Effectiveness of a Biocellulose Wound Dressing for the Treatment of Chronic Venous Leg Ulcers: Results of a Single Center Randomized Study Involving 24 Patients
Abstract: Venous ulceration, a relative common manifestation of chronic venous insufficiency and venous hypertension, is often difficult to treat. Successful treatment begins with the management of the underlying pathology and wound bed preparation. This article reports the authors? experience with a novel wound dressing produced from microbial cellulose synthesized by an acid-producing bacterium, Acetobacter xylinium. Twenty-four patients with chronic venous insufficiency and lower-leg ulceration were treated with either biocellulose wound dressing (BWD) plus a two-layer compression bandage or standard care. Standard care consisted of a nonadherent primary wound dressing plus a two-layer compression bandage. Evaluations were performed weekly to measure wound pain, nonviable tissue reduction, degree of wound granulation, and wound healing (reduction in wound size and surface area). BWD was significantly more effective than standard care for autolytic debridement (reduction in the amount of nonviable tissue [p=0.0094]). The mean number of days to >75-percent granulation was 43 days for the BWD treated group and 71 for the standard care group. Mean percent reduction in wound area was also greater for the BWD treated group at Week 6 (39% vs. 19%) and at Week 12 (74% vs. 49%). When compared to patients treated with standard care, the group treated with BWD reported less wound pain at each evaluation point. Significant differences in wound pain scores between the two treatments were noted at Week 3, 6 (p=0.039), and 8 (p=0.043).
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Wound Bed Preparation: The Science Behind the Removal of Barriers to Healing [PART 1]
Abstract: Wound healing involves a well-orchestrated, complex process leading to repair of injured tissues. However, chronic wounds do not follow the normal pattern of repair. This is due to underlying physiological problems associated with their development, which unless corrected would continue to cause wound deterioration. The key to effective wound care lies in a combination of three approaches: treatment of underlying medical problems, assessment and treatment of local wound bed, and effective management of any patient-centered concerns. An essential component of this recommended approach is restoration of healthy granulation tissue in the wound bed. Wound bed preparation brings a number of existing procedures, including debridement, treatment of infection, and management of exudate levels, together into a systematic approach to help restore the chronic wound bed environment. The aim of wound bed preparation is to remove the barriers to healing and initiate the repair process. This review explores the scientific rationale behind this concept and examines how wound bed preparation offers healthcare professionals an improved paradigm for the treatment of chronic wounds. By implementing wound bed preparation, the formation of healthy granulation tissue will be optimized and the efficiency of biotechnological therapies improved, which would ultimately reduce the time to wound closure.
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Debridement: Rationale and Therapeutic Options
Abstract: Debridement is commonly defined as the process of removing necrotic, devitalized tissue and foreign material from a wound. The presence of necrotic tissue within a wound may impair wound repair processes by stimulating inflammation and delaying granulation and epithelialization. However, the above definition of debridement may not tell the whole story. Debridement may additionally remove senescent cells from the wound bed and nonmigratory cells from the ulcer edge and also remove excessive or abnormal bacteria; all of which may allow for improved availability of growth factors. This supplement will review the rationale for debridement, existing clinical data supporting debridement, and the various debridement options available. The supplement was supported through an unrestricted education grant from Healthpoint Ltd., Ft. Worth, Texas.
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A Prospective, Randomized, Comparative Study of Collagenase and Papain-Urea for Pressure Ulcer Debridement
Abstract: Objective: To evaluate and compare the ability of two commercial chemical debridement ointments to effectively remove devitalized tissue and promote granulation in pressure ulcers requiring debridement. One of the test agents was an enzymatic formulation (collagenase) and the other a formulation of papain and urea. Design: This study was a prospective, randomized, parallel group, tri-center, open-label, clinical trial with a two-week screening period to stabilize the wound and an evaluation period of four weeks in duration. Setting: The patients who participated in the trial were nursing home residents in northern New Jersey. Participants: Twenty-eight patients were randomly assigned to ulcer treatment with either collagenase debriding ointment (n = 12) or papain-urea debriding ointment (n = 14). Two patients dropped out early due to unrelated treatment issues. Measurements: Wounds were treated once daily until complete debridement or four weeks. The major outcome of nonviable (necrotic) tissue reduction (determined by planimetry) was assessed weekly by intention to treat. The amount of nonviable tissue, degree of wound granulation, and overall wound response were evaluated weekly using a visual scale. Wound area measurements were performed by morphometric analysis of perimeter tracings. Results: The papain-urea debriding ointment was significantly more effective (p < 0.0167) than the collagenase ointment in reducing the amount of necrotic tissue at each of the three prospectively determined weekly evaluations. Development of granulation tissue in wounds treated with papain-urea was significantly enhanced as compared to wounds treated with collagenase. Epithelialization generally correlated with the development of a granulating wound bed as determined by visual assessment. However, the general increase in the amount of epithelial tissue associated with the papain-urea-treated wounds did not predict a significantly different rate of reduction in the actual wound area. Conclusion: This study evaluated th
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Safety Evaluation of a New Ionic Silver Dressing in the Management of Chronic Ulcers
Abstract: A new dressing incorporating ionic silver (AQUACEL® Ag, ConvaTec, A Bristol-Myers Squibb Co., Princeton, New Jersey) was evaluated in an open-label, multicenter, noncomparative study in 18 subjects with chronic leg ulcers of mixed etiology, 11 of which were infected at baseline. The primary aim was to assess safety. Initial performance parameters were also examined. There were no serious adverse events. Two nonserious adverse events were considered to be related or probably related to the dressing. Among 15 evaluable subjects, reduction in pain score from baseline to final assessment was significant (p<0.05), both with the dressing in place and upon removal. Decreases in slough and increases in granulation tissue and epithelial cover were observed: changes from baseline were statistically significant (p<0.05) and were accompanied by a mean reduction in ulcer area of 23.9 percent. In line with expectations, no ulcers healed during the 28-day study period, but seven subjects (39%) had marked improvement, 10 (56%) had mild improvement, and one (5%) had marked deterioration. Infection resolved in 2 of 11 ulcers infected at baseline without the need for antibiotic treatment. Only one ulcer became infected during the study. In 129 dressing changes, the mean wear time was 3.59 days. No leakage was observed in 69.8 percent of changes. In all cases, the dressing was rated as easy to remove. Addition of ionic silver to the dressing conferred no additional safety issues. The initial performance of the ionic silver dressing suggests that it might have potential in assisting management of wounds at risk of infection.
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Debridement: Rationale and Therapeutic Options
Abstract: Debridement is commonly defined as the process of removing necrotic, devitalized tissue and foreign material from a wound. The presence of necrotic tissue within a wound may impair wound repair processes by stimulating inflammation and delaying granulation and epithelialization. However, the above definition of debridement may not tell the whole story. Debridement may additionally remove senescent cells from the wound bed and nonmigratory cells from the ulcer edge and also remove excessive or abnormal bacteria; all of which may allow for improved availability of growth factors. This supplement will review the rationale for debridement, existing clinical data supporting debridement, and the various debridement options available. The supplement was supported through an unrestricted education grant from Healthpoint Ltd., Ft. Worth, Texas.
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Diabetic Foot Ulcers
Diabetic Foot Ulcers Evidence Corner: Diabetic Foot Ulcers - Laura Bolton, PhD Laura Bolton, PhD Dear Readers: Foot problems are the most frequent cause of hospitalization in diabetic patients. Evidence Summary: Healing Effects of Diabetic Foot Debridement Reference: Smith J. Debridement of diabetic foot ulcers (Cochrane Review). Methods: All randomized controlled trials (RCTs) comparing effect of debridement modalities on either complete diabetic foot ulcer healing or rate of diabetic foot...
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April 2007
Visit http://www.convatec.com for more information.Mölnlycke Launches First Silver Dressing Containing Safetac® Technology Mölnlycke Health Care US, LLC (Norcross, Ga) introduces Mepilex® Ag, the first silver dressing made with Safetac® technology. Visit http://www.lps1530.com for more information.Gentleheal Superabsorbent Foam Minimizes Wound ...
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Chronic Wounds: Factors Influencing Healing Within 3 Months and Nonhealing After 5?6 Months of Care
Chronic wounds affect approximately 2.5 million to 4.5 million people in the US and are particularly a problem for the elderly. Nonhealing or slow healing wounds represent a major health burden and drain on resources, contributing to substantial disability, morbidity, and costs. This study was conducted to identify factors that influence the healing of chronic wounds within 3 months of starting treatment, compared to factors influencing nonhealing wounds after 5 or 6 months of treatment. A retrospective review of medical records of subjects with chronic pressure, diabetic, or venous ulcers using a structured data collection form and protocol was conducted at 4 sites located in disperse geographic areas. The sample consisted of 400 subjects with at least 3 months of data. Demographic, case mix, wound characteristics, and treatment characteristics were analyzed. Consistent with the literature, wounds that were larger, deeper, infected, draining larger amounts of exudate, and/or covered with slough or eschar were significantly less likely to heal within 3 months and more likely not to heal after 5?6 months of treatment. Medicaid insurance coverage and being non-white were also associated with poorer healing. A lower percentage of antimicrobial dressings was associated with faster healing, while a lower percentage of moisture-management dressings was associated with nonhealing after 5?6 months. The analysis also showed that inappropriate management of wound exudate and necrotic tissue was associated with poorer healing outcomes. While the influence of insurance coverage and race on healing needs further exploration, healing rates could improve in certain centers through better adherence to evidence-based wound management recommendations.
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Evidence Corner
Rationale: The main treatment for VUs is compression. Objective: This systematic review explored the effects of wound dressings on healing VUs. Conclusions: Certain modalities can improve the percent of VUs healed and time to healing.Clinical Perspective Though these 2 systematic reviews seem to differ in their conclusions, ...
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