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

One of the leading questions on clinicians' minds is, What are the implications of the new ruling of the Centers for Medicare & Medicaid Services (CMS) in acute care, and how will it affect the wound care clinician? The CMS recently unveiled its plans for reimbursement and nonpayment for facility-acquired pressure ulcers, among other issues, in acute care. Change is coming, and this time prevention and intervention underlie the CMS payment reform ruling, which includes payment incentive for prevention and quality patient care. Intensive and comprehensive patient screenings at the outset of admission, as well as diligent prevention during patient stay, are the mainstays of this initiative. Anyone who works in a hospital will play a major role.

Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings.

Venous disease has a spectrum of presentations. The most advanced state of chronic venous insufficiency (CVI) managed by wound care specialists being ulceration of the lower extremity. The goal of all treatments for advanced venous disease is to decrease ambulatory venous hypertension. Treatment can be divided into exogenous and endogenous methods. Exogenous methods include those applied externally such as compression, elevation, debridement and wound dressings. Endogenous methods treat the underlying venous pathology either due to venous valvular dysfunction or venous obstruction leading to venous hypertension. Recently, significant advances in endogenous methods have evolved. The development of a new concept, minimally invasive vein surgery (MIVS), has improved upon traditional, open, invasive treatments of venous disease. MIVS techniques are performed percutaneously, with minimal anesthesia, no incisions and rarely require hospital admission. This article summarizes the concept of MIVS, describes each method of MIVS and its complementary role in the management of venous leg ulcers patients.

Background

Small clinical studies suggest adjunctive use of acoustic pressure wound therapy (APWT) may enhance wound healing, even in challenging patients. This noncontact low-frequency, nonthermal ultrasound therapy for assisting with the debridement of necrotic tissue from challenging wounds is generally better tolerated by patients for whom treatment-related wound pain, anticoagulation, or medical instability precludes sharp, surgical, or mechanical debridement.

Objective

To evaluate changes in amount of devitalized tissue, amount and type of wound drainage, and wound surface area after administration of APWT.

Design

Retrospective chart review of 48 consecutive patients treated with adjunctive APWT at a single center between January 2006 and October 2007.

Methods

Paired comparisons of baseline versus posttreatment values for wound area, tissue characteristics, drainage, and pain were analyzed. Time, frequency, and duration of APWT and treatment-related adverse events were collected.

Results

APWT was administered a mean of 2.1 times per week for a mean of 4.1 minutes per session. Mean duration of therapy was 5.5 weeks. Median wound area was reduced by 92% from baseline to end of APWT (6.2 cm² to 0.2 cm²,P < .0001). The proportion of wounds with >75% granulation tissue increased from 37% to 89% (P < .0001). The proportion of wounds without fibrin slough or eschar increased from 31% to 75% (P < .0001) and from 72% to 94% (P = .02), respectively.

Limitations

Retrospective design, lack of control group, small sample population.

Conclusion

As an adjunct to conventional wound management, APWT appears to improve parameters associated with wound healing, including increased tissue granulation, decreased necrotic tissue, and decreased wound area.