Wound management & prevention最新文献

Background: Traumatic injuries have increased risks for infection and progression to difficult-to-heal wounds. Often, they are inadequately treated with single-purpose dressings. Involving wound care specialists allows for integrating various advanced wound treatments. The objective of this report was to assess if healing rates correlated with using unique combination therapies.

Methods: An observational, prospective analysis was performed, reviewing patients with acute wounds from admission until healed. Systematic assessments were standardized, employing T.I.M.E. (tissue, infection /inflammation, moisture balance, edge/periwound). Key outcomes included wound progression, dimensions, treatments, healing time, and health care utilization metrics.

Results: A total of 124 patients with acute wounds up to 1120 cm3 healed using multimodal therapy. Median time to wound specialist consultation was 2 days. It was determined that all patients were treated with a pure hypochlorous acid-based wound cleanser combined with negative pressure wound therapy, collagen, silver, manuka honey, and/or foam dressings. Median healing time was 19 days. Delays were associated with smoking, immunocompromise, and inability to obtain wound care supplies.

Conclusions: Optimizing advanced therapeutic combinations with innovative dressings, including pHA and other beneficial components, has shown reduced health care utilization of acute wound patients by shortening healing time. The resulting decrease in dressing changes, follow-up appointments, and home care could increase patient satisfaction and improve outcomes.

Background: A wound must progress through serial steps of healing to achieve structural and functional stability. This process is hampered in chronic wounds and wounds with delayed healing. Wound cover through skin grafting or a flap, or spontaneous healing through epithelization, requires healthy granulation tissue. Wound infection inhibits the formation of such tissue.

Material and methods: This study included 24 cases of chronic wounds with large raw areas that did not respond to conventional therapy for more than 3 weeks. Wounds were treated with 2% citric acid ointment with the aim of promoting healthy granulation and appropriate wound bed preparation. Infective agents, their sensitivity, and response to citric acid were studied.

Results: Thirty-two bacterial strains were isolated. The most common was Staphylococcus aureus (12, 37.5%), followed by Pseudomonas aeruginosa (8, 25.0%). The majority of isolates were resistant to multiple antibiotics. The study's endpoint was the appearance of healthy granulation tissue suitable for split-thickness skin grafting or healing by secondary intention. Application of 2% citric acid ointment resulted in the formation of healthy granulation tissue in all cases after 3 to 20 applications.

Conclusion: Citric acid ointment (2%) is highly effective in controlling infections and promoting formation of healthy granulation tissue.

Background: Early esophageal fistula formation following anterior cervical spine surgery presents a formidable clinical challenge, necessitating astute rehabilitative nursing management. Such fistulas, if not promptly and effectively managed, can precipitate grave complications including mediastinitis, sepsis, respiratory failure, and, in severe instances, mortality. This underscores the critical need for immediate, comprehensive nursing interventions designed to mitigate these risks and enhance patient outcomes. Esophageal fistula is a rare but consequential complication after anterior cervical discectomy and fusion (ACDF), with numerous pathogenetic factors. Proactive preventive and interventional treatments are the key to rapid recovery.

Case report: In this case report, a 64-year-old female was discharged from the hospital 82 days after surgery with full recovery after a personalized rehabilitation care program based on the enhanced recovery after surgery (ERAS) concept.

Conclusion: It is important to consider follow-up in patients with spontaneously healed esophageal perforations. Aggressive prevention, early identification, and interventional treatment are key to reducing postoperative pain and facilitating recovery.

Background: Cancerous wounds are a significant challenge in cancer care, reducing the quality of life and affecting psychological well-being.

Purpose: This case report describes a 59-year-old female who developed a severe cancerous wound. The report presents comprehensive nursing measures for patients with cancerous wounds and discusses key nursing factors that promote wound healing.

Case study: The patient, diagnosed with stage Ⅲ B ALK-negative anaplastic large cell lymphoma, developed a severe cancerous wound. Specialist nurses developed a detailed wound care plan during 2 inpatient chemotherapy sessions, including wound care, pain management, nutrition support, psychosocial support, and continued transitional care after discharge. Her wound decreased in size and eventually healed.

Conclusion: Implementing nursing measures for patients with cancerous wounds-including assessment of systemic and local wounds, wound care, pain management, nutrition support, psychosocial support, health education, and transitional care-can help manage wounds and lead to complete healing. Specialized nurses play a key role in treating severe wounds. This case highlights the need for comprehensive and scientific nursing practices for patients with cancerous wounds. It conveys a positive attitude towards treatment and a sense of responsibility among nurses.

Background: Venous leg ulcers (VLUs) are associated with various physical and social adverse effects for patients but also contribute to a significant socioeconomic burden.

Purpose: To examine the clinical performance and safety of a collagen-alginate dressing in combination with standard wound care in non-healing VLUs.

Methods: In an observational, explorative, single-center study, VLUs of 60 patients were covered with a collagen-alginate dressing. Wounds were assessed during 5 visits over a 4-week period. At the final visit, health care professionals gave an overall assessment of the dressing. Outcome parameters were wound area reduction, wound pain, wound-related quality of life (QoL), and incidence of adverse events.

Results: The mean wound area decreased (17.8 ± 11.2 cm² versus 11.4 ± 9.0 cm²; P < .0001), and 4 patients achieved complete closure. Wound pain decreased after 2 weeks, and intake of analgesics reduced. Patients' wound-related QoL improved and a correlation between the well-being sub-score and wound area reduction was found. All health care professionals rated the collagen-alginate dressing as 'very good' or 'good.'

Conclusion: The collagen-alginate dressing is safe and effective in promoting healing and addressing the pain of VLUs. It also improves patients' QoL, possibly by reducing wound area, pain, and exudate.

Background: The presence of heavy microbial colony formation, polymicrobial infection, and local altered pH contribute to the high rate of postoperative complications following surgical reconstruction of stage IV pressure injuries (PIs).

Purpose: The objective of this study was to determine the rate of bacteria-related postoperative complications following surgical reconstruction of stage IV PIs in which a pure hypochlorous acid (pHA) antimicrobially preserved wound cleaning solution was used.

Methods: This 1-year retrospective review evaluated the outcomes of patients who underwent surgical reconstructive treatment of chronic stage IV PI. Surgical management consisted of wide debridement, intraoperative cultures, and irrigation with 8 to 10 minutes indwelling of a pHA antimicrobially preserved wound cleaning solution prior to closure and application of incisional negative pressure wound therapy (iNPWT).

Results: Thirteen patients (18 chronic, stage IV PIs) were included in the study. Intraoperative cultures were positive for 10/18 wounds (55.6%). A bacteria-related postoperative complication occurred in 1 patient (1/13, 7.7%; postoperative dehiscence requiring reoperation).

Conclusions: Adjunctive irrigation and indwelling of a pHA antimicrobially preserved wound cleansing solution in the surgical management of chronic, stage IV PIs in this 1-year retrospective review resulted in a 7.7% bacteria-related postoperative complication rate.

Background: Negative pressure wound therapy (NPWT) promotes wound sterilization, improves tissue granulation, and ensures appropriate wound healing. Its potential in contaminated abdominal procedures is still under study, but the results are promising.

Purpose: This research provides insight into the use of NPWT for the effective preparation of laparotomy wounds in close proximity to ostomies. It also demonstrates the application of NPWT systems for successful skin graft take under these conditions.

Methods: The authors describe 3 cases in the burn unit of an academic hospital in the northeastern United States treated successfully with a combination of NPWT and skin grafting to manage open abdominal laparotomy wounds in close proximity to ostomies.

Results: NPWT improved skin graft survival by promoting the creation of a clean base, which is important for ensuring appropriate skin graft take, and strengthening the bond between the graft and the recipient wound bed.

Conclusion: Despite these successful results, evidence in this area is still mixed and would benefit from further studies in the field.

Purpose: The aim of this study was to explore the clinical efficacy of vacuum sealing drainage in combination with silver-containing dressings for the treatment of chronic refractory wounds.

Methods: In this retrospective study, 80 patients with chronic refractory wounds who were treated in the hospital were retrospectively selected as the study objects. Based on the treatment modalities, the patients were divided into the study group (SG; n = 40, receiving vacuum sealing drainage combined with silver-containing dressings) and the control group (CG; n = 40, receiving vacuum sealing drainage alone).

Results: The total effective rate of the SG was 92.5%, significantly higher than the 75% in the CG. After treatment, the SG exhibited lower positive rates in bacterial culture, as well as decreased levels of C-reactive protein and erythrocyte sedimentation rate compared to the CG. Starting from the sixth day of treatment, the SG reported statistically significant lower pain intensity scores than the CG. Additionally, the SG exhibited significantly lower dimension scores in terms of scar thickness, color, tenderness, and vascular distribution compared to the CG.

Conclusion: The combined application of vacuum sealing drainage and silver-containing dressings demonstrated a positive treatment efficacy for patients with chronic refractory wounds.

Background: New research is crucial in addressing the role of nurses in preventing pressure injuries (PIs) and remedying deficiencies in their self-efficacy in this area.

Purpose: The aim of this study was to examine the self-efficacy perceptions of nurses in managing PIs within surgical services.

Methods: The study involved 186 nurses from surgical services. Data were collected using a self-efficacy scale and a personal information form designed to assess nurses' PI management skills. Analysis involved descriptive (number, percentile) and inferential statistics (ANOVA, t- s) in SPSS-24.

Results: Surgical nurses reported their self-efficacy in managing PIs with a mean score of 47.38 ± 21.87 on a self-efficacy scale, indicating a broad range of perceptions. Average scores were 43.55 ± 23.47 for evaluation, 48.39 ± 25.65 for planning, 43.68 ± 25.34 for surveillance, and 50.64 ± 22.23 for decision-making. Of note, nurses reported the lowest self-efficacy scores for evaluation. No significant differences were found based on employment duration, gender, or education. Significant differences were observed based on age, service level, and post-graduate education (P < .05).

Conclusion: This study highlights the need for enhanced nurse self-efficacy in PI management in surgical services, emphasizing the role of education programs focused on evaluation skills.