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Wound Management (wound + management)
Selected AbstractsSutured wounds: Factors associated with patient-rated cosmetic scoresEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2006Tatiana Lowe Abstract Objective: To determine the association between wound characteristics, wound management in the ED and patient-rated cosmetic appearance of sutured wounds. Our hypothesis was that practitioner seniority would most strongly predict outcome. Methods: Prospective recruitment of patients with lacerations sutured at the primary ED visit was performed. Data collected included patient demographics, wound characteristics and wound management. A standardized telephone questionnaire was administered 14 days and 3 months later. Scar appearance was scored using a verbal rating scale from zero to 10. Data were obtained about suture removal, antibiotic compliance, infection and dehiscence rates at 2 weeks. Associations of variables with cosmetic scores were analysed using multivariate linear regression. Results: One hundred and thirty-two patients were evaluated. Mean cosmetic scores were not significantly associated with seniority (P = 0.07). Lacerations repaired by senior practitioners were more likely to result from glass or general trauma (P = 0.007), be shorter (P = 0.03), be cleaned with antiseptic (P = 0.03), not to re-open (P = 0.01) or require re-suturing (P = 0.03). Following multivariate regression factors significantly associated with cosmetic scores at 14 days and 3 months were site of injury (P < 0.003) and time from injury to repair (P < 0.009). Wounds of the torso, leg or foot had lower cosmetic scores at both time-points. An association with age (P = 0.04) was present at 3 months. Conclusions: Previous research found improvement between short-term doctor-rated cosmesis and training beyond internship. Our study demonstrated a non-significant trend relationship between seniority and patient-rated outcome, both short and long-term. However, staff seniority was overshadowed by the site of laceration and time from injury to repair. [source] Synthesis and Characterization of Thrombin Conjugated ,-Fe2O3 Magnetic Nanoparticles for HemostasisADVANCED ENGINEERING MATERIALS, Issue 12 2009Ofra Ziv Abstract Thrombin is the final protease produced in the clotting pathways. Thrombin has been used in the clinic more than six decades for topical hemostasis and wound management. In human plasma the half-life of thrombin is shorter than 15 seconds due to close control by inhibitors. In order to stabilize thrombin, this enzyme was conjugated covalently and physically to ,-Fe2O3 magnetic nanoparticles. The physical conjugation was accomplished through adsorption of thrombin to BSA coating on the nanoparticles. The coagulant activity of the covalently bound thrombin was significantly lower than that of the physically adsorbed thrombin. Leakage of the physically bound thrombin into PBS containing 4% HSA was negligible. The physical conjugation of thrombin onto the nanoparticles stabilized the thrombin against its major inhibitor antithrombin III and improved its storage stability. At optimal CaCl2 concentration, the clotting time by the bound thrombin is shorter than that of the free enzyme. This novel conjugated thrombin may be an efficient candidate for topical hemostasis and wound healing. [source] Silver dressings: their role in wound managementINTERNATIONAL WOUND JOURNAL, Issue 4 2006David J Leaper Abstract Dressings have a part to play in the management of wounds; whether they are sutured or open, usually chronic wounds of many aetiologies which are healing by secondary intention. They traditionally provide a moist wound environment, but this property has been extended through simple to complex, active dressings which can handle excessive exudate, aid in debridement, and promote disorganised, stalled healing. The control of infection remains a major challenge. Inappropriate antibiotic use risks allergy, toxicity and most importantly resistance, which is much reduced by the use of topical antiseptics (such as povidone iodine and chlorhexidine). The definition of what is an antimicrobial and the recognition of infection has proven difficult. Although silver has been recognised for centuries to inhibit infection its use in wound care is relatively recent. Evidence of the efficacy of the growing number of silver dressings in clinical trials, judged by the criteria of the Cochrane Collaboration, is lacking, but there are good indications for the use of silver dressings, to remove or reduce an increasing bioburden in burns and open wounds healing by secondary intention, or to act as a barrier against cross contamination of resistant organisms such as MRSA. More laboratory, and clinical data in particular, are needed to prove the value of the many silver dressings which are now available. Some confusion persists over the measurement of toxicity and antibacterial activity but all dressings provide an antibacterial action, involving several methods of delivery. Nanocrystalline technology appears to give the highest, sustained release of silver to a wound without clear risk of toxicity. [source] Scalp necrosis and giant cell arteritis: case report and issues in wound managementINTERNATIONAL WOUND JOURNAL, Issue 4 2005Stefan J Landis Abstract Scalp necrosis is rare in patients with giant cell arteritis. Here, we report the case of an 81-year-old woman who presented with a management problem that required a truly multidisciplinary approach to treatment. A combined approach of effective wound bed preparation with selective debridement, prolonged antimicrobial therapy, corticosteroid use and careful dressing choices resulted in a successful outcome in a potentially disastrous situation. [source] The effectiveness of silver-releasing dressings in the management of non-healing chronic wounds: a meta-analysisJOURNAL OF CLINICAL NURSING, Issue 5 2009Shu-Fen Lo Aim., The purpose of this study was to examine the efficacy of silver-releasing dressings in the management of non-healing chronic wounds. Background., Non-healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking. Design., Systematic review and meta-analysis. Methods., A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950,June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed. Results., Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI95: 0·16,0·39, p < 0·001), reduced odour (CI95: 0·24,0·52, p < 0·001) and pain-related symptoms (CI95: 0·18,0·47, p < 0·001), decreased wound exudates (CI95: 0·17,0·44, p < 0·001) and had a prolonged dressing wear time (CI95: 0·19,0·48, p = 0·028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI95: 0·04,0·33, p = 0·013) using silver dressings in wound management with no associated severe adverse events. Conclusion., This meta-analysis confirms the effectiveness of silver dressings in wound healing and improving patients' quality of life. However, it also highlights the need for additional well-designed randomised controlled trials to evaluate the effectiveness of silver-related dressings further. Relevance to clinical practice., The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds. [source] Arteriolosclerotic ulcer of MartorellJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2010JDD Vuerstaek Abstract In 1945, Martorell described ischaemic leg ulcers in patients with hypertension. He suggested that the ischaemic necrosis was secondary to a hypertensive arteriolar disease and referred to them as ,hypertensive ischaemic ulcers'. In recent years, the specific entity of these ulcers has been questioned. Others claim they have a much higher incidence, but presume the diagnosis is frequently missed. Almost 900 cases of Martorell's ulcers have been reported in literature since the first description. A systematic review and comprehensive search of literature (evidence-based) was needed to characterize this type of ulcer. Based on aetiology and histopathology, it seems to be justified to maintain the name ,arteriolosclerotic ulcer of Martorell'. We conclude that the arteriolosclerotic ulcer of Martorell is a specific entity with its own clinical and histological diagnostic keys, wound management and preventive measures. We introduce a set of criteria that may be used to facilitate diagnosing arteriolosclerotic ulcer of Martorell as well as a flowchart that includes diagnosis, treatment and prevention of this particular type of vascular leg ulcer. [source] Toxic epidermal necrolysis; 15 years' experience in a Dutch burns centreJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 6 2007B Gerdts Abstract Background, Toxic epidermal necrolysis (TEN) is a severe and potentially fatal drug reaction characterized by an extensive skin rash with blisters and exfoliation, frequently accompanied by mucositis. The wounds caused by TEN are similar to second-degree burns and severe cases may involve large areas of skin loss. Objectives, Analysis of our results in patients with TEN and evaluation of the variety of therapeutic interventions that has been studied and suggested in TEN. Patients/methods, Retrospective analysis of 19 consecutive patients with TEN treated in our burns centre between 1989 and 2004. Results, Immediate withdrawal of any potentially fatal drug, maximum supportive care, and a restricted and tailored antibiotic, medical and surgical treatment regimen confined mortality to 21%, whereas prognosis scores like APACHE II and SCORTEN predicted mortality of 22 and 30%, respectively. A positive contribution of selective digestive decontamination is suggested but has yet to be established. Conclusions, Because of a potentially fatal outcome, fast referral of a patient suspected of TEN to a specialized centre (mostly a burns unit or specialized dermatology centre) for expert wound management and tailored comprehensive care is strongly advised and contributes to survival. [source] The gel swelling properties of alginate fibers and their applications in wound managementPOLYMERS FOR ADVANCED TECHNOLOGIES, Issue 1 2008Yimin Qin Abstract Calcium alginate fibers have a novel gel-forming capability in that, upon the ion exchange between sodium ions in the contact solution and calcium ions in the fiber, the fiber slowly transforms into a fibrous gel. This paper reviews the principles of the gel-forming process for alginate fibers and analyzed the gelling behavior of various types of alginate fibers. The absorption characteristics of alginate wound dressings were analyzed and it was found that alginate wound dressings absorb a large quantity of liquid into the fiber structure, in addition to those held between the fibers in the textile structure. This gives rise to the unique gel blocking properties of alginate wound dressings. In addition, alginate wound dressings also have novel hemostatic and antimicrobial properties as well as the ability to promote wound healing. They are now widely used in the management of highly exuding wounds such as leg ulcers, pressure sores, and surgical wounds. Copyright © 2007 John Wiley & Sons, Ltd. [source] Clinical practice guidelines for the management of acute limb compartment syndrome following traumaANZ JOURNAL OF SURGERY, Issue 3 2010Christopher J. Wall Abstract Background:, Acute compartment syndrome is a serious and not uncommon complication of limb trauma. The condition is a surgical emergency, and is associated with significant morbidity if not managed appropriately. There is variation in management of acute limb compartment syndrome in Australia. Methods:, Clinical practice guidelines for the management of acute limb compartment syndrome following trauma were developed in accordance with Australian National Health and Medical Research Council recommendations. The guidelines were based on critically appraised literature evidence and the consensus opinion of a multidisciplinary team involved in trauma management who met in a nominal panel process. Results:, Recommendations were developed for key decision nodes in the patient care pathway, including methods of diagnosis in alert and unconscious patients, appropriate assessment of compartment pressure, timing and technique of fasciotomy, fasciotomy wound management, and prevention of compartment syndrome in patients with limb injuries. The recommendations were largely consensus based in the absence of well-designed clinical trial evidence. Conclusions:, Clinical practice guidelines for the management of acute limb compartment syndrome following trauma have been developed that will support consistency in management and optimize patient health outcomes. [source] | |||||||||||||