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Zhou F, Zhang Y, Gao J, Xiang G, Li Z, Cai L. Reconstruction of foot and ankle defects using the vaccum sealing drainage versus the induced-membrane the elderly: A retrospective comparative study. Int Wound J 2024; 21:e14362. [PMID: 37605359 PMCID: PMC10781590 DOI: 10.1111/iwj.14362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
The purpose of this study was to compare the reconstructive outcomes of soft-tissue defects around foot and ankle with vaccum sealing drainage (VSD) or induction membrane (IM) of cement formation and attempt to provide an optimal strategy for elderly patients. A retrospective review of all continuous patients with foot and ankle reconstruction using different flaps from October of 2016 and October of 2020 was performed. Based on the different way, the patients were divided into two groups: VSD group (n = 26) and IM group (n = 27). Outcomes were assessed according to the size of the defect, frequency of debridement procedures, hospitalization time, duration of healing, the healing rate, major amputation rate, functional outcomes and complications. Immunohistochemistry (IHC) detection of vascular endothelial growth factor (VEGF) was also be completed. We found that there was no difference in demographic characteristics, size of the defect, debridement times and functional outcomes between the two groups (p > 0.05); however, a significant difference in the wound healing time, hospitalization time and complications were noted between them(p < 0.05). The fresh granulation tissue of both groups showed abundant positive expression of VEGF. Thus, the VSD and IM are both available for foot and ankle reconstruction in elderly patients. However, the IM group offers short hospitalization time, duration of healing and lower frequency of postoperative complications. Thus, we advocate the IM for reconstruction of defects of the foot and ankle region in the elderly patients.
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Affiliation(s)
- Feiya Zhou
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Yingying Zhang
- Department of RadiologyThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Jianyuan Gao
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Guangheng Xiang
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Zhijie Li
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
| | - Leyi Cai
- Department of Orthopaedics SurgeryThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvincePeople's Republic of China
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2
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Li D, Mathews C, Zamarripa C, Zhang F, Xiao Q. Wound tissue segmentation by computerised image analysis of clinical pressure injury photographs: a pilot study. J Wound Care 2022; 31:710-719. [PMID: 36001699 DOI: 10.12968/jowc.2022.31.8.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Wound tissues can provide ample information about the wound development and healing process. However, the manual identification and measurement of wound tissue types is time-consuming and challenging due to the complexities of pressure injuries (PI). This study aims to develop an image analysis algorithm to automatically identify and differentiate wound tissue types from PI wound beds. METHOD This was a cross-sectional algorithm development study. PI photographs were obtained from a western Pennsylvania hospital. We used our previously developed wound bed segmentation tool to identify PI wound beds. We then used the k-means clustering method to classify the subzones on the wound beds. Finally, the support vector machine classifier was used to identify the classified subzones to certain types of wound tissue. RESULTS An image analysis algorithm was developed, using 64 selected PI photographs, to automatically identify different wound tissues for PIs. CONCLUSION Validation of the wound tissue identification of the PIs by image analysis algorithm demonstrated that our image analysis algorithm is a reliable and objective approach to monitoring wound healing progress through clinical PI photographs, and offers new insight into PI evaluation and documentation. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Dan Li
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, US
| | - Carol Mathews
- University of Pittsburgh Medical Center Presbyterian Shadyside, US
| | | | - Fei Zhang
- Department of Nurse Anesthesia, University of Pittsburgh School of Nursing, US
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China
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3
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Wilson JM, Petis SM, Pagnano MW, Sierra RJ, Trousdale RT, Taunton MJ. Scar Perception After Two Surgical Approaches for Total Hip Arthroplasty. Arthroplast Today 2022; 14:96-99. [PMID: 35252513 PMCID: PMC8892017 DOI: 10.1016/j.artd.2022.01.028] [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: 12/09/2020] [Revised: 12/13/2021] [Accepted: 01/15/2022] [Indexed: 02/06/2023] Open
Abstract
Background There is a paucity of literature examining patients’ and health-care providers’ perception of surgical scars after total hip arthroplasty (THA). This study examined perception of surgical scars after direct anterior (DAA) or posterior approach (PA) for THA using validated scar-assessment scales. Material and methods Seventy-five DAA and 75 PA THA patients underwent scar assessment using the Patient Observer Scar Assessment Scale (POSAS) and Stony Brook Scar Evaluation Scales. Mean age was different between the cohorts (DAA 67 vs PA 62 years, P = .01). All patients had subcuticular running closure, secured with skin adhesive glue. Mean time from THA to scar assessment was 3.1 and 3.6 years for the DAA and PA groups, respectively (P = .18). Results Scar opinion on the POSAS patient-reported scale was graded closer to normal skin more often for DAA than for PA patients (P = .03). More irregularities were graded for the DAA scars on the POSAS observer scale (P = .02) and the Stony Brook Scar Evaluation Scales (P = .04). Age did not predict scar opinion on any of the scales (P > .05). Female gender and a history of keloids predicted poorer scar appearance (P = .001 and P = .02). Overall scar appearance was rated as “good” in 93% of the DAA and 91% of the PA patients (P = .63). Conclusion Differences exist in DAA and PA scar perception based on validated scales. Future randomized trials in scar assessment may control for confounding variables such as age and gender, as well as potential biases when using scar assessment scales.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Petis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mark W Pagnano
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Abstract
Surgical site infections (SSIs) are among the most common and most costly health care-associated infections, leading to adverse patient outcomes and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSI. In particular, improved adherence to evidence-based preventive measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI.
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Affiliation(s)
- Jessica Seidelman
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC, USA.
| | - Deverick J Anderson
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC, USA
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5
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Kewcharoen J, Kanitsoraphan C, Thangjui S, Leesutipornchai T, Saowapa S, Pokawattana A, Navaravong L. Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta-analysis. J Arrhythm 2021; 37:635-644. [PMID: 34141016 PMCID: PMC8207394 DOI: 10.1002/joa3.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/31/2020] [Accepted: 01/21/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Several studies have shown an inconsistent relationship between postimplantation pocket hematoma and cardiac implantable electronic device (CIED) infection. In this study, we performed a systematic review and meta-analysis to explore the effect of postimplantation hematoma and the risk of CIED infection. METHODS We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, case-control studies, cross-sectional studies, and randomized controlled trials that reported incidence of postimplantation pocket hematoma and CIED infection during the follow-up period. CIED infection was defined as either a device-related local or systemic infection. Data from each study were combined using the random effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). RESULTS Fourteen studies were included in final analysis, involving a total of 28 319 participants. In random-effect model, we found that postimplantation pocket hematoma significantly increases the risk of overall CIED infection (OR = 6.30, 95% CI: 3.87-10.24, I 2 = 49.3%). There was no publication bias observed in the funnel plot as well as no small-study effect observed in Egger's test. CONCLUSIONS Our meta-analysis demonstrated that postimplantation pocket hematoma significantly increases the risk of CIED infection. Precaution should be taken during device implantation to reduce postimplantation hematoma and subsequent CIED infection.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency ProgramHonoluluHIUSA
| | | | | | | | - Sakditad Saowapa
- Faculty of MedicineRamathibodi HospitalMahidol UniversityBangkokThailand
| | | | - Leenhapong Navaravong
- Division of Cardiovascular MedicineUniversity of Utah School of MedicineSalt Lake CityUTUSA
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Ariza F, Castaño DA, Bolaños-Aldana JD, Quintana-Díaz M. Surgical site infection in adults undergoing major non-cardiac surgery and its association with anemia, severe bleeding and intraoperative transfusion: A preliminary report from a prospective registry. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction
Surgical site infection (SSI) is among the most common healthcare-related infections. Given their greater morbidity and surgical complexity, patients undergoing major surgery are exposed to a high risk of SSI.
Objective
To determine the incidence of SSI in adult patients undergoing major elective non-cardiac surgery, and to identify risk factors associated with its occurrence within the first 30 days after surgery.
Methods
An analytical study was designed on the basis of a prospective institutional registry. Clinical and laboratory variables associated with perioperative management were recorded. An active search was conducted in order to find SSI episodes, renal failure and multiple organ dysfunction during the first 30 days after surgery. Adjusted logistic regression was done to identify potential associations between risk factors and the development of SSI.
Results
Overall, 1501 patients were included. The incidence of SSI during the first 30 days after surgery was 6.72% (95% CI 5.57-8.11). ASA III, abdominal surgery and longer procedures were more frequent in the SSI group. Association with the occurrence of SSI was documented for preoperative hemoglobin levels (adjusted OR 0.79 [95% CI 0.72-0.88], p = 0.04), intraoperative transfusion (adjusted OR 2,47 [95% CI 1.16-5.27], p = 0.02) and major blood loss (adjusted OR 3.80 [95% CI 1.63-8.88], p = 0.04).
Conclusion
Preoperative hemoglobin level, intraoperative transfusion and major bleeding are independent risk factors associated with the occurrence of SSI in adult patients undergoing major elective non-cardiac surgery.
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Skin and soft tissue infections and current antimicrobial prescribing practices in Australian aged care residents. Epidemiol Infect 2020; 147:e87. [PMID: 30869059 PMCID: PMC6519684 DOI: 10.1017/s0950268819000128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To determine the burden of skin and soft tissue infections (SSTI), the nature of antimicrobial prescribing and factors contributing to inappropriate prescribing for SSTIs in Australian aged care facilities, SSTI and antimicrobial prescribing data were collected via a standardised national survey. The proportion of residents prescribed ⩾1 antimicrobial for presumed SSTI and the proportion whose infections met McGeer et al. surveillance definitions were determined. Antimicrobial choice was compared to national prescribing guidelines and prescription duration analysed using a negative binomial mixed-effects regression model. Of 12 319 surveyed residents, 452 (3.7%) were prescribed an antimicrobial for a SSTI and 29% of these residents had confirmed infection. Topical clotrimazole was most frequently prescribed, often for unspecified indications. Where an indication was documented, antimicrobial choice was generally aligned with recommendations. Duration of prescribing (in days) was associated with use of an agent for prophylaxis (rate ratio (RR) 1.63, 95% confidence interval (CI) 1.08–2.52), PRN orders (RR 2.10, 95% CI 1.42–3.11) and prescription of a topical agent (RR 1.47, 95% CI 1.08–2.02), while documentation of a review or stop date was associated with reduced duration of prescribing (RR 0.33, 95% CI 0.25–0.43). Antimicrobial prescribing for SSTI is frequent in aged care facilities in Australia. Methods to enhance appropriate prescribing, including clinician documentation, are required.
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Munro EL, Hickling DF, Williams DM, Bell JJ. Malnutrition is independently associated with skin tears in hospital inpatient setting-Findings of a 6-year point prevalence audit. Int Wound J 2018; 15:527-533. [PMID: 29797534 PMCID: PMC7949896 DOI: 10.1111/iwj.12893] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/11/2017] [Accepted: 12/31/2017] [Indexed: 12/14/2022] Open
Abstract
Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13-2.36) and multiple skin tears (OR 2.48 [95% CI 1.37-4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure.
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Affiliation(s)
- Emma L Munro
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQLDAustralia
| | - Donna F Hickling
- Nutrition and Dietetics & Allied Health ServicesThe Prince Charles HospitalChermsideQLDAustralia
| | | | - Jack J Bell
- School of Human Movement and Nutrition SciencesUniversity of QueenslandSt LuciaQLDAustralia
- Nutrition and Dietetics & Allied Health ServicesThe Prince Charles HospitalChermsideQLDAustralia
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Wu S, Applewhite AJ, Niezgoda J, Snyder R, Shah J, Cullen B, Schultz G, Harrison J, Hill R, Howell M, Speyrer M, Utra H, de Leon J, Lee W, Treadwell T. Oxidized Regenerated Cellulose/Collagen Dressings: Review of Evidence and Recommendations. Adv Skin Wound Care 2017; 30:S1-S18. [PMID: 29049055 PMCID: PMC5704727 DOI: 10.1097/01.asw.0000525951.20270.6c] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds. DESIGN A multidisciplinary panel meeting was convened to discuss the use of ORC/collagen dressings in wound care and provide practice recommendations. A literature search was conducted to provide a brief review of the peer-reviewed studies published between January 2000 and March 2016 to inform the meeting. SETTING A 2-day panel meeting convened in February 2017. PARTICIPANTS Healthcare providers with experience using ORC/collagen dressings. This multidisciplinary panel of 15 experts in wound healing included podiatrists, wound care specialists (doctors, certified wound care nurses, and research scientists), and an orthopedist. RESULTS The literature search identified 58 articles, a majority of which were low levels of evidence (69.3% were level 3 or lower). Panel members identified wound types, such as abrasions, burns, stalled wounds, diabetic foot ulcers, and pressure injuries, where ORC/collagen dressing use could be beneficial. Panel members then provided recommendations and technical pearls for the use of ORC/collagen dressings in practice. Barriers to ORC/collagen dressing use were discussed, and potential resolutions were offered. CONCLUSIONS An ORC/collagen dressing can be a critical tool for clinicians to help manage a variety of wounds. Clinical and economic studies comparing standard-of-care dressings and plain collagen dressings to ORC/collagen dressings are needed.
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Affiliation(s)
- Stephanie Wu
- Stephanie Wu, DPM, MS, is Professor of Surgery, Dr William M. School College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, Center for Lower Extremity Ambulatory Research (CLEAR), North Chicago, Illinois. Andrew J. Applewhite, MD, CSWP, is Medical Director and Physician, Comprehensive Wound Care and Hyperbaric Center at Baylor University Medical Center, Dallas, Texas. Jeffrey Niezgoda, MD, FACHM, MAPWCA, CHWS, is President and Chief Medical Officer of Advancing the Zenith of Healthcare, Milwaukee, Wisconsin. Robert Snyder, DPM, MSc, is Professor and Director of Clinical Research, Barry University School of Podiatric Medicine, North Miami Beach, Florida. Jayesh Shah, MD, is President, South Texas Wound Associated PA, San Antonio, Texas. Breda Cullen, PhD, is R&D Program Director, Systagenix, Gargrave, United Kingdom. Gregory Schultz, PhD, is Professor, University of Florida College of Medicine, Gainesville, Florida. Janis Harrison, BSN, RN, CWOCN, CFCN, is Partner and Chief Clinical Consultant to Harrison WOC Services LLC, Thurston, Nebraska. Rosemary Hill, RN, CWOCN, CETN(C), is Enterostomal Therapist, Lions Gate Hospital, North Vancouver, British Columbia, Canada. Melania Howell, RN, CWOCN, is Wound Care Consultant, Dynamic Wound Care Solutions LLC, Turlock, California. Marcus Speyrer, RN, CWS, is Chief Operating Officer, The Wound Treatment Center LLC, Opelousas General Health System, Opelousas, Louisiana. Howard Utra, BSN, RN, CWCN, is Registered Nurse, Innovated Healing Systems, Tampa, Florida. Jean de Leon, MD, FAPWCA, is Professor, University of Texas Southwestern Medical Center, Dallas, Texas. Wayne Lee, MD, is in private practice, Hill Country Orthopaedic Surgery & Sports Medicine, San Antonio, Texas. Terry Treadwell, MD, is Medical Director, Institute for Advanced Wound Care at Baptist Medical Center, Montgomery, Alabama. ACKNOWLEDGMENTS: The authors thank Ricardo Martinez and Julie M. Robertson (ACELITY) for manuscript preparation and editing. Drs Wu, Applewhite, Niezgoda, Snyder, Shah, Schultz, de Leon, Lee, and Treadwell; Ms Harrison, Hill, and Howell; and Mr Speyrer and Mr Utra are consultants for ACELITY. Dr Cullen is an employee of Systagenix, an ACELITY Company. The panel meeting was sponsored by ACELITY
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Dubin AK, Wei J, Sullivan S, Udaltsova N, Zaritsky E, Yamamoto MP. Minilaparotomy Versus Laparoscopic Myomectomy After Cessation of Power Morcellation: Rate of Wound Complications. J Minim Invasive Gynecol 2017; 24:946-953. [DOI: 10.1016/j.jmig.2017.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022]
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Components and Quality Measures of DIME (Devitalized Tissue, Infection/Inflammation, Moisture Balance, and Edge Preparation) in Wound Care. Adv Skin Wound Care 2017; 29:205-15. [PMID: 27089149 PMCID: PMC4845765 DOI: 10.1097/01.asw.0000482354.01988.b4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES: To discuss how patient considerations and the initial wound environment can affect wound treatment and summarize the way in which the initial US Wound Registry measures capture aspects of the DIME (Debridement/devitalized tissue, Infection or inflammation, Moisture balance, and wound Edge preparation/wound depth) principles. DISCUSSION: The treatment of chronic wounds often involves extended hospital stays and long-term outpatient follow-up visits with costly advanced therapeutic interventions. As complex care is required for chronic wounds, treatment guidelines such as DIME have evolved to include consideration of patient-centered concerns and etiology, as well as features of wound bed preparation. The US healthcare system is in the midst of transitioning to a quality-based system. However, as wound care is not yet a recognized specialty, it is poorly represented in the current approved quality-based measures. CONCLUSION: This article helps to identify the practice guidelines that are not currently represented by quality metrics.
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Van Putte L, De Schrijver S, Moortgat P. The effects of advanced glycation end products (AGEs) on dermal wound healing and scar formation: a systematic review. Scars Burn Heal 2016; 2:2059513116676828. [PMID: 29799552 PMCID: PMC5965313 DOI: 10.1177/2059513116676828] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction: With ageing, the skin gradually loses its youthful appearance and functions
like wound healing and scar formation. The pathophysiological theory of
Advanced Glycation End products (AGEs) has gained traction during the last
decade. This review aims to document the influence of AGEs on the mechanical
and physiologic properties of the skin, how they affect dermal wound healing
and scar formation in high-AGE populations like elderly patients and
diabetics, and potential therapeutic strategies. Methods: This systematic literature study involved a structured search in Pubmed and
Web of Science with qualitative analysis of 14 articles after a three-staged
selection process with the use of in- and exclusion criteria. Results: Overall, AGEs cause shortened, thinned, and disorganized collagen fibrils,
consequently reducing elasticity and skin/scar thickness with increased
contraction and delayed wound closure. Documented therapeutic strategies
include dietary AGE restriction, sRAGE decoy receptors, aminoguanidine,
RAGE-blocking antibodies, targeted therapy, thymosin β4, anti-oxidant agents
and gold nanoparticles, ethyl pyruvate, Gal-3 manipulation and
metformin. Discussion: With lack of evidence concerning scars, no definitive conclusions can yet be
made about the role of AGEs on possible appearance or function of scar
tissue. However, all results suggest that scars tend to be more rigid and
contractile with persistent redness and reduced tendency towards hypertrophy
as AGEs accumulate. Conclusion: Abundant evidence supports the pathologic role of AGEs in ageing and dermal
wound healing and the effectiveness of possible therapeutic agents. More
research is required to conclude its role in scar formation and scar
therapy. Our skin is the body’s first line of defense. It is the barrier that protects us
from chemical and biological threats such as viruses, bacteria or corrosive
liquids. It is the sensor that allows us to detect physical threats like extreme
temperatures, pressure and pain. And when these preventative measures fail, the
skin has yet another property: the ability to heal. Skin changes visibly with age, most notably with the appearance of wrinkles.
However, there is more to ageing than meets the eye; invisible alterations cause
the decline of various functions of the skin, such as wound healing and scar
formation. An array of non-conclusive research has been done in this field. One
theory that has gained traction during the last decade is the Advanced Glycation
End products (AGEs) theory. The theory states that AGEs play an important role
in skin aging, wound healing and the effectiveness of different therapeutic
options. Their presence supposedly indicates a diminished ability for wound
healing and scar formation. AGEs are proteins to which sugar molecule is bound. The sugar molecule inhibits
the original protein from functioning properly. As skin contains many proteins
like collagen, the formation of these AGEs could be a viable explanation for the
diminished functioning with ageing. In this review, we investigated whether the
accumulation of AGEs affects wound healing and scar formation. Normal scar formation results in a thin scar. However, it may happen that
scarring results in thick, large, painful and itchy scars. We investigated
whether people with a high AGE content in their skin, like diabetics and
elderly, have difficulties forming aesthetically pleasing scars. Secondly, we
investigated which therapies reduce the AGE content and, if so, whether these
therapies can improve wound healing and scarring. This literature study involved
research in scientific databases with qualitative analysis of 14 articles after
a three-staged selection process with the use of set criteria. We found the different ways in which AGEs affect skin properties and wound
healing. Collagen, one of the most important proteins in the skin, is affected
by these AGEs. Once a sugar binds to it, the collagen strings becomes thinner
and shorter, and the different collagen proteins cross-link with each other in
an unstructured way. The result of these alterations is a reduced elasticity,
i.e. the skin becomes stiffer. The scar will be thinner and the time for wounds
to close is longer. We also found strategies to diminish the AGE content,
including dietary AGE restriction and Metformin, a drug used in diabetes. We can conclude that there is proof of AGEs playing an important role in skin
ageing, wound healing and the effectiveness of different therapeutic options.
However, more research is required to conclude the exact role of AGEs in scar
formation and scar therapy.
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Affiliation(s)
- Lennert Van Putte
- Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Sofie De Schrijver
- Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Peter Moortgat
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium
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Abstract
OBJECTIVE Complex wounds are often difficult to close and sometimes require a split-thickness skin graft (STSG). However, epidermal skin grafts, which contain only an epidermal layer of skin, are a viable option for wound coverage in these challenging wounds. We report our experience using an automated epidermal harvesting tool to harvest epidermal skin grafts for the treatment of complex wounds. METHOD Epidermal skin grafts were harvested from the patient's thigh, which was first washed with isopropyl alcohol. After harvesting, they were transferred to the recipient site using a film dressing. A bolster dressing using gauze and a self-adherent wrap held the grafts in place. RESULTS We selected 34 patients with wounds that had been present from several weeks to over a year. Prior treatments, included skin substitutes, alginate dressings, Unna Boot, and collagen dressings. There were 17 female and 17 male patients with a mean age of 67.1 years (range: 37-103). Wound types were: traumatic wounds, diabetic foot ulcers, venous stasis ulcers, pressure ulcers, and surgical wounds. Patient comorbidities included hypertension, diabetes, congestive heart failure, and osteoarthritis. Mean epithelialisation rate at the recipient site was 7.0 weeks (range: 1-35 weeks). Wound complications included drainage, hypergranulation, and oedema. At follow-up 82.4% (28/34) of wounds were healed, 2.9% (1/34) wounds showed improved healing, 11.8% (4/34) of wounds did not heal, and 2.9% (1/34) were lost to follow-up. All donor sites healed without complications. CONCLUSION In our cohort, use of epidermal skin grafts in conjunction with bolster dressings resulted in full closure or wound improvement of a majority of patients. Epidermal grafting provides another treatment option to physicians when only the epidermal layer is needed. DECLARATION OF INTEREST Dr. Bhatia is a consultant for KCI, an Acelity company.
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Affiliation(s)
- A Bhatia
- President and CEO, Columbus Podiatry and Surgery, Inc. and Total Healing Wound Centers, Columbus, OH, US, Assistant Medical Director, Wound Clinic, Fairfield Medical Center, Lancaster, OH, US
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Vandervord JG, Tolerton SK, Campbell PA, Darke JM, Loch-Wilkinson AMV. Acute management of skin tears: a change in practice pilot study. Int Wound J 2016; 13:59-64. [PMID: 24612698 PMCID: PMC7949676 DOI: 10.1111/iwj.12227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/03/2014] [Indexed: 11/30/2022] Open
Abstract
Skin tears are an increasingly common injury occurring in the elderly population and have significant associated morbidity secondary to poor wound healing, prolonged hospital stays and reduced mobility. There has been a shift in practice for the acute management of skin tears within our institution, which has resulted in improved outcomes and reduced morbidity for this common and debilitating injury. Review of past and current practices including cost analyses has led to the establishment of a management protocol for the hospital and wider area health service with the aim to reduce the burden of disease amongst our ever-expanding elderly population.
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Affiliation(s)
- John G Vandervord
- Department of Plastic & Reconstructive Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah K Tolerton
- Department of Plastic & Reconstructive Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Peter A Campbell
- Department of Plastic & Reconstructive Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Jan M Darke
- Department of Plastic & Reconstructive Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
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15
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McDaniel J, Giovannelli M, Happ MB. Exemplars of complex assessment and care for hospitalized older adults: genital herpes infection. Geriatr Nurs 2015; 35:233-5. [PMID: 24942524 DOI: 10.1016/j.gerinurse.2014.04.005] [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]
Affiliation(s)
- Jodi McDaniel
- The Ohio State University College of Nursing, Center of Excellence in Critical and Complex Care, 378 Newton Hall, 1585 Neil Ave., Columbus, OH 43210, USA
| | | | - Mary Beth Happ
- The Ohio State University College of Nursing, Center of Excellence in Critical and Complex Care, 378 Newton Hall, 1585 Neil Ave., Columbus, OH 43210, USA.
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16
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Affiliation(s)
- Kimberly LeBlanc
- Kimberly LeBlanc is a consultant at KDS Professional Consulting, Ottawa, Ontario, Canada; Sharon Baranoski is president of Wound Care Dynamics Inc., Shorewood, Ill
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International Skin Tear Advisory Panel: a tool kit to aid in the prevention, assessment, and treatment of skin tears using a Simplified Classification System ©. Adv Skin Wound Care 2014; 26:459-76; quiz 477-8. [PMID: 24045566 DOI: 10.1097/01.asw.0000434056.04071.68] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To enhance the learner's competence with knowledge regarding utilization of a tool kit to aid in the prevention, assessment, and treatment of skin tears. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of skin tear prevention and classification as presented in the International Skin Tear Advisory Panel's tool kit.2. Apply information from the skin tear tool kit to patient care scenarios. ABSTRACT The International Skin Tear Advisory Panel has created a tool kit for the prevention, identification, and treatment of skin tears. The tool kit is based on extensive literature reviews, international input from healthcare professionals, and on expert opinion. It has undergone a modified Delphi process.
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18
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Affiliation(s)
- Kimberly LeBlanc
- Kimberly LeBlanc is a consultant at KDS Professional Consulting, Ottawa, Ontario, Canada; Sharon Baranoski is president of Wound Care Dynamics Inc., Shorewood, Ill
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Hurlow J, Bliss DZ. Dry Skin in Older Adults. Geriatr Nurs 2011; 32:257-62. [DOI: 10.1016/j.gerinurse.2011.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Revised: 03/13/2011] [Accepted: 03/16/2011] [Indexed: 11/26/2022]
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20
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Gentian Violet 1% Solution in the Treatment of Wounds in the Geriatric Patient: A Retrospective Study. Geriatr Nurs 2011; 32:85-95. [DOI: 10.1016/j.gerinurse.2010.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 11/18/2022]
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