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Introduction:

Maceration is the elixation of the skin by prolonged exposure to moisture impeding healing due to failure of skin protection and possible microbial infections. Chronic wounds are often colonized by different kinds of microorganisms, mostly S.aureus and P.aeruginosa. Bacterial load on the wound surface perpetuates an inflammatory environment. It is of interest to elucidate dressing performance by comprehensive in vitro testing including binding capacity for elastase, determination of antibacterial activity, and assessment of fluid handling capability.

Methods:

A hydroactive dressing (HAD) consisting of cellulose/ethyl-sulfonate-cellulose fibres has been investigated. An in vitro maceration model was used to quantify and evaluate fluid uptake, fluid distribution, and shape changes. Binding capacity for elastase was determined over 24h. Determination of antimicrobial activity was performed according to JIS L 1902:2008 against S.aureus and P.aeruginosa.

Results:

HAD exhibited significantly higher fluid uptake than an alginate (AD) or a sodiumcarboxymethylcellulose dressing (SCD). It was shown that it possess a distinctly higher form stability. The SCD already macerated before the dressing was completely soaked while leakage with HAD and AD was only observed after they were completely gelled. HAD is further able to reduce the activity of elastase in vitro. And it exhibited a strong antibacterial activity against S.aureus and a significant antibacterial activity against P.aeruginosa.

Conclusions:

Performance of dressings can be assessed and compared under standard conditions in vitro. Here, HAD is able to reduce elastase activity, inhibit bacterial growth, and possess superior fluid handling capacity compared to AD and SCD.

Aim:

A National Best Practice Statement for the holistic management of venous leg ulcers¹ presents a treatment pathway, originally developed by Atkin and Tickle². The aim was to revise this treatment pathway to reflect new evidence³.

Method:

The treatment pathway was originally developed to reflect published RCT evidence for venous intervention reducing episodes of reoccurrence (ESCHAR trial)⁴ and with leg ulcer hosiery kits as first line as a result of the publication of the VenUS lV study⁵. The treatment pathway has been used since 2016 and needed further updating to reflect the recent evidence investigating the impact of early venous ablation in patients with venous leg ulcers (EVRA)⁶.

Results / Discussion:

In a group of 34 patients with leg ulceration the implementation of this pathway into everyday clinical practice has been shown after 3 months to deliver a number of benefits including increased healing rates, improved documentation and a reduction of nursing visits⁷;

 From 0% to 76% having their leg ulcer diagnosis recorded

 From 34% to 76% having their ABPI recorded

 From 13% to 83% use of compression therapy

 From 7% to 56% healing or signs of healing

 43% reduction in nursing visits

Conclusion:

It is vital to ensure that current research evidence is adopted within frontline services as soon as possible. Formalised evidence-based pathways provide a practical treatment guide and can help reduce unwanted variations, as standardising clinical processes through the use of a pathway is known to optimise the quality of treatments and improve patient satisfaction.

Introduction

Liam is a 26 year old man who suffered a post trauma DVT when just 18 years old. He has Warfarin therapy and has a history of venous leg ulceration for 8 years. Because of the damage to his primary, deep veins he had developed a collateral venous circulation.

Liam describes having a leg ulcer at a young age as “life changing”. It stopped him playing sport and swimming and it changed how he interacting with friends. Because of his damaged circulation and medication he lived with the constant fear that his leg was going to deteriorate or bleed. Despite this, Liam continued to work full time and support his family.

Method

In the summer of 2018, Liam’s nurse changes his treatment from a combination long-stretch cohesive bandage system, to a cohesive short stretch bandage system. She also implemented a Monofilament fibre biofilm based treatment regime to expedite wound bed preparation and disruption of the biofilm (Morris et al, 2016).

Results

There was a dramatic reduction in leg oedema and improvement in leg shape almost immediately the new bandage system was started. Things continued to improve over the following months. Liam reported that the cohesive short stretch bandage system made “his leg feels much more comfortable with less ridging and less slippage”. His leg shape was much better, and it was easier to wear socks and shoes. Liam said that nobody noticed he had a bandage on.

In December 2018, after 8 years of ulceration, Liam’s venous leg ulcer healed.

Conclusion

This case study demonstrates how learning and implementing new knowledge, technology and skills can translate into improved patient outcomes. By sharing Liam’s story we can really understand the devastating effect a leg ulcer can have, especially on a teenager and young adult.

Liam now has a bespoke plan for the prevention of future venous leg ulcers which will include higher compression during working periods when he will be on his feet for long periods. This is achieved by using short stretch wrap systems to encourage continued self-care and ownership of his long term condition.

Introduction

This national, multicentre patient evaluation examines the enhancements that have recently been made to a superabsorbent dressing* and how this product improvement** has led to enhanced performance and improved patient related outcomes. The enhancements are a wider border and more ergonomic shape and a new structure to the superabsorbent polymer which increases absorbency.

Method

The recently developed and improved superabsorbent wound dressing was evaluated in six clinical sites on 27 patients with wounds requiring management of exudate of varying levels.

Results

The mean age of the patients who participated was 70 years and the main wound type was leg ulcer. At the start of the evaluation the surrounding skin was mostly reported to be macerated and/or red and excoriated. Exudate levels were light in 4 cases, moderate in 12 cases and heavy in 11 cases. The improved superabsorbent was used on its own as a primary dressing in only 5 cases and in combination with another primary dressing in 15 cases (7 did not answer the question). A topical antimicrobial was combined with the new superabsorbent in 60% of cases and a contact layer in 20% of cases. It was used under full or reduced compression in 21 cases. In most cases the improved superabsorbent replaced either another superabsorbent or absorbent dressing. The frequency of dressing changes varied from daily to weekly prior to the evaluation with 7 clinicians stating that the new and improved superabsorbent had reduced the frequency of dressing changes. The others either did not comment on this, or did not see a change. Other parameters were rated as good and very good and are outlined in Table 1.

Discussion

Although the improved superabsorbent dressing includes a very effective wound contact layer, 20% of cases used the product in combination with another contact layer. Use with another contact layer would not be recommended as this is not necessary and increases costs. Superabsorbent dressings are designed for the management of medium to high levels of exudate and should not be considered in low exudate.

Conclusion

The new and improved superabsorbent wound dressing demonstrated clear advantages for clinicians managing exudate. The patient shown in Figure 1 - 3 is still being managed with the improved product as this is the only dressing he doesn’t react to.

Objective:

Best practice in wound bed preparation and biofilm-based wound management includes debridement to create a clean wound bed and to assist in minimising the redevelopment of biofilm. Biofilm that is not removed inhibits healing and redevelops if not prevented from doing so with topical antimicrobial agents. Monofilament fibre debriding technology (MFDT) is used for effective and rapid mechanical debridement of loose material, slough and biofilm. The objective of this evaluation was to determine the clinical effect and consequential levels of health professional and patient satisfaction with the results of a biofilm pathway that included MFDT to achieve debridement.

Methods:

This non-comparative, open label evaluation was conducted in static and non-static wounds that required debridement. MFDT was used to debride in a two-week evaluation of a biofilm pathway. Wounds were debrided three times in week one and twice in week two. Each debridement was followed by treatment with an antimicrobial dressing. Other care included secondary dressings and compression delivered according to local practice, guidelines and formularies. After the clinical evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with the biofilm pathway.

Results:

There were 706 health professionals who provided answers to the survey questions. Wound types evaluated were leg ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%). Of the wounds, 9% were reported as non-static despite the eligibility criteria. Not all wounds followed the pathway. The most frequently-used antimicrobial was silver. Non-antimicrobial products used included all-in-one dressings, other secondary dressings and compression. There was a change in 77% of wounds overall after two weeks. Change was reported almost equally for both static and non-static wounds. Health professionals who did or did not follow the pathway were ‘completely satisfied’ or ‘satisfied’ with the overall clinical outcome 96% and 95%, respectively. Of the patients, 77% were ‘completely satisfied’ or ‘satisfied’ with healing after following the pathway, as reported by the treating health professional.

Conclusion:

The biofilm pathway that includes MFDT appears effective. Wounds managed on the pathway were debrided effectively and healing progressed to the satisfaction of both health professionals and patients.

Background and study aims

Endoscopic negative pressure therapy (ENPT) is used to close transmural defects in the rectum and esophagus. Very few reports have described

ENPT to manage duodenal defects. This study was designed to demonstrate ENPT in a population of 11 patients with transmural duodenal leakages.

Patients and methods

The method of ENPT was adapted for duodenal use. Open-pore polyurethane-foam or a thin, open-pore double-layered film was wrapped around the distal end of a gastroduodenal tube. First, this open-pore element was placed on the inner wound in the duodenum with endoscopy. Second, continuous negative pressure of –125mmHg was applied with an electronic pump. Drains were changed after 2 to 7 days.

Results

Eleven patients were treated with duodenal leaks. Eight defects occurred after operative closure of perforated duodenal ulcers, papillectomy or stricturoplasty, one anastomotic leakage after Billroth – 1 distal gastric resection, one iatrogenic perforation in endoscopic retrograde cholangiopancreatography, and one by a surgical drain. Median duration of therapy was 11 days (range 7 – 24 days). Complete healing of defects was achieved in all patients.

Conclusion

ENPT is an innovative endoscopic alternative for treatment of transmural duodenal defects.

In the current first report, it is shown how a post-laryngectomy pharyngocutaneous fistula was successfully closed by endoscopic negative pressure therapy (ENPT; also termed endoscopic vacuum therapy, EVT). The duration of negative pressure treatment was 14 days. Up until now, ENPT has been used for treatment of transmural defects in the rectum and esophagus. The new endoscopic method can also be used in the ENT field for closure of pharyngocutaneous fistulas.

The cost that chronic wound care imposes on both patients and health services worldwide is well recognised. Most patients with venous leg ulcers require compression therapy over the long term, for both treatment as well as to prevent recurrence of these wounds. Caring for patients with chronic wounds makes up a large part of the workload for district and community nurses, and encouraging self-management among patients is a worthwhile effort to limit the costs and resources directed for this purpose. The present article describes the practical use of the ReadyWrap range of compression garments, which are available in various different styles, and aid patients, their families and carers in the self-management of venous leg ulcers. These products are designed with their long-term use in mind, and, as described in the case studies in this article, patients show good concordance to compression therapy involving ReadyWrap.