Maintenance of wakefulness test in military personnel with upper airway resistance syndrome and mild to moderate obstructive sleep apnea

Background  Sleep-disordered breathing (SDB) and the associated symptom of excessive daytime sleepiness (EDS) in military personnel has influential consequences in both the garrison and the deployed environments. The maintenance of wakefulness test (MWT) is a daytime study used to evaluate the tendency to stay awake. We evaluated consecutive patients diagnosed with mild to moderate obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) to provide an objective measure of their EDS using the MWT. Materials and methods  All military personnel referred between February 2004 and March 2005 with a clinical evaluation suspicious for SDB were evaluated with an overnight polysomnography (PSG). After overnight PSG, military personnel with mild to moderate OSA and UARS were evaluated with a 40-min protocol MWT. Abnormal MWT was defined as sleep onset latency mean below 19.4 min (<2 SD below the mean). Results  Sixty-two military personnel met entry criteria. Fifty-nine were men. Nineteen patients (32%) were diagnosed with UARS with a mean respiratory disturbance index of 11/h (5–20/h). Forty-one (68%) of the military personnel had OSA with a mean apnea–hypopnea index of 12/h (5–29/h). As a collective group, the mean Epworth Sleepiness Scale was elevated at 13/24 (1–24). This subjective excessive sleepiness was assessed with the MWT test, which resulted in a group mean MWT sleep onset latency of 27 min (5–40 min). Eighteen soldiers (30% of the total patients) had abnormal MWTs [six patients (33.3%) with UARS and 12 (67%) with OSA]. Conclusion  Military personnel with mild to moderate OSA and UARS often have abnormal MWTs and therefore have a pathological tendency to fall asleep. This EDS could pose a safety hazard in those personnel, military or civilian, who operate dangerous vehicles, machinery, or carry a firearm. Military personnel with untreated SDB are also at risk for the consequences of decreased mental alertness and decreased cognitive functioning due to daytime sleepiness. All work was completed at the Brooke Army Medical Center, Fort Sam Houston, Texas. The opinions expressed herein are those of the authors and should not be construed as official or reflecting the policy of either the Department of the Army, Department of Defense, or the US Government.     

Ballistic injury

Wound profiles made under controlled conditions in the wound ballistics laboratory at the Letterman Army Institute of Research showed the location along their tissue path at which projectiles cause tissue disruption and the type of disruption (crush from direct contact with the projectile or stretch from temporary cavitation). Comparison of wound profiles showed the fallacy in attempting to judge wound severity using velocity alone, and laid to rest the common belief that in treating a wound caused by a high-velocity missile, one needs to excise tissue far in excess of that which appears damaged. All penetrating projectile wounds, whether civilian or military, therefore should be treated the same regardless of projectile velocity. Diagnosis of the approximate amount and location of tissue disruption is made by physical examination and appropriate radiographic studies. These wounds are contaminated, and coverage with a penicillin-type antibiotic should be provided.     

Maggot secretions suppress pro-inflammatory responses of human monocytes through elevation of cyclic AMP

Aims/hypothesis  Maggots of the blowfly Lucilia sericata are used for the treatment of chronic wounds. As monocytes may contribute to the excessive inflammatory responses in such wounds, this study focussed on the effects of maggot secretions on the pro-inflammatory activities of these cells. Methods  Freshly isolated monocytes were incubated with a range of secretions for 1 h and then stimulated with lipopolysaccharides (range 0–100 ng/ml) or lipoteichoic acid (range 0–5 μg/ml) for 18 h. The expression of cell surface molecules, cytokine and chemokine levels in culture supernatants, cell viability, chemotaxis, and phagocytosis and killing of Staphylococcus aureus were measured. Results  Maggot secretions dose-dependently inhibited production of the pro-inflammatory cytokines TNF-α, IL-12p40 and macrophage migration inhibitory factor by lipopolysaccharides- and lipoteichoic acid-stimulated monocytes, while enhancing production of the anti-inflammatory cytokine IL-10. Expression of cell surface receptors involved in pathogen recognition remained unaffected by secretions. In addition, maggot secretions altered the chemokine profile of monocytes by downregulating macrophage inflammatory protein-1β and upregulating monocyte chemoattractant protein-1 and IL-8. Nevertheless, chemotactic responses of monocytes were inhibited by secretions. Furthermore, maggot secretions did not affect phagocytosis and intracellular killing of S. aureus by human monocytes. Finally, secretions induced a transient rise in the intracellular cyclic AMP concentration in monocytes and Rp-cyclic AMPS inhibited the effects of secretions. Conclusions/interpretation  Maggot secretions inhibit the pro-inflammatory responses of human monocytes through a cyclic AMP-dependent mechanism. Regulation of the inflammatory processes by maggots contributes to their beneficial effects on chronic wounds.     

Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials

Aims This review compares the most popular techniques in managing the wounds after excisional haemorrhoidectomy, which are either to lay the wounds open or to close them. Methods Randomized controlled trials were identified from the major electronic databases using the search terms “hemorrhoid*” and “haemorrhoid*.” Duration of operation, pain, length of hospital stay, time off work, time for wound healing, patient satisfaction, continence, manometry findings and complications were assessed. Quantitative meta-analysis was performed as appropriate or possible. Results Six trials including 686 patients met the inclusion criteria. The median follow-up time ranged from 1.5 to 19.5 months. Quantitative meta-analysis showed that there was no significant difference in cure rates between the two techniques (relative risk, 1.4; 95% CI, 0.86 to 2.2; p=0.191). Open haemor-rhoidectomy was more quickly performed (weighted mean difference, 1.03 min; 95% CI, 0.51 to 1.54; p<0.001). Closed haemorrhoidectomy wounds showed faster healing (weighted mean difference, 1.2 weeks; 95% CI, 0.88 to 1.55; p<0.001). Hospital stay, maximum pain score, total and individual complication rates were not significantly different. Conclusions Apart from faster wound healing after closed haemorrhoidectomy, open and closed techniques appeared equally effective and safe. However, there were only a few studies which presented information in different ways, and statistical heterogeneity was high.     

Ligasure™ <Emphasis Type="Italic">vs</Emphasis>. Conventional Diathermy in Excisional Hemorrhoidectomy: A Prospective,Randomized Study

Purpose  This study was designed to compare the surgical outcomes of hemorrhoidectomy performed by the Ligasure™ with that performed by the conventional diathermy. Methods  A total of 110 patients were randomized to Ligasure™ (55 patients) or diathermy (55 patients) hemorrhoidectomy. The operative time, postoperative pain scores, parenteral analgesic requirements in the first 24 hours, postoperative complications, and wound healing rates at six weeks postoperatively were documented. Results  The median operative time was 8 (range, 7–10) minutes for the Ligasure™ group and 18 (range, 15–21) minutes for the diathermy group (P < 0.001). Throughout the first postoperative week, the daily median pain score was lower in the Ligasure™ group than in the diathermy group (P < 0.001). The median number of analgesic ampoules during the first 24 hours postoperatively was lower in the Ligasure™ group (P < 0.001). There was no statistically significant difference in the incidence of postoperative complications. At six weeks postoperatively, more patients in the Ligasure™ group had complete healing of wounds (P = 0). Conclusion  Ligasure™ provides a superior alternative to conventional diathermy in hemorrhoidectomy by reducing the operative time, postoperative pain, parenteral analgesic requirements during the first 24 hours postoperatively, and the time to complete healing of wounds. Reprints are not available.     

Sulfamylon,an adjunct in the treatment of indolent wounds:

Summary Indolent perineal wounds in 20 patients treated with Sulfamylon. Six (35.3 per cent) patients' wounds healed completely and seven (41.2 per cent) had good results. This preliminary report indicates that further trials with Sulfamylon for the treatment of indolent wounds are indicated. Read at the meeting of the American proctologic Society, Hollywood, Florida, April 12–16, 1970.     

The Oblique Rectus Abdominal Myocutaneous Flap for Complex Pelvic Wound Reconstruction

Purpose  The oblique rectus abdominal myocutaneous flap is a seldom used flap design based on perforating vessels exiting the rectus near the umbilicus. Compared to other flaps, the oblique rectus abdominal myocutaneous flap provides increased soft tissue to fill pelvic dead space, with the further advantage of intact skin to close perineal defects. Here we detail the oblique rectus abdominal myocutaneous flap in achieving closure of complex perineal wounds. Methods  A review of indications and outcomes in 16 patients undergoing complex pelvic operations requiring reconstruction with this flap was undertaken. Results  All patients had been previously treated with pelvic irradiation for cancer. Indications for flap reconstruction included abdominal perineal resection for anal/rectal cancer, pelvic sarcoma/sacral resection/exenteration, small bowel/colonic fistula resection, and total proctocolectomy with vaginal reconstruction. Median follow-up was 17 (range, 1–57) months. Complications included epidermal necrosis at the flap tip (n = 2), delayed perineal wound breakdown (n = 1), one abdominal wound infection, one small abdominal dehiscence, and four pelvic abscesses all managed nonoperatively. A single recurrent fistula required operative resection three months postoperatively. There were no cases of complete flap necrosis, vascular failure or persistently draining perineal sinus, and no mortalities related to the flap reconstruction. Conclusions  The treatment of complex pelvic wounds, especially following pelvic radiation, is facilitated by the oblique rectus abdominal myocutaneous flap. This technique provides ample tissue for large pelvic wounds, including skin for perineal defects. Comparing our results to existing literature, the oblique rectus abdominal myocutaneous flap displays a favorable morbidity profile, providing a safe means of delivering well-vascularized tissue to the pelvic cavity and perineal floor. Presented at the Midwestern Surgical Association, Mackinac Island, Michigan, August 6 to 8, 2006 Reprints are not available.     

Mechanical Strain Stress Suppresses Expression of HSP70 and Wound Restoration in Gastric Mucosal Cells

The major heat shock protein, HSP70, is known to be involved in cytoprotection against environmental stresses mediated by their function as a “molecular chaperone.” However, the influence of HSP70 on gastric mucosal healing under physical stimulation or stress is not completely understood. Rat gastric mucosal cells (RGM-1) were stably transfected with pBK-CMV containing the human HSP70 gene (7018-RGM-1) or pBK-CMV alone (pBK-CMV-12). Artificial wounds were created. Mechanical stretch was applied to 7018-RGM-1 cells or pBK-CMV-12 cells. The effect of mechanical stretch on HSP70 expression was assessed by Western blot analysis. Expression of HSP70 was decreased by mechanical stretch in pBK-CMV-12 cells. However, expression of HSP70 was not decreased by mechanical stretch in 7018-RGM-1 cells. Furthermore, the wound restoration of pBK-CMV-12 cells was suppressed under mechanical stretch condition. On the other hand, the wound restoration of 7018-RGM-1 cells was not affected by mechanical stretch. These results suggest that HSP70 plays an important role in gastric wound healing under physical stress. Masaru Odashima and Michiro Otaka are equally contributed to the study     

Non-healing wounds: The geriatric approach

The most common types of non-healing wounds are four types: pressure ulcers, diabetic ulcers, ischemic ulcers and venous ulcers. Many of those wounds develop among the elderly, becoming non-healing to the extent that the patient may live with them all of his life, or even die because of them. Not enough attention is paid to the underlying contributing problems specific to the elderly patient. Those factors are physiologic (aging skin, immune state and atherosclerosis) and pathologic situation (diabetic disease, ischemia of leg). Therefore, the geriatric approach to a non-healing wound is comprehensive and multidisciplinary. Those including: patient’s co-morbidities, functional state as measured by the activities of daily living (ADL) scale, nutritional status, social support, ethical beliefs and quality of life and not only the wound itself. Each discipline (the nursing staff, physician, dietitian, occupational, physical therapists and social worker) has its own task in preventing and treating such wounds. The ultimate goal therefore has been altered from healing of the wounds to symptom control, prevention of complications and to contribute to the patient’s overall wellbeing. This review discusses all those items in a geriatric point of view, and how to deal with the non-healing wounds as a geriatric syndrome.     

Management of the perineal wound after rectal excision for neoplastic disease: A controlled clinical trial

Summary Two methods of management of the perineal wound after rectal excision for neoplastic disease were compared in a prospective randomized clinical trial in 65 patients. Twenty-eight patients (Group A) were treated by partial closure of the perineal wound and cigarette drainage of the pelvic space, according to the method proposed by Gabriel. Thirty-seven patients (Group B) were treated by complete suture of the perineal wound and suction drainage of the pelvic space according to the method proposed by Altemeier. Immediate and late results were better in patients in Group B. They achieved healingper primam in 62.85 per cent of cases and had significantly shorter hospital stays than patients in Group A. Three months postoperatively, 91.42 per cent of patients in Group B and 59.25 per cent of those in Group A had complete healing of the perineal wounds, with a statistically significant difference (χ² with Yates correction =7.27, P<0.01). The development in 10 patients of Group B of perineal abscesses or hematomas necessitated reopening of the perineal wounds: however, the postoperative courses were similar to those of patients in Group A. It is concluded that healing by primary intention with use of the method described herein is the treatment of choice for managing the perineal wounds in patients undergoing rectal excision for neoplastic disease.     

Healing diabetic neuropathic foot ulcers: are we getting better?

AIM: To benchmark by year the likelihood that an individual with a diabetic neuropathic foot ulcer will heal over more than a 10-year period. PATIENTS AND METHODS: A cohort study within a multicentre wound care network of individuals with a diabetic neuropathic foot ulcer who were treated by a standard wound care algorithm. The main outcome was a healed wound by the 20th week of care stratified by calendar year. RESULTS: We evaluated 27 193 individuals with a neuropathic foot ulcer. Between 1988 and 1990 approximately 66% of patients did not heal. By 1999 this percentage had decreased to 49%. The change in the rate of failure to heal is very closely associated with an increase over time in the proportion of patients seen with wounds identified as prognostically favourable using a previously published prognostic model (i.e. individuals with wounds < or = 2 cm2, wounds < or = 2 months old, and wounds of grade < or = 2). Nevertheless, even among those most likely to heal, the likelihood of failing to heal went from 62% prior to 1991 to 32% in 2000. CONCLUSIONS: We have shown that individuals with a diabetic neuropathic foot ulcer seeking care are more likely to heal today than 10 years ago. The primary reason for this improvement is that individuals are seeking care when their wounds are most easily treated and these are now more likely to heal.     

Stab wounds to the abdomen: failure of blunt probing to predict peritoneal penetration

A study was conducted to examine the usefulness of blunt probing for evaluation of penetrating abdominal trauma. Ten anesthetized adult beagles weighing 8 to 17 kg were sacrificed by ventricular fibrillation following a standardized resuscitation protocol. Immediately thereafter, the abdomen was shaved and ten stab wounds were placed in the abdomen of each dog with #11 blade. A separate individual probed the wounds sequentially with a cotton swab and predicted on the basis of this examination whether the wound penetrated the parietal peritoneum (deep) or not (superficial). The abdomen then was opened and reflected, by a midline incision, and peritoneal penetration was verified visually by two observers. Statistical analysis of data was performed using the z test for binomial proportions. Fifty-nine of the 100 wounds were found to penetrate the parietal peritoneum. Examiners predicted 35 correctly, but called 24 of 59 superficial. Thirty-eight of 41 superficial wounds were identified correctly; three were incorrectly called deep. Sensitivity was .59 (z = 1.432, P greater than .5); specificity was .93 (z = 5.466, P less than .001). Blunt probing may be a useful technique if peritoneal penetration is determined, but it is inaccurate in predicting peritoneal nonpenetration. If violation of the peritoneum is not determined with this technique, other methods must be used.     

Procedures associated with infective endocarditis in adults: A case confrol study

OBJECT:: To assess the relative risk of infective endocarditis associatedwith various procedures and the protective efficacy of antibioticprophylaxis by a case-control study. BACKGROUND:: Recommendations for the prevention of infective endocarditisare based on the hypothesis of a relationship between proceduresand infective endocarditis which is supported by anecdotal reportsand data from experimental models. METHODS:: Cases met the Von Reyn's diagnostic criteria modified with echocardiographicand macroscopic findings, Controls were recruited from cardiologyor medicinal wards. Cases (n=171) and controls were matchedas regards sex, age and underlying cardiac condition, They wererequested to indicate all the medical, surgical or dental procedureswithin the previous 3 months, Among potential confounding factors,infectious episodes and skin wounds in the previous 3 monthswere reported, Antibiotic prophylaxis administration was documentedfor type, dosage, duration and administration schedule. RESULTS:: Cases significantly more frequently than controls had undergoneat least one procedure (matched odds ratio, 1·6; 95%confidence interval, 1·01 to 2·53). Dental proceduresconsidered as a whole were not associated with an increasedrisk, although scaling and root canal treatment showed a trendtowards a higher risk of infective endocarditis (P=0·065).Among non-dental procedures, only surgery appeared to be atrisk (matched odds ratio, 4·7; 95% confidence interval,1·02 to 22). Considering all procedures, the risk ofinfective endocarditis increased significantly with the numberof procedures. While general co-morbid conditions did not differbetween the two groups, cases significantly more frequentlythan controls had experienced an infectious episode or a skinwound In multivariate analysis, only infectious episodes andskin wounds significantly increased the risk of infective endocarditis.Scaling was the only independent risk factor for viridans streptococcalinfective endocarditis. The 46% protective efficacy of antibioticprophylaxis was not significant. CONCLUSIONS:: Procedures do increase the risk of infective endocarditis. Theinterpretation of the apparent low risk associated with dentalprocedures may be as a result of the current practice of antibioticprophylaxis. Our data suggest that surgery should be more clearlymentioned in future guidelines, and reemphasize that a rigoroustreatment of any focal infection in cardiac patients is mandatory.From the efficacy rate of antibiotic prophylaxis, it can beestimated that the overall incidence of infective endocarditismight be reduced by 5 to 10% in France by appropriate use ofantibiotic prophylaxis in cardiac patients.     

Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic, contaminated wounds

It is common practice to soak acute traumatic wounds in dilute povidone-iodine solution before definitive wound cleaning and debridement. The effectiveness of soaking wounds is unknown. Using quantitative wound bacterial counts as a measure of efficacy, we compared wounds soaked in 1% povidone-iodine solution or in normal saline with wounds receiving no treatment. Adult patients were eligible for the study if they were seen in the emergency department with visibly contaminated traumatic wounds within 12 hours of injury. Patients were excluded if they refused consent, were allergic to iodine, or had taken antibiotics within five days; if the wound did not require debridement; if the wound had been previously cleaned; or if subsequent cultures were sterile. Thirty-three heavily contaminated acute traumatic wounds in 29 patients were included in the study. Wounds were randomly assigned to one of three groups. Tissue samples were taken before and after a ten-minute period of soaking in either povidone-iodine or saline; controls were covered with gauze during the ten-minute period. The mean bacterial count per gram of tissue decreased 6.4 x 10(5) (standard deviation, 1.68 x 10(6)) after no soak, increased 3.39 x 10(7) (1.05 x 10(8)) after saline soak, and decreased 9.19 x 10(6) (1.72 x 10(7)) after povidone-iodine soak. Wounds with counts of less than 10(5) bacteria/g tissue are unlikely to become infected. Multiple regression analysis was used to analyze the changes in bacterial count after treatment as a function of experimental group and initial bacterial count. There was no significant difference between the control and povidone-iodine groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of anti-hepatitis A antibodies, hepatitis B viral markers, and anti-hepatitis C antibodies among immigrants from the former USSR who arrived in israel during 1990–1991

Summary The goal of this study was to assess the susceptibility of the sub-population of over 500,000 immigrants from the former USSR who came to Israel during 1989–94 to HAV infection, and to provide military physicians with estimates of the prevalence of HBV and HCV carriage in this sub-population. 987 males aged 17–49 and 195 females aged 17–19, reporting to military recruitment offices between December 1991 and March 1992 were tested. Anti-HAV, anti-HBV antibodies and hepatitis B surface antigen (HBsAg) were detected by using standard enzyme immunoassay (EIA) tests, and anti-HCV antibodies by a second-generation EIA and confirmed by a third-generation INNO-LIA test. It was found that in the 17–19-year age-group the prevalence of anti-HAV antibodies was 37%, anti-HBV was 12.8%, HBsAg was 3.0% and anti-HCV 1.3%. All markers were higher among males. The prevalence of anti-HAV and anti-HBs antibodies increased with age among males. That of HBsAg and anti-HCV antibodies increased with age overall. In the multiple logistic regression analysis, HAV and HBV seropositivity were significantly associated with the mother's education and republic of origin. It was concluded that the prevalence of anti-HAV antibodies is similar to that among the local population, which should not be considered at a higher risk of infection during military service. On the other hand, the higher prevalence of HBsAg and anti-HCV antibodies in this sub-population should heighten the awareness of the possibility of chronic liver pathology.     

Optical monitoring and treatment of potentially lethal wound infections in vivo

We report on the use of optical techniques to monitor and treat Pseudomonas aeruginosa wound infections in mice. Bioluminescent bacteria transduced with a plasmid containing a bacterial lux gene operon allow the infection in excisional mouse wounds to be imaged by use of a sensitive charge-coupled device camera. Photodynamic therapy (PDT) targeted bacteria, by use of a polycationic photosensitizer conjugate, which is designed to penetrate the gram-negative cell wall and was topically applied to the wound and was followed by red-light illumination. There was a rapid light dose-dependent loss of luminescence, as measured by image analysis, in the wounds treated with conjugate and light, a loss that was not seen in untreated wounds, wounds treated with light alone, or wounds treated with conjugate alone. P. aeruginosa was invasive in our mouse model, and all 3 groups of control mice died within 5 days; in contrast, 90% of PDT-treated mice survived. PDT-treated wounds healed significantly faster than did silver nitrate-treated wounds, and this was not due to either inhibition of healing by silver nitrate or stimulation of healing by PDT.     

Influences of anti-tumour necrosis factor agents on postoperative recovery in patients with rheumatoid arthritis

The aim of this study is to investigate the influences of the anti-tumour necrosis factor (TNF) agents infliximab and etanercept on the postoperative recovery of patients with rheumatoid arthritis (RA). We also investigated the effects of biologics on wound healing. Patients with RA were split into a TNF group (n = 39) that underwent 39 operations and were treated with anti-TNF agents, and a non-TNF group (n = 74) that underwent 74 operations and were treated only with conventional disease-modifying antirheumatic drugs. Operations included ankle arthrodesis and total arthroplasty of the hip, knee, elbow, shoulder and ankle. Adverse events (AEs) of surgical wounds, time for complete wound healing, febrile period after operation and recovery parameters after operation (%recovery of haemoglobin (Hb), total protein and albumin at 4 weeks after operation compared with pre-operation levels) were investigated. AEs of surgical wounds occurred in two operations (5.1%) in the TNF group and in five operations (6.8%) in the non-TNF group, but this difference was not statistically significant. There were also no significant differences in the time for complete wound healing and in the length of the febrile period between the two groups. Percentage recovery of Hb was significantly better in the TNF group than in the non-TNF group (96.3% vs. 90.1%, respectively; p < 0.05). These results suggest that the use of anti-TNF agents does not cause specific AEs on surgical wounds after elective orthopaedic operations in RA patients and might improve the percentage recovery of Hb due to its prompt anti-TNF effects.     

Viral Infections in Burn Patients: A State-Of-The-Art Review

Infections that are triggered by the accompanying immunosuppression in patients with burn wounds are very common regardless of age. Among burn patients, the most frequently diagnosed infections include the bacterial ones primarily caused by Pseudomonas aeruginosa or Klebsiella pneumonia, as well as fungal infections with the etiology of Candida spp. or Aspergillus spp. Besides, burn wounds are highly susceptible to viral infections mainly due to the impaired immune responses and defective functions of the immune cells within the wound microenvironment. The most prevalent viruses that invade burn wounds include herpes simplex virus (HSV), cytomegalovirus (CMV), human papilloma virus (HPV), and varicella zoster virus (VZV). Likewise, less prevalent infections such as those caused by the orf virus or Epstein–Barr Virus (EBV) might also occur in immunosuppressed burn patients. Viral infections result in increased morbidity and mortality rates in severely burned patients. Additionally, a positive correlation between the hospitalization duration and the severity of the viral infection has been demonstrated. Viral infections trigger the occurrence of various complications, ranging from mild symptoms to even fatal incidents. Accurate detection of viral infection is of great clinical importance because of the possibility for a quicker introduction of proper treatment therapy and shortening of hospitalization time. The aim of this paper is to provide a comprehensive review of the literature and summarize the findings regarding the most common viral infections in immunosuppressed burn patients.     

Qualitative bacteriology in malignant wounds--a prospective, randomized, clinical study to compare the effect of honey and silver dressings

Between 5% and 10% of cancer patients develop malignant wounds. In vitro and some clinical studies suggest that silver- or honey-coated dressings may have an antibacterial effect in nonmalignant wounds, but their possible antibacterial effect in malignant wounds remains unknown. A prospective, randomized, single-blind controlled clinical study was conducted to evaluate the bacteriology of malignant wounds and compare the effect of a honey-coated (Group A) to a silver-coated (Group B) dressing on the qualitative bacteriology of malignant wounds. All wound interventions were performed by the same healthcare professional. Swab cultures were obtained at baseline and following a 4-week intervention and were evaluated without information about the patient treatment group. Of the 75 patients with advanced cancer and malignant wounds identified, 67 (34 in group A, 33 in group B; median age 64 years, range 47-92) consented to participate and completed the 4-week study. The majority were women (88%) with breast cancer (79%). No statistically significant differences were found between the type and number of different wound pathogens in the wounds during the course of the study or between Group A and Group B. Neither anti-neoplastic nor antibiotic treatment influenced the presence of wound pathogens. Staphylococci were found in 42%, enteric bacteria in 34%, anaerobic bacteria in 16%, Pseudomonas in 10%, and hemolytic streptococci in 6% of wounds at baseline; in total, 25 different bacterial species were identified. Sixty-one percent (61%) of wounds decreased in size following treatment, but no significant differences were observed between the type and variety of wound pathogens and whether wound size decreased. Although quantitative bacteriological changes may have occurred, the possible antibacterial effect of the honey or silver dressing could not be confirmed in these malignant wounds. Routine wound swabbing of malignant wounds is of little value and should be restricted to cases where signs of infection requiring antibiotic intervention are observed or where resistant organisms require special infection control measures.