October, 2006

Dear Readers,

I call your attention to Dr. Keith Van Meter’s review of the book, Science and Practice of Pressure Ulcer Management, edited by Romanelli, Clark, Cherry, Colin, and Defloor. He suggests that this is “an essential read” for those of us who are interested in pressure ulcer pathophysiology, prevention, and treatment. With the many new books being published on wound healing, we hope to regularly include selected reviews in upcoming issues of WOUNDS.

Hamm et al (Pathophysiology and multidisciplinary management of leg wounds in sickle cell disease: a case discussion and literature review) present a thorough review of this common inherited genetic disorder with special attention to how it relates to lower extremity wounds. In a case study of a young patient with sickle cell disease and longstanding leg ulcers, the authors detail the special challenges, multidisciplinary treatment approaches, and outcomes of the therapeutic efforts.

Over 40 years have elapsed since George Winter’s research on occlusive dressings opened minds to the possibilities that controlling the physical wound environment could impact favorably on wound healing. A long list of experimental and clinical studies have followed showing the benefits of moist wound healing as well as its shortcomings. Today, there are many commercially available dressings from which to choose, perhaps making the choice of the best dressing difficult. Vermeulen et al (Inter- and intra-observer [dis]agreement among physicians and nurses as to the choice of dressings in surgical patients with open wounds) investigated the level of agreement among physicians and nurses in choosing gauze-based dressings or occlusive dressings on open surgical wounds. Their choices were also compared with the decisions of an 18-member panel of wound care experts. Agreement was poor among the physicians and equally poor among the nurses. Choices were divergent from the recommendations of the expert panel. The authors advocate, not surprisingly, better education “…in local wound care regarding dressing materials and wound classification and an evidence-based selection from the large arsenal of products available…” in order to optimize treatment.

Gawley and Gould (Evaluation of a low profile noncontact normothermic wound dressing for split-thickness skin graft donor site healing) report findings from an experimental study of partial-thickness excisions treated with noncontact normothermic wound therapy (NNWT). While this treatment has been studied in venous, pressure, and diabetic ulcers, it is thought that this is the first study on its use in healing acute wounds. In comparing NNWT and the control dressing (petrolatum-impregnated gauze covered by a transparent film) treatments, it was found that healing was significantly prolonged by NNWT (average of 14 days versus 10.8 days). Patients rated wound pain under NNWT to be greater than control. In the discussion, the authors offer thoughts on the mechanisms responsible for the differences seen between the 2 treatments. It is concluded that NNWT did not provide a benefit over moist occlusive dressings for partial-thickness wound healing.

Varma et al (Efficacy of polyurethane foam dressing in debrided diabetic lower limb wounds) assessed the benefits of treating diabetic foot ulcers with a low-cost polyurethane foam dressing versus the control (traditional treatments employed and described in the manuscript). In studying 48 patients (24 in each treatment group), they found healing times of 22.5 ± 15.4 days for the foam treatment and 52.0 ± 22.7 days for control. Based upon the findings, the authors use this dressing material in their practice.