1
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Yap JW, Ismail NI, Lee CS, Oh DY. Impact of Interfering Substances on the Bactericidal Efficacy of Different Commercially Available Hypochlorous Acid-Based Wound Irrigation Solutions Commonly Found in South-East Asia. Antibiotics (Basel) 2024; 13:309. [PMID: 38666985 PMCID: PMC11047473 DOI: 10.3390/antibiotics13040309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024] Open
Abstract
The high prevalence of chronic wounds is a growing concern. Recently, hypochlorous acid (HOCl)-based solutions were introduced as an alternative antimicrobial for wound cleansing. In this study, we assessed the in vitro bactericidal activities of seven commercially available wound irrigation products commonly found in South-East Asia. The evaluation was conducted using quantitative suspension method, EN 13727 in either low or high protein conditions. Under low protein conditions, four out of the five HOCl products achieved bactericidal activity (≥5 log10 reduction factor; RF) within 2-5 min, and only one product achieved 5 log10 RF at 15 s. None of the HOCl achieved 5 log10 RF under high protein, even after 30 min of exposure time. In contrast, protein interference on the antimicrobial activities of polyhexamethylene biguanide-based product is less pronounced (low protein: 60 s vs. high protein: 2 min to attain ≥5 log10 RF). Octenidine dihydrochloride is the only active not affected by protein interference achieving ≥5 log10 RF within 15 s in both low and high protein conditions. These findings warrant the need to screen antimicrobial wound care products, especially HOCl-based products, in high protein condition to better reflect the antimicrobial activities in wound care.
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Affiliation(s)
- Jiann Wen Yap
- Wound and Stoma Care Unit, Queen Elizabeth Hospital, Karung Berkunci No. 2029, Kota Kinabalu 88586, Sabah, Malaysia;
| | - Neni Iffanida Ismail
- TECOLAB SDN BHD, J-2-6, Pusat Komersial Jalan Kuching, Kuala Lumpur 51200, Malaysia; (N.I.I.); (C.S.L.)
| | - Cheng Shoou Lee
- TECOLAB SDN BHD, J-2-6, Pusat Komersial Jalan Kuching, Kuala Lumpur 51200, Malaysia; (N.I.I.); (C.S.L.)
| | - Ding Yuan Oh
- Schülke & Mayr (Asia) Pte Ltd., 10 Jalan Kilang #04-01/02/03, Singapore 159410, Singapore
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2
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Swanson T, Ousey K, Haesler E, Bjarnsholt T, Carville K, Idensohn P, Kalan L, Keast DH, Larsen D, Percival S, Schultz G, Sussman G, Waters N, Weir D. IWII Wound Infection in Clinical Practice consensus document: 2022 update. J Wound Care 2022; 31:S10-S21. [PMID: 36475844 DOI: 10.12968/jowc.2022.31.sup12.s10] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII-WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted.
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Affiliation(s)
| | - Karen Ousey
- Professor of Skin Integrity, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK.,Adjunct Professor, School of Nursing, Queensland University of Technology, Australia.,Visiting Professor, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Emily Haesler
- Adjunct Professor, Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.,Adjunct Associate Professor, Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, Australia.,Honorary Senior Lecturer, The Australian National University Medical School, Canberra, Australia
| | - Thomas Bjarnsholt
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Keryln Carville
- Professor of Primary Health Care, Silver Chain and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Patricia Idensohn
- Wound Nurse Specialist, Educator & Consultant in Private Practice, CliniCare, Ballito, South Africa.,Principal Lecturer and Co-Ordinator, School of Nursing, University of the Free State, South Africa
| | - Lindsay Kalan
- Medical Microbiology & Immunology, University of Wisconsin, US
| | - David H Keast
- Parkwood Institute, St Joseph's Healthcare, London, Canada
| | | | - Steven Percival
- Professor (Honorary), University of Liverpool, UK.,CEO and Director, Biofilm Centre, 5D Health Protection Group Ltd, Liverpool, UK
| | - Gregory Schultz
- Emeritus Professor of Obstetrics & Gynecology, University of Florida, US
| | - Geoff Sussman
- Associate Professor of Wound Care, Faculty of Medicine, Nursing and Health Science, Monash University, Australia.,Clinical Lecturer Medical Education, University of Melbourne, Australia
| | - Nicola Waters
- Senior Research Associate, Health, The Conference Board of Canada.,Adjunct Professor, University of British Columbia, Okanagan, Canada
| | - Dot Weir
- Clinician, Saratoga Hospital Center for Wound Healing and Hyperbaric Medicine, Saratoga Springs, New York, US.,Co-chair, Symposium on Advanced Wound Care, US.,Faculty, Wound Certification Prep Course, US
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3
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Wynn M. How to cleanse a wound. Nurs Stand 2022; 37:e11956. [PMID: 36062314 DOI: 10.7748/ns.2022.e11956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Abstract
Wound cleansing is a routine element of wound care. However, unnecessary cleansing, inappropriate techniques and inappropriate use of cleansing solutions can negatively affect patient outcomes. Therefore, it is essential that nurses understand when and how to cleanse a wound, and are able to select the most appropriate solution to use based on a holistic wound assessment. Nurses undertaking wound cleansing must have the knowledge and skills required to do so safely and must work within their level of competence. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of.
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Affiliation(s)
- Matthew Wynn
- School of Health and Society, University of Salford, Salford, England
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4
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Faucher N, Fromantin I, Barrois B, Carvalho P, Chignon-Sicard B, Chopin A, Duteille F, Jurus C, Meaume S, Kern J, Philippe A, Vasseur P. [Not Available]. Soins 2022; 67:14-17. [PMID: 36180170 DOI: 10.1016/s0038-0814(22)00234-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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5
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Cheong JZA, Liu A, Rust CJ, Tran CL, Hassan SE, Kalan LR, Gibson ALF. Robbing Peter to Pay Paul: Chlorhexidine gluconate demonstrates short-term efficacy and long-term cytotoxicity. Wound Repair Regen 2022; 30:573-584. [PMID: 36638156 PMCID: PMC9542784 DOI: 10.1111/wrr.13044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 01/27/2023]
Abstract
Wound cleansing agents are routine in wound care and preoperative preparation. Antiseptic activity intends to prevent contaminating microbes from establishing an infection while also raising concerns of cytotoxicity and delayed wound healing. We evaluated the cytotoxicity of five clinically used wound cleaning agents (saline, povidone iodine, Dove® and Dial® soaps, and chlorhexidine gluconate [CHG]) using both an ex vivo and in vivo human skin xenograft mouse model, in contrast to classical in vitro models that lack the structural and compositional heterogeneity of human skin. We further established an ex vivo wound contamination model inoculated with ~100 cells of Pseudomonas aeruginosa or Staphylococcus aureus to evaluate antimicrobial efficacy. Scanning electron microscopy and confocal microscopy were used to evaluate phenotypic and spatial characteristics of bacterial cells in wound tissue. CHG significantly reduced metabolic activity of the skin explants, while all treatments except saline affected local cellular viability. CHG cytotoxicity persisted and progressed over 14 days, impairing wound healing in vivo. Within the contamination model, CHG treatment resulted in a significant reduction of P. aeruginosa wound surface counts at 24 h post-treatment. However, this effect was transient and serial application of CHG had no effect on both P. aeruginosa or S. aureus microbial growth. Microscopy revealed that viable cells of P. aeruginosa reside deep within wound tissue post-CHG application, likely serving as a reservoir to re-populate the tissue to a high bioburden. We reveal concerning cytotoxicity and limited antimicrobial activity of CHG in human skin using clinically relevant models, with the ability to resolve spatial localization and temporal dynamics of tissue viability and microbial growth.
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Affiliation(s)
- J. Z. Alex Cheong
- Department of Medical Microbiology and ImmunologyUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA,Microbiology Doctoral Training ProgramUniversity of Wisconsin–MadisonMadisonWisconsinUSA
| | - Aiping Liu
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Clayton J. Rust
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Collin L. Tran
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sameeha E. Hassan
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Lindsay R. Kalan
- Department of Medical Microbiology and ImmunologyUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA,Department of Medicine, Division of Infectious DiseaseUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
| | - Angela L. F. Gibson
- Department of SurgeryUniversity of Wisconsin–Madison, School of Medicine and Public HealthMadisonWisconsinUSA
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6
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Willmore J, Wrotslavsky P. Preoperative contaminated wound management using short-term negative pressure wound therapy with instillation. J Wound Care 2021; 30:994-1000. [PMID: 34882001 DOI: 10.12968/jowc.2021.30.12.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The short-term application of negative pressure wound therapy with instillation and dwell time (NPWTi-d) enables the delivery of topical wound solutions, the solubilisation of debris and cleansing of the wound bed. The application of NPWTi-d may support the transition of the wound to a more manageable state and minimises the use of more invasive techniques. METHOD In this case series, we describe the process of applying NPWTi-d early as part of a contaminated wound treatment plan. RESULTS The case series included 15 patients in the preoperative setting. Wound types included surgical dehiscence, hard-to-heal wounds, heel pressure ulcers, diabetic foot ulcers, a cat bite and an amputation left open. Normal saline or a 0.125% sodium hypochlorite solution were instilled and allowed to dwell for five minutes, followed by 15 minutes of continuous negative pressure at -125mmHg. NPWTi-d was continued for 4-36 hours, or until the operating room became available. After NPWTi-d, we observed a decreased amount of devitalised tissue in the wound bed and reduced oedema and erythema in the periwound area. Patient white blood cells also significantly decreased in all cases after NPWTi-d (p<0.001). CONCLUSION Short-term use of NPWTi-d may be a useful option for supporting the surgical treatment of contaminated lower extremity wounds.
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Affiliation(s)
- James Willmore
- Advanced Foot and Ankle Center of San Diego, San Diego, CA, US
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7
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Ousey K, Hodgson H, Rippon MG, Rogers AA. Hydro-responsive wound dressings for treating hard-to-heal wounds: a narrative review of the clinical evidence. J Wound Care 2021; 30:980-992. [PMID: 34881992 DOI: 10.12968/jowc.2021.30.12.980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.
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Affiliation(s)
- Karen Ousey
- Institute of Skin Integrity and Infection Prevention, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | | | - Mark G Rippon
- University of Huddersfield, Queensgate, Huddersfield, UK
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8
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Abstract
OBJECTIVE The burden of wound care within the NHS is estimated at a cost of £5.3 billion per year and is set to rise annually by 30%. This case series describes the results of using polyhexanide (PHMB) and betaine wound irrigation solution and gels (Prontosan, B.Braun Medical Ltd., UK) across the UK in hard-to-heal (also described as chronic) wounds up to 20 years' duration, with an observation period of greater than one month. Over half of the hard-to-heal wounds were healed and vast improvements to all other wounds were observed. Improvements to wound bed condition were reported as early as two days after commencing initial treatment, with decreases in malodour, exudate, slough and pain reported across the case series. In addition to wound bed improvements, a reduction in dressing change frequency of 55% was observed in hard-to-heal wounds under the new treatment regime.
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Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant/Lecturer; School of Human and Health Sciences, University of Huddersfield and Mid Yorkshire NHS Trust, Yorkshire, UK
| | - John Stephenson
- Senior Lecturer in Biomedical Statistics; School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Dawn M Cooper
- Visiting Research Fellow; School of Biosciences and Chemistry, Sheffield Hallam University, Sheffield, UK
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9
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Kim PJ, Lavery LA, Galiano RD, Salgado CJ, Orgill DP, Kovach SJ, Bernstein BH, Attinger CE. The impact of negative-pressure wound therapy with instillation on wounds requiring operative debridement: Pilot randomised, controlled trial. Int Wound J 2020; 17:1194-1208. [PMID: 32567234 PMCID: PMC7540575 DOI: 10.1111/iwj.13424] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/20/2022] Open
Abstract
Presence of bacteria in wounds can delay healing. Addition of a regularly instilled topical solution over the wound during negative‐pressure wound therapy (NPWT) may reduce bioburden levels compared with standard NPWT alone. We performed a prospective, randomised, multi‐centre, post‐market trial to compare effects of NPWT with instillation and dwell of polyhexamethylene biguanide solution vs NPWT without instillation therapy in wounds requiring operative debridement. Results showed a significantly greater mean decrease in total bacterial counts from time of initial surgical debridement to first dressing change in NPWT plus instillation (n = 69) subjects compared with standard NPWT (n = 63) subjects (−0.18 vs 0.6 log10 CFU/g, respectively). There was no significant difference between the groups in the primary endpoint of required inpatient operating room debridements after initial debridement. Time to readiness for wound closure/coverage, proportion of wounds closed, and incidence of wound complications were similar. NPWT subjects had 3.1 times the risk of re‐hospitalisation compared with NPWT plus instillation subjects. This study provides a basis for exploring research options to understand the impact of NPWT with instillation on wound healing.
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Affiliation(s)
- Paul J Kim
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | - Dennis P Orgill
- Division of Plastic Surgery, Brigham & Women's Hospital Wound Care Center, Boston, Massachusetts, USA
| | - Stephen J Kovach
- Penn Plastic Surgery University City, Philadelphia, Pennsylvania, USA
| | | | - Christopher E Attinger
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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10
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Kirsner RS, Amaya R, Bass K, Boyar V, Ciprandi G, Glat PM, Percival SL, Romanelli M, Pittinger TP. Effects of a surfactant-based gel on acute and chronic paediatric wounds: a panel discussion and case series. J Wound Care 2019; 28:398-408. [PMID: 31166855 DOI: 10.12968/jowc.2019.28.6.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
On 20 November 2018, following the International Society for Paediatric Wound Care conference, a closed panel meeting took place in which the use of a surfactant-based gel (PluroGel (PMM), Medline Industries, Illinois, US) in paediatric wound care was discussed. The authors shared their experiences, thoughts, experimental data and clinical results. The panel identified the need for a product that can gently cleanse paediatric wounds and remove devitalised tissue without causing discomfort or skin reactions, as well as potentially promote healing. In adults, PMM has been shown to assist healing by hydrating the wound, controlling exudate and debriding non-viable tissue. Islands of neo-epithelium have also been reported to appear rapidly in different parts of the wound bed. No adverse effects on these proliferating cells have been observed. In vitro data suggest that PMM can remove biofilm, as well as potentially promote healing through cell salvage. The panel, therefore, set out to discuss their experiences of using PMM in the paediatric patients and to establish a consensus on the indications for its use and application in this population. This article will describe the main outcomes of that discussion and present case studies from paediatric patients with a variety of wound types, who were treated with PMM by members of the panel.
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Affiliation(s)
- Robert S Kirsner
- Chairman and Harvey Blank Professor, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, US
| | - Rene Amaya
- Director, Pediatric Wound Care and Laser Specialist, Houston, Texas, US
| | - Kathryn Bass
- Associate Professor of Surgery, Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, New York, US
| | - Vita Boyar
- Director of Neonatal Wound Services, Neonatal-Perinatal Medicine, Alexandra and Steven Cohen Children's Medical Center of New York, Northwell Health, Zucker School of Medicine at Hofstra, Northwell, US
| | - Guido Ciprandi
- Paediatric and Plastic Surgeon, Bambino Gesù Children's Hospital, Department of Surgery, Division of Plastic and Maxillofacial Surgery, Head Wound Care Surgical Unit, Rome, Italy
| | - Paul M Glat
- Professor of Surgery and Pediatrics, Drexel University College of Medicine and Chief of Plastic Surgery, St. Christopher's Hospital for Children, Philadelphia, US
| | - Steven L Percival
- CEO of 5D Heath Protection Group Ltd, 5D Health Protection Group Ltd, Liverpool, UK
| | - Marco Romanelli
- Professor and Chairman, Department of Dermatology, University of Pisa, Italy
| | - Timothy P Pittinger
- Paediatric Surgeon, Department of Surgery & Regional Burn Center, Akron Children's Hospital, Akron, Ohio, US
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11
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Abstract
The human body is a complex, multisystem organism that can manifest disease processes in a multitude of ways. Over the decades, technological advancements have allowed us to make precise diagnoses so that clinicians can thoroughly treat the underlying cause. Frequently these disease processes require surgical intervention to eliminate the progression and provide the patient with positive outcomes. When surgical intervention is required, the patient is often left with large complex wounds. Just like medical advancements, wound care modalities have made vast technological improvements. Wounds previously being treated with simple but labor-intensive treatments such as gauze packings and return operating room interventions, can now be treated with negative pressure wound therapy combined with instillation and dwell (NPWTi-d). This therapy combines the benefits of negative pressure while cleansing the wound through the instillation of a topical wound cleanser in a controlled environment. In this case review, we will highlight a case of necrotizing fasciitis in which surgical intervention was required and negative pressure wound therapy with instillation and the use of reticulated open cell foam dressing with through holes (ROCF-CC) was utilized. Negative pressure with instillation was used to remove infectious material and other nonviable tissue from the wound base while promoting granulation tissue production. By utilizing this treatment, we were able to decrease the patient's return trips to the operating room (OR), enhance granulation tissue production, and ultimately achieve positive patient outcomes.
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Affiliation(s)
- Kersten Reider
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
| | - Elizabeth McElroy
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
| | - Stormy Lemay
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
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12
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McElroy E, Lemay S, Reider K, Behnam AB. A Case Review of Wound Bed Preparation in an Infected Venous Leg Ulcer Utilizing Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation. Cureus 2018; 10:e3504. [PMID: 30613453 PMCID: PMC6314798 DOI: 10.7759/cureus.3504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) have major financial implications for patients and healthcare professionals. VLUs, in particular, require significant care, can be slow to heal, and have a high rate of recurrence. These factors combine to make VLUs a major burden on the healthcare system. Recent estimates show that the cost of treatment of VLUs per patient in the United States is $10,000 to $12,000 per year, with the average lifetime cost of care greater than $40,000. Infected VLUs often require surgical debridement for the removal of bacterial burden and biofilm. The use of negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown to decrease OR visits, length of hospitalization, and therapy days in lower extremity and trunk wounds. In 2017, a novel reticulated open cell foam dressing with through holes (ROCF-CC) was introduced as a dressing option with NPWTi-d. ROCF-CC assists in removing thick wound exudate and infectious materials. This dressing option is especially helpful for wound cleansing when debridement is not possible or appropriate in patients.
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Affiliation(s)
- Elizabeth McElroy
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
| | - Stormy Lemay
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
| | - Kersten Reider
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
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13
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Lemay S, McElroy E, Reider K. A Case Review of Necrotizing Soft Tissue Infection of the Abdomen Utilizing Negative Pressure Wound Therapy with Instillation and Novel Reticulated Open Cell Foam Dressing. Cureus 2018; 10:e3497. [PMID: 30613452 PMCID: PMC6314795 DOI: 10.7759/cureus.3497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Necrotizing soft tissue infection is a rapidly spreading bacterial infection that can quickly destroy a person’s muscles, skin, and underlying tissue. In this retrospect chart review, we will look at how the utilization of negative pressure wound therapy with instillation and dwell (NPWTi-d) and novel reticulated open cell foam (ROCF-CC) assisted with the healing of a patient’s wound along with decreasing the time spent in the operating room. NPWTi-d provided the benefits of wound healing such as solubilizing the infectious material and removing the devitalized tissue. Using this form of treatment, we were able to improve the patient’s quality of life and decrease her time in the hospital.
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Affiliation(s)
- Stormy Lemay
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
| | - Elizabeth McElroy
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
| | - Kersten Reider
- Wound, Ostomy, Continence Care / Nursing Administration, Reading Health System, Reading, USA
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14
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Abstract
We describe our early experience with a novel foam dressing together with negative pressure wound therapy and instillation (NPWTi-d) for cleansing and removal of infectious materials. This is a prospective review of the clinical outcomes of three patients using V.A.C. VERAFLO™ Therapy with the V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. This novel foam dressing has been designed in a unique way to help facilitate the removal of infectious material, thick fibrinous exudate, slough, and other wound bioburden. To our best knowledge, this is the first reported case series using this dressing in the Middle East. Our preliminary results suggest that adjunctive use of NPWTi-d using V.A.C. VERAFLO CLEANSE CHOICE™ Dressing can clean large or complex wounds when complete surgical debridement is not possible or when areas of non-viable tissue remain present on the wound bed after surgical debridement.
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15
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Slaviero L, Avruscio G, Vindigni V, Tocco-Tussardi I. Antiseptics for burns: a review of the evidence. Ann Burns Fire Disasters 2018; 31:198-203. [PMID: 30863253 PMCID: PMC6367858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Abstract
The burn patient is easily subject to colonization by microorganisms and infection, due to reduced defence capabilities and immune dysfunction. Moreover, burn units and intensive care units are characterized by a selection of resistant bacterial strains. If the burn patient is not adequately cared for in terms of infection prevention and control, sepsis is inevitable. Nowadays, several different antiseptics and antiseptic dressings are used in the topical treatment of burns, each with positive and negative effects. Topical antiseptics allow control of bacterial load, but they can also cause cytotoxicity and reduce healing rate. Choosing the most effective antiseptic is crucial to preventing infection from compromising wound healing. The present study aims to review the available literature in order to highlight evidence on the use of topical antiseptics in burns.
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Affiliation(s)
- L. Slaviero
- Social and Health Care Services Centre, Alpago, Belluno, Italy
| | - G. Avruscio
- Angiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy
| | - V. Vindigni
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - I Tocco-Tussardi
- Clinic of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padova, Padova, Italy
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Lessing MC, James RB, Ingram SC. Comparison of the Effects of Different Negative Pressure Wound Therapy Modes-Continuous, Noncontinuous, and With Instillation-on Porcine Excisional Wounds. Eplasty 2013; 13:e51. [PMID: 24106564 PMCID: PMC3791820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Negative pressure wound therapy (NPWT) can be delivered in continuous or noncontinuous modes, while NPWT with instillation (NPWTi) couples NPWT with automated delivery and removal of topical wound treatment solutions and suspensions. This porcine study compared granulation response of NPWTi (instillation foam dressing with saline) to NPWT (standard foam dressing) in continuous and noncontinuous modes. METHODS Full-thickness dorsal excisional wounds in pigs were treated with continuous NPWT, intermittent NPWT, dynamic (controlled variable) NPWT, and NPWTi with saline (n = 10 per group). Wound dimensions were determined from 3D images collected on days 0, 2, 5, and 7. On day 7, animals were euthanized and specimens were harvested for histopathological review. RESULTS Average granulation thickness was not statistically different among continuous (3.29 ± 0.33 mm), intermittent (3.03 ± 0.47 mm), and dynamic (3.40 ± 0.34 mm) NPWT wounds at day 7. Average granulation thickness of NPWTi wounds (4.75 ± 0.54 mm), however, was statistically greater (P < .05) by 44%, 57%, and 40%, respectively, than that of wounds treated with continuous, intermittent, and dynamic NPWT. Analysis of 3D images revealed a greater reduction in wound area and perimeter in NPWTi wounds compared to all NPWT wounds (P < .05). In addition, the average wound fill rate for NPWTi wounds was faster than that for continuous (40%; P < .05), intermittent (25%; P > .05), and dynamic (65%; P < .05) NPWT wounds. CONCLUSIONS Although not confirmed in humans, these porcine data suggest that NPWTi with saline may stimulate a faster rate of wound granulation than NPWT in continuous and noncontinuous modes.
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Affiliation(s)
| | - Roberta B. James
- Biometrics Data Management, Kinetic Concepts, Inc, San Antonio, Tex
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