Volume 14 - Issue 12 - December, 2002
Design and Evaluation of Clinical Studies
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Dear Readers:
This month’s Evidence Corner helps you design and evaluate clinical studies to assure that they answer the questions addressed. The first emphasizes the importance of enrolling sufficient numbers of patients in comparative clinical studies so that a clinically significant difference in treatment outcomes will be reported as statistically significant. The second article compares outcomes achieved using successive absorbent then moisture-retentive protocols of care with those resulting from use of a single dressing, inadvertently highlighting the importance of desig
Pretibial Myxedema
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Department Editor: Tania Phillips, MD, FRCPC
Overall Learning Objectives: The physician or podiatrist participant will develop a rational approach to the evaluation and treatment of a variety of uncommon wounds and will have an increased awareness of the differential diagnosis of cutaneous wounds and the systemic diseases associated with these wounds.
Submissions: To submit a case for consideration in Diagnostic Dilemmas, e-mail or write to: Executive Editor, WOUNDS, 83 General Warren Blvd., Suite 100, Malvern, PA 19355, eklumpp@hmpcommunications.com
Completio
Diagnosis of Wound Infections: Current Culturing Practices of U.S. Wound Care Professionals
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Introduction In recent years, substantive basic science and clinical research have been conducted to evaluate the mechanisms of wound healing, the efficacy of various modalities for treatment of wounds, and the best methods for diagnosing wound infection. A great deal of this effort has been directed toward evaluating the most accurate and reproducible methods for diagnosing chronic wound infection. From the surface, this seems like a fairly simple clinical question. However, it quickly becomes apparent that this question is quite involved. For example, chronic wounds often harbor bacteria
Correlation of Semi-Quantitative Swab Cultures to Quantitative Swab Cultures from Chronic Wounds
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Introduction
The relationship between tissue bioburden and wound healing has been established by several studies and confirms that high bioburden delays wound healing.1,2 The reports also indicate that tissue bioburden has a greater effect on wound healing than the presence of systemic diseases, such as diabetes and cardiovascular disease. When high levels of bacteria in the wound are suspected to be the cause of nonhealing, a culture needs to be obtained. The gold standard for determining wound bacterial level is quantitative tissue biopsy, but this modality is not generally used be
Topical Doxepin Significantly Decreases Itching and Erythema in the Healed Burn Wound
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Introduction
Severe pruritus or itching is a common and disabling problem in patients with healed burn wounds. Itching is most common in burns that take about three weeks to heal. The mechanism is not clearly defined, but increased histamine release from the wound is a major etiologic factor, as is the case with a number of other skin disorders.1–4
The source of the histamine would be the increased mast cell population typically present in the healed burn wound.5,6 Any wound itching, manipulation, or increase in wound temperature exacerbates the itching.
The mechanism of
Case Report: Implications for a Patient Diagnosed with Fournier’s Gangrene
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Introduction
Fournier’s gangrene (FG) is a type of necrotizing fasciitis (NF). FG specifically involves the perineum and is a rare mixed aerobic and anaerobic soft-tissue infection. FG generally causes the perineal tissue to slough; in male patients, this includes the skin, subcutaneous tissue, and fascia of the scrotum and penis.1
Risk factors for the development of FG include advancing age, malnutrition, obesity, alcoholism, intravenous drug use, diabetes mellitus, peripheral vascular disease, and immunosuppression.2–8 Patients at risk for FG typically have at least
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