Volume 25 - Issue 2 - February 2013

Negative Pressure Wound Therapy in a Neonate with a Complex Abdominal Wound

Index: WOUNDS. 2013;25(1):E1-E4.

  Abstract: Negative pressure wound therapy (NPWT) is used successfully in managing abdominal wounds in neonates, but wounds with stomas present additional challenges. This case study evaluates the effectiveness of NPWT on such a wound, using pediatric urine collection bags to manage stoma output. Methods. Negative pressure wound therapy was applied to a dehisced abdominal surgical wound, located between a jejunostomy stoma and mucous fistula, along with separate pediatric urine collection bags for each stoma. Results. The wound had sufficiently healed after 14 days. Conclusion. Neonatal abdominal wounds, in the presence of stomas and fistulae can be effectively treated with NPWT when separate collection bags are used.

Effect of Proteasome Inhibitor 1 on Wound Healing: A Potential Scar Prevention Therapy

Index: WOUNDS. 2013;25(2):28–33.

  Abstract: in vitro and in vivo assessments suggest that proteasome inhibitors may be useful for modulating wound healing. Methods. Proteasome Inhibitor I was used to assess the potential utility of proteasome inhibitors in improving wound healing in a standard rat model. Bilateral, 6 cm incisions were made 1 cm lateral to the spine of adult male Sprague Dawley rats. Animals were randomly assigned to 1 of 3 groups: no treatment (n = 15), low concentration (1% w/v, n = 15), or high concentration (5% w/v, n = 15). Treatments were applied to the left side incision at 0 hours, 24 hours, and 48 hours. Right-side incisions received a vehicle, dimethyl sulfoxide, alone and independent of the assigned group, serving as both external and internal controls. Rats were sacrificed at days 7, 14, and 28 (n = 5 per group) and wounds subjected to mechanical testing and histology. Results. No significant intergroup difference existed at 7 and 14 days. On day 28, a dose-dependent increase in tensile strength with increasing Proteasome Inhibitor I was observed. Conclusion. Results suggest dimethyl sulfoxide was not the ideal vehicle and additional improvement may be realized by optimizing the delivery method.

Pressure Map Technology for Pressure Ulcer Patients: Can We Handle the Truth?

Index: WOUNDS. 2013;25(2):34–40.

  Abstract: Objective. The purpose of this study was to trial new pressure mapping technology for patients with pressure ulcers. Methods. Pressure mapping data was recorded during 3 phases of technology implementation, as nurses became increasingly familiar with pressure mapping technology in a 55-bed, long-term acute care (LTAC) facility in North Texas. Forty-three patients with pressure ulcers were selected for the study. Patients with pressure ulcers, or who were considered at high risk for developing pressure ulcers based on a Braden score of ≤ 12, were selected to utilize a pressure-sensing device system. Results. Turning timeliness improved greatly from the baseline phase to the last phase. The average turning after the 2-hour alarm decreased from 120 minutes to 44 minutes, and the median time to turning decreased from 39 minutes to 17 minutes. If time past 2 hours is considered the most damaging time to tissue, these reductions (average and median) represented 63% and 56% less potential tissue damage. Conclusion. Pressure mapping technology is in its infancy and this paper discusses implications for the future, including barriers to implementation and potential advanced applications. While only changes in nursing practice were measured in this study, the changes observed suggest the technology can be instrumental in reducing hospital-acquired pressure ulcers and improving the healing of pressure wounds in the future.

Treatment of Sternal Wound Infection with Vacuum-Assisted Closure

Index: WOUNDS. 2013;25(2):41–50.

  Abstract: Introduction. Previous work has demonstrated the efficacy of vacuum-assisted closure (VAC) in the treatment of poststernotomy local wound infections, compared to historical treatment protocol. The negative pressure has been found to protect wounds against contamination, prevent wound fluid retention, increase blood flow, and increase rates of granulation tissue formation. For this study, a retrospective analysis compared patients receiving VAC as definitive treatment versus bridging to delayed flap closure. Methods. Sixteen patients developed sternal wound infections after cardiac surgeries at the authors’ institution from 2006 to 2008. Data was gathered regarding patient comorbidities, treatment method, and outcome. Study objectives included assessment of risk factors that warranted secondary surgical closure and examination of long-term followup where VAC was the definitive treatment modality. Results. Group A (n = 12) had VAC as the final treatment modality. Group B (n = 4) required myocutaneous flap closure. One patient in Group B passed away prior to flap surgery. Both groups had similar risk factors, except Group B had a higher risk of body mass index (BMI) > 35 that was near statistically significant (P = 0.085; odds ratio = 0.0, 95% CI = [0.0 – 1.21]). Group A required a shorter hospital stay on average. Long-term follow-up showed the majority of Group A had completely healed sternal wounds 2-3 years from initial cardiac surgery. Conclusions. Vacuum-assisted closure as definitive treatment modality is a successful, first line therapy for local superficial sternal wound infections. When deep infections occur, however, VAC as bridge-to-flap coverage is recommended over attempted secondary healing with VAC.

Use of Modified Superabsorbent Polymer Dressings for Protease Modulation in Improved Chronic Wound Care

Index: WOUNDS. 2013;25(2):51–57.

  Abstract: With more than 6 million patients affected with them in the United States, chronic ulcers represent one of the greatest problems in wound care. High levels of corrosive proteases, particularly matrix metalloproteinases (MMPs), within the wound environment are thought to contribute to the persistence of these wounds through denaturation of connective tissue proteins crucial to healing progression. Therefore, there is considerable interest in protease modulation using wound dressings to promote healing in chronic wounds. Such modulation could be achieved by direct absorption of proteases, by depleting co-factors within the wound, or by release of protease inhibitors. Method. The aim of this study is to examine protease modulation of a range of dressings with different chemistries, particularly those having demonstrated efficacy in chronic wound healing. Results. XTRASORB® HCS (dressing A) and XTRASORB® Foam (dressing B) were able to modulate proteases by both direct absorption of MMPs and depleting metal ion co-factors, and resulted in complete elimination of protease activity in the assay used. Duoderm® (dressing C) was able to modulate proteases by direct absorption only, and not by co-factor depletion. Promogran® (dressing D) was able to reduce MMP activity, but this was shown to be pH dependant, with any protease modulation being lost at neutral pH. Neither Allevyn® (dressing E) nor Vigilon® (dressing F) were able to modulate proteases by any mechanism. None of the protease modulating dressings acted through the release of protease inhibitors. Conclusion. Of the dressings studied, dressing A and dressing B were the most effective protease modulators due to their acting through 2 separate mechanisms.

Editorial Message: Sterile? Does It Matter?

  “Question the unquestionable.” – Ratan Tata, executive

Dear Readers,
  Ever since bacteria were found to cause infections, attempts have been made to reduce their numbers in wounds. Among the maneuvers used to minimize wound infection are washing the wound with antiseptics and sterile water, irrigating the wound with sterile solutions, surgeons scrubbing their hands with various antibacterial agents prior to operations and procedures, providers wearing sterile gloves to prevent further contamination of the wound, and using antibiotics to kill any unwanted bacteria. As a surgeon, sterile technique and the necessity for it were beaten into me from the beginning of my training. Recent evidence, however, seems to point out that many of the things we learned concerning the importance of sterility and sterile technique may not be so important after all.

Evidence Corner: Topical Medications Improve Cold Sore Outcomes

Dear Readers:
  Recurrent orofacial herpes simplex virus (HSV) infection called herpes labialis (HSL), or cold sores, affects 1 in 3 persons in the western world. Most primary infections occur in childhood then recur as reactivated HSV, a DNA virus, migrates to the lips, face, or oral mucosa, usually from the sensory trigeminal ganglion.

  This recurrent infection creates a partial-thickness wound,2,3 that is usually shorter than the primary episode, progressing through 1 or more of the typical stages: prodrome, redness, papule, vesicle, ulcer, hard crust, and residual swelling/dry flaking before normal skin is restored. “False prodrome” can occur without progressing to the papule stage in up to one-third of episodes. Nonulcerative episodes stopped by the host’s immune response after the papule stage may last only 3 days. Classical ulcerative HSL lesions which progress through the vesicle, ulcer, crusting, and flaking stages last 7-10 days as compared to 5-6 days on average for ulcerative and nonulcerative lesions mixed.

New Products and Industry News

Patients With Diabetes Underuse Special Footwear

  A new study has found that patients with diabetes walk without wearing specialized footwear designed to prevent foot sores too often.

  According to research published in Diabetes Care, a new study of 107 diabetic patients found that 29% of steps by patients during a 2-week period were taken without the use of their custom-made shoes. Researchers also found that patients wore their preventive shoes less often at home than when they were outside of their house (39% compared to 87%, respectively).

  Visit http://care.diabetesjournals.org/content/early/2013/01/11/dc12-1330.abst... for more information.


Membership Continues Upward Trend

  AAWC membership increased by 20% over the past year. Thank you for your commitment to the AAWC. If you are not yet a member, now is a great time to join. Here’s why:

    • Clinician dues remain low. The AAWC’s low clinician dues are a recognized and value-added perk of AAWC clinician membership. Dues will remain $115 (as opposed to $145) — a 20% savings. AAWC also has great rates for students and retirees, and corporations and healthcare facilities are encouraged to be part of AAWC. Individuals with wounds and lay-caregivers can join the Wounds In Need (WIN) network free of charge to access resources and help them take a proactive role in care. These specially designated categories help make the most of membership.