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Liosatos K, Tobiano G, Gillespie BM. Patient participation in surgical wound care in acute care settings: An integrative review. Int J Nurs Stud 2024; 157:104839. [PMID: 38901124 DOI: 10.1016/j.ijnurstu.2024.104839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/02/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Surgical site infections can significantly impact postoperative recovery. Patient participation, which involves patients actively engaging in wound care, has been linked to improved healing and reduced wound complications. However, there is limited synthesis of the literature that explores the patient's role and participation in the context of surgical wound care. OBJECTIVE To explore patients' perceptions of how they participate in surgical wound care, within 30 days post-operation. DESIGN An integrative review guided by Whittemore and Knafl's methodology. This review was registered with PROSPERO (CRD42022363669). DATA SOURCES Searches were conducted in Medline (Ovid), CINAHL (Complete), and EMBASE (Elsevier) databases in October 2023, supplemented by forward and backward citation searching. REVIEW METHODS Based on a priori eligibility criteria, two authors independently screened articles to select relevant studies. The quality of the included research articles was critically appraised using the Mixed Methods Appraisal Tool. A descriptive and thematic synthesis was used to synthesise the findings. RESULTS Of the 4701 records screened for titles and abstracts, 25 studies using qualitative, quantitative, and mixed-methods designs were included. Three key themes were identified. In theme 1, 'I am healing: how my wound shapes me and my journey,' physical symptoms, psychological factors and previous experiences significantly influenced patients' engagement in wound care. Theme 2, 'Taking charge of my healing: my active engagement in wound care' described how patient participation in surgical wound care goes beyond clinical procedures and can include the use of technology and holistic self-care. Finally, theme 3, 'Navigating the path to recovery: How others shape my experience' showed that effective communication is crucial for promoting participation, yet issues like inadequate information can leave patients unprepared for wound management. CONCLUSIONS This review highlights opportunities to personalise and prioritise a patient-oriented approach to surgical wound care. Clinicians and educators should adopt an individualised approach by tailoring patient participation based on patient factors (i.e. physical symptoms) and adopt patient-centred communication approaches. Researchers should focus on exploring approaches to self-care and technology, as these approaches may enhance patient participation in wound care.
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Affiliation(s)
- Kita Liosatos
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia.
| | - Georgia Tobiano
- NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
| | - Brigid M Gillespie
- School of Nursing and Midwifery, Griffith Health, Gold Coast Campus, Queensland 4222, Australia; NHMRC Centre for Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD 4222, Australia; Gold Coast Hospital and Health Service, Queensland 4215, Australia
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Nyman J, Hasselmann J, Monsen C, Acosta S. Staged versus nonstaged elective hybrid iliofemoral revascularization - analysis of ten years of prospective data. Ann Vasc Surg 2024:S0890-5096(24)00423-0. [PMID: 39009127 DOI: 10.1016/j.avsg.2024.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/29/2024] [Accepted: 05/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Reports of large series of hybrid iliofemoral revascularization for chronic lower limb ischemia are scarce. The aims of this study were to evaluate outcomes for staged and nonstaged procedures, and to evaluate risk factors for outcomes at 90 days. METHODS Patients were consecutively included between 2013 and 2023. Surgical site infection (SSI) was defined by the ASEPSIS criteria and major adverse limb events (MALE) as onset of acute or continuing or worsening chronic limb ischemia or major amputation. Factors associated with outcomes were tested in a multivariable logistic regression analysis and expressed in odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Patients undergoing nonstaged procedures (n = 124) had higher Trans-Atlantic Inter-Society Consensus (TASC) class representing anatomical occlusive complexity, more often through-and through femoral guidewire access, more endoprosthesis, more covered stents, longer procedure time with open groin wounds, and less contralateral femoral access, than those undergoing staged procedures (n = 31). The median time interval between the staged procedures was 1 day, and iliac stenting was done first in 77%. The median in-hospital stay was nonsignificantly longer in staged procedure (8 vs. 6 days, P = 0.053). The overall SSI and MALE rates were 25.8% and 20.0%, respectively, without differences between groups. Diabetes mellitus (OR 3.7, 95% CI 1.2-7.2]) and presence of a foot ulcer (OR 3.7, 95% CI [1.5-9.4]) were independently associated with MALE at 90 days. Postoperative hyperglycemia was nonsignificantly associated with SSI (OR 2.1 (95% CI 1.0-4.5), P = 0.066) in multivariable analysis. CONCLUSIONS The risks of SSI and MALE after elective hybrid iliofemoral revascularization were high. There appears to be no benefit in performing staged as opposed to nonstaged procedures. The extent of iliofemoral occlusive disease according to the TASC classification had little influence on outcomes whereas diabetes mellitus and presence of a foot ulcer had greater impact on MALE.
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Affiliation(s)
- Johan Nyman
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.
| | - Julien Hasselmann
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Christina Monsen
- Department of Allied Health Professions, Skane University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skane University Hospital, Malmö, Sweden; Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
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Graversen CB, Missel M, Jakobsen S. Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery: A qualitative study. JOURNAL OF VASCULAR NURSING 2023; 41:171-179. [PMID: 38072569 DOI: 10.1016/j.jvn.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Closed-incision negative pressure therapy may lower the risk of surgical site infections in patients after peripheral arterial surgery. AIM To explore patient experience of negative pressure therapy applied to groin incisions after discharge following peripheral arterial surgery, and to study their perception and attitudes toward the self-care information sheet they received at the vascular department. METHODS A qualitative study underpinned by Gadamer's philosophical hermeneutics was conducted semi-structured interviews by telephone around day seven after therapy ended with ten participants. All had received self-care information sheet at the discharge and been home with closed-incision negative pressure therapy for 3-6 days. The participants had open peripheral arterial surgery in the groin in form of femoral thromboendarterectomy. Kvale and Brinkmann's research guided the data collection, analysis, and interpretation. FINDINGS Patients found themselves coping with an unfamiliar situation after peripheral arterial surgery and the need arose to conceal the pump and tubing that were part of their incision treatment to protect their self-image. Their treatment became a constant companion, with some patients viewing the equipment as an extension of their bodies and others feeling its impact on activities of daily living. Patients perceived the treatment as providing reassurance, albeit with constraints, leading to feelings of manageability and an increasing sense of control. They viewed the written information as informative but with room for improvement. CONCLUSIONS Patient experiences of closed-incision negative pressure therapy on groin incisions after discharge following peripheral arterial surgery showed that they perceived it as safe and manageable. Patients need support, however, in learning how to hide the treatment and to expand their own involvement and improve self-care. The study found that patient involvement and individually tailored information is essential to facilitating a healthy transition from hospital to self-care at home and that written information must be improved further.
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Affiliation(s)
- Camilla Borch Graversen
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns vej 5, 2100 Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns vej 5, 2100 Copenhagen, Denmark
| | - Sally Jakobsen
- Department of Vascular Surgery, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns vej 5, 2100 Copenhagen, Denmark.
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Doss ER, Vogel TR, Kruse RL, Camazine M, Schlesselman C, Popejoy LL. Discharge process challenges of an academic vascular surgery service: A qualitative study. Res Nurs Health 2023; 46:210-219. [PMID: 36582026 DOI: 10.1002/nur.22292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/23/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022]
Abstract
Vascular surgery patients have a high incidence of unplanned hospital readmissions and complications. Previous research has not fully examined specific elements of the hospital discharge process for vascular surgery patients to identify issues that may contribute to readmissions. The objective of this qualitative descriptive study was to explore challenges identified by healthcare providers and patients regarding the discharge process from an academic vascular surgery service. Data were collected from eight focus group interviews and analyzed for relevant themes. Patients and healthcare providers identified several challenges within the standard discharge process, including ineffective communication, insufficient time for discharge education, and limitations accessing providers with post-discharge concerns. These obstacles may be ameliorated in part by specialized coordinators, caregiver support, and use of adaptive strategies outside of the current discharge process. The discharge challenges described by study participants likely contribute to adverse post-hospitalization outcomes, including unplanned hospital readmissions. A multifaceted approach that incorporates standardized discharge processes, as well as informal problem-solving strategies, is recommended to improve hospital discharge and outcomes for vascular surgery patients.
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Affiliation(s)
- Elizabeth R Doss
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Todd R Vogel
- Division of Vascular Surgery, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Maraya Camazine
- Division of Vascular Surgery, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Chase Schlesselman
- Division of Vascular Surgery, School of Medicine, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Lori L Popejoy
- Sinclair School of Nursing, University of Missouri-Columbia, Columbia, Missouri, USA
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Przybek-Mita J, Bazaliński D, Szewczyk MT, Kardyś D, Mańkowski B, Więch P. Nurses' Readiness to Undertake Controlled Negative Pressure Therapy in the Treatment of Chronic Wounds-Research Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3388. [PMID: 36834083 PMCID: PMC9966321 DOI: 10.3390/ijerph20043388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Local wound treatment with negative pressure wound therapy (NPWT) shortens the healing process but requires the supervision of trained medical personnel for administering the therapeutic procedures. Professional supervision and control of the effectiveness of NPWT, as well as education conducted by nurses, are of particular importance for therapeutic and caring processes, both in hospital and at home. The aim of the study was the assessment of the perception of NPWT by certified nurses in the topical treatment of chronic wounds. The study was conducted using the method of estimation and a diagnostic survey with the proprietary NPWT perception questionnaire: 495 subjects were enrolled in the study and 401 respondents aged 25-67 years qualified for statistical analysis. Despite their experience and competence, the respondents critically assessed their knowledge, pointing to an average subjective level of knowledge related to wound treatment and a low level of knowledge related to NPWT. Most of the respondents had no experience of independent treatment using this method. The data obtained from the questionnaire clearly indicate theoretical preparation and high motivation to undertake activities related to the implementation of NPWT in their own practice. Low readiness values suggested that the subjects did not have the resources or the ability to implement the method. The perception of NPWT in the surveyed group of nurses was determined by numerous factors, including self-assessment of their own knowledge, motivation and readiness to use NPWT. A high level of NPWT perception was noted, despite low motivation related to the availability and knowledge of the method. Theoretical knowledge is insufficient to implement innovative methods in local wound treatment. Practical skills and motivation are indispensable elements that should be met during the training and education of nurses in the field of wound care.
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Affiliation(s)
- Joanna Przybek-Mita
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland
- Postgraduate Nursing and Midwifery Education Centre, 35-083 Rzeszów, Poland
| | - Dariusz Bazaliński
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland
- Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów Father B. Markiewicz, 36-200 Brzozów, Poland
| | - Maria Teresa Szewczyk
- Department of Perioperative Nursing, Department of Surgical Nursing and Chronic Wound Care, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-821 Bydgoszcz, Poland
| | - Daria Kardyś
- Department of Hematology, Clinical Provincial F. Chopin Memorial Hospital No. 1, 2 Szopen Street, 35-055 Rzeszów, Poland
| | - Bartosz Mańkowski
- General Surgery and Multi-Organ Disorders Ward, Multidisciplinary Municipal J. Struś Memorial Hospital in Poznań, 61-285 Poznań, Poland
- Craniofacial Surgery Clinic of Medical University in Poznań, 61-701 Poznań, Poland
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland
- Departmenet of Nursing, Institute of Health Protection, State University of Applied Sciences in Przemyśl, 37-700 Przemyśl, Poland
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Doss ER, Popejoy LL. Interventions to Prevent Readmissions in Hospitalized Peripheral Vascular Surgery Patients: A Systematic Review. Clin Nurs Res 2023; 32:423-432. [PMID: 35369738 DOI: 10.1177/10547738221085612] [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: 02/01/2023]
Abstract
A large proportion of peripheral vascular patients worldwide experience unplanned hospital readmissions after inpatient vascular surgery. This review was conducted to identify acute care and post-discharge interventions that may help in reducing unplanned vascular surgery readmissions. A computer-based search of four databases was conducted July 2021 for original research reports published 2000 to 2021. Eight studies met inclusion criteria, with interventions including multidisciplinary care teams, advance practice provider discharge coordination, individualized case management, home care nursing, early primary care provider or telephone follow-up, and telehealth driven follow up evaluated. Some reductions in readmission rates were associated with most interventions but were inconsistent across studies. Further research is necessary to clarify and validate these findings, incorporate patient perspectives, and explore the role of technology-based interventions. This work is key to improving the patient's experience, reduce healthcare costs, and strengthen the quality of vascular surgery care.
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Ma GW, Botros D, Summers deLuca L, Kayssi A. Qualitative research in vascular surgery. Semin Vasc Surg 2022; 35:438-446. [DOI: 10.1053/j.semvascsurg.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/15/2022] [Accepted: 10/15/2022] [Indexed: 11/15/2022]
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Huang Y, Mao B, Hu J, Xu B, Ni P, Hou L, Xie T. Consensus on the health education of home-based negative pressure wound therapy for patients with chronic wounds: a modified Delphi study. BURNS & TRAUMA 2022; 9:tkab046. [PMID: 34993255 PMCID: PMC8717889 DOI: 10.1093/burnst/tkab046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/30/2021] [Indexed: 01/13/2023]
Abstract
Background The study aimed to develop consensus on the components of health education of home-based negative pressure wound therapy (NPWT) for patients with chronic wounds. Methods A Delphi method was used to achieve consensus on the components of health education and 75% agreement and coefficient of variation (CV) <0.25 were used as cutoff. Sixteen experts were recruited purposefully to finish this study. Results Two rounds of consultation were implemented. Consensus was achieved on 36 of the 42 statements. The final agreed list of statements represented three domains: health education before carrying out home-based NPWT, health education for the treatment day of NPWT at hospital and health education for NPWT at home. Conclusions This study was the first attempt to develop consensus on the comprehensive components of health education of home-based NPWT for patients with chronic wounds. According to the established framework and components of health education, wound professionals can safely and effectively implement health education of home-based NPWT for patients with chronic wounds and improve their self-care ability and treatment experience at home.
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Affiliation(s)
- Yao Huang
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Beiqian Mao
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Virginia 23298, USA
| | - Bing Xu
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Pengwen Ni
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Lili Hou
- Nursing Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Ting Xie
- Wound Healing Center at Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Huang Y, Hu J, Mao B, Ni P, Shou Y, Hou L, Xie T. Perspectives on the Process of Negative Pressure Wound Therapy at Home in Patients With Chronic Wound: A Qualitative Descriptive Study. INT J LOW EXTR WOUND 2020; 21:384-396. [PMID: 32772902 DOI: 10.1177/1534734620946577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to explore the experience of negative pressure wound therapy (NPWT) at home among Chinese chronic wound patients. Qualitative descriptive study design was adopted, and qualitative data were collected through semistructured in-depth interviews. A purposive, sampling method was used. Informants were recruited from one single wound healing center of a teaching hospital and were interviewed following one course of NPWT at home. A thematic content analysis was undertaken in the framework of input-process-output theory to guide analysis. Of the 13 participants interviewed, 9 were female and 4 were male with an age ranging from 20 to 69 years. Two major categories with their corresponding codes were identified. The first, positive experience, had 6 codes: high-degree identity and feeling hope (input); easy operation and convenience (process); improvement of symptoms and effective treatment (output). The second category, negative experience, had 11 codes: high expenditure, defects of the NPWT device, health education deficiency, and lack of independence and rationales in making decision of NPWT (input); poor communication with wound professionals, unexpected circumstances, therapeutic side effects, and a change of self-image (process); impact on physical symptoms and daily life, impact on social activities, and impact on psychological well-being (output). Patients considered the NPWT at home as a promising regimen, but they also had a feeling of not being prepared and lack of health education to make medical decision independently. The participants' perceptions and experiences would provide valuable information to promote the intervention program of health education and advance service process optimization.
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Affiliation(s)
- Yao Huang
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Jiao Tong University School of nursing
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, USA
| | - Beiqian Mao
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengwen Ni
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyan Shou
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lili Hou
- Nursing department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Xie
- Emergency Department, Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Inpatient Versus Outpatient Management of Negative Pressure Wound Therapy in Pediatric Patients. J Surg Res 2020; 254:197-205. [PMID: 32450421 DOI: 10.1016/j.jss.2020.04.025] [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: 07/29/2019] [Revised: 04/05/2020] [Accepted: 04/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of our study was to leverage a population-level analysis to advance our current knowledge about outpatient NPWT use in pediatric patients. MATERIALS AND METHODS We analyzed the Truven Health Analytics MarketScan Commercial Claims Database from 2006 to 2014 to identify children treated with NPWT. We compared patient characteristics, indications, complications before and after NPWT, health care utilization within 30 d of NPWT initiation, and health care cost profile of patients treated with NPWT primarily as outpatients versus inpatients. Outpatient NPWT was defined as patients with ≤50% of NPWT coded during an inpatient hospitalization, whereas inpatient NPWT was defined as patients with >50% of NPWT. RESULTS We identified 3184 patients (1621 inpatients and 1563 outpatients) aged 0-17 y, who were treated with NPWT from 2006 to 2014. Outpatient NPWT was implemented across multiple ages, comorbidities, and indications, with a low complication rate (2.4%). After controlling for hematologic comorbidity and indications, outpatient NPWT was associated with lower risk of complications (odds ratio: 0.57, 95% confidence interval 0.38-0.86) and lower median total costs ($5602.03) compared with inpatient ($15,233.21) therapy. CONCLUSIONS Outpatient NPWT management in pediatric patients was associated with low complication rates. Additional studies are necessary to determine the most overall cost-effective treatment setting for NPWT in the pediatric population.
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Bazaliński D, Kózka M, Karnas M, Więch P. Effectiveness of Chronic Wound Debridement with the Use of Larvae of Lucilia Sericata. J Clin Med 2019; 8:E1845. [PMID: 31684038 PMCID: PMC6912827 DOI: 10.3390/jcm8111845] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023] Open
Abstract
The process of successful wound healing depends on effective debridement and infection control. One method of wound debridement, known since antiquity, is based on the use of fly larvae. Solid scientific evidence proves that maggot debridement therapy (MDT), like surgical intervention, can be effectively and safely used to remove necrotic tissue. Based on a review of the related literature, this study was designed to assess the effectiveness of chronic wound cleansing with the use of larvae of Lucilia sericata (Phaenicia sericata). Maggot therapy, applied in wound debridement and treatment, is a safe and effective method. Its benefits are associated with debridement, disinfection and faster tissue growth. MDT may reduce the duration of antibiotic therapy and the need for hospitalization, or it may decrease the number of outpatient visits required. It is a relatively cost-effective method, and, in addition to financial gains, it may reduce the frequency of inpatient treatment. In the literature, an increasing amount of scientific evidence confirms that such treatment can effectively reduce the biofilm and bacterial load in a wound.
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Affiliation(s)
- Dariusz Bazaliński
- Father B. Markiewicz Podkarpackie Specialist Oncology Centre, Specialist Hospital in Brzozów, 36-200 Brzozów, Poland.
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, 31-501 Krakow, Poland.
| | - Magdalena Karnas
- New Medical Technologies, Holy Family Specialist Hospital, 36-060 Rudna Mała, Poland.
| | - Paweł Więch
- Institute of Health Sciences, College of Medical Sciences of the University of Rzeszów, University of Rzeszów, 35-959 Rzeszów, Poland.
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Bazaliński D, Więch P, Kaczmarska D, Sałacińska I, Kózka M. Use of controlled negative pressure in management of phlegmon caused by fulminant complication of pressure wound: A case report. Medicine (Baltimore) 2018; 97:e11319. [PMID: 29995766 PMCID: PMC6076132 DOI: 10.1097/md.0000000000011319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
RATIONALE Effective wound healing depends on the adequate choice of the wound cleansing method, to enable rapid removal of necrotic tissue. Negative pressure wound therapy (NPWT) is an effective non-invasive technique for management of wounds of varied aetiology, including deep tissue injuries caused by pressure. PATIENT CONCERNS This article discusses a case of an 82-year-old female receiving hospice care at home owing to progressing untreated thoracic spinal stenosis, bedridden for 4 years, incapable of self-care. DIAGNOSES Three fulminant pressure wounds, 50 cm each, with signs of undermining, Stage II/IV according to National Pressure Ulcer Advisory Panel, were identified in the area of the sacrum and the right and left trochanter. Despite measures used to prevent pressure sores, and nutritional supplementation, two months later a fourth pressure ulcer involving subcutaneous tissue was identified in the area of the right sciatic tuber, accompanied with signs of systemic inflammatory response, as well as massive phlegmon and lesion in the ischial bone. INTERVENTIONS As previously applied treatments (surgical necrectomy, biological therapy - Lucilia Sericata maggots, autolysis, pharmacological therapy) proved ineffective, NPWT was experimentally administered to evacuate exudate and to cleanse the wound. OUTCOMES Application of negative pressure during a 42-day therapy allowed significantly faster cleansing of the wound. The pressure wounds was significantly reduced in size, and necrotic tissue was removed from the sciatic tuber, which ultimately was covered with granulation tissue. LESSONS Controlled negative pressure can successfully be used in the process of cleansing an infected pressure wound to safely remove exudate and to minimise local inflammation. Administration of controlled negative pressure is an effective and safe method in the process of cleansing an infected pressure wound.
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Affiliation(s)
- Dariusz Bazaliński
- Institute of Nursing and Health Sciences, Department of Medicine, University of Rzeszow, Rzeszow
- Specialist Hospital Podkarpackie Oncology Center in Brzozów, Brzozow
| | - Paweł Więch
- Institute of Nursing and Health Sciences, Department of Medicine, University of Rzeszow, Rzeszow
| | - Dorota Kaczmarska
- Specialist Hospital Podkarpackie Oncology Center in Brzozów, Brzozow
| | - Izabela Sałacińska
- Institute of Nursing and Health Sciences, Department of Medicine, University of Rzeszow, Rzeszow
| | - Maria Kózka
- Department of Clinical Nursing, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Krakow, Poland
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McCaughan D, Sheard L, Cullum N, Dumville J, Chetter I. Patients' perceptions and experiences of living with a surgical wound healing by secondary intention: A qualitative study. Int J Nurs Stud 2018; 77:29-38. [PMID: 29031127 PMCID: PMC5744862 DOI: 10.1016/j.ijnurstu.2017.09.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 08/14/2017] [Accepted: 09/23/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most surgical wounds heal by primary intention, that is to say, the edges of the wound are brought together with sutures, staples, adhesive glue or clips. However, some wounds may be left open to heal (if there is a risk of infection, or if there has been significant tissue loss), and are known as 'surgical wounds healing by secondary intention'. They are estimated to comprise approximately 28% of all surgical wounds and are frequently complex to manage. However, they are under researched and little is known of their impact on patients' lives. OBJECTIVES To explore patients' views and experiences of living with a surgical wound healing by secondary intention. DESIGN A qualitative, descriptive approach. SETTINGS Participants were recruited from acute and community nursing services in two locations in the North of England characterised by high levels of deprivation and diverse populations. PARTICIPANTS Participants were aged 18 years or older and had at least one surgical wound healing by secondary intention, which was slow to heal. Purposeful sampling was used to include patients of different gender, age, wound duration and type of surgery (general, vascular and orthopaedic). Twenty people were interviewed between January and July 2012. METHODS Semi-structured interviews were conducted, guided by use of a topic guide developed with input from patient advisors. Data were thematically analysed using steps integral to the 'Framework' approach to analysis, including familiarisation with data; development of a coding scheme; coding, charting and cross comparison of data; interpretation of identified themes. FINDINGS Alarm, shock and disbelief were frequently expressed initial reactions, particularly to "unexpected" surgical wounds healing by secondary intention. Wound associated factors almost universally had a profound negative impact on daily life, physical and psychosocial functioning, and wellbeing. Feelings of frustration, powerlessness and guilt were common and debilitating. Patients' hopes for healing were often unrealistic, posing challenges for the clinicians caring for them. Participants expressed dissatisfaction with a perceived lack of continuity and consistency of care in relation to wound management. CONCLUSIONS Surgical wounds healing by secondary intention can have a devastating effect on patients, both physical and psychosocial. Repercussions for patients' family members can also be extremely detrimental, including financial pressures. Health care professionals involved in the care of patients with these wounds face multiple, complex challenges, compounded by the limited evidence base regarding cost-effectiveness of different treatment regimens for these types of wounds.
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Affiliation(s)
- Dorothy McCaughan
- University of York, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Laura Sheard
- Bradford Institute for Health Research, Bradford, BD9 6RJ, UK
| | - Nicky Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK; Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Jean McFarlane Building, Manchester M13 9PL, UK
| | - Jo Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Ian Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull, Hull and East Yorkshire NHS trust, Hull, HU3 2JZ, UK
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