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Wound healing is a complex series of events that are interlinked and dependent on one another. Acute wounds usually follow a well-defined process. In the past this model of healing has been applied also to chronic wounds, but it is well known that chronic wound healing is different from acute wound healing. Wound bed preparation as a concept allows the clinician to focus systematically on all of the critical components of a non-healing wound to identify the cause of the problem, and implement a care programme in order to achieve wound healing. To assist with implementing the concept of wound bed preparation, the TIME acronym was developed in 2002 by a group of wound care experts. It is important to understand wound bed preparation and TIME within the context of total patient care. Debridement is an integrated part of wound management, achieving certain goals and, thus, creating a healthy wound bed, margins and peri-wound skin with the objective to promote and accelerate healing. Debridement is defined as the removal of foreign material and necrotic tissue from a wound and it can also help to stimulate wound healing. However, not all methods of debridement are the same. Each method has advantages and disadvantages that must be clearly understood. Wound cleansing loosens and washes away cellular debris such as bacteria, exudate, purulent material and residual topical agents from previous dressings. Failure to use the correct method for a given wound may lead to further delays in wound healing, increase patient suffering, and unnecessarily increase the cost of care. Aim of this review is to give an overview of current standards and definitions concerning wound bed preparation and debridement.

Significant NHS reforms mean tissue viability services need to implement new treatments and ways of working in order to deliver significant cost savings. In this two part article, the changing NHS is discussed, followed by an example of a new treatment, a monofilament fibre pad that can aid in the clinician in accurately assessing pressure ulcers.

Introduction:

A variety of occlusive dressings for the treatment of chronic wounds is available, including films, foams, and gels, of diverse materials such as alginates, polyurethane, hyaluronic acid, or collagen. Not all of them are able to handle the excess amount of exudate of highly exuding wounds. Hence, dressings containing superabsorbent polymers (SAP) have been developed. SAP’s are able to absorb a multiple amount of fluid of their own dry weight while keeping the wound environment moist. An additional inhibition of microbial growth would be beneficial. Important pathogens of nosocomial infections are Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Candida albicans. Hence, we have tested two SAP-containing wound dressings for their antibacterial and antifungal activity according to the JIS L 1902:2002 in vitro.

Materials and Methods:

According to the JIS L 1902:2002, samples of 400 mg of the dressings*# were used for testing. The samples were incubated up to 24 h at 37°C under aerobic conditions with the pathogens. Additionally, effect on P. aeruginosa growth was investigated after a prolonged incubation period of 7 days.

Results:

Both SAP-dressings exhibited a strong reduction (>3 log) of P. aeruginosa, K. pneumoniae, and E. coli after 24 h and were also able to significantly inhibit the growth of S. aureus and C. albicans (app. 2 log). Moreover, P. aeruginosa growth was completely inhibited over a period of 7 days. No significant differences were observed between the two dressings tested.

Conclusions:

SAP-containing wound dressings show distinct antibacterial and antifungal properties. Their use should aid treatment of wound infections by entrapment of the microorganisms in the forming gel during uptake of wound exudate and the inhibition of microbial growth.

This article aims to strike a balance between compression bandaging to treat oedema and a positive patient experience.Compression therapy is well recognised as a key component in the management of venous and lymphatic conditions. Science indicates that intermittent pressures provided by inelastic bandage systems rhythmically stimulate venous and lymphatic flow to reduce and contain oedema. However, sustained high pressures are not always tolerated by patients who wear bandages. This may be overcome by applying inelastic bandages with high working and tolerable lower resting pressures. As compression is vital to prevent prolonged suffering caused by ulceration and oedema, concordance and listening to patients is the key to successful treatment.

Supported by the NHS Lymphoedema Service Administrator, this article reports on a project undertaken by a clinical nurse specialist in Lymphoedema (CNS) and in part fulfilment of an MSc in Skin integrity skills and treatment, achieved from the University of Hertfordshire, September 2011. The need for the project was generated by the 5-day delay experienced by terminally ill patients in a hospice while waiting to receive treatment for lymphorrhoea from the community-based CNS. The training and assessment of healthcare assistants in a cost-effective treatment enabled the instigation of care within 3 hours of the development of lymphorrhoea in a patient and an evaluation of its competent delivery.