirmed in a larger sample. RELEVANCE TO CLINICAL PRACTICE: Studies showing evidence that early functional rehabilitation process is a safe practice for women having surgery for breast cancer, as well as the present research, are of interest to health professionals who care for these patients and contribute to the wider global clinical community.

[Clinical approach in vulvar cancer surgery]. / Démarche clinique dans la chirurgie du cancer de la vulve.

Vulva cancer is rare. It is mainly treated through surgery. Recurrent scarring complications can prolong the period of hospitalisation. To reduce scar dihiscence, the nursing team of the Oscar Lambret Centre in Lille treats scars by negative pressure as a preventative measure. It also integrates into its clinical approach the prevention of pain and malnutrition.

Development of abdominal wound dehiscence after a colectomy: a nursing challenge.

Abdominal wound dehiscence is associated with prolonged hospitalization, high morbidity and mortality rates, an increase in health care costs, and risk of further surgery. A case of wound dehiscence in a patient following major abdominal surgery is reviewed and a framework for understanding wound complication as a challenge to nursing care is provided.

The role of community nurses in providing a seamless patient pathway.

Every day, community nursing teams deliver evidence-based practice and use their expertise to oversee complex care pathways. However, much of the valuable work community nurses undertake remains invisible or tacit as practitioners concentrate on managing their patients' needs rather than raising the profile of the service they offer. This case study demonstrates the crucial role a community nursing team played in coordinating services, risk management and delivering evidence-based care. This enabled an individual to heal his problematic abdominal wound and quickly regain his former quality of life. When community nursing teams apply their experience and clinical expertise, they can facilitate dramatic improvements in patients' health and recovery times. Nursing teams need to highlight and promote the valuable role they play in care pathways to the commissioners of community services. Patients can then continue to be supported by professionals with the experience and skills to assist them in managing complex clinical situations.

[Living with a chronic abdominal wound--the patients' perspective]. / Leben mit einer chronischen Bauchwunde--Die Erfahrung Betroffener und ihre Erwartungen an die betreuenden Fachpersonen.

Chronic abdominal wounds lead to prolonged hospital stays. However, no data exist that describe the experience of persons living with a chronic abdominal wound. The aim of this qualitative study was to explore the experience of persons living with chronic abdominal wounds and elicit their expectations in health professionals. Narrative interviews were conducted with five women and four men. Using content analysis techniques, five categories with one to four subcategories emerged from the data. "Returning to everyday life without a wound" represents the main goal of the participants and is driven by their hope to achieve this outcome. "Everyday life with the wound" illustrates the reality of participants' lives, which is affected by suffering. "The patients' work" demonstrates the component that patients contribute to managing their wound. "The work of primary support persons" shows the importance of the work of people close to the patient. "The work of professionals" includes the expectations that patients have in their caregivers. Teamwork between professionals, patients and primary support persons seems to be an essential condition for the successful healing of an abdominal wound.

A home care wound care challenge: its rewards, inspiration, and positive outcomes.

Quite often, home health team members are presented with a challenge to provide management for a patient who has undergone a complex gastrointestinal surgery. An appropriate plan of care includes the incision, wound, and colostomy care, as well as the psychosocial support, time management, and cost issues. Many times this requires ingenuity and flexibility on the part of the home care team. Comorbidities often increase the acuity of the nursing care as well. In any case and no matter how difficult the circumstances, the goal for the patient's plan of care is to achieve an optimal outcome that will encourage independence and a feeling of self-worth.

¿Es posible la terapia de presión negativa en hospitalización a domicilio?: caso clínico / Is negative pressure therapy possible in hospitalization at home?: clinical case

La dehiscencia de la sutura de la herida quirúrgica por causas infecciosas es una de las complicaciones que aumenta los costes de la estancia hospitalaria. La terapia de presión negativa (TPN) se utiliza para la cura de heridas complejas. Objetivo: mostrar la eficacia de la TPN en una herida abdominal cavitada, mediante la descripción de un caso clínico, tratada en el Dispositivo Transversal de Hospitalización a Domicilio (HAD) del Hospital Clínic de Barcelona. Metodología: Descripción de las características de la herida, realización del plan de cuidados, tratamiento y la evolución durante el ingreso en HAD. Resultados: Este trabajo muestra los efectos beneficiosos del dispositivo de HAD respecto al tratamiento de heridas con TPN. Conclusiones: Se muestra la necesidad de la realización de estudios, no solo casos clínicos, para generar evidencia científica de la TPN en el ámbito de HAD (AU)

Suture dehiscence of the surgical wound due to infection is one of the complications, which make the costs of hospital stay increase. Negative pressure therapy (NPT) is used to treat complex wounds. Objective: to show the effectiveness of TPN of the cavitated abdominal wound, by describing a clinical case, treated at the Home Hospitalization Transversal Device (HH) of Barcelona Clinic Hospital. Methods: The characteristics of the wound, care plan, treatment and evolution during admission to HH are described. Results: This work shows the benefit of the HH with regarding the treatment of wounds with NPT. Conclusions: It is shown the need for studies -not only clinical casesto generate scientific evidence of NPT in the HH setting (AU)

A Skin-stretching Wound Closure System to Prevent and Manage Dehiscence of High-tension Flap Donor Sites: A Report of 2 Cases.

Tension on the suture line of flap donor sites raises the risk of delayed healing and wound dehiscence. Closing a large flap donor site without a skin/flap graft is a major surgical challenge. Recently, the authors started using a skin-stretching wound closure system designed to harness both mechanical creep and stress-relaxation principles for the management of a variety of surgically closed wounds, including flap donor sites. The system consists of a pair of attachment plates connected by a long, flexible approximation strap that can be invasively (sutured) or noninvasively (by adhesion) secured to the skin wound edges and gradually tightened. The care and outcomes of 2 of the 41 patients whose wounds were managed with this system at the authors\'92 plastic/reconstructive and wound repair center during a period of 7 months are described. The first case involved a 20-year-old patient with a 16 cm x 8 cm deep inferior epigastric perforator flap to reconstruct a malignant tumor resection of the groin. The second patient required a 10 cm x 8 cm anterolateral thigh free-flap to repair a traumatic dorsal skin, soft tissue defect. Wounds were assessed and tension adjusted every 2 or 3 days. Both lesions healed by primary intention and with a good cosmetic outcome. Controlled clinical studies are needed to examine the effectiveness, efficacy, indications, complications, and cost effectiveness of this closure system.

Management of multiple enterocutaneous fistulas.

Enterocutaneous fistulas present a difficult management problem in the intensive care unit. Although some patients require surgical intervention for fistula control, key elements to good clinical management include mechanical control and vigorous nutritional support. This approach includes eradication of malnutrition, support of the hypercatabolic state, and maintenance or replacement of protein loss from fistula drainage. Good mechanical control involves integument protection and a mechanism of drainage collection. The patient we describe taxed the ingenuity and creativity of all those concerned with his care. Modification of a previously described technique to protect surrounding skin and collect fistula output served as a simple and inexpensive approach to eliminate infection potential, improve the patient's comfort, and decrease the nursing time that would have been required for frequent, complex dressing changes.

Accountability and responsibility.

What can you do if the most appropriate treatment does not comply with a guideline, policy or procedure? A tissue viability team was faced with this dilemma when considering treatment options for an open wound in a woman with cancer.

Neonatal wound dehiscence and the subsequent healing process: a case study.

Many neonates require abdominal surgery for a variety of reasons, including necrotizing enterocolitis (NEC). Secondary complications of abdominal surgery include alterations in skin integrity and potential wound dehiscence. These alterations may actually worsen when treated with products "traditionally" used postoperatively. The author simultaneously utilized basic wound care products with currently recognized therapies in managing a 29-week premature infant who experienced dehiscence secondary to bowel repair. By utilizing the correct products and incorporating the principles of moist wound healing and occlusion, this Stage III/IV wound, measuring 12 cm x 3 cm, closed within 35 days of dehiscence. A team-oriented and coordinated approach proved that wounds can, and will, improve, even in this fragile population.

Assessment and management of stomal complications: a framework for clinical decision making.

Assessment and management of stoma complications are often the responsibility of nurses across the continuum of care. These complications can occur at different times based on their etiology - immediately postoperatively or even several years after surgery - and often require modifications in a person's daily stoma management. This article presents a conceptual framework to help categorize types of stoma complications based on either etiology or location and offers management options to facilitate quality care. The five major categories of complications include Poor Siting, Stoma Proper, Peri-Intestinal Area, Mucocutaneous Junction, and Iatrogenic. Most of these suggested approaches to care are the recommendations of certified ostomy nurses based on their educational training, expert opinion, and successful experiences. Although these recommendations have often solved the specific problems and greatly improved the quality of life for the person with stomal complications, much research is still needed to confirm and/or improve these nursing approaches.

Management of a dehisced abdominal wound with VAC therapy.

The management of large cavity wounds has always posed particular challenges for nurses and clinicians. The National Institute for Clinical Excellence (NICE, 2001) suggests that the number of difficult-to-heal surgical wounds may increase in the future and that increased knowledge and expertise should be available across primary and secondary care. Recent research into wound healing has tended to focus on the biology of wound healing and manipulation of the healing processes with new dressings technology and other clinical and cost-effective treatments. Vacuum-assisted closure (VAC) is an innovation that is being given increasing attention. In Northampton, one patient nursed in the community setting has recently benefited from the technology to accelerate healing of a deep abdominal cavity. This article considers the historical management of cavity wounds and presents a case study. The feelings of the patient and the experiences of the district nurses in overcoming management problems are discussed. The case has proved to be the catalyst for a collaborative initiative across primary and secondary care services to ensure that all patients requiring the treatment are able to receive it in the community setting as well as in the hospital, when they are ready for discharge. It is recognized in Northampton that there are several applications for VAC in wound management and that the treatment has many benefits for patients and for those managing finite NHS resources.

Above the knee amputation wound which dehisced following surgery.

This case study describes the wound care of Mrs A, a female patient whose above the knee amputation wound dehisced after surgery. The management of this wound was complex and challenging and required that many members of the multidisciplinary team to work together to achieve a satisfactory outcome.