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Situation

44 year old man with chronic history of gout in many joints. The patient had surgical intervention on right big toe due to infection of joint, pain and bone osteomyelitis.

At 2 week post-surgery, the patient experienced delayed healing, pain and odour from the wound. On presentation, the wound had heavy thick slough, undermining of edges and slight hypergranulation at base of wound.

Action(s) taken/treatment(s) provided

Monofilament fibre lolly was used to clean wound bed, disrupt and remove biofilm and slough. Second generation hydrogel dressing then applied to wound bed for autolytic debridement and softening of slough. Pain relief was instant and patient no longer required oral pain medication. Biocellulose hydrobalance dressing was also applied at day 4 to improve and speed up epithelialisation process.

Outcome(s)

Patient and clinician happy with progress in first 7 days. The treatment and dressings reduced pain and allowed the patient to walk and wear his own shoes. Wound was fully healed after 26 days.

Lesson(s) learned

The use of monofilament fibre lolly combined with additional autolytic debridement with second generation ionic hydrogel dressing helped to prepare the wound bed and removed slough, debris and other barriers to healing. Further treatment with hydrogel dressing and hydrobalance dressing helped to create optimal conditions for wound healing.

Situation

Patient presented to Hospital in the Home with large wound on the right leg which was suspected to have been caused by a spider bite. The patient was suffering from extreme pain, swelling and blistering.

Action(s) taken/ treatment provided

Wound needed debridement in the clinic to remove necrotic tissue and hardened slough. Due to the wound size and complexity, a combination of debridement methods were chosen, including mechanical with monofilament fibre pad, sharp and autolytic with ionic gel dressing. After full debridement was achieved, the wound bed was able to be thoroughly assessed and wound care plan put in place. Dressing regime included ongoing use of monofilament fibre pad for mechanical debridement and wound bed preparation and gel dressing for pain relief and dynamic fluid management.

Outcome(s)

The dressings were well tolerated and comfortable for the patient. Over the 4 months of treatment, the wound progressed towards healing and no surgical/specialist intervention or lengthy hospital stay was required.

Lesson(s) learned

Wounds with this level of complexity are often not expected to be treated in community settings. With introduction of new products onto the hospital formulary due to a new contract, new technologies were able to be used by the community nurse with successful patient outcomes. The products selected were cost effective, easy to use and reduced the need for antimicrobial dressings. Moving forward, products such as the new second generation ionic gel dressing can be used effectively in the community, reducing the need for specialist intervention.

Situation

Intellectually disabled 54 year old man with diabetes, obesity and hypertension. The patient has peripheral neuropathy of feet and developed a diabetic foot ulcer. Surgical debridement was performed in OR and wound was initially treated with impregnated gauze ribbon changed twice daily and cleaned with PHMB solution.

Action(s) taken/ treatment provided

A review of treatment regime and dressings was conducted at 5 weeks post-operation due to deterioration of wound, odour and possibility of future amputation of foot. New treatment plan included cleansing and debridement with and monofilament fibre pad and use of biocellulose hydrobalance dressing dipped in PHMB solution to improve rate of healing.

Outcome(s)

After 9 days, wound was granulating with reduced level of exudate and odour. Total cost of dressings over 9 days of treatment was $114.51. Patient was able to be transferred to a rehabilitation facility and avoided amputation.

Lesson(s) learned

After 5 weeks using a wound dressing regime including gauze and time consuming twice-daily dressing changes, the wound had deteriorated, rather than progressed towards healing. The change of dressing plan resulted in granulation and wound progression in just 9 days. Dressings were cost effective and saved time as did not need to be changed so regularly.

Since the introduction of negative pressure therapy of the abdomen, care has been taken to protect the intestine from the effects of negative pressure in order to avoid impairments of abdominal organs. As an alternative to the widespread AB-Thera^R system (KCI, San Antonio, Texas, USA), the different concept of Suprasorb CNP^R (Lohmann & Rauscher, Austria-Germany) was introduced by the producer with the premise of achieving a better therapeutic effect. Due to numerous pores of the film, the effects of the negative pressure are brought to the surface of the intestinal organs and these effects were tested on seven experimental animals. Particular attention was paid to the small intestine, colon, liver, and pancreas. Over 8 h continuously, three animals were tested with −80 mmHg, 4 with −60 mmHg. The results showed no macroscopic pathological changes. The histological results showed borderline changes in the small intestine and colon with −80 mmHg application, minimal or none with −60 mmHg. The liver and pancreas were found free of pathological changes. For use on human organs, the intra-abdominal application of −60 mmHg for the Suprasorb CNP system is proposed as the standard.

The use of negative pressure dressings for open abdominal therapy has made a great impact on strategies for open abdominal treatment. Observed intestinal damage and developement of fistula formation raises questions about safety of commonly used systems (AB-Thera). The most common used system uses foils for shielding intestines directly from negative pressure. As an alternative a system with open pore dressing in double layer film was introduced (Suprasorb CNP) and proved to safe in animal studies. We compared the effects of this two systems on patients requiring open abdominal treatment.Materials and methods: Patients with secondary peritonitis in at least two abdominal quadrants were included in this randomized study. Inclusion criteria were secondary peritonitis (ACS), abdominal compartment syndrome, and abdominal trauma combined with ACS and/or contaminated abdomen. Patients with active bleeding and pancreatitis were not included. We examined Mannheim peritonitis Index (MPI), bloodcount, PCT, amount of fluid collected, and morphological changes on the bowel. Data were collected on day 2, 4, 7, 14, 21, and 28. Primary end point was fascial closure. Examination was terminated in case of death and damage to the abdominal organs. Groups were compared using Mann Whitney U-test and chi square test. Trend evaluation was evaluated using an one way repeated measure analysis of variance. P-values below 0.05 was

Endoscopic negative pressure therapy (ENPT) represents a modern and effective treatment strategy for gastrointestinal tract wall defects. The intracavitary treatment strategy is based on placing a sponge within the defect cavity (Fig. 1), whereas the intraluminal treatment approach is based on placing a drainage device within the visceral lumen overlapping the defect area (Fig. 2). These strategies complement each other and are successful treatments for gastrointestinal perforation and postoperative adverse events in the upper or lower GI tract.

An open-pore film drainage (OFD) device was first described in 2015 by Loske et al3 and has been used for several indications in the upper GI tract, urinary tract, and other sites. OFD may offer several advantages in terms of easier placement, adhesiveness to the wound base, less frequent reintervention, and better fluid mobilization. In this video (Video 1, available online at www.giejournal.org), we present the assembly and placement procedure of a fashioned OFD device that allows simultaneous enteral feeding.

PURPOSE

Staple line leak (SLL) is a serious complication after sleeve gastrectomy (SG). Common endoscopic treatment options include self-expandable metallic stent (SEMS), endoscopic internal drainage (EID), and endoscopic closure. The endoscopic negative pressure therapy (ENPT) is a promising treatment option combining temporary sealing of the defect with drainage of the inflammatory bed. In this study, we compare the outcome of ENPT and SEMS for the treatment of SLL following SG.

MATERIALS AND METHODS

A retrospective cohort of 27 patients (21 females) treated at a single center for SLL after SG was included. ENPT was primary therapy for 14 patients and compared with 13 patients treated primarily using SEMS.

RESULTS

ENPT was associated with a significant reduction of hospital stay (19 ± 15.1 vs. 56.69 ± 47.21 days, p = 0.027), reduced duration of endoscopic treatment (9.8 ± 8.6 vs. 44.92 ± 60.98 days, p = 0.009), and shorter transabdominal drain dwell time (15 (5-96) vs. 45 (12-162) days, p = 0.014) when compared to SEMS. Whereas endoscopic management was successful in 12/14 (85.7%) of patients from the ENPT group, SEMS was successful in only 5/13 (38.5%) of patients (p = 0.015). Furthermore, ENPT was associated with a significant reduction of endoscopic adverse events compared with SEMS (14.3% vs. 76.92% p = 0.001).

CONCLUSION

Compared with SEMS, ENPT is effective and safe in treating SLL after SG providing higher success rates, shorter treatment duration, and lower adverse events rates.

A monofilament fibre debridement pad has been found to be a rapid and effective mechanical method of removing dry skin, biofilm and debris from acute and chronic wounds with minimal patient discomfort. Evidence of its impact on prescribing and wound healing, however, has been more limited. The aim of this audit was to show evidence of the monofilament fibre debridement pad's impact on wound treatment costs through an analysis of NHS wound-care prescribing data in England. A dataset for 486 uniquely identified patients who had been newly prescribed the monofilament fibre debridement pad was obtained from the NHS Business Services Authority. All data were anonymised. Costs were identified for the six months before and six months after the month of first prescription of the monofilament fibre debridement pad. The total cost of wound-care prescribing fell by 14% or £101,723 in the six months after the intervention compared with the six months before. The average monthly expenditure per patient fell from £244 before the intervention to £209 (n=486) after. These results indicate that use of the monofilament fibre debridement pad could reduce prescribing costs and the use of antimicrobial and negative pressure therapies. Further research is warranted to investigate the clinical role of the monofilament fibre debridement pad in wound healing.

OBJECTIVE

The aim of this study was to evaluate the effect of an iodine tampon on postoperative discomfort after surgical removal of a mandibular third molar.

MATERIAL AND METHODS

Patients were randomly assigned to two groups: one group received an alveolar iodine-containing tampon in the extraction socket (N = 44), and the other group used a disposable syringe (Monoject®) to rinse the wound (N = 43). Postoperative discomfort was assessed with the Oral Health Impact Profile-14 (OHIP-14) questionnaire, Pain Intensity Numerical Rating Scale (PI-NRS), and questions about self-care and discomfort.

RESULTS

This study included 87 patients (52 women and 35 men) with an average age of 26.47 years (SD, 6.36). The mean OHIP-14 sum scores were significantly lower in the iodine tampon group compared with the Monoject® syringe group. Mean PI-NRS scores significantly differed between the iodine tampon group (3.33; SE, 0.27) and Monoject® syringe group (4.46; SE, 0.27) (F (1, 85) = 8.16, p < 0.01), with no interaction effect between time and PI-NRS (F (6, 510) = 1.26, p = 0.28). Patients in the iodine tampon group reported less postoperative discomfort.

CONCLUSIONS

Insertion of an iodine-containing tampon in the postoperative socket reduced the pain and impact on oral health-related quality of life during the first postoperative week and positively influenced postoperative sequelae.