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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.

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.

Dressings continue to be a key part of successful wound care, however, choosing the right product for the right patient at the right time can be challenging for the clinician (Hedger, 2014). Modern foam dressings have been widely available since the mid-1970s with the aim to manage light-to-heavy exuding wounds (Hedger et al, 2014). Historically, bordered foam dressings have utilised acrylic-based adhesives; however, these have been associated with increased risk of skin sensitisation and medical adhesive-related skin injuries (MARSI; Meuleneire and Rucknagel, 2013; Hedger et al, 2014; Mestach et al, 2018; Downie and Collier, 2021). A clinical evaluation was undertaken to detail the characteristics and performance of Suprasorb® P sensitive silicone foam dressing (L&R Healthcare). The evaluation comprised a minimum of four dressing changes over at least 2 weeks. Fifty patients (51 wounds) were included in the evaluation. At the final evaluation, 57% (n=29) of the wounds were recorded as improved, 37% (n=19) were recorded as static and 6% (n=3) were recorded as having deteriorated. Of the 27% (n=14) evaluations where patients reported self caring, 71% scored Suprasorb P sensitive as above average for ease of use, suggesting the dressing may be suitable for patients who were self-caring and can apply their own dressing. Suprasorb P sensitive performed well in all the parameters evaluated and may be considered where effective exudate handling, improved patient comfort and ease of handling is required.

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.

Die endoskopische Vakuumtherapie (EVT) ist ein fester Bestandteil der Therapie postoperativer Anastomoseninsuffizienzen im Gastrointestinaltrakt. In jüngster Zeit wird die EVT auch bei anderen Indikationen wie Perforationen, endoskopisch zugänglichen Abszessen oder enterokutanen Fisteln mit Erfolg angewendet. Dieser Beitrag erläutert schrittweise den Gebrauch der EVT und zeigt die Möglichkeiten, aber auch Risiken und Grenzen der Therapie auf.

A 57-year-old patient underwent emergency laparotomy for an acute abdomen with free intra-abdominal air caused by a perforated distal gastric ulcer. Surgical closure was performed by suture. Histological adenocarcinoma was found Therefore, revision laparotomy with distal gastric resection and Roux-en-y reconstruction was done 3 days later. At 6 days postoperatively, a discharge of biliary secretions via target drainage for duodenal stump insufficiency was seen. Surgical closure was tried in another revision laparotomy. But again biliary secretion occurred proving the persistent duodenal leakage.

Passive drainage via the operative drain was sufficient to avoid development of an acute abdomen, therefore the duodenal secretions were drained passively. Secretion of 100–200 ml daily persisted for 21 days with formation of a duodenal cutaneous fistula channel ([Fig. 1]).

Then, treatment was switched to active drainage management with endoscopic negative pressure using an open-pore film drain. The drain was made by wrapping a strip of thin, double-layered, open-pore film (Suprasorb CNP Drainage Film; Lohmann & Rauscher, Rengsdorf, Germany) around the distal drainage end and fixing it with a suture [1] [2] [3] [4] [5] ([Fig. 2]). This created a small-bore open-pore drainage tube to which negative pressure could be applied. The open-pore film drain used had a diameter of only 5 mm. The length of the drainage element was 10 cm. The drain was simply manually inserted in the cutaneous opening into the pre-existing 12-cm-long fistula channel. Suction of –125 mmHg was applied (ACTIV.A.C; KCI, San Antonio, Texas, USA). The secretion stopped immediately. After 4 days, endoscopic negative pressure treatment was terminated. The open-pore film drain was removed by pulling out the tube ([Fig. 3]). Endoscopic inspection of the fistula channel showed the typical suction effects ([Fig. 4]), with the regular pore structure of the open-pore membrane ([Video 1]). The fistula was closed. The open-pore film drain is a simple device that can be used to achieve duodenal cutaneous fistula closure very easily by negative pressure in appropriate cases.