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Brekelmans W, Borger van der Burg BLS, Fischer B, Hesseling-Kuijpers M, Hoencamp R, Smit HJ. Real-Life Data on Wound Healing Speed and Duration to Wound Closure by Different Aetiology in a Primary Care Centre in the Netherlands. INT J LOW EXTR WOUND 2024:15347346241273327. [PMID: 39169854 DOI: 10.1177/15347346241273327] [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: 08/23/2024]
Abstract
Correct classification of wounds is of paramount importance for diagnostic and therapeutic pathways. The aim of this study was to provide insight in the incidence of different aetiology of wounds and the healing time in a primary care setting. All patients with a wound presented in Primary Care (PC) practice from January 2017 through 2020 were included. A retrospective analysis related to age, sex, duration of wound healing, healing-rates, aetiology and comorbidity of the patients was performed. The prevalence of wounds in primary care was is 3.9 per 1000. In more than 90% of the wounds heal within 37 days. The wound healing speed and duration to closure differ significantly (P = .002) between aetiology. This study shows that 90% of wounds that enter a Dutch GP practice heal within 37 days. This study provides unique data on wound healing rates differentiated by etiology.
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Affiliation(s)
- Wouter Brekelmans
- Division of Surgery, Alrijne Ziekenhuis, Leiderdorp, the Netherlands
- Alrijne Wound Centre, Leiderdorp, the Netherlands
- Division of Surgery, Leids Universitair Medisch Centrum, Leiden, the Netherlands
| | | | | | | | - Rigo Hoencamp
- Division of Surgery, Alrijne Ziekenhuis, Leiderdorp, the Netherlands
- Alrijne Wound Centre, Leiderdorp, the Netherlands
- Division of Surgery, Leids Universitair Medisch Centrum, Leiden, the Netherlands
- Ministry of Defence, The Hague, the Netherlands
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Colboc H, Ayoub N, Pegalajar-Jurado A, Schueller R, Armstrong F. Performance of a silicone foam dressing in management of wounds in a community setting: a sub-analysis of the VIPES study. J Wound Care 2024; 33:542-553. [PMID: 39140478 DOI: 10.12968/jowc.2024.0122] [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] [Indexed: 08/15/2024]
Abstract
OBJECTIVE Managing the gap between the dressing and the wound bed can facilitate the healing of exuding wounds. A silicone foam dressing (Biatain Silicone; Coloplast A/S, Denmark) was developed for application to exuding wounds. A sub-analysis of the real-world, prospective, observational VIPES (Observatoire en Ville des Plaies ExSudatives) study was conducted to investigate the use and performance of the silicone foam dressing in a community nursing setting in France. METHOD The sub-analysis included patients from the VIPES study who received the silicone foam dressing as a primary dressing for an acute or hard-to-heal (chronic) wound. Epidemiological and wound healing outcomes were reported via a smartphone application. RESULTS Overall, 64 patients were included in the sub-analysis. At baseline, most wounds (n=33/40; 82.5%) were in treatment failure (i.e., were stagnant, non-healing or had poor exudate management). At the last follow-up visit, a median of 22.5 (range: 3-151) days post baseline, 48.4% of wounds had healed and 25.0% were progressing towards healing. From baseline to the last follow-up visit, significant reductions in exudate level (p<0.0001) and exudate pooling (p<0.0001), and significant improvements in wound edges (p≤0.0001) and periwound skin (p<0.01) were observed. A total of 62.3% of patients had re-epithelialising wounds at the last follow-up visit. The majority of nurses (88.3%) and patients (85.0%) reported that the wound had improved and, at most dressing removals (93.5%), nurses reported that the dressing conformed closely to the wound bed. CONCLUSION Overall, the data suggest that use of the silicone foam dressing in community practice supported the healing of wounds, illustrating the importance of exudate and gap management.
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Affiliation(s)
- Hester Colboc
- Dermatologist and Geriatrician, Service de Gériatrie-Plaies et Cicatrisation, Sorbonne Université, Hôpital Rothschild, Paris, France
| | - Nayla Ayoub
- Senior Medical Specialist, Wound and Skin Care, Coloplast A/S, Humlebaek, Denmark
| | | | | | - Florence Armstrong
- Medical Manager, Wound and Skin Care, Laboratoires Coloplast SAS, Paris, France
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Robin C, Poiroux L, Delaunay J, Seuwou P, Martin L, Démoulins E. Tele-expertise assessment of chronic wounds by advanced practice dermatology nurses. Ann Dermatol Venereol 2024; 151:103273. [PMID: 38678771 DOI: 10.1016/j.annder.2024.103273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/04/2023] [Accepted: 03/07/2024] [Indexed: 05/01/2024]
Affiliation(s)
- C Robin
- Service de Dermatologie, CHU d'Angers, 49933 Angers, France.
| | - L Poiroux
- Direction de la recherche clinique et de l'innovation, CHU d'Angers, 49933 Angers, France
| | - J Delaunay
- Service de Dermatologie, CHU d'Angers, 49933 Angers, France
| | - P Seuwou
- University of Northampton, Northampton, United Kingdom
| | - L Martin
- Service de Dermatologie, CHU d'Angers, 49933 Angers, France
| | - E Démoulins
- Service de Dermatologie, CHU d'Angers, 49933 Angers, France
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Díaz-Herrera MÁ, Martínez-Riera JR, Verdú-Soriano J, Capillas-Pérez RM, Pont-García C, Tenllado-Pérez S, Cunillera-Puértolas O, Berenguer-Pérez M, Gea-Caballero V. Multicentre Study of Chronic Wounds Point Prevalence in Primary Health Care in the Southern Metropolitan Area of Barcelona. J Clin Med 2021; 10:jcm10040797. [PMID: 33669397 PMCID: PMC7920417 DOI: 10.3390/jcm10040797] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Chronic wounds give rise to major costs and resource consumption in health care systems, due to their protracted healing time. Incidence and prevalence data are scarce or nonexistent in community settings. Objective: The aim of the present epidemiological study was to analyse and determine the prevalence of chronic wounds in the community in the south of the province of Barcelona (Spain). Design: A cross-sectional, multicentre secondary data analysis study was conducted in the community (excluding nursing homes) in Barcelona between 16 April and 13 June 2013. It included 52 primary care centres that serve a total population of 1,217,564 inhabitants. Results: The observed prevalence was 0.11%. Venous ulcers presented the highest prevalence, at 0.04%, followed by pressure injuries, at 0.03%. The >74 age group presented the highest frequency of chronic wounds, accounting for 69.4% of cases. Conclusion: The results obtained are consistent with those reported in previous similar studies conducted in Spain and elsewhere. As with most studies that adjusted their variables for age and sex, we found that the prevalence of ulcers increased with age and was higher in women, except in the case of diabetic foot ulcers and ischaemic ulcers, which were more frequent in men.
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Affiliation(s)
- Miguel Ángel Díaz-Herrera
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
- Teaching Committee, Hospital Universitari General de Catalunya, 08195 Sant Cugat del Vallès, Barcelona, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08940 Cornellà de Llobregat, Spain;
| | - José Ramón Martínez-Riera
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
- Correspondence: (J.R.M.-R.); (J.V.-S.)
| | - José Verdú-Soriano
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
- Correspondence: (J.R.M.-R.); (J.V.-S.)
| | - Raúl Miguel Capillas-Pérez
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
| | - Carme Pont-García
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
| | - Silvia Tenllado-Pérez
- Direcció d’Atenció Primaria Costa Ponent, Institut Català de la Salut, Avinguda de la Gran via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Barcelona, Spain; (M.Á.D.-H.); (R.M.C.-P.); (S.T.-P.)
| | - Oriol Cunillera-Puértolas
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08940 Cornellà de Llobregat, Spain;
- Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain
| | - Miriam Berenguer-Pérez
- Community Nursing, Preventive Medicine, Public Health and History of Science Department, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain;
| | - Vicente Gea-Caballero
- Nursing School La Fe, Adscript Center of University of Valencia, Research Group GREIACC, Health Research Institute La Fe, Avinguda Fernando Abril Martorell nº 106, Torre H. CP, 46006 Valencia, Spain;
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Brekelmans W, Borger van der Burg BLS, Leurs LN, Hoogendoorn R, Zuure FBJM, Hoencamp R. Optimization of Best Practice Wound Care in the Netherlands. INT J LOW EXTR WOUND 2020; 21:513-520. [DOI: 10.1177/1534734620965815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Estimates regarding the prevalence of chronic wounds in the Netherlands vary from 350 000 to 500 000. The cross-sectional multicenter study presented here provides evidence for the incidence and prevalence of wounds and chronic wounds. The primary aim of the present study was to provide evidence for incidence and prevalence of (chronic) wounds outside the hospital. The secondary aim was to optimize the organization for chronic wounds care within our region. From January 2017 until January 2018, information was prospectively collected of patients with new onset of wounds in 2 general practitioner practices to which 19 100 patients are enrolled. For the patients with new onset of wounds the “fast track protocol” was used and outcomes including etiology and wound healing were measured. This protocol included a structured treatment protocol and predetermined triage moments. The Alrijne Wound Centre database 2014 was used as a control group (469 records). The incidence of new onset of wounds was 364/19 100 (1.9%). The prevalence of wounds was 405/19 100 (2.1%). The prevalence of chronic wounds, that is, wounds that did not show a sufficient healing rate after 4 to 6 weeks, was 78/19 100 (0.4%). Time to referral to a wound physician (the triage moment) was 5 weeks versus 19 weeks in 2014 ( P < .001). Unnecessary referrals to the hospital was reduced by 17.4% ( P = .007). In conclusion, the prevalence of the chronic wounds was 4 per 1000 patients. The use of the “fast track” protocol optimizes wound care, wounds heal faster, and unnecessary referrals decrease significantly.
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Affiliation(s)
- Wouter Brekelmans
- Alrijne Ziekenhuis, Leiderdorp, The Netherlands
- Alrijne Wound Centre, Leiderdorp, The Netherlands
- Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Boudewijn L. S. Borger van der Burg
- Alrijne Ziekenhuis, Leiderdorp, The Netherlands
- Alrijne Wound Centre, Leiderdorp, The Netherlands
- Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | | | | | | | - Rigo Hoencamp
- Alrijne Ziekenhuis, Leiderdorp, The Netherlands
- Alrijne Wound Centre, Leiderdorp, The Netherlands
- Leids Universitair Medisch Centrum, Leiden, The Netherlands
- Ministry of Defense, The Hague, The Netherlands
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Palmier S. [Observational study of the second-line nursing consultation in wounds and scarring: A didactic situation under construction]. Rech Soins Infirm 2019; 137:49-61. [PMID: 31453671 DOI: 10.3917/rsi.137.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction and objective : In the activity of wound and scar nurses (Infirmières spécialisées en plaies et cicatrisation ; ISPC), the "second-line" nursing consultation is also an opportunity to offer applicants the opportunity for training. This study is part of an exploratory perspective, with the objective of questioning the didactic dimension of this type of consultation. To address the issue, attention is focused on the analysis of the ISPC's activity.Material and method : Two simple self-confrontation interviews of an ISPC are analyzed on the basis of video consultations.Results and discussion : Although the results identified remain incomplete since the interviews were based on a single individual, this article shows how the ISPC, after the interviews, is able to formulate future adjustments to their practice. The first avenue is to highlight a necessary transformation of the discourse of the ISPC during consultations. The second is to question the modality of the post-consultation follow-up.
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Schuster P. [Nurses' management of chronic wounds: A comparative review of pedagogical practices in initial training in France and Lorraine]. Rech Soins Infirm 2019:54-65. [PMID: 31210500 DOI: 10.3917/rsi.136.0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Managing chronic wounds is a large part of a nurse's role. However, this complex mission requires nursing professionals to have a wide knowledge base. OBJECTIVE OF THE STUDY The objective is to undertake a comparative review of pedagogical practices used to teach nursing students about chronic wounds in French nursing training institutes (compared to nursing training institutes in Lorraine). METHOD A survey was carried out using a self-administered online questionnaire disseminated via the national nursing training network Cefiec, between February and April 2018. It contained 21 questions. MAIN RESULTS 34.8% of nursing training institutes have a teacher with a university diploma in wounds and healing. Only 30.4% offer hospital-based clinical teaching on this topic. In Lorraine, 40% of nursing training institutes cover the preparation of the wound bed using the TIME model, and 20% cover debridement, compared to 40% and 7.5% nationally. DISCUSSION Teaching content varies greatly depending on the training institute, and shows that there is a theoretical and practical deficiency in teaching on topics including preparing the wound bed, debridement, and venous compression. Collaboration with expert nurses and referral hospitals is common. Teachers still do not have sufficient access to continuing training and scientific journals.
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[Medical residents and wound healing: A French national survey]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:324-330. [PMID: 31474342 DOI: 10.1016/j.jdmv.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 05/30/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Around 2.5 million wounds are recorded in France, representing, in terms of cost and quality of life, a real problem of public health issue. In France, residents are among the first line personnel having to manage wounds and their complications: this study is carried out to identify the view and feelings of residents concerning their preparation and training in this field. MATERIALS AND METHODS A questionnaire was distributed to residents throughout France. Residents' characteristics, interests and training in wound healing, training courses and opinions concerning their training were recorded. RESULTS Seven hundred and eleven French residents answered the questionnaire, the majority of whom (79 %) had not experienced training in wound healing. The majority of residents (69 %) believe that all physicians are concerned. Training in wound management and wound healing is considered insufficient (94 %) and most (79 %) had never received any training in wound management and wound healing. Ninety-eight percent stated they needed additional training courses in wound management. CONCLUSIONS Wound management and healing is a topic of interest to residents. Residents need more training in wound management in their curriculum to improve their practice.
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Laporte J, Herlin C, Delicque J, Saunière D, Perrot P, Duteille F. [Free flaps use in chronic wounds: Retrospective study about 91 cases]. ANN CHIR PLAST ESTH 2018; 64:251-258. [PMID: 30327209 DOI: 10.1016/j.anplas.2018.07.014] [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: 03/22/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Chronic wounds represent a major health challenge with no current standardized surgical treatment. The use of free flaps is little discussed in the literature, with a supposed propensity to failure given unfavorable local conditions and land often debility. We present here the analysis of our monocentric experience of the use of free flaps in the curative treatment of chronic wounds. PATIENTS ET METHODS We performed a retrospective monocentric study over 18 years of all free flaps used for the treatment of a chronic wound between January 2001 and September 2016. Several criteria were evaluated on patients, wounds, free flaps used and immediate to late outcomes. RESULTS Ninety-one patients were included (sex ratio M/F: 3.55) with an average age of 41.6±16 years. Wounds were localized to the leg in 92.3% of cases and 58% of patients had initial osteomyelitis. The flaps used were predominantly muscle flaps (61.6%). The flaps survival rate was 92.3%. With a mean follow-up of 50 months, the reconstructive failure rate was 20.9%. The presence of a chronic osteomyelitis is the only statistically significant factor of reconstruction failure (P=0.0169) with a risk of failure multiplied by 5. CONCLUSION Our study demonstrates that the reliability of free flaps in the treatment of chronic wounds is comparable, regardless of the time since the initial cutaneous lesion, to that existing in the treatment of acute wounds or in the reconstruction after oncological excision. The presence of a chronic osteomyelitis, however, represents a major risk of reconstruction failure by increasing 5 times the risk of failure. Recent changes in the integumentary reconstruction paradigm of the lower limb will undoubtedly allow in the next few years to establish more rationally the place of muscle free flaps in the therapeutic armamentarium of chronic wounds.
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Affiliation(s)
- J Laporte
- Plastic and reconstructive surgery department, university hospital Caremeau of Nîmes, place du Pr-Robert-Debré, 30029 Nîmes, France.
| | - C Herlin
- Plastic and reconstructive surgery department, university hospital Lapeyronie of Montpellier, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - J Delicque
- Medical imaging department, university hospital Saint-Éloi of Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - D Saunière
- Plastic and reconstructive surgery department, university hospital Caremeau of Nîmes, place du Pr-Robert-Debré, 30029 Nîmes, France
| | - P Perrot
- Plastic and reconstructive surgery department, university hospital Hôtel-Dieu of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Duteille
- Plastic and reconstructive surgery department, university hospital Hôtel-Dieu of Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Clarke M, Moore Z, Patton D, O'Connor T, Nugent L. The impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage. Br J Community Nurs 2017; 22:S6-S19. [PMID: 29189069 DOI: 10.12968/bjcn.2017.22.sup12.s6] [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 To investigate the impact of an educational intervention on home support workers' ability to detect early pressure ulcer damage. METHOD A repeated measure design was employed to quantify the effectiveness of an educational intervention, consisting of one pre-test and two post-tests. RESULTS Education was provided to home support workers and this was followed by an assessment of their ability to correctly classify 20 photographs detailing varying stages of skin damage severity. At the baseline (pre-education), 58% of the photographs were classified correctly. At post-test 1, 55% of the photographs were classified correctly. In post-test 2 this increased to 58%, achieving the original baseline scores. There was a moderate negative relationship between pre-training and post-test 2 scores (r=-0.44; n=27; p=0.02). CONCLUSIONS The educational intervention has been shown not to have a statistically significantly positive effect on home support workers' ability to detect early pressure ulcer damage. The moderate negative relationship between pre-training and post-test 2 scores concur with the aforementioned qualitative findings, and similarly indicate behaviour associated with individuals experiencing difficulty comprehending new health terms.
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Affiliation(s)
- Mairead Clarke
- Community Registered Nurse, Community Health Organisation, 08, Ireland
| | - Zena Moore
- Professor of Nursing & Head of School of Nursing and Midwifery, Royal College of Surgeons, Ireland
| | - Declan Patton
- Senior Lecturer and Director of Nursing & Midwifery Research, Royal College of Surgeons, Ireland
| | - Tom O'Connor
- Senior Lecturer and Director of Academic Affairs, School of Nursing & Midwifery, Royal College of Surgeons, Ireland
| | - Linda Nugent
- Lecturer, School of Nursing & Midwifery, Royal College of Surgeons, Ireland
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White-Chu EF. Prognostication and Management of Non-Healable Wounds and Wounds at the End of Life. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0129-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Humbert P, Faivre B, Véran Y, Debure C, Truchetet F, Bécherel PA, Plantin P, Kerihuel JC, Eming SA, Dissemond J, Weyandt G, Kaspar D, Smola H, Zöllner P. Protease-modulating polyacrylate-based hydrogel stimulates wound bed preparation in venous leg ulcers--a randomized controlled trial. J Eur Acad Dermatol Venereol 2014; 28:1742-50. [PMID: 24612304 PMCID: PMC4263240 DOI: 10.1111/jdv.12400] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/14/2014] [Indexed: 01/10/2023]
Abstract
Background Stringent control of proteolytic activity represents a major therapeutic approach for wound-bed preparation. Objectives We tested whether a protease-modulating polyacrylate- (PA-) containing hydrogel resulted in a more efficient wound-bed preparation of venous leg ulcers when compared to an amorphous hydrogel without known protease-modulating properties. Methods Patients were randomized to the polyacrylate-based hydrogel (n = 34) or to an amorphous hydrogel (n = 41). Wound beds were evaluated by three blinded experts using photographs taken on days 0, 7 and 14. Results After 14 days of treatment there was an absolute decrease in fibrin and necrotic tissue of 37.6 ± 29.9 percentage points in the PA-based hydrogel group and by 16.8 ± 23.0 percentage points in the amorphous hydrogel group. The absolute increase in the proportion of ulcer area covered by granulation tissue was 36.0 ± 27.4 percentage points in the PA-based hydrogel group and 14.5 ± 22.0 percentage points in the control group. The differences between the groups were significant (decrease in fibrin and necrotic tissue P = 0.004 and increase in granulation tissue P = 0.0005, respectively). Conclusion In particular, long-standing wounds profited from the treatment with the PA-based hydrogel. These data suggest that PA-based hydrogel dressings can stimulate normalization of the wound environment, particularly in hard-to-heal ulcers.
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Affiliation(s)
- P Humbert
- Research and Studies Center on the Integument (CERT), Clinical Investigation Center (CIC BT506), Department of Dermatology, University Hospital, Besançon, France; INSERM UMR, University of Franche-Comté, Besançon, France
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Fromantin I, Seyer D, Watson S, Rollot F, Elard J, Escande MC, De Rycke Y, Kriegel I, Larreta Garde V. Bacterial floras and biofilms of malignant wounds associated with breast cancers. J Clin Microbiol 2013; 51:3368-73. [PMID: 23926169 PMCID: PMC3811619 DOI: 10.1128/jcm.01277-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/29/2013] [Indexed: 12/17/2022] Open
Abstract
The risk of infections and the appearance of symptoms (e.g., odors) represent the main troubles resulting from malignant wounds. The aim of this study was to characterize the balance of bacterial floras and the relationships between biofilms and bacteria and the emergence of symptoms. Experimental research was carried out for 42 days on malignant wounds associated with breast cancer. Investigations of bacterial floras (aerobes, aero-anaerobes, and anaerobes), detection of the presence of biofilms by microscopic epifluorescence, and clinical assessment were performed. We characterized biofilms in 32 malignant wounds associated with breast cancer and bacterial floras in 25 such wounds. A mixed group of floras, composed of 54 different bacterial types, was identified, with an average number per patient of 3.6 aerobic species and 1.7 anaerobic species; the presence of strict anaerobic bacterial strains was evidenced in 70% of the wounds; biofilm was observed in 35% of the cases. Odor was a reliable indicator of colonization by anaerobes, even when this symptom was not directly linked to any of the identified anaerobic bacteria. Bacteria are more likely to be present during myelosuppression and significantly increase the emergence of odors and pain when present at amounts of >10(5) · g(-1). The presence of biofilms was not associated with clinical signs or with precise types of bacteria. No infections occurred during the 42-day evaluation period. This study provides a dynamic description of the bacterial floras of tumoral wounds. The study results highlight the absolute need for new therapeutic options that are effective for use on circulating bacteria as well as on bacteria organized in biofilm.
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Affiliation(s)
- Isabelle Fromantin
- Departments of Supportive Care
- Laboratory ERRMECe, University of Cergy Pontoise–UFR Sciences et Techniques, Cergy Pontoise, France
| | - Damien Seyer
- Laboratory ERRMECe, University of Cergy Pontoise–UFR Sciences et Techniques, Cergy Pontoise, France
| | | | | | | | | | | | - Irène Kriegel
- Anesthesia Reanimation, Institut Curie, Paris, France
| | - Véronique Larreta Garde
- Laboratory ERRMECe, University of Cergy Pontoise–UFR Sciences et Techniques, Cergy Pontoise, France
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Bessa LJ, Fazii P, Di Giulio M, Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection. Int Wound J 2013; 12:47-52. [PMID: 23433007 DOI: 10.1111/iwj.12049] [Citation(s) in RCA: 233] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/24/2013] [Indexed: 11/27/2022] Open
Abstract
Wound infection plays an important role in the development of chronicity, delaying wound healing. This study aimed to identify the bacterial pathogens present in infected wounds and characterise their resistance profile to the most common antibiotics used in therapy. Three hundred and twelve wound swab samples were collected from 213 patients and analysed for the identification of microorganisms and for the determination of their antibiotic susceptibility. Patients with diverse type of wounds were included in this retrospective study, carried out from March to September 2012. A total of 28 species were isolated from 217 infected wounds. The most common bacterial species detected was Staphylococcus aureus (37%), followed by Pseudomonas aeruginosa (17%), Proteus mirabilis (10%), Escherichia coli (6%) and Corynebacterium spp. (5%). Polymicrobial infection was found in 59 (27·1%) of the samples and was mainly constituted with two species. The most common association was S. aureus/P. aeruginosa. All Gram-positives were susceptible to vancomycin and linezolid. Gram-negatives showed quite high resistance to the majority of antibiotics, being amikacin the most active against these bacteria. This study is mostly oriented to health care practitioners who deal with wound management, making them aware about the importance of wound infection and helping them to choose the adequate treatment options to control microbial infection in wounds.
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Affiliation(s)
- Lucinda J Bessa
- Department of Biomedical Sciences, University 'G. d'Annunzio', Chieti-Pescara, Chieti, Italy
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Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing and Comprehensive Wound Center, University Medical Center Hamburg, D-20246 Hamburg, Germany.
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