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Kumata Y, Ishii D, Ishii S, Motoki K, Ueno N, Hinooka R, Miyagi H. A case series of prophylactic negative pressure wound therapy use with purse-string closure in stoma closure wounds in infants. Surg Case Rep 2024; 10:20. [PMID: 38228981 DOI: 10.1186/s40792-024-01818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The study introduces the application of negative pressure wound therapy (NPWT) in pediatric stoma closure, emphasizing the importance of enhancing aesthetics and minimizing surgical site infections (SSI). CASE PRESENTATION The case series involves four infants undergoing non-umbilical stoma closure with a combination of purse-string closure (PSC) and NPWT, focusing on aesthetic outcomes and infection prevention. NPWT was initiated immediately after surgery, and patients were monitored every 3-4 days. Notably, none of the four infants experienced SSI or other complications. The patients adequately tolerated NPWT, with no significant adverse events. Furthermore, Manchester Scar Scale (MSS) was 9 [7-10], and Patient and Observer Scar Assessment Scale (POSAS) (observer) was 12.5 [12-19], POSAS (patient) was 12.5 [11-16] (all median values [minimum-maximum]), indicating that excellent aesthetic outcomes were achieved. DISCUSSION We emphasizes the significance of aesthetics in pediatric patients; in addition, our findings demonstrate that four infants who received NPWT combined with PSC achieved superior outcomes that did the most recent four infants who underwent PSC only at our institution. It also addresses the risk of SSI in stoma closure and discusses the pros and potential cons of using NPWT in pediatric cases, underlining the need for further research and the accumulation of additional reports. CONCLUSIONS This is the inaugural report of prophylactic NPWT for pediatric stoma closure, emphasizing the effectiveness of combining PSC and NPWT for SSI prevention and improved aesthetics. The study calls for additional research and reports on NPWT in pediatric cases to further solidify its benefits in this patient population.
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Affiliation(s)
- Yuka Kumata
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Daisuke Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.
| | - Seiya Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Keita Motoki
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naomi Ueno
- Nursing Department, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Ranko Hinooka
- Nursing Department, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Hisayuki Miyagi
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan
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Wei M, Yang D, Chen L, Wu L, Lu M, Wang J, Qiu T. The prevalence of medical adhesive-related skin injury caused by protective dressings among medical staff members during the 2019 coronavirus pandemic in China. J Tissue Viability 2023; 32:69-73. [PMID: 36639257 PMCID: PMC9827744 DOI: 10.1016/j.jtv.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/11/2020] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
AIM To explore the prevalence and risk factors for medical adhesive-related skin injury (MARSI) caused by protective dressings among medical staff members during the 2019 coronavirus disease pandemic (COVID-19) in China. MATERIALS AND METHODS A cross-sectional survey was conducted using a questionnaire. The questionnaire was released through the Questionnaire Star website and was completed online. The prevalence of MARSI was calculated and risk factors were analyzed using a multiple regression model. RESULTS A total of 414 front-line medical staff members treating COVID-19 patients were enrolled from 46 hospitals across four provinces and two municipalities. Overall, 83.1% used protective medical adhesive dressings applied to the head and face to prevent skin damage from personal protective equipment. The prevalence of MARSI caused by adhesive dressings was 41.9%. By multiple regression analysis, the type of dressing, duration of dressing usage, and pain score were risk factors for MARSI development. CONCLUSIONS The high prevalence indicates MARSI is common among front-line medical staff members, especially those using hydrocolloid dressings and longer durations of dressing usage. Pain upon dressing removal can be severe and increased the risk of MARSI. We call for paying more attention to MARSI and recommend multisite studies with larger sample sizes to enhance the generalizability of these findings.
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Affiliation(s)
- Min Wei
- Wound Care Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | | | - Lu Chen
- Nursing Department Office, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Ling Wu
- Wound Care Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Minyuan Lu
- Affiliated Hospital of YangZhou University, Nanjing, Jiangsu, China
| | - Jiandong Wang
- Department of Pathology, Jinglin Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Ting Qiu
- Department of Orthopedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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Stricker S, Eberhard N, Licci M, Greuter L, Zweifel C, Guzman R, Soleman J. Wound closure with a mesh and liquid tissue adhesive (Dermabond Prineo) system in pediatric spine surgery: a prospective single-center cohort study incorporating parent-reported outcome measures. J Neurosurg Pediatr 2022; 30:624-632. [PMID: 36459394 DOI: 10.3171/2022.8.peds22270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wound healing can be challenging in children undergoing spine surgery for neurological conditions due to a high risk of cerebrospinal fluid (CSF) leakage and wound infection. In adults, use of the Dermabond Prineo (DP) skin closure system, which consists of both tissue adhesive glue and a self-adhesive mesh, for wound closure of medium-length surgical incisions has been reported. The aim of this study was to investigate the efficiency and cosmetic outcome of DP for wound closure in extra- and intradural pediatric neurological spine surgery. METHODS In this prospective cohort study, 47 children underwent 50 spine procedures using DP for wound closure between 2018 and 2022 at a single institution. Patient demographic and surgical data were collected. The primary outcome was revision surgery for wound healing disorders, while secondary outcomes were infections, minor wound healing disorders, and both physician and parental satisfaction (parent-reported outcome measures [PROMs]) at last follow-up. RESULTS Among 50 spinal (45 intra- and 5 extradural) interventions, 1 patient (2%) underwent revision surgery for a cutaneous CSF fistula and pseudomeningocele. Minor wound healing disorders occurred after 16 surgeries, which did not require surgical wound revision and resolved completely. No allergic reactions to DP or surgical site infections within 30 days were observed. The parents and the medical team described wound care as significantly facilitated since wound dressing changes were not needed. Three families (6.4%) encountered difficulties in wound care, and 46 (97.9%) were satisfied with DP. The cosmetic outcome based on PROMs was excellent, with a mean score of 8 (IQR 2) on a scale from 1 to 10. At long-term follow-up, a mean of 11.3 ± 10.7 months after surgery, physicians rated the cosmetic outcome on the visual analog scale (median score 9, IQR 1) and Hollander scale (median score 6, IQR 1). The outcomes were similar among the different pathologies and age groups and did not differ in patients with and without syndromic malformations. CONCLUSIONS The application of DP is simple, enables good patient comfort, facilitates both professional and parental wound care, and leads to excellent cosmetic results. DP possibly aids in the reduction of postoperative CSF leakage and infections after pediatric neurological spine surgery.
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Affiliation(s)
- Sarah Stricker
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Noëmi Eberhard
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Maria Licci
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Ladina Greuter
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
| | - Christian Zweifel
- 2Department of Neurosurgery, University Hospital of Basel
- 3Faculty of Medicine, University of Basel
- 4Division of Neurosurgery, Department of Surgery, Kantonsspital Graubünden, Chur; and
| | - Raphael Guzman
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
- 3Faculty of Medicine, University of Basel
| | - Jehuda Soleman
- 1Department of Pediatric Neurosurgery, Children's University Hospital of Basel
- 2Department of Neurosurgery, University Hospital of Basel
- 3Faculty of Medicine, University of Basel
- 5Clinical Trial Unit, University Hospital of Basel, Switzerland
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Ciprandi G, Crucianelli S, Grussu F, Spuntarelli G, Marino SFM, Urbani U, Bernaschi P, Sisto A, Rizzo MI, Zama M. Meeting the Challenges in Pediatric Wound Care: Our 15-Year Experience with Dialkylcarbamoyl Chloride-Coated Dressing Technology in Acute and Chronic Wounds. CHRONIC WOUND CARE MANAGEMENT AND RESEARCH 2022. [DOI: 10.2147/cwcmr.s376889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Considerations for Skin and Wound Care in Pediatric Patients. Phys Med Rehabil Clin N Am 2022; 33:759-771. [DOI: 10.1016/j.pmr.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ciprandi G, Kjartansson H, Grussu F, Baldursson BT, Frattaroli J, Urbani U, Zama M. Use of acellular intact fish skin grafts in treating acute paediatric wounds during the COVID-19 pandemic: a case series. J Wound Care 2022; 31:824-831. [DOI: 10.12968/jowc.2022.31.10.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Objective: More specific strategies are needed to support children requiring skin grafting. Our goal was to identify procedures that reduce operating times, post-operative complications, pain and length of hospital stay. Patient safety, optimal wound bed support and quick micro-debridement with locoregional anaesthesia were prioritised. Ultimately, a novel acellular fish skin graft (FSG) derived from north Atlantic cod was selected for use. Method: We admitted consecutive paediatric patients with various lesions requiring skin grafting for definitive wound closure. All FSGs were applied and bolstered in the operating room following debridement. Results: In a cohort of 15 patients, the average age was 8 years and 9 months (4 years 1 month–13 years 5 months). Negative pressure wound therapy (NPWT) was given to 12 patients. Rapid wound healing was observed in all patients, with a wound area coverage of 100% and complete healing in 95% of wounds. Time until engraftment in patients receiving NPWT was reduced by about a half (to an average 12 days) from our standard experience of 21 days. Ten patients received locoregional anaesthesia and were discharged after day surgery. The operating time was <60 minutes, and no complications or allergic reactions were reported. Excellent pliability of the healed wound was achieved in all patients, without signs of itching and scratching in the postoperative period. This case series is the first and largest using FSG to treat paediatric patients with different wound aetiologies. We attribute the rapid transition to acute wound status and the good pliability of the new epidermal–dermal complex to the preserved molecular components of the FSG, including omega-3. Conclusion: FSG represents an innovative and sustainable solution for paediatric wound care that results in shorter surgery time and reduced hospital stays, with accelerated wound healing times.
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Affiliation(s)
- Guido Ciprandi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Hilmar Kjartansson
- Landspitali University Hospital, Reykjavik, Iceland
- Kerecis Limited, Reykjavik, Iceland
| | - Francesca Grussu
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Baldur T Baldursson
- Landspitali University Hospital, Reykjavik, Iceland
- Kerecis Limited, Reykjavik, Iceland
| | - Jacopo Frattaroli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Urbano Urbani
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mario Zama
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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8
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Staphylococcal Scalded Skin Syndrome, Identification, and Wound Care. Adv Neonatal Care 2022; 22:325-332. [DOI: 10.1097/anc.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shi ZY, Hou SL, Li XW. Silver dressing in the management of an infant's urachal anomaly infected with methicillin-resistant Staphylococcus aureus: A case report. World J Clin Cases 2022; 10:2629-2636. [PMID: 35434059 PMCID: PMC8968584 DOI: 10.12998/wjcc.v10.i8.2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/29/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Symptomatic urachal anomalies are rare disorders. The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life. However, recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management. In this case, we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well.
CASE SUMMARY Female baby A, weighing 2.88 kg at 38+5 wk of gestational age, was referred to the hospital because of a red, swollen umbilicus approximately 2 cm × 2 cm in size with yellow purulent exudate. Through physical and ultrasound examination, the baby was finally diagnosed with a urachal anomaly. We first used oxacillin to prevent infection for 3 d. On the 4th day, microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing. After 5 d, the symptoms of the umbilicus disappeared, and we discontinued silver dressing application. On the 12th day, umbilical exudate testing was negative for MRSA. On the 14th day, the baby's blood testing showed a white blood cell count of 14.7 × 109/L, neutrophil percentage of 27.8%, and C-reactive protein level of 1.0 mg/L, suggesting that the infection had been controlled. We stopped treatment, and the baby was discharged with no complications. In this case, the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods, which was a different course from that of some other urachal remnant cases.
CONCLUSION Anomalies that do not connect with the bladder can be treated with nonoperative management, including application of conservative antibiotics and local intervention with silver-based dressings. Silver sulfate dressings are absolutely safe for neonates with judicious use, and they play an established role in preventing infection without resistance, which is a common problem with other antibiotics and antiseptics.
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Affiliation(s)
- Ze-Yao Shi
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Shu-Lin Hou
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Xiao-Wen Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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Carney BC, Oliver MA, Erdi M, Kirkpatrick LD, Tranchina SP, Rozyyev S, Keyloun JW, Saruwatari MS, Daristotle JL, Moffatt LT, Kofinas P, Sandler AD, Shupp JW. Evaluation of Healing Outcomes Combining A Novel Polymer Formulation with Autologous Skin Cell Suspension to Treat Deep Partial and Full Thickness Wounds in a Porcine Model; A Pilot Study. Burns 2022; 48:1950-1965. [DOI: 10.1016/j.burns.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/29/2021] [Accepted: 01/16/2022] [Indexed: 11/02/2022]
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Daristotle JL, Erdi M, Lau LW, Zaki ST, Srinivasan P, Balabhadrapatruni M, Ayyub OB, Sandler AD, Kofinas P. Biodegradable, Tissue Adhesive Polyester Blends for Safe, Complete Wound Healing. ACS Biomater Sci Eng 2021; 7:3908-3916. [PMID: 34323468 PMCID: PMC8594560 DOI: 10.1021/acsbiomaterials.1c00865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Pressure-sensitive adhesives typically used for bandages are nonbiodegradable, inhibiting healing, and may cause an allergic reaction. Here, we investigated the effect of biodegradable copolymers with promising thermomechanical properties on wound healing for their eventual use as biodegradable, biocompatible adhesives. Blends of low molecular weight (LMW) and high molecular weight (HMW) poly(lactide-co-caprolactone) (PLCL) are investigated as tissue adhesives in comparison to a clinical control. Wounds treated with PLCL blend adhesives heal completely with similar vascularization, scarring, and inflammation indicators, yet require fewer dressing changes due to integration of the PLCL adhesive into the wound. A blend of LMW and HMW PLCL produces an adhesive material with significantly higher adhesive strength than either neat polymer. Wound adhesion is comparable to a polyurethane bandage, utilizing conventional nonbiodegradable adhesives designed for extremely strong adhesion.
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Affiliation(s)
- John L Daristotle
- Fischell Department of Bioengineering, University of Maryland, 3102 A. James Clark Hall, 8278 Paint Branch Dr., College Park, Maryland 20742, United States
| | - Metecan Erdi
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Dr., College Park, Maryland 20742, United States
| | - Lung W Lau
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, 111 Michigan Avenue NW, Washington, District of Columbia 20010, United States
| | - Shadden T Zaki
- Department of Materials Science and Engineering, University of Maryland, 4418 Stadium Dr., College Park, Maryland 20742, United States
| | - Priya Srinivasan
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, 111 Michigan Avenue NW, Washington, District of Columbia 20010, United States
| | - Manogna Balabhadrapatruni
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Dr., College Park, Maryland 20742, United States
| | - Omar B Ayyub
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Dr., College Park, Maryland 20742, United States
| | - Anthony D Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, 111 Michigan Avenue NW, Washington, District of Columbia 20010, United States
| | - Peter Kofinas
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Dr., College Park, Maryland 20742, United States
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Secco IL, Danski MTR, Pereira HP, Almeida TQRD, Cruz TR. Nursing care of a newborn with deep incisional surgical site infection: a case report. Rev Esc Enferm USP 2021; 55:e03769. [PMID: 34105685 DOI: 10.1590/s1980-220x2020047203769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/02/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe a case of deep incisional surgical site infection in a children's hospital in South Brazil, emphasizing the nursing care measures provided to the newborn. METHOD Case study with data collection from medical record, approved by the institution and the Human Research Ethics Committee. RESULTS From the diagnosis of surgical site infection, a plan was established for specific care of the lesion using occlusive dressings made with technologies aimed at accelerating the second-intention healing process. CONCLUSION Despite the severity of the lesions, the scientific knowledge and the skill of the nurses during treatment of the surgical site infection provided the newborn with full surgical wound healing and hospital discharge before the estimated moment.
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Affiliation(s)
- Izabela Linha Secco
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brasil
| | | | - Higor Pacheco Pereira
- Universidade Federal do Paraná, Programa de Pós-Graduação em Enfermagem, Curitiba, PR, Brasil
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Abstract
GENERAL PURPOSE To provide wound care information that considers the specific physiology of neonates. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Differentiate the use of hydrocolloids, hydrogels, foam dressings, and barrier creams in the neonatal population.2. Identify issues related to the use of solvents, alginates, collagen dressings, and negative-pressure wound therapy in neonates. ABSTRACT OBJECTIVETo discuss what is known about the wound milieu in premature and full-term neonates, including the unique challenges pediatric clinicians face, the therapies that have proven effective, and the therapies contraindicated for use in neonatal wound healing to guide treatment that accounts for the specific physiological characteristics of this often overlooked population. DATA SOURCES Data were collected on neonatal wound healing from a wide variety of sources, including PubMed, Google Scholar, journals, and textbooks. STUDY SELECTION Selection criteria included publications focused on the differences and nuances of wound healing in neonates in comparison with all other age groups. DATA EXTRACTION Data were extracted based on articles covering wound healing therapies with proven effectiveness in neonates. Terms for neonatal wound care were compiled, and then a comprehensive literature search was performed by the authors. DATA SYNTHESIS Although many therapies are safe for treatment of older children and adolescents, most have not been explicitly tested for neonatal use. This article reviews therapies with proven effectiveness and/or specific concerns in the neonatal population. CONCLUSION This review sheds light on the advantages and disadvantages of current standards of care regarding wound healing for neonates to direct researchers and clinicians toward developing treatments specifically for this delicate population.
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Medical-Grade Honey for the Treatment of Extravasation-Induced Injuries in Preterm Neonates: A Case Series. Adv Neonatal Care 2021; 21:122-132. [PMID: 32675576 DOI: 10.1097/anc.0000000000000781] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Preterm neonates often depend on peripheral intravenous administration of nutrition and medication. Since their skin is not fully developed and very vulnerable, extravasation injury is a risk. Medical-grade honey (MGH) possesses antimicrobial activity and stimulates wound healing; although its use in neonatal patients is limited. CLINICAL FINDINGS We present a case series of 7 preterm neonates (28-36 weeks of gestation) with extravasation injuries secondary to peripheral intravenous administration of total parental nutrition and medication. PRIMARY DIAGNOSIS Extravasation injury following the unintentional leakage of total parenteral nutrition, and medication into the surrounding tissue. Signs of extravasation include local pain, erythema, burning, pruritus, and/or swelling. INTERVENTIONS All extravasation injuries were treated with daily cleaning and application of MGH. Some of the cases needed additional surgical intervention or assisted debridement. OUTCOMES After treatment, all extravasation injury wounds presented with granulation tissue formation progressed to normal epithelialization and closed in 7 to 67 days (median: 32 days). Upon initial application, peripheral edema and inflammation decreased. When present, necrotic tissue was effectively debrided, slough was removed, and no signs of infection were detected, irrespective of initial wound presentations. Cicatrization was minimal, and the full range of motion was preserved in all cases. PRACTICE RECOMMENDATIONS Continuous and thorough assessment of peripheral intravenous line placement for malposition, leaking, and signs of extravasation is needed for fast discovery and prevention of further damage. CONCLUSION Medical-grade honey possesses antimicrobial, anti-inflammatory, and antioxidative activity, enhancing wound healing. Medical-grade honey was safe and effective for treating extravasation-induced injuries, independent of location and severity. We recommend MGH for treating extravasation wounds and consideration for other types of wounds.
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Jones JW, Whiting ZG, Gabay EM, Rana MS, Rutter MJ, Reilly BK. Novel use of lip balm under tracheostomy ties to prevent skin irritation in the pediatric patient. Int J Pediatr Otorhinolaryngol 2020; 138:110280. [PMID: 32798832 DOI: 10.1016/j.ijporl.2020.110280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/25/2020] [Accepted: 07/25/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To study the effectiveness of lip balm in reducing skin irritation and preventing pressure induced injury in tracheostomy dependent children. METHODS The skin of tracheostomy patients presenting to a pediatric otolaryngology clinic over a 12 month period from 2018 to 2019 was assessed and categorized as hyperemic blanchable (abnormal pre-pressure injury), hyperemic non-blanchable, partial thickness skin loss, or full thickness skin loss. Caregivers were instructed to apply lip balm to the skin under soft ties three times per day and with tracheostomy tie changes. Patients were followed prospectively by a tracheostomy care nurse. RESULTS 24 patients enrolled and reported daily adherence with lip balm use. Median age was 7.3 years (interquartile range, IQR, = 1.3-12.4) with 10 females and 14 males. The majority of patients (n = 20) were identified as having hyperemic blanchable skin. 96% (23/24) of caregivers reported a subjective benefit. 79.2% (95% CI: 57.8%-92.9%) of patients with hyperemic skin (n = 24) demonstrated complete resolution with continued application, and was found to be significant: all patients had skin hyperemia before application, while 20.8% (5/24) continued to have hyperemia after application (P < .001). Infants and ventilation dependent patients demonstrated recovery rates of 88.9% and 75% respectively. Median duration of follow-up was 6.3 months (IQR = 3.4-11.3). There were no documented allergic reactions, accidental decannulations, or skin deterioration in the cohort. CONCLUSIONS Lip balm appears to be a low cost, hydrophobic, and friction-reducing agent that is potentially useful in preventing at risk pressure injuries in tracheostomy dependent pediatric patients.
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Affiliation(s)
- Joel W Jones
- Department of Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA.
| | - Zachariah G Whiting
- Department of Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Elyse M Gabay
- Department of Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Md Sohel Rana
- Department of Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Michael J Rutter
- Department of Otolaryngology, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Brian K Reilly
- Department of Otolaryngology, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA
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Mayers A, Dunleavy ML, Chau MM, Hennrikus W. The Vacuum-Assisted Closure Device Increases Value in the Treatment of Gustilo Grade IIIb Open Tibia Fractures in Children. Cureus 2020; 12:e10194. [PMID: 33033672 PMCID: PMC7532879 DOI: 10.7759/cureus.10194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Wound management associated with Gustilo grade IIIb open tibia fractures in children often requires muscle flaps, skin grafts, and amputations. The purpose of this study is to report the outcomes and complications of vacuum-assisted closure (VAC) treatment, as well as discuss its role in optimizing value when treating these injuries. Methods A retrospective review of medical records and imaging studies was performed from 2008-2015. Six pediatric patients with Gustilo grade IIIb fractures managed with the VAC were identified. The time to treatment, frequency of VAC changes, VAC size, and closure attempts, including muscle flaps and skin grafts, were documented. Fracture fixation methods, the incidence of delayed union or nonunion, as well as the occurrence of deep tissue infection and compartment syndrome were detailed. Results Five patients were male and one was female with an average age of 12 years (range 8-15 years). All patients sustained a Gustilo IIIb open tibia fracture and were treated with irrigation, debridement, intravenous (IV) antibiotics, fixation, and a VAC as a wound care adjunct. Three patients required both a muscle flap and a skin graft. One patient required a skin graft. There was one case of deep tissue infection. Three patients were treated successfully with the VAC alone and did not require any flap procedures. Conclusions Wound care for Gustilo grade IIIb open tibia fractures in children traditionally involved potentially painful twice-daily dressing changes with solutions such as dilute bleach or iodine. The implementation of VAC markedly reduced the frequency of dressing changes every three days. In the current study, the open wound gradually closed with only a VAC in 50% of Gustilo grade IIIb open pediatric tibia fractures. In summary, the VAC is an adjunct that increases value in the care of pediatric patients with Gustilo grade IIIb open tibia fractures (Value = Outcomes/Cost). Level of evidence Therapeutic level IV
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Affiliation(s)
- Alex Mayers
- Orthopaedics, Geisinger Medical Center, Danville, USA
| | - Mark L Dunleavy
- Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Michael M Chau
- Orthopaedics, University of Minnesota School of Medicine, Minneapolis, USA
| | - William Hennrikus
- Orthopaedics, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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McNamara SA, Hirt PA, Weigelt MA, Nanda S, de Bedout V, Kirsner RS, Schachner LA. Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review. J Wound Care 2020; 29:321-334. [PMID: 32530778 DOI: 10.12968/jowc.2020.29.6.321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.
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Affiliation(s)
- Stephanie A McNamara
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Penelope A Hirt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Maximillian A Weigelt
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Sonali Nanda
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Valeria de Bedout
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Robert S Kirsner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
| | - Lawrence A Schachner
- University of Miami Miller School of Medicine, Dr. Phillip Frost Dermatology and Cutaneous Surgery, 1321 NW 14th Street, Suite 506, Miami, FL 33125, US
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Rivolo M, Dionisi S, Olivari D, Ciprandi G, Crucianelli S, Marcadelli S, Zortea RR, Bellini F, Martinato M, Gabrielli A, Pomponio G. Heel Pressure Injuries: Consensus-Based Recommendations for Assessment and Management. Adv Wound Care (New Rochelle) 2020; 9:332-347. [PMID: 32286202 PMCID: PMC7155923 DOI: 10.1089/wound.2019.1042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/12/2019] [Indexed: 12/27/2022] Open
Abstract
Significance: A systematic approach to develop experts-based recommendations could have a favorable impact on clinical problems characterized by scarce and low-quality evidence as heel pressure ulcers. Recent Advances: A systematic approach was used to conduce a formal consensus initiative. A multidisciplinary panel of experts identified relevant clinical questions, performed a systematic search of the literature, and created a list of statements. GRADE Working Group guidelines were followed. An independent international jury reviewed and voted recommendations for clinical practice. Consent was developed according to Delphi rules and GRADE method was used to attribute grade of strength. Critical Issues: The extensive search of the literature retrieved 42 pertinent articles (26 clinical studies, 7 systematic reviews or meta-analysis, 5 other reviews, 2 consensus-based articles, and 2 in vitro studies). Thirty-five recommendations and statements were created. Only 1 of 35, concerning ankle-brachial pressure index reliability in diabetic patients, was rejected by the panel. No sufficient agreement was achieved on toe brachial index test to rule out the orphan heel syndrome, removing dry eschar in adult patients without vascular impairment, and using an antimicrobial dressing in children with infected heel pressure injuries. Eleven recommendations were approved with a weak grade of strength. Experts strongly endorsed 20 recommendations. Offloading, stages I and II pressure injuries, and referral criteria were areas characterized by higher level of agreement. Future Directions: We believe that the results of our effort could improve practice, especially in areas where clear and shared opinions emerged. Barriers and limits that could hinder implementation are also discussed in the article.
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Affiliation(s)
- Massimo Rivolo
- Independent Tissue Viability Nurse Consultant, Turin, Italy
| | | | - Diletta Olivari
- Clinica Medica, Università Politecnica delle Marche, Ancona, Italy
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19
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Daristotle JL, Zaki ST, Lau LW, Ayyub OB, Djouini M, Srinivasan P, Erdi M, Sandler AD, Kofinas P. Pressure-Sensitive Tissue Adhesion and Biodegradation of Viscoelastic Polymer Blends. ACS APPLIED MATERIALS & INTERFACES 2020; 12:16050-16057. [PMID: 32191429 PMCID: PMC7271901 DOI: 10.1021/acsami.0c00497] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Viscoelastic blends of biodegradable polyesters with low and high molecular weight distributions have remarkably strong adhesion (significantly greater than 1 N/cm2) to soft, wet tissue. Those that transition from viscous flow to elastic, solidlike behavior at approximately 1 Hz demonstrate pressure-sensitivity yet also have sufficient elasticity for durable bonding to soft, wet tissue. The pressure-sensitive tissue adhesive (PSTA) blends produce increasingly stronger pull-apart adhesion in response to compressive pressure application, from 10 to 300 s. By incorporating a stiffer high molecular weight component, the PSTA exhibits dramatically improved burst pressure (greater than 100 kPa) when used as a tissue sealant. The PSTA's biodegradation mechanism can be switched from erosion (occurring primarily over the first 10 days) to bulk chemical degradation (and minimal erosion) depending on the chemistry of the high molecular weight component. Interestingly, fibrosis toward the PSTA is reduced when fast-occurring erosion is the dominant biodegradation mechanism.
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Affiliation(s)
- John L. Daristotle
- Fischell Department of Bioengineering, University of Maryland, Room 3102 A. James Clark Hall, 8278 Paint Branch Drive, College Park, Maryland 20742, United States
| | - Shadden T. Zaki
- Department of Materials Science and Engineering, University of Maryland, 4418 Stadium Drive, College Park, Maryland 20742, United States
| | - Lung W. Lau
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, 111 Michigan Avenue NW, Washington, D.C. 20010, United States
| | - Omar B. Ayyub
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Drive, College Park, Maryland 20742, United States
| | - Massi Djouini
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Drive, College Park, Maryland 20742, United States
| | - Priya Srinivasan
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, 111 Michigan Avenue NW, Washington, D.C. 20010, United States
| | - Metecan Erdi
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Drive, College Park, Maryland 20742, United States
| | - Anthony D. Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, 111 Michigan Avenue NW, Washington, D.C. 20010, United States
| | - Peter Kofinas
- Department of Chemical and Biomolecular Engineering, University of Maryland, 4418 Stadium Drive, College Park, Maryland 20742, United States
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Pressure Injuries in the Pediatric Population: A National Pressure Ulcer Advisory Panel White Paper. Adv Skin Wound Care 2019; 32:394-408. [DOI: 10.1097/01.asw.0000577124.58253.66] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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22
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Medical Adhesive-Related Skin Injuries and Associated Risk Factors in a Pediatric Intensive Care Unit. Adv Skin Wound Care 2019; 32:176-182. [PMID: 30845071 DOI: 10.1097/01.asw.0000553601.05196.fb] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU). METHODS A cross-sectional design was adopted in the PICU of a university-based children's hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed. MAIN OUTCOME MEASURES Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients' clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically. MAIN RESULTS The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings. CONCLUSIONS Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).
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Topical Leptospermum Honey in the Management of Aplasia Cutis Congenita in Neonates. J Wound Ostomy Continence Nurs 2019; 46:343-345. [DOI: 10.1097/won.0000000000000541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Scientific and Clinical Abstracts From WOCNext 2019. J Wound Ostomy Continence Nurs 2019. [DOI: 10.1097/won.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prevention and Management of Incontinence-Associated Dermatitis in the Pediatric Population: An Integrative Review. J Wound Ostomy Continence Nurs 2019; 46:30-37. [PMID: 30608338 DOI: 10.1097/won.0000000000000490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An integrative review was conducted to synthesize evidence on prevention and management of incontinence-associated dermatitis (IAD) in the pediatric population. A 5-step integrative process was used to guide the review. Articles published from January 2000 to April 6, 2017, were identified and retrieved from CINAHL, PubMed, ProQuest (MEDLINE), and Scopus; key terms were associated with IAD, pediatric, prevention, and management. Supplemental and manual searches were carried out to identify other relevant studies. The studies' findings were extracted and summarized in a table of evidence, with their quality evaluated using the Joanna Briggs Institute's Critical Appraisal Checklist. Sixteen articles were included in the review. Articles explored prevention and management strategies including skin cleansing technique, diaper selection, and the application of topical skin care products. Inconsistent and limited evidence was found regarding the benefits of using disposable wipes in preference to water-moistened washcloths in the cleansing process and on the use of superabsorbent polymer diapers with breathable outer lining in IAD prevention. Findings were inconclusive with regard to the best topical skin care product for IAD care. However, the application of skin protectants was encouraged by the authors, as well as promoted in various clinical guidelines. The development of a structured skin care regimen supplemented by a comprehensive patient education program was advised to enhance the prevention and management of IAD.
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26
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Santosa KB, Keller M, Olsen M, Keane AM, Sears ED, Snyder-Warwick AK. Negative-Pressure Wound Therapy in Infants and Children: A Population-Based Study. J Surg Res 2019; 235:560-568. [PMID: 30691843 PMCID: PMC6364568 DOI: 10.1016/j.jss.2018.10.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/27/2018] [Accepted: 10/25/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although the safety and benefits of negative-pressure wound therapy (NPWT) have been clearly demonstrated in the adult population, studies evaluating the safety and describing the use of NPWT in the pediatric population have been limited. Given this paucity, the goals of this study were to (1) evaluate the literature dedicated to NPWT use in infants and children and (2) leverage a population-level analysis to describe the experience of NPWT use in the pediatric population. MATERIALS AND METHODS We performed a literature review and analyzed the Truven Health Analytics MarketScan Commercial Claims Databases from 2006 to 2014 to identify infants and children treated with NPWT. We evaluated patient characteristics, indications, complications before and after NPWT placement, and health care utilization within 30 d of NPWT placement. RESULTS We identified 457 articles, 11 of which fit our inclusion criteria. Most studies (65.2%) were case reports or series with less than 10 patients. In addition, we identified 3184 patients aged younger than of 18 y who were treated with NPWT between 2006 and 2014. Serious incident complications within 30 d after NPWT placement were rare (bleeding 0.6%, septicemia 0.5%, and sepsis 0.5%). CONCLUSIONS Despite the lack of robust studies, NPWT is widely used for many indications and across different ages and providers. Given the low incidence of serious complications, we conclude that NPWT use in infants and children is safe and can be effectively used by different providers spanning surgical and nonsurgical disciplines.
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Affiliation(s)
- Katherine B. Santosa
- Postdoctoral Research Fellow, Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110;
| | - Matt Keller
- Senior Statistical Data Analyst, Division of Infectious Diseases, Department of Internal Medicine, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Margaret Olsen
- Professor, Division of Infectious Diseases, Department of Internal Medicine, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Alexandra M. Keane
- Medical Student, Washington University School of Medicine, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110
| | - Erika D. Sears
- Assistant Professor, Section of Plastic Surgery, Department of Surgery, University of Michigan, 1500 E. Medical Center Drive Ann Arbor, MI 48109
| | - Alison K. Snyder-Warwick
- Assistant Professor, Division of Plastic Surgery, Department of Surgery, Washington University, 660 S. Euclid Avenue Campus Box 8238 St. Louis, MO 63110 St. Louis, MO
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Nigatu AS, Ashar H, Sethuraman SN, Wardlow R, Maples D, Malayer J, Ranjan A. Elastin-like polypeptide incorporated thermally sensitive liposome improve antibiotic therapy against musculoskeletal bacterial pathogens. Int J Hyperthermia 2019; 34:201-208. [PMID: 29278945 DOI: 10.1080/02656736.2017.1420249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Musculoskeletal infections caused by bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa in children and adults can lead to adverse outcomes including a need for extensive surgical debridement and limb amputation. To enable targeted antimicrobial release in infected tissues, the objective of this study was to design and investigate novel elastin-like polypeptide (ELP)-based thermally sensitive liposomes in vitro. ELP biopolymers can change their phase behaviour at higher temperatures. We hypothesised that ELP-TSL will improve therapeutic efficacy by releasing antimicrobial payloads locally at higher temperatures (≥39 °C). ELP-TSL library were formulated by varying cholesterol and phospholipid composition by the thin film and extrusion method. A broad-spectrum antimicrobial (Ciprofloxacin or Cipro) was encapsulated inside the liposomes by the ammonium sulphate gradient method. Cipro release from ELP-TSLs was assessed in physiological buffers containing ∼25% serum by fluorescence spectroscopy, and efficacy against Staphylococcus aureus and Pseudomonas aeruginosa was assessed by disc diffusion and planktonic assay. Active loading of Cipro achieved an encapsulation efficiency of 40-70% in the ELP-TSL depending upon composition. ELP-TSL Cipro release was near complete at ≥39 °C; however, the release rates could be delayed by cholesterol. Triggered release of Cipro from ELP-TSL at ∼42 °C induced significant killing of S. aureus and P. aeruginosa compared to 37 °C. Our in vitro data suggest that ELP-TSL may potentially improve bacterial wound therapy in patients.
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Affiliation(s)
- Adane S Nigatu
- a Center for Veterinary Health Sciences , Oklahoma State University , Stillwater , OK , USA
| | - Harshini Ashar
- a Center for Veterinary Health Sciences , Oklahoma State University , Stillwater , OK , USA
| | | | - Rachel Wardlow
- a Center for Veterinary Health Sciences , Oklahoma State University , Stillwater , OK , USA
| | - Danny Maples
- a Center for Veterinary Health Sciences , Oklahoma State University , Stillwater , OK , USA
| | - Jerry Malayer
- a Center for Veterinary Health Sciences , Oklahoma State University , Stillwater , OK , USA
| | - Ashish Ranjan
- a Center for Veterinary Health Sciences , Oklahoma State University , Stillwater , OK , USA
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28
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Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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Ousey K, Cutting KF, Rogers AA, Rippon MG. The importance of hydration in wound healing: reinvigorating the clinical perspective. J Wound Care 2016; 25:122, 124-30. [PMID: 26947692 DOI: 10.12968/jowc.2016.25.3.122] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.
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Affiliation(s)
- K Ousey
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
| | | | | | - M G Rippon
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
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Rippon M, Ousey K, Cutting K. Wound healing and hyper-hydration: a counterintuitive model. J Wound Care 2016; 25:68, 70-5. [DOI: 10.12968/jowc.2016.25.2.68] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- M.G. Rippon
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
| | - K. Ousey
- School of Human and Health Sciences, Institute of Skin Integrity and Infection Prevention. University of Huddersfield, Queensgate, Huddersfield
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Hilliard C, Brenner M. Assimilation into daily practice: implementing and sustaining a randomised-controlled trial in a children's clinical service. J Clin Nurs 2015; 25:186-93. [DOI: 10.1111/jocn.13108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Carol Hilliard
- Nursing Practice Development Unit; Our Lady's Children's Hospital Crumlin; Dublin 12 Ireland
| | - Maria Brenner
- School of Nursing, Midwifery & Health Systems; University College Dublin; Dublin 4 Ireland
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Keswani SG. Second Annual Meeting of the International Society of Pediatric Wound Care. Adv Wound Care (New Rochelle) 2015; 4:583-586. [PMID: 26487976 DOI: 10.1089/wound.2015.0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The overarching goals of the International Society of Pediatric Wound Care (ISPeW) are to (1) set global standards for the assessment and treatment of pediatric wounds of varying etiologies; (2) provide a forum for international interprofessional collaboration among healthcare professionals, researchers, educators, and industry leaders dedicated to the care of pediatric wounds; (3) promote and support clinical research focused on the prevention, assessment, and treatment of pediatric wounds; (4) collaborate with wound care organizations worldwide on pediatric wound care issues; and (5) provide evidence-based pediatric wound care education to healthcare professionals, parents, and lay caregivers. This edition of Advances in Wound Care includes some of the work that was presented at the 2014 ISPeW meeting in Rome. The first article by Dr. Romanelli, is an in-depth description of the progression of skin physiology throughout its maturational stages and clinical implication. A cutting edge article by Dr. Timothy King then follows, with regard to scar prevention in postnatal tissues. This is followed by a comprehensive look at debridement techniques in pediatric trauma by Dr. Ankush Gosain. Next, is a cautionary article by Dr. Luca Spazzapan that examines the prevalence of diabetic foot ulcers in children and the potential for an epidemic. The last article in this series is from the keynote speaker, Dr. Amit Geffen, who eloquently examines the use of biomaterials to offload and prevent pediatric pressure ulcers.
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Affiliation(s)
- Sundeep G. Keswani
- Laboratory for Regenerative Tissue Repair, Division of Pediatric, General, Thoracic and Fetal Surgery, Texas Children' Hospital and the Baylor College of Medicine, Houston, Texas
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Block L, King TW, Gosain A. Debridement Techniques in Pediatric Trauma and Burn-Related Wounds. Adv Wound Care (New Rochelle) 2015; 4:596-606. [PMID: 26487978 DOI: 10.1089/wound.2015.0640] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Significance: Traumatic injuries are the leading cause of morbidity and mortality in children. The purpose of this review is to provide an overview of the initial assessment and management of traumatic and burn wounds in children. Special attention is given to wound cleansing, debridement techniques, and considerations for pain management and psychosocial support for children and families. Recent Advances: Basic and translational research over the last 5-7 years has advanced our knowledge related to the optimal care of acute pediatric traumatic and burn wounds. Data concerning methods, volume, solution and timing for irrigation of acute traumatic wounds, timing and methods of wound debridement, including hydrosurgery and plasma knife coblation, and wound dressings are presented. Additionally, data concerning the long-term psychosocial outcomes following acute injury are presented. Critical Issues: The care of pediatric trauma and burn-related wounds requires prompt assessment, pain control, cleansing, debridement, application of appropriate dressings, and close follow-up. Ideally, a knowledgeable multidisciplinary team cares for these patients. A limitation in the care of these patients is the relative paucity of data specific to the care of acute traumatic wounds in the pediatric population. Future Directions: Research is ongoing in the arenas of new debridement techniques and instruments, and in wound dressing technology. Dedicated research on these topics in the pediatric population will serve to strengthen and advance the care of pediatric patients with acute traumatic and burn wounds.
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Affiliation(s)
- Lisa Block
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Timothy W. King
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ankush Gosain
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Pediatric Trauma Program, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Amaya R. Safety and efficacy of active Leptospermum honey in neonatal and paediatric wound debridement. J Wound Care 2015; 24:95; 97-103. [DOI: 10.12968/jowc.2015.24.3.95] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- R. Amaya
- Paediatric Specialist; Pediatric Specialists of Houston,1140 Business Center Drive, Suite 300, Houston, TX 77043
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