Wound management & prevention最新文献

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.

Background: Hospital-acquired occipital pressure injuries are a preventable cause of morbidity and mortality in the perioperative setting.

Purpose: To find the occipital cushion/pillow with the lowest measured peak pressures and the highest measured surface area using pressure mapping technology.

Materials and methods: A quality improvement project involving 3 operating room staff volunteers was conducted using pressure mapping. Five different pillows were tested based on what the study location commonly used and had available. The pillows included: standard pillow with pillowcase, non-powered fluidized positioner, medium-sized (17 × 17 × 1.5 inches) static seat cushion placed under the shoulders and head, pediatric-sized (13 × 13 × 2 inches) static air cushion placed under the head, and foam donut.

Results: The non-powered fluidized positioner had the highest average pressure and peak pressure for all 3 volunteers. The medium static air seat cushion had the lowest average and peak pressures for 2 out of 3 volunteers. None of the head cushions consistently demonstrated a larger surface area of pressure distribution.

Conclusions: The medium-sized static air seat cushion, placed under the shoulders and head, demonstrated the most favorable pressure redistribution properties. The non-powered fluidized positioner demonstrated the least favorable pressure redistribution properties.

Background: Aberrant tissue repair can result in the formation of chronic wounds and pathological scarring, which can severely impact a patient's quality of life. Due to their complexity, treatment of these conditions remains challenging.

Purpose: This review article provides a brief overview of the various treatments with regards to application, possible mechanism(s) of action, new developments, and areas requiring further research.

Methods: A literature review on the different therapies/products currently used for chronic wounds and pathological scars was conducted. Several databases-including PubMed, ScienceDirect, Web of Science, and Google Scholar-were searched to find relevant articles on this topic.

Results: Numerous products and treatment options, including several promising new technologies, are currently available. These therapies/products aim to accelerate wound healing, reduce scarring, and ultimately reach the goal of scarless tissue regeneration.

Conclusion: Currently, no gold standard therapy exists for chronic wounds and pathological scars. Existing treatments demonstrate varying levels of efficacy, and further research is required regarding their safety and molecular mechanism(s) of action.

Background: Peristomal skin complications are frequent in ostomy patients, mostly occurring as a result of effluent leaking from the system. Accurate selection of ostomy products prevents complication onset, but still largely relies on the subjective evaluation of professionals.

Purpose: To evaluate the functionality of a tool conceived to help practitioners objectively identify the most appropriate ostomy system based on patient characteristics.

Methods: Professionals completed a dedicated questionnaire focused on new ostomy surgeries and changes in the abdominal profile and ostomy characteristics after 30 days from prescription.

Results: The questionnaires supported a high functionality of the tool; the pouching system chosen immediately after intervention was largely confirmed (911/959 = 95% of cases; P < .001) also in the short-term. System revision was needed only in few cases (48/959 = 5%) and mostly after ileostomy (27/959 = 2.82% of total cases), even though confirmation did not significantly vary depending on intervention (P = .1).

Conclusions: The tool can help practitioners in selecting the most adequate ostomy product(s), thus preventing postsurgical complications due to effluent leakage from the stoma and improving patients' quality of life.

Background: Pressure injury (PI) is a significant health concern among older inpatients, particularly in regions with diverse ethnic populations. Understanding the epidemiological characteristics and preventive measures is crucial for improving patient outcomes.

Purpose: To analyze the epidemiological characteristics, prevention status, and influencing factors of pressure injury (PI) in older inpatients of Zhuang and Han nationality in Guangxi, China.

Methods: A total of 2206 inpatients age 60 years or older in 2 class III grade A general hospitals in the Guangxi Zhuang Autonomous Region between April 1, 2021, and May 27, 2021, were included in this cross-sectional study. Epidemiological characteristics-including age, sex, educational background, race, ethnicity, and hospitalization information-were collected using a general information questionnaire designed by the researchers. The PI risk factors were evaluated using the Braden Scale. Prevention status was assessed using the Epidemiology and Prevention Skin Injuries in the Elderly Scale and Skin Injury Survey Scale.

Results: Of the total 2206 patients included in the study, 555 (25.16%) were of Zhuang nationality and 1651 (74.84%) were of Han nationality. The overall PI incidence was 2.58%, with PI prevalence of 1.80% and 2.85% in Zhuang and Han patients, respectively. The main influencing factor for PI in Zhuang patients was caregivers (P < .05), whereas in Han patients the main influencing factors were urinary conditions, Alzheimer disease, sedatives, and antihypertensive drugs (P < .05).

Conclusion: The PI prevalence rates were similar in both ethnic groups. Health care staff in high-risk departments for PI must remain vigilant and take appropriate action.

Background：This study reports experience of wound care at the site of cannulation in the case of a patient with dilated cardiomyopathy (DCM) weaned from extracorporeal membrane oxygenation (ECMO).

Purpose: To describe the use of a self-made vacuum-sealing drainage device with constant-temperature flushing to manage wound exudates in the cannulation site, aiming to create an environment conducive to wound healing.

Materials and methods: Exudates from the wound were processed using the vacuum-sealing drainage technique combined with constant-temperature flushing. Anti-infective agents were systemically administered to control infection and promote wound healing. Additionally, the patient's nutritional status, pain management, psychological well-being, and rehabilitation were assessed and managed as part of the comprehensive care approach.

Results: The wound exhibited gradual healing under this multifaceted care strategy. After 48 days of treatment, the patient demonstrated stable disease conditions and achieved wound closure. The patient was subsequently transferred to a general ward for further care.

Conclusion: The use of a self-made vacuum-sealing drainage device with constant-temperature flushing, along with comprehensive patient management, proved effective in wound care for a critically ill patient with ECMO cannulation. This approach fosters an optimal environment for wound healing and contributes to patient recovery and stability.

Background: Peristomal skin complications (PSCs) are the most common complication among patients with ostomies after ostomy creation.

Purpose: This systematic review and meta-analysis aimed to evaluate the factors influencing the occurrence of peristomal skin complications.

Methods: A systematic review was conducted across multiple databases by using a combination of subject terms and free words for online search. The databases were searched from their inception to October 31, 2023. All studies that met inclusion criteria were examined to identify risk factors for PSCs. Two researchers independently conducted literature screening and information extraction, evaluated the literature quality using the Newcastle-Ottawa Scale, and performed descriptive analysis of the results.

Results: Ten studies were included in this review. A total of 3753 patients with ostomies participated in the studies, and 981 patients suffered from PSCs, with PSC incidence ranging from 15.5% to 47.7%. Type of ostomy, diabetes, self-care knowledge, and chemotherapy were significant factors associated with PSCs.

Conclusion: This review highlighted 4 factors that influence the occurrence of peristomal skin complications. The quality of included literature is generally low, with significant heterogeneity in study design and choice of outcome indicators. Therefore, further research involving high-quality studies with larger sample sizes is needed for deeper investigation.

Background: There are no scales used by stoma and wound care nurses to evaluate the stoma care skills of individuals with a urostomy.

Purpose: This study was conducted to investigate the Turkish validity and reliability of the Urostomy Education Scale (UES).

Methods: The study sample consisted of 66 patients who had undergone radical cystectomy, were in the 0- to 7-day postoperative period, were older than 18 years of age, had no physical or mental disabilities, had no urostomy complications, and agreed to participate in the study. This study used translation and back-translation to determine the linguistic validity of the UES in Türkiye. Expert opinion was consulted for content validity. Then, 2 competent and 2 experienced nurses evaluated the face validity of the scale with 5 individuals with urostomies. Reliability of the scale was assessed using internal consistency, interrater reliability, and intraclass correlation coefficients.

Results: The content validity index was 0.81 and α = 0.66 to 0.95 for the Cronbach's alpha of the competent nurse assessment and α = 0.68 to 0.96 in the expert nurse assessment. The intraclass correlation coefficient (ICC) results indicated sufficient and statistically significant agreement (ICC range: 0.6-1) between the evaluations made by the 2 evaluators for each skill.

Conclusion: The Turkish version of the 7-item UES is a valid and reliable tool that can be used to determine the self-care levels of individuals with a urostomy.