The journal of the American College of Certified Wound Specialists最新文献

Clostridium tertium has historically been regarded as nonpathogenic, and its implication as the primary microbe in infectious etiologies remains unclear. Although there have been several reports of C tertium isolated from blood, tissue, and other specimens, largely this population has consisted of patients with neutropenia, hematologic malignancies, or gastrointestinal disorders. Here we describe a case of a 39-year-old nonimmunocompromised man with a history of type 1 diabetes mellitus and intravenous drug use who presented to our institution with a necrotizing soft tissue infection involving his right upper extremity. The infection had developed after the patient had injected methamphetamines. At surgery, tissue was obtained for Gram stain and culture, yielding C tertium, after an initial misidentification as Lactobacillus species. After undergoing extensive surgical debridement and treatment with an appropriate antibiotic regimen, the patient was able to be discharged home with retained function of his extremity. Although not common, infections involving C tertium can produce severe, potentially life- and limb-threatening disease processes, which may require aggressive therapy even in the nonimmunocompromised patient.

Chronic venous disorders are common in the Western world. The current treatment of venous leg ulcers is unsatisfactory despite the availability of well-documented standards of care. Patients today are interested in alternative approaches to modern medicine. We have developed a wound-healing powder containing natural ingredients with absorptive, aromatic, antiseptic, and anti-inflammatory synergistic properties. This report describes 3 cases that were successfully treated with the powder, demonstrating the potential of herbal remedies in the clinical treatment of venous leg ulcers.

Dr Jayesh Shah authors this quarterly column, consisting of 5 questions with explanations, to help you practice for your exam.

Pressure ulcer prevalence remains a major health concern in long-term care facilities. The treatment of these pressure ulcers causes a financial drain on health care resources and adds potential costs for the family of the institutionalized elderly, according to the Agency for Healthcare Research and Quality. The prevention of pressure ulcer development continues to be an essential objective of caregivers for elderly people. This study demonstrated a correlation between the permanent assignment of nursing assistants and the prevention of pressure ulcers among the elderly in a nursing home.

Silver-containing topical agents are used to help prevent infectious complications in wound therapy. Toxicity from topical silver agent exposure was initially reported in 1975 and was clinically characterized by granulocytopenia. Currently, the data regarding potential toxicity associated with silver-impregnated devices are limited. A 23-year-old patient receiving chemotherapy for acute lymphoblastic leukemia presented with necrotizing fasciitis of the abdominal wall and scrotum from a Crohn disease–related psoas-enteric fistula. Surgical debridement of the soft-tissue and abdominal musculature was performed to the peritoneum. Silver-containing foam sponges and wound vacuum-assisted closure were applied directly to the peritoneum 2 weeks after initial debridement. Subsequently, the patient developed leukopenia, and workup revealed the serum silver level was 4 times normal level. Silver-impregnated sponges were discontinued and silver-free sponges and wound vacuum-assisted closure therapy resumed, followed by leukopenia resolution. Silver toxicity associated with routine application of silver-impregnated sponges has not been previously reported.

Background

This exploratory study was conducted in an effort to demonstrate that bioelectrical impedance analysis (BIA) phase angle measurement is a novel tool for monitoring the effectiveness of a wound care regimen at a regional level and is valuable in comparing that status with the overall metabolic health of the patient. Isolating and measuring the extent to which nutritional supplementation contributes to the healing process is difficult and confounded by the many treatment modalities patients undergo.

Objective

The authors conducted a limited exploratory study to determine whether regional phase angle measurements accurately reflected the status of chronic nonhealing wounds. This information would potentially provide the ability to quantitatively evaluate of the role of nutritional supplementation in wounds of varying etiologies by comparing regional BIA phase angle measurement with overall BIA phase angle measurement.

Methods

Eleven patients with wounds of varying etiologies were selected to participate. Each patient underwent a treatment regimen specific to his or her condition, and all patients were given JUVEN^® nutritional supplement.

Results and Conclusion

In all patients, the BIA phase angle measurement mirrored the health of the wound and provided an accurate tool for assessing the regional tissue health, a valuable insight in measuring the effectiveness of a systemic treatment.

Microbial cellulose is a natural polymer that can hold a quantity of water without any disconformities. Therefore, it is proposed for use as wound dressing material. We report a case of 28% total body surface area partial-thickness flame burn: approximately 4.5% superficial partial-thickness burns on anterior face and 23.5% combined superficial and deep partial-thickness burns on both upper arms and anterior trunk. A microbial cellulose dressing, Nanocell (Thai Nano Cellulose Co Ltd, Bangkok, Thailand), was applied to the face wound only once, without any further dressing change. Progress of healing, until full epithelialization on the face, was observed for 2 weeks. During the treatment period, the patient did not show any irritation or allergic reaction to this new dressing, and wound swab culture showed no evidence of bacteria presence. This innovative material can be an alternative dressing for superficial partial-thickness burn wounds.

Dr Jayesh Shah authors this quarterly column, consisting of 4 questions with explanations, to help you practice for your exam.

A wound practitioner’s best-laid plan of care and strategy for healing an ulcerated foot is doomed to fail without a properly conceived approach based on sound off-loading principles. Wound healing that has stalled despite best-practice techniques may require reevaluation of off-loading choices. This is particularly true in the patient with abnormal foot pathologies. Special considerations are certainly required with neuropathic ulcers; however, any wound on a weight-bearing surface of the foot requires proper off-loading. This discussion explores the basic biomechanical and pathomechanical concepts that modify and influence ambulation and gait patterns. Integration of these concepts into the choices for off-loading to deter pathologic influences will alert the reader of precautionary measures and other factors for consideration. The aim of this column is to provide both an adequate working knowledge of the available off-loading devices and the necessary tools and concepts needed to stimulate wise decision protocols for wound management and healing.