September, 2006

Dear Readers,

The importance of removing necrotic tissue for enabling a wound to heal is well accepted. The treatment choices have included surgical, enzymatic, and autolytic debridement. Historically, and again more recently, an interest in maggot therapy (MT) has developed. In this month’s Evidence Corner, Dr. Laura Bolton reviews 2 studies on the treatment of pressure ulcers or diabetic foot ulcers with MT. While the results are interesting and appear to suggest debriding efficacy of MT compared to conservative approaches, it is clear that randomized, controlled trials are required to compare MT to validated debridement methods reported and substantiated in the literature.

Gabriel et al report on the use of negative pressure wound therapy (NPWT) in conjunction with a silver dressing designed for a NPWT system (Reducing bacterial bioburden in infected wounds with vacuum assisted closure and a new silver dressing—a pilot study). In a case series of 5 patients, the authors found that the time to clear infection, time to wound closure, and time to discharge from the hospital were reduced compared to their previous experience with moist wound care therapy. Further controlled trials with larger patient populations will be of interest.

Dobke et al (Telemedicine for problematic wound management: enhancing communication between long-term care, skilled nursing, and home caregivers and a surgical wound specialist) assessed the accuracy of wound evaluations made from records and images transmitted electronically and later verified by direct evaluation of the patients (N = 120). In this series, only 2 cases required a change in the diagnosis and treatment plans. The use of telemedicine for providing quality diagnosis and treatment plans to patients at remote sites lacking a wound specialist was found to be a valid approach. The authors discuss the limitations related to the quality of the transmitted digital images and lack of direct patient-physician interaction.

Dalla Paola et al (Super-oxidized solution [SOS] therapy for infected diabetic foot ulcers) compared the antibacterial effects of SOS and 10% povidone iodine (PI) for treating infected diabetic foot ulcers in 218 patients. The SOS is a stable solution (pH 6.2–7.8) containing sodium hypochlorite, hypochlorous acid, sodium chloride, and oxidized water. Significant reductions in bacterial levels and shorter healing times in the SOS-treated wounds are reported. No skin reactions were seen as compared to 18 adverse reactions in the PI-treated group. The authors point out that improved healing as compared to PI may relate to the lack of local side effects. They conclude that SOS is safe and effective for the treatment of infected foot lesions. In future studies, it will be interesting to compare this material to other widely used antibacterial treatments for wounds.

Moore et al (The use of silver-impregnated packing strips in the treatment of osteomyelitis: a case report) present their experience in treating a poorly healing foot ulcer following surgical debridement, good wound care approaches, and the appropriate use of systemic antibiotics. After adding silver-impregnated packing strips to the treatment regimen, wound closure was facilitated. The technique warrants further evaluation “…as an adjunct to the treatment protocol in clinical osteomyelitis.”