Role of nitric oxide in wound healing

Chronic wounds mainly affect elderly individuals and persons with comorbid diseases due to a compromised immune status. An age-related decline in immune function deters proper healing of wounds in an orderly and timely manner. Thus, older adults with 1 or more concomitant illnesses are more likely to experience and sufferfrom a nonhealing wound, which may drastically decrease their quality of life and financial resources. Novel therapies in wound care management rely heavily on our current knowledge of wound healing physiology. It is well established that normal wound healing occurs sequentially and is strictly regulated by pro-inflammatory cytokines and growth factors. A multitude of commercial products such as growth factors are available; however, their effectiveness in healing chronic wounds has yet to be proven. Recently, investigators have implicated nitric oxide (NO) in the exertion of regulatoryforces on various cellular activities of the inflammatory and proliferative phases of wound healing. Gene therapy in animal studies has shown promising results and is furthering our understanding of impaired wound healing. The purpose of this article is to review the literature on NO and its role in wound healing. A discussion of the physiology of normal healing and the pathophysiology of chronic wounds is provided.     

Infectious diseases of refugees and immigrants: dengue fever

PURPOSE: To describe the assessment and management of chronic wounds and detail current recommendations for optimal wound care practices. DATA SOURCES: Selected scientific literature, clinical practice guidelines, and the authors' clinical experience. CONCLUSION: Multiple factors play a role in the problems associated with chronic wounds. Wound care is costly in regards to medical care, as well as costly in terms of the hardship placed on the patient, family and staff. Too often, wound care practices are based on rituals than research. IMPLICATIONS FOR PRACTICE: The assessment and management of chronic wounds needs to be individualized according to a thorough assessment of the wound, the patients' lifestyle, and the caregiver's knowledge and skill for managing th wound. It is also important to know what wound care products are available and the types of wounds appropriate for their use.     

Collagen powder dressings in the healing of secondary intention wounds. Report of a case

The wounds mean not only an important bio-psico-social problem for the patient who suffers them, but also an important economic burden for the sanitary system. One of the many wounds classifications allows us to differentiate between acute wounds (slight traumatism, surgical wounds...) and chronic wounds (pressure ulcers, vascular ulcers...), this differentiation allows us to distinguish between wound healing by primary intention (that occurs in acute wounds where filling of cavity is not needed). And wound repair by secondary intention (the way by which chronic wounds are normally solved), a long process in time that needs the filling of the cavity with a neoformation tissue, the granulation tissue. In the present article we described the use of a new dressing of exogenous collagen (Catrix) in the healing of wounds by secondary intention, as well as the actions of this dressing in the different phases of healing. For all it, we supported by a clinical case treated in our unit that corresponds to the healing by second intention of a post-surgical wound secondary to debride by a suppurative hydrosadenitis, that was admitted to our unit waiting for skin graft.     

Living with a chronic abdominal wound--the patients' perspective

Chronic abdominal wounds lead to prolonged hospital stays. However, no data exist that describe the experience of persons living with a chronic abdominal wound. The aim of this qualitative study was to explore the experience of persons living with chronic abdominal wounds and elicit their expectations in health professionals. Narrative interviews were conducted with five women and four men. Using content analysis techniques, five categories with one to four subcategories emerged from the data. "Returning to everyday life without a wound" represents the main goal of the participants and is driven by their hope to achieve this outcome. "Everyday life with the wound" illustrates the reality of participants' lives, which is affected by suffering. "The patients' work" demonstrates the component that patients contribute to managing their wound. "The work of primary support persons" shows the importance of the work of people close to the patient. "The work of professionals" includes the expectations that patients have in their caregivers. Teamwork between professionals, patients and primary support persons seems to be an essential condition for the successful healing of an abdominal wound.     

Managing chronic, nonhealing wounds using a research-based protocol

The physical, emotional, and financial costs of caring for patients with chronic, nonhealing leg wounds are substantial. In fiscal year 2001, the home care department of a large Veterans Affairs medical center in the Pacific Northwest spent nearly half of its annual budget on veterans needing wound care. In this article, the authors describe a practice improvement project designed to improve the wound care management of homebound veterans with chronic, nonhealing lower extremity wounds using a research-based protocol and consultation by a certified wound care specialist, as well as the effect of this program on home care expenditures.     

A world of pain

Though a common condition, chronic wound pain is poorly recognised and managed. Older people, who are the most commonly affected, can become socially isolated as a result. More than a million people in the UK have chronic wounds. Depression is common in people with chronic wound pain. Up to 50 per cent of community nurses' working time can be spent with people who have chronic leg ulcers.     

The principles of chronic wound assessment and measurement

The management of chronic diseases in the elderly population is a major challenge for professional nurses. Chronic wounds, such as pressure ulcers, diabetic foot ulcers, venous ulcers, and arterial ulcers are common problems among patients with chronic diseases. This article aims to improve the knowledge base of nurses who assess and identify the etiology of chronic wounds, in the hope that an improved pool of knowledge can be drawn upon and applied in clinical practice. The article discusses patient assessment, chronic wound assessment, assessment of healing, and wound classification systems that can provide a structured approach to the management of chronic wounds. It provides a rational and systematic approach to both assessment and management that is particularly useful in the management of non-healing wounds. It can be used as a source of reference for nurses in the organization of wound management plans and the provision of better care for patients.     

Understanding the inflammatory process in wound healing

The basic elements of wound healing can be described using three sequential and overlapping phases: inflammation, proliferation and regeneration. These phases represent a highly organized, tightly regulated and complex sequence of events that are dependent on an exquisite balance between various cell types and mediators. Inflammation is a prerequisite to healing; however, chronic wounds in particular exhibit a prolonged inflammatory response, thus providing an ideal environment for bacterial infiltration and proliferation. Considering that approximately 70% of all wounds are chronic, with the majority of wound care being delivered in the community, this paper aims to support nurses in their understanding of inflammation in order to enhance clinical practice.     

Chronic Wound Healing: A Review of Current Management and Treatments

Wound healing is a complex, highly regulated process that is critical in maintaining the barrier function of skin. With numerous disease processes, the cascade of events involved in wound healing can be affected, resulting in chronic, non-healing wounds that subject the patient to significant discomfort and distress while draining the medical system of an enormous amount of resources. The healing of a superficial wound requires many factors to work in concert, and wound dressings and treatments have evolved considerably to address possible barriers to wound healing, ranging from infection to hypoxia. Even optimally, wound tissue never reaches its pre-injured strength and multiple aberrant healing states can result in chronic non-healing wounds. This article will review wound healing physiology and discuss current approaches for treating a wound.     

Honey in wound care: effects, clinical application and patient benefit

The use of honey in wound management has enjoyed a resurgence. This is largely due to the growing clinical problem of antibiotic-resistant bacteria and the combined difficulties for the practitioner in managing chronic wound types, such as burns, leg ulcers or surgical wounds, that may become infected, for example, with methicillin-resistant Staphylococcus aureus or Pseudomonas. The associated costs of treating such wounds are escalating as a result. While the use of honey as a wound dressing has been recognized, at least since Egyptian times circa 2000 BC, it is only more recently, due to the development and licensing of modern honey wound dressings, that such dressings have become more widely available and used in wound management. This article focuses on the use of honey in the treatment of infected wounds and burns. It will examine the effects of honey at the wound bed and its clinical applications, along with the current dressings available. Also discussed are the practical considerations, if, like any wound dressing, honey is to be used safely, appropriately and for the benefit of the patient.     

Vacuum-assisted closure use in calciphylaxis

Calciphylaxis-induced chronic wounds are difficult to heal. The value of vacuum-assisted closure (VAC) was assessed in two patients with calciphylaxis. Two middle-aged females with type 2 diabetes were transferred to the burn unit with a clinical diagnosis of necrotizing fasciitis, although the pathologic diagnosis was calciphylaxis. With extensive debridement, antibiotics, and meticulous wound care, one patient had progressive necrosis of her skin from 18 to 48% TBSA, whereas the other progressed from 5 to 10% TBSA only. The patient with the smaller chronic wound healed well and left the hospital at 72 days after admission. Although there was some success with the use of VAC, the patient with the extensive progressive wounds developed a fungal wound infection that did not respond to treatment; she died 78 days after initiation of burn center treatment. Some disadvantages to the usefulness would be extensive contiguous wounds and the lack of an intact skin surface. The VAC system was of value in healing wounds resulting from calciphylaxis.     

封闭负压引流干预慢性创面神经生长因子和微血管的变化

背景：随着老龄化程度的增加,慢性创面呈上升趋势,在治愈慢性创面方法匮乏的情况下,封闭负压引流技术开始应用于临床。目的：观察封闭负压引流技术对人慢性创面组织中神经生长因子表达及微血管数量的影响,探索促进慢性创面愈合的机制。方法：以10例慢性创面患者为观察对象,其中胸部软组织缺损、骨髓炎伴骨外露和截肢后残端大面积皮肤缺损各1例、皮肤撕脱伤后创面感染2例、胫骨骨髓炎2例、术后伤口感染3例。分别于封闭负压引流技术吸引前、吸引7 d和14 d切取创周皮肤和创面内肉芽组织,采用免疫组织化学技术检测神经生长因子表达和微血管数量变化,并观察伤口愈合情况。结果与结论：封闭负压引流技术治疗7 d和14 d后成纤维细胞及血管内皮细胞中的神经生长因子表达明显高于治疗前（P ＜0.001）。封闭负压引流治疗使微血管数量显著增加（P ＜0.05-0.01）。封闭负压引流治疗前创基内肉芽组织量少且较晦暗,存在坏死组织和较多脓性分泌物,伤口周围组织肿胀明显。经封闭负压引流治疗后,伤口内坏死组织和脓性分泌物逐渐减少,肉芽组织呈细颗粒状,鲜红色,触之易出血,伤口周围水肿消退。提示封闭负压引流技术可以提高慢性创面创周组织中神经生长因子表达和微血管数量,促进创面愈合。     

Prontosan wound irrigation and gel: management of chronic wounds

Chronic wounds present a challenge that is costly in terms of quality of life to the patient and in financial terms for the NHS. Several factors contribute to the development of a chronic wound, in particular the influence of bacteria as a biofilm within the wound environment. Irrigating a wound with normal saline has long been advocated as the most appropriate method of wound irrigation but biofilms are now known to be resistant to this method of cleansing. A small (10 patient) evaluation of the use of Prontosan in patients whose duration of chronic wounds exceeded 1 year has demonstrated that Prontosan wound irrigation and Prontosan gel are an appropriate alternative for cleaning, moistening and decontaminating encrusted, contaminated and chronic skin wounds, and can have a dramatic influence of the quality of life for such patients. This article discusses the cause of chronicity within a wound and discusses in depth three of the ten patients in the evaluation.     

Nurse driven outpatient wound center: Reducing readmission with wound care excellence

There is a growing need for new and innovative ways to care for patients in the ambulatory setting, including providing wound care for patients.A vascular surgery department in a large urban academic medical center noted there was an increasing number of patients with chronic wounds that needed weekly care. The number of patients, the time needed to provide wound care, and limited clinic space was creating a strain on traditional clinic hours.Collaboration between one of the vascular surgery advanced practice registered nurses (APRN) and vascular registered nurse (RN) led to the creation of a vascular wound clinic. Patients with chronic wounds were identified by vascular surgeons at one institution and referred to the wound clinic. A retrospective chart review was used to look at number of patients, number of visits per patient, surgical interventions, number of wounds closed, size of wounds, and complications.The ability to provide a single point of contact for the patient's vascular surgery and wound care needs allowed the clinic to provide comprehensive care for 29 patients and close more than 75% of wounds. The retrospective chart review found that patients receiving weekly wound care with clear communication from the multidisciplinary team, the nursing and nurse practitioner interventions kept most patients out of the hospital, with only two unplanned readmissions to the hospital, neither due to chronic wounds.This nursing led wound clinic was able to accommodate complex vascular surgery patients, heal chronic wounds, and decrease unplanned readmissions. Expanding the clinic to assist with limb salvage and more podiatric patients is providing a new patient base and improving the care for the community that it serves.     

Nutrition for wound healing

The importance of the role of nutrition in wound healing is an area that has been widely explored over the last decade. It is well recognised that both macronutrients (protein, fat and carbohydrate) and micronutrients (vitamins, minerals and trace elements) play important parts in the healing of both chronic wounds and acute injuries. The term 'wound' encompasses many different situations from leg ulcers to laparostomy wounds. This article provides an overview of the role of different nutrients in the healing of wounds and guidance to nurses on first-line assessments, which can be used to ensure the patient is receiving adequate nutrition for successful wound healing. It will focus on commonly seen wounds in primary and secondary care but will not cover specialist wound management, such as laparostomy sites and burns, as these must always be cared for by experienced and specialist multidisciplinary teams.     

Treatment of a venous leg ulcer with a honey alginate dressing

The management of chronic wounds such as venous ulcers is a common and long-term issue with the aging population. Non-standard treatment that is both medically and financially effective needs to be identified. Honey has been used for its healing properties for centuries and has been used to successfully heal wounds including pressure-ulcers in our care facility. However, there is not much evidence for its use in treating venous ulcers. To this end, I trialed the use of a honey-impregnated alginate dressing on a man who had a long-standing history of venous ulcers on his leg with the aim of evaluating the effectiveness of honey as an alternative treatment to the current wound management therapies. The honey seemed to act as an effective antibacterial, anti-inflammatory and deodorizing dressing, with total healing of the ulcer achieved. This result, together with past successes with the use of honey alginate on ulcerated wounds, has led to this product becoming mainstream in the treatment of chronic wounds within our care facility.     

The use of honey for the treatment of two patients with pressure ulcers

Chronic wounds such as pressure ulcers, leg ulcers and diabetic wounds are a common problem among older people and alternative methods to the current time-consuming and costly practices of wound management in the nursing home need to be identified. To this end, we trialled the use of a honey alginate on two elderly males in our nursing home who were suffering from pressure ulcers (one on the ankle and one on the sacral region), to evaluate its effectiveness as a viable alternative to the current wound management practices in nursing homes. The use of honey resulted in a rapid and complete healing of both wounds. In addition, the antibacterial activity of honey had a deodorizing effect on the wounds and its anti-inflammatory actions helped reduce the level of pain. Similar healing results are also being observed in other patients with pressure-induced ulcers and as a result honey alginates are now being used as the 'standard' treatment for chronic wounds in our nursing home.     

Examining the literature on using tap water in wound cleansing

Practitioners working in the community setting and whose caseload predominantly consists of treating chronic wounds often use tap water as a wound cleanser with the rationale that chronic wounds are already colonised with bacteria. However, there is some controversy, as discussed within this review, of the suitability of tap water as a cleansing agent for acute wounds.     

高渗盐敷料结合负压封闭引流技术在慢性伤口中的应用

目的：探讨高渗盐敷料结合负压封闭引流技术在慢性伤口中应用效果。方法将68例因各种原因导致的迁延不愈的慢性伤口患者随机分为治疗组和对照组各34例,治疗组采用高渗盐敷料为伤口填充材料,以一次性使用胃管为引流管连接负压瓶为患者进行创面负压引流治疗;对照组采用湿性愈合原理常规换药,比较两组治疗效果。结果治疗组伤口治愈率为91．17％,对照组为70．59％,两组比较差异有统计学意义（χ2＝4．66,P＜0．05）;治疗组伤口面积愈合率（92．58±3．68）％,伤口愈合时间（12．15±2．74）d,换药次数（2．25±0．28）次,均优于对照组,差异有统计学意义（t值分别为6．034,-14．884,-15．257;P＜0．05）。结论高渗盐敷料结合负压封闭引流技术能够营造有利于慢性伤口愈合的环境,改善局部血供,促进伤口愈合。降低换药次数及费用,提高伤口愈合质量。