Dear Readers:

  Split-thickness skin grafts are the most common plastic surgery procedure used to replace injured or missing skin. Split-thickness skin-graft donor sites (SSDS) are often considered a “standard” partial-thickness acute wound that readily reepithelizes with minimal complications. Conversely, large, painful SSDS are often reported as unhealed for 2 to 3 weeks. SSDS typically heal in 6.8 to 9.05 days when dressed with moisture-retentive hydrocolloid or film dressings, or 10.5 to 12.9 days if dressed with impregnated gauze. Patients experience less pain and fewer infections for their SSDS when hydrocolloid or film dressings are used.² Aside from these recognized benefits of moist wound healing what other aspects of care affect SSDS outcomes? Two recent publications reviewed in this month’s Evidence Corner explore this question.

Dear Readers:
  The Association for the Advancement of Wound Care (AAWC) recently updated its Venous Ulcer Guideline, accessible at www.aawconline.org/professional-resources/resources/. Summarizing the best available evidence through 2010, the AAWC Guideline Task Force found recommendations with little evidence for self-care interventions, such as leg elevation, walking, or exercise that may empower individuals with venous insufficiency to help reduce the likelihood of a venous leg ulcer (VU) or VU recurrence once healed. This seemed odd, considering the growing trend toward patient-centered care. Researchers in Australia and the Netherlands are providing evidence that these self-care interventions work. This edition of Evidence Corner summarizes two recent studies that support the efficacy of these self-care interventions in improving outcomes for patients with venous insufficiency. Why not put the patient on the wound care team by encouraging self-care that works?

Laura Bolton, PhD, FAPWCA
Adjunct Associate Professor
Department of Surgery, UMDNJ
WOUNDS Editorial Advisory Board Member and Department Editor

Dear Readers:

  Multidisciplinary teams wielding evidence-based protocols report improved acute¹ and chronic^2,3 wound outcomes; however, few have tested this hypothesis in a randomized controlled trial (RCT) comparing team care to a non-team standard of care (SOC). This edition of Evidence Corner explores RCTs testing whether teams really do work. One study in Taiwan investigated long-term interdisciplinary postoperative care in elderly subjects with hip fractures. The second, in Australian skilled nursing facilities, explored healing and costs for SOC compared to those resulting from team care to manage skin tears, leg ulcers, and pressure ulcers. Both studies conclude that team care works. Read on to discover why it is so difficult to answer this question.

Dear Readers:

  Wound needs seem simple: stop all causes of tissue damage, cleanse and debride if needed, protect from contamination, manage excess exudate, hydrate a dry wound, and maintain a moist wound environment.^1,2 Absorbent and specialty absorbent dressings help deal with excess fluid escaping the wound, but unseen fluid beneath an eschar or in interstitial spaces may pose an equal or greater danger to tissue repair or regeneration. What, if anything, is one to do when the excess fluid is concealed within local tissue or accumulates beneath a dried eschar? This Evidence Corner features two randomized controlled trials (RCT) researching very different ways to manage that hidden fluid. The first describes a cotton swab technique already taught in some medical universities that may help reduce the likelihood of surgical site infections (SSI) for clinicians practicing in settings with limited resources. The second study, an interim analysis, compares outcomes achieved using two different forms of vacuum to draw hidden fluid from a wound. One vacuum source requires electricity; the other does not.

Laura Bolton, PhD, FAPWCA
Adjunct Associate Professor
Department of Surgery, UMDNJ
WOUNDS Editorial Advisory Board Member and Department Editor

Dear Readers:

Dear Readers:

Dear Readers: Increasing evidence supports the importance of nutrition in wound care. Proper nutrition provides the essential amino acid building blocks of cells, extracellular matrix and granulation tissue proteins, essential fatty acids and carbohydrates to fuel cell migration and proliferation, the function and production of molecules required to repair or regenerate all aspects of damaged tissue, and the water that permits function of the metabolic pathways involved.

Dear Readers:

  This research explored the response to a pressure insult in flank tissue of 15 normal control Wistar and 22 DK non-obese diabetic mice with hyperglycemia and without hyperlipidemia. Tissue was harvested 1, 3, 5, 7, and 14 days after applying a pressure of 8 kg over a 3 cm2 area of abdominal flank skin and from contralateral unwounded skin on about 3 mice at each time interval. Less mature, less cross-linked collagen was reported in the hyperglycemic mice intact skin than in control mice and increased depth of tissue damage in response to pressure compared to controls.