The use of negative-pressure wound therapy to manage enteroatmospheric fistulae in two patients with large abdominal wounds.

Enteric fistulae are a relatively common complication of bowel surgery or in surgery where the bowel has been exposed. Fistulae can present a significant threat to patients' well-being. Changes in surgical techniques and in particular the rise in damage control surgery for emergency patients have led to an increase in open abdominal wounds. The presence of an enteroatmospheric fistula on the surface of a wound can cause a number of distressing symptoms/issues for the patient whilst providing a significant challenge for the clinician. The loss of fluid, proteins and electrolytes will place the patient in danger of becoming hypokalaemic and malnourished. A variety of techniques are available, most refer to a method of isolating the fistula using stoma rings or washers and ostomy paste. The role of negative pressure in the management of wounds with fistula is in its infancy; however, there is evidence to suggest that isolation techniques can be advantageous in managing wounds with fistulae.

Venous leg ulcer management: single use negative pressure wound therapy.

A number of leg ulcer specialist/tissue viability specialists from across the UK were invited to evaluate PICO (Smith and Nephew, Hull) as a treatment for venous leg ulcers also in conjunction with a variety of compression bandages and garments. Patients across 5 sites had PICO applied in conjunction with compression therapy. This group of treating clinicians were then asked to give feedback on the outcome of the patients on whom they had used the new device. All feedback was recorded at a meeting and this was used to create a guideline for use.

Diagnosis, treatment and nursing management of patients with pilonidal sinus disease.

Pilonidal sinus disease is a common disorder that occurs in the cleavage between the buttocks and can cause discomfort and embarrassment for patients. It frequently recurs following surgery and requires time-consuming wound care. This article discusses the incidence, pathophysiology, clinical presentation and appropriate management of patients with the disease.

Using case reports to aid reflective practice in wound care.

Reflection is a widely-used tool in education and practice for giving individuals insight into events and incidents. Case reports, though lacking in rigour as a source of evidence, also provide an opportunity to reflect on and examine practice. They therefore provide a useful opportunity of examining practice in wound care, which is lacking in many nursing curricula. A case report is given here to illustrate some of the lessons that can be learned by reflection--even by an experienced nurse.

Necrotizing fasciitis in primary care: presentation, risk factors and treatment.

Necrotizing skin infections, although rare, have proven difficult to manage and treat in a wide range of patient groups. The risks of extensive tissue necrosis, systemic sepsis and potentially organ failure make this disease one which health-care professionals must be aware of. Treatment involves rapid debridement and intensive therapy including broad spectrum antibiotics. Appropriate wound care is essential as is a great deal of psychological support for the patient and relatives. This article also highlights some of the risk factors which may pre-dispose a patient to infection.

Evolution or revolution? Adapting to complexity in wound management.

Wound clinics are seeing an increase in the number of 'complex' wounds, which arise as the result of the interaction between multiple coexisting systemic pathologies, environmental factors and local wound factors. These complex wounds require an approach to diagnosis and management that can encapsulate all these factors. Unified wound assessment approaches such as HEIDI (History, Examination, Investigations, Diagnosis and management plan), wound bed preparation and applied wound management systems are essential to reach a definitive diagnosis and to ensure that management is agreed between the various clinical specialities that may be involved. A series of case histories is presented that illustrate the benefits of a unified approach to wound management. Results of a study into the cost-effectiveness of an improved foam dressing are presented, and the problems of demonstrating the ability to make long-term savings through short-term expenditure are discussed.

PHMB: Utilización del apósito de espuma antimicrobiana (AMD) KendallTM(PHMB 0, 5%) en el tratamiento de las heridas crónicas / PHMB: The role ok KendallTM AMD Antimicrobial Foam Dressing (0.5% PHMB) in the treatment of wounds

Abordamos la parte más problemática del tratamiento de las heridas crónicaso agudas, de acuerdo con los profesionales especializados es la infección de laherida. La sobrecarga bacteriana puede retardar la curación de la herida y disminuirla calidad del paciente como consecuencia del aumento del dolor, delexudado y del posible mal olor. Se han recopilado casos clínicos durante losúltimos 6 meses en una unidad especializada en el cuidado de heridas de loshospitales Doncaster y Bassetlaw, RU. Estos casos ilustran la variedad de tiposde herida que pueden tratarse con éxito con el nuevo apósito de Espumaantimicrobiano KendallTM AMD (PHMB 0,5%). Se pudo concluir que elapósito de Espuma KendallTM AMD actúa bien como antimicrobiano y comoproducto de vendaje moderno. Su utilización disminuye la carga bacteriana altiempo que consigue la absorción del exudado y el mantenimiento de un ambienteóptimo para la curación de la herida (AU)

The most troublesome part of wound healing according to the care practitioners isthe Wound infection. The presence of excess bacteria in the wound can lead to delayedhealing that lead to a reduced quality of life for the patient due to increasedpain, higher exudates levels and potential malodor. The following patient case reporthave been collated over the past six months in a specialist wound care clinicin Doncaster and Bassetlaw, UK. These cases illustrate the range of wound typesthat have been successfully treated with the new KendallTM AMD AntimicrobialFoam dressing (PHMB 0,5%). The conclusion was that KendallTM AMD Foamdressing functions well as an antimicrobial and a modern wound dressing (..) (AU)

Patterns of use of an emergency department-based observation unit.

Emergency department (ED)-based observation units are becoming increasingly used for the assessment and treatment of patients who may not require inpatient management or monitoring. This is a retrospective study of 5,714 patients seen in an ED observation unit from October 16, 1996 through July 12, 2000. Of the 5,714 patients seen in the observation unit, 4,191 were discharged and 1,314 were admitted. The average length of stay was 14.92 hours. The largest group of patients seen in the observation unit was those with chest pain (almost 26%). Patients suffering abdominal pain/colic represented the second largest group (almost 16%). Pediatric patients had the shortest stay, averaging only 11.2 hours, although adult and geriatric patients averaged 15.1 hours and 15.4 hours, respectfully. The ED-based observation unit can be of great value to patient care. Although not a substitute for an inpatient unit, it is meant to be a convenient location from which to observe patients who exhibit questionable admitting criteria.