Recherche de publication

OBJECTIVE

Late-stage lymphoedema is characterised by chronic swelling, shape distortion, inflammatory processes and tissue fibrosis. Our aim was to perform a clinical audit of a lymphoedema compression bandaging system (Rosidal Soft foam roll layer and figure-of-eight application of Actico cohesive inelastic bandages) specifically designed for patients with late stage lower limb lymphoedema.

METHOD

The audit explored suitability of the bandaging system, benchmarking limb volume changes with research evidence, and reporting patient and practitioner evaluations.

RESULTS

A mean reduction (33%) in excess limb volume was reported for the 11 patients with unilateral lymphoedema who completed a course of bandaging over 12 days. Mean percentage reduction of absolute limb volume after treatment was 8%. Patient and practitioner evaluations indicated the suitability of this bandage system for patients with late stage lymphoedema in terms of comfort and effectiveness.

CONCLUSION

The bandaging system is suitable for patients with late stage chronic swelling. Two parameters for calculating change in limb volume are not interchangeable. Future evaluation of the bandaging system, using validated outcome measures within a comprehensive research study is required.

DECLARATION OF INTEREST

Activa Healthcare provided financial support to the project and supplied the materials.

This document is a practical guide to the management of hyperkeratosis of the lower limb for all healthcare professionals involved in the care of patients with hyperkeratosis or those who are at risk of developing the condition, such as specialist nurses, district nurses, practice nurses, GPs, and podiatrists.

It offers pragmatic clinical recommendations for all aspects of care and introduces a novel, stepped approach to management, covering assessment, treatment and management of patients with hyperkeratosis, prevention of recurrence, and prophylactic measures for patients who may be at risk of developing the condition. The document also presents outcome measures that can be used to assess the efficacy of prevention and treatment interventions.

There is currently no standardised strategy or evidence-based national guideline for the management of hyperkeratosis and the condition is poorly represented generally in the medical literature. This document is therefore based on the best available evidence, supported by the consensus opinion of an expert working group of key opinion leaders from a wide range of disciplines, including lymphoedema, wound care, diabetes, dermatology and general practice. It aims to build on the success of the All Wales guidance on hyperkeratosis, which drew largely from the experience of its Tissue Viability Nurse Forum (AWTVNF, 2014).

In producing consensus recommendations, the expert working group recognises the many challenges facing healthcare professionals in this field, such as time constraints hindering a holistic approach, lack of cohesive national or local strategies for managing hyperkeratosis, and limited experience with newer, more efficacious technologies.

With these issues in mind, this document seeks to improve understanding of hyperkeratosis and equip healthcare professionals with the knowledge and skills necessary to recognise and treat this chronic condition effectively.

Caroline Dowsett, Chair

Die Prävalenz venöser Abflussstörungen als Ursache einer chronischen Wundheilungsstörung wird je nach Veröffentlichung mit bis zu 80% aller chronischen Ulzerationen am Unterschenkel angegeben. Somit ist die venöse Abflussstörung die häufigste Ursache von Ulcera cruris.

Aim:

Debridement and removal of biofilm is a major challenge in treatment of patients with chronic wounds. Surgical debridement requires trained personal, operation theatre and is often associated with pain but conventional methods relaying on cotton gauze may not be enough. A monofilament debrider* consisting of polyester fibres presents a fast and almost painless option for debridement. Hence, we have investigated the capacity of this monofilament debrider* to remove biofilm in vitro and compared it to cotton gauze**.

Methods:

For the wound debridement model, a S.aureus biofilm is cultivated on glass plates. The monofilament debrider* and conventional cotton gauze** were used to debride/clean the glass plates under standardized conditions (p=0.067N/cm2, v=1.6cm/s). Afterwards, the glass plates were stained with crystal violet to visualize the bacteria residuals. Plate images were obtained and all images were processed using ImageJ 1.45m.

Results:

Monofilament debrider* and cotton gauze** initially exhibited a comparable cleansing performance. However, the monofilament debrider* demonstrated a significantly higher cleansing capacity. While the monofilament debrider’ was able to achieve a retained high reduction of the biofilm over wiping several plates, gauze** quickly lost its efficacy.

Conclusions: The reduction of biofilm achieved using the monofilament debrider* is significantly higher than that of cotton gauze**. Moreover, it presents a non-invasive and therefore almost painless alternative to other. Hence, this technique should provide a valuable tool in the treatment of patients with chronic wounds to improve the quality of life as well as to safe costs.