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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.

Moffat et al (2003) report that 1.33 people in every 1 000 of the UK population have chronic oedema, although the true prevalence is likely to be higher. Chronic oedema is often associated with a range of skin conditions, including hyperkeratosis. This article describes the use of a monofilament fibre debridement pad to reduce hyperkeratosis on the legs of a 57-year-old man with a long-standing history of bilateral lymphovenous oedema. As part of an holistic care programme, the monofilament fibre debridement pad was found to quickly and effectively reduce hyperkeratosis.

observe higher Ca2+-concentrations especially at the border between SG and SC. Higher Ca2+concentrations are found extracellular as well as intracellular. The increase of extra- and intracellular Ca2+-concentration is more pronounced in triple provoked murine skin compared to single provoked skin. However, even though the number of provocations shows a significant correlation with epidermal thickness and IgE-serum concentration, there is no significant correlation to Ca2+concentration, neither in the overall gradient, nor in the intracellular/extracellular concentrations in the stratum granulosum. This the first description of the alteration of extracellular and intracellular Ca2+-levels in an atopic eczema mimicking model.

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.

OBJECTIVES

The aim of this study was to investigate the influence of a biosynthetic cellulose wound dressing (BWD) to stimulate wound healing in patients with a venous leg ulcer on periulcer skin condition when compared with standard care using a foam dressing.

METHODS

Each patient with a venous ulcer received compression therapy with a short stretch bandage system and either a BWD + foam (study group [SG]) or foam (control group [CG]). Periulcer skin condition was compared with the untreated lower leg skin and the forearm skin, using noninvasive parameters, comparing day 0 versus day 28 results. Ulcers were further evaluated for healing rate. The study period was 28 days, and the follow-up period was 12 weeks. Fifty patients were recruited to the study, of which N = 46 (SG, n = 26; CG, n = 20) completed the 28-day study period and were included in the analysis.

RESULTS

The BWD showed a more improved periulcer skin condition versus the CG. Transepidermal water loss was significantly less in the SG (P = .003), as well as the results shown with the chromatometer (P =. 05). Ulcer healing rate was also statistically significant in favor of the SG (P = .0001).

CONCLUSION

Treatment for the BWD + foam group was shown to be safe and significantly improved periwound skin condition, leading to more expeditious wound healing than treatment with foam alone.

BACKGROUND

Inelastic multicomponent compression (ICM) bandages applied by specialized medical staff are the standard of care for compression therapy of lymphedema of the extremities. However, new adjustable compression wraps (ACWs), which can be applied by patients themselves and, up to now, have been mainly recommended for the maintenance treatment phase of lymphedema, may be an important step toward the self-management of the initial treatment phase.

METHODS

This prospective, randomized, controlled comparative study assessed the effectiveness of an ACW in the treatment of leg lymphedema, compared with the traditional treatment with conventional IMC bandages. Included were 30 hospitalized patients admitted due to moderate to severe unilateral lymphedema (stages 2-3) of the leg. The primary outcome measures in both groups were reduction in volume of the affected leg and interface pressure after 2 and 24 hours. Patients were randomized into two groups of 15 patients: group A received ACW and group B received IMC bandages, both applied by experienced staff. After 2 hours, the staff replaced IMC bandages and the patients applied ACW, as previously instructed. Finally, compression was removed after 24 hours. Classic water displacement volumetry was performed before compression and after 2 hours and after 24 hours of compression. The interface pressure was measured immediately after application of compression, 2 hours after compression, before and after compression renewal, and finally, after 24 hours. Patients in the ACW group were allowed to adjust the wrap themselves when they considered it necessary.

RESULTS

The reduction in median volume after 2 hours was 109 mL (interquartile range [IQR], 64-271 mL; -3.1%) in the ACW group and 75 mL (IQR, 41-135; -2.4%) in the IMC group (not significant). After 24 hours, the reduction in median volume was 339 mL (IQR, 231-493 mL; -10.3%) in the ACW group and 190 mL (IQR, 113-296 mL; -5.9%) in the IMC group (P < .05). The interface pressure dropped significantly after 2 and 24 hours in the IMC group (-50% and -6%), but significantly less in the ACW group (-26% and -44%), mainly due to self-readjustment. The median pressures achieved after self-application of ACW (52 mm Hg; IQR, 44-61 mm Hg) were of the same order as those produced by the nurses after the first application of ACW (53 mm Hg; IQR, 39-59 mm Hg), with less variation.

CONCLUSIONS

In patients with moderate to severe lymphedema of the legs, ACW achieved a significantly more pronounced reduction in volume after 24 hours than IMC bandages. Patients were able to apply and adjust the device after being instructed in its use and after an initial 2-hour period of wear. Autonomous handling of ACW seemed to improve the clinical outcome and is a promising step toward self-management involving effective compression.