Wound management & prevention最新文献

Background: Elevated bacterial bioburden and biofilm formation are common causes for delayed wound healing. Biofilm is an assemblage of surface-associated microbes enclosed in a self-produced matrix. Identifying and managing biofilm is a crucial component of successful wound care protocols.

Purpose: To determine the effects of a native cross-linked extra cellular matrix with polyhexamethylene biguanide (PHMP; PHMP antimicrobial [PCMP]), in conjunction with next-generation DNA sequencing (NGS) and targeted debridement by fluorescence imaging, on managing bacterial bioburden to support wound healing.

Methods: Over 6 weeks, fluorescence images were captured to assess bacterial contamination as were standard images with measurements. Tissue swabs were obtained and analyzed using NGS to quantify bacterial bioburden. PCMP was applied at each treatment visit.

Results: Baseline wound duration was 23.0 ± 6.7 weeks, and baseline size was 7.9 ± 7.1 cm2. Two out of 5 wounds healed by week 4. The mean percentage area reduction of all wounds was 59.7% by week 4 and 78.1% by week 6. All wounds were fluorescence positive on week 1 and fluorescence negative by Week 4.

Conclusion: PCMP, as an antimicrobial barrier, combined with use of a real-time method of bacterial detection, may be beneficial in managing the wound healing environment.

Background: Disposable mechanical negative pressure wound therapy (dNPWT) can help manage lower extremity wounds in the outpatient clinic.

Purpose: We assessed dNPWT use in 16 patients at a podiatry clinic.

Methods: Patients were treated between October 31, 2019 and December 16, 2021. All patients received dNPWT with dressing changes every 2 to 3 days. Demographics, baseline wound and subsequent wound visit data, and treatments were recorded. Wound healing outcomes were assessed.

Results: Average patient age was 59.6 ± 8.9 years old. Patient comorbidities included poor nutritional status, diabetes, and hypertension. Wound types consisted of 6 diabetic foot ulcers, 9 surgical wounds, and 1 pressure injury. At baseline, the average wound age was 15.6 weeks, average area was 5.5 cm2, and average volume was 3.3 cm3. The average time from presentation to end of dNPWT was 45.5 days. In this timeframe, wounds improved in granulation tissue amount (81%), reduced in area (63%), and reduced in volume (69%). By the end of treatment, a majority of patients (88%) displayed 76% to 100% wound bed coverage with healthy granulation tissue. The remaining 12% showed <76% coverage with granulation tissue.

Conclusions: In this retrospective study, 14 of 16 patients displayed improvement in wound area, volume, and granulation tissue amount during dNPWT treatment.

Background: Diabetic Wounds (DW) are a debilitating complication of diabetes. Although various therapeutic strategies are available for DW management, none of them meet all the fundamentals due to the multifaceted pathophysiology of DW. Given the ever-present threat of DW, novel improved therapeutic strategies and the fortification of DW research deserve better prioritization.

Purpose: The current review aims to provide the detailed role of human β defensin-2 (HBD-2) in skin wounds with a prospective significance in DW treatment.

Methods: This review was conducted through searches of relevant abstracts, research and review articles, and patents, in Scopus, Web of Science, PubMed, Google Scholar, and Clinical Trials databases of English language articles.

Results: HBD-2 is a critical innate immune-response protein that defends the human body from infections. Recent reports also support the role of HBD-2 in suppressing inflammation and promoting proliferation and angiogenesis. Based on the literature, its therapeutic administration has been proposed to maintain the equilibrium of systemic homeostasis in DW.

Conclusion: It has been hypothesized that HBD-2 could be a crucial modulator for controlling chronic inflammation and size by promoting proliferation and angiogenesis, opening up new therapy options in DW.

Background: Use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) can assist with wound bed preparation for successful closure. The authors present their experience using NPWTi-d to manage lower extremity wounds in 4 patients and discuss the feasibility of improving cost efficiency.

Methods: NPWTi-d involved instillation of normal saline with an 8-to 10 minute dwell time, followed by 3 to 3.5 hours of -125 mm Hg. Therapy continued for 6 to 7 days with dressing changes every 2 to 3 days.

Results: Patients were all male, between the ages of 24 and 83 years old. Wound etiologies included chemical burn, deep tissue laceration, compartment syndrome with hematoma, and diabetic foot osteomyelitis. All wounds required cleansing. Prior to NPWTi-d, surgical debridement and antibiotics were administered as necessary. After NPWTi-d, the wounds exhibited healthy granulation and reduced in size, allowing for discharge to outpatient care. Upon follow-up 2 to 6 months later, no patients experienced wound complications or required readmission to the operating room, potentially saving on time and cost.

Conclusion: In these patients, use of NPWTi-d assisted in cleansing the wound surface and producing a positive healing outcome. Despite higher initial costs of NPWTi-d over standard dressings, a wound management protocol including NPWTi-d may help mitigate expenses incurred by delayed healing.

"OBJECTIVE: The aim of the study was to comparatively evaluate the in vivo interphase pressure (IP) and statis stiffness index (SSI), upon initial application, of 7, 2-layer cohesive bandage kits when applied on healthy volunteers.

Method: Bandages were applied in random order, on non-consecutive days by a single experienced clinician. The IP at the time of application was measured on the right lower limb of 10 healthy volunteers at 2 different points (B1, C). Measurements were made in 2 positions, supine and standing. There were 2 consecutive applications and measurements made for each compression bandage set. Statistical analysis of the outcome data was performed, utilizing a repeated measures analysis of variance (ANOVA) to determine: the effects of the bandage type on IP and SSI for each of the measurement points and according to the subject's position. Post hoc analyses were performed by Tukey and Bonferroni test to identify significant differences. The dispersion of the recorded pressures within the study population (dispersion between subjects) was assessed by the coefficient of variations.

Results: The in vivo IP measured at B1 in the supine position varied from 50.1 mmHg (±5.3) to 73.7 mmHg (±13.4). The in vivo IP measured at C in the supine position varied from 53.2 mmHg (±7.6) to 69.3 mmHg (±10.6). Bonferroni post hoc analyses demonstrated with a 95% confidence interval, there was a significant difference between wraps and placed them into 5 groups for the IP measured at B1, and 3 groups for measurements taken at C. A regression model including the main effects of the wrap and the subject with their interaction were similar for the IP observed at B1 and C in the supine position (r2 = 0.881). The in vivo SSI measured at B1 varied from 11.95 (±5.4) to 6.65 (±4.4). Post hoc analyses similarly demonstrated significant differences placing the wraps into 3 different groups. Statistical analysis of the variability of the IP observed at B1 and C showed there was a significant difference at B1 (P = .001), which was not observed at C (P = .347).

Conclusion: Sub-bandage pressure measurements produced by the 7, '2-layer cohesive' compression box sets were not equivocal. IP and SSI varied by textile composition, clinically supporting the trial of alternative '2-layer cohesive' compression box set if the desired outcome (ie, wound healing, edema reduction) is not achieved. Additional study in patients with edema is warranted to allow an evidenced-based approached to the selection of a compression bandage set.

Background: Pressure injury (PI) due to medical devices is one of the most common PIs, especially in patients treated in intensive care. Medical device-related pressure injuries (MDRPIs), as part of their treatment, require extra care and prevention interventions than injuries caused by immobilization. Standardized nursing models are needed to care for PIs caused by medical devices on mucous membranes.

Purpose: To provide information about the evaluation and care of the MDRPIs in the mucosal membrane due to the endotracheal tube (ET).

Case report: A 35-year-old male with chronic obstructive pulmonary disease (COPD) and coronavirus disease has MDRPIs on the lower lip edge due to the ET on the fifteenth day after intubation. North American Nursing Diagnosis Association (NANDA) diagnoses were determined by systematically analyzing the data using the Gordon's Functional Health Patterns (GFHP) model in the patient. Nursing care was planned and applied in line with the determined NANDA diagnoses, Nursing Outcomes Classification (NOC) interventions, and using the recommendations of current PI guides for treatment of MDRPIs.

Conclusion: This case report illustrates MDRPIs resulting from ET and provides information about the formation of MDRPIs and appropriate maintenance therapy. Future research is recommended to examine and evaluate the nursing care and outcome of MDRPIs in different mucosal membranes.