Suprathel, a new skin substitute, in the management of partial-thickness burn wounds: results of a clinical study

OBJECTIVE: A prospective, randomized, bicentric, nonblinded, clinical study was conducted to evaluate the impact on wound healing of Suprathel in partial-thickness burn injuries. Suprathel represents an absorbable, synthetic wound dressing with properties of natural epithelium. METHODS: Thirty patients suffering from second-degree burn injuries were included in the study, with a mean of age 40.4 years old. Burn injuries were randomly selected, partly treated with Omiderm and partly treated with Suprathel. The first gauze change was applied the fifth day postoperatively, followed by regular wound inspection until complete reepithelization. The study focused on patient pain score, healing time, analysis of wound bed, ease of care, and treatment costs. RESULTS: There was no significant difference between the 2 materials tested regarding healing time and reepithelization. There was a significant lower pain score for patients treated with Suprathel (P = 0.0072). Suprathel becomes transparent when applied, thus allowing close monitoring of wound healing. In contrast to Omiderm, Suprathel shows better attachment and adherence to wounds. During the course of healing, it detaches smoothly, without damaging the reepithelized wound surface. Moreover, it reduces the frequency of dressing changes required. Ease of care of Suprathel has been rated outstanding by patients and healthcare professionals. When interviewed, patients reported Suprathel as their treatment preference. As dressing material, Omiderm is more cost-effective than Suprathel. CONCLUSION: Suprathel represents a reliable epidermal skin substitute, with a good impact on wound healing and pain reduction in partial-thickness burn injuries. Although it is less cost-effective than Omiderm, the significant increase of patient comfort makes this material represent a reliable and solid treatment alternative when dealing with partial-thickness burn injuries. Further studies with this synthetic dressing on other types of wounds are warranted.     

Suprathel, a new skin substitute, in the management of donor sites of split-thickness skin grafts: results of a clinical study

OBJECTIVE: A prospective, randomized, two center clinical study was conducted to evaluate the impact on wound healing of Suprathel in donor sites of split-thickness skin grafts. Suprathel represents an absorbable, synthetic wound dressing with properties of natural epithelium. METHODS: 22 burn patients who were treated with split-thickness skin grafts, and with a mean age of 39.6 years were included in the study. Donor sites of skin grafts were randomly selected; partly treated with Jelonet and partly treated with Suprathel. First gauze change was carried out the fifth day postoperatively followed by regular wound inspection until complete re-epithelization. The study focused on patient pain score, healing time, analysis of wound bed, ease of care, and treatment costs. RESULTS: There was no significant difference between the two materials tested regarding healing time and re-epithelization. There was a significantly lower pain score for patients treated with Suprathel (p=0.0002). Suprathel became transparent when applied and allowed close monitoring of wound healing. In contrast to Jelonet, Suprathel showed excellent plasticity with better attachment and adherence to wound surfaces. Throughout the healing process it detached from wounds without damaging the new epithelial surface. In addition, wound areas treated with Suprathel required less frequent dressing changes. It also demonstrated excellent ease of care. This, altogether with the significant pain reduction, presented a positive feedback by patients and healthcare professionals who both rated Suprathel as their treatment preference. Though Jelonet is more cost effective as dressing material, the study revealed an overall reduction in total treatment costs achieved with Suprathel. CONCLUSION: Suprathel represents a solid, reliable epidermal skin substitute with impact on wound healing, patient comfort and ease of care. The material effectiveness contributes to the reduction of overall treatment costs.     

创口治疗技术平台的建设及运作

Chronic wounds are a major healthcare problem costing billions of dollars a year over the world. However, it is regrettable that a large number of chronic wounds are still treated simply by conventional dressing change in local clinics,lacking of definite diagnosis and personalized care. This situation results in a low wound healing rate, unsatisfied life quality of the patients, and higher medical cost for the prolonged promiscuous care. We should not only emphasize the importance of wound care in clinical practice, but also emphasize the importance of establishing wound care centers. With the experience of our practice in wound care center, the construction of wound care technology platform is strongly suggested. This platform could act as an education base to train more professional wound care doctors, nurses, and care workers, as well as resolve many technical difficulties involved in the treatment of many complicated chronic wounds.     

Application of bacterial nanocellulose-based wound dressings in the management of thermal injuries: Experience in 92 children

BackgroundManagement of pediatric thermal injuries involves a high standard of care in a multidisciplinary setting. To avoid physical and psychological sequelae, wound dressings should minimize hospitalization time and anesthesia while maximizing patient comfort.Patients and methods190 children with thermal injuries of the torso, arms and legs were treated with polyurethane foam dressings or bacterial nanocellulose sheets. Data were analyzed retrospectively regarding hospitalization, procedures with general anesthesia, scar formation, rate of infection and need for skin grafting.ResultsThe groups did not differ significantly concerning age, gender distribution or percentage of injured total body surface area. Statistical analysis showed that length of hospitalized care and procedures undergoing anesthesia were significantly reduced in the nanocellulose group (each p < 0.0001). There was no significant difference in rate of complications, wound healing and rate of skin grafting between the two subgroups.DiscussionActing as a temporary epidermal substitute, bacterial nanocellulose enables undisturbed reepithelialization without further wound dressing changes. In children, no additional topical antimicrobial agents are indicated for unimpaired wound healing.ConclusionsBacterial nanocellulose is superior to polyurethane foam regarding length of hospitalization and number of interventions under anesthesia. It offers a safe, cost-effective treatment option and provides excellent comfort in pediatric patients.     

VSD治疗手部感染性创面的疗效分析

目的探讨应用负压封闭引流技术(Vacuum Sealing Drainage,VSD)治疗手部感染性创面的临床效果。方法回顾性分析2014年12月-2019年3月收治的皮肤缺损伴感染患者40例。随机分为VSD治疗组(A组)20例,常规换药治疗组(B组)20例。A组给予手术清创,负压引流材料覆盖创面,并给予庆大霉素持续冲洗。B组给予手术清创后,每日换药。两组肉芽组织新鲜后给予植皮治疗。回顾性分析两组平均住院时间、创面愈合时间、创面评分、疼痛程度评分、抗菌药物使用时间、换药次数。结果A组住院时间、创面愈合时间、创面评分、疼痛程度评分、抗菌药物使用时间、换药次数均少于B组,A组疼痛评分低于B组。两组差异有统计学意义(P<0.01)。结论应用VSD治疗手部感染性创面可促进肉芽组织生长,加速创面愈合,减少患者住院时间及抗菌药物使用,减轻患者的痛苦,临床效果良好,值得推广。     

Do stakeholders in wound care prefer evidence‐based wound care products? A survey in the Netherlands

For several wound products compelling evidence is available on their effectiveness, for example, from systematic reviews. The process of buying, prescribing and applying wound materials involve many stakeholders, who may not be aware of this evidence, although this is essential for uniform and optimum treatment choice. In this survey, we determined the general awareness and use of evidence, based on (Cochrane) systematic reviews, for wound products in open wounds and burns among wound care stakeholders, including doctors, nurses, buyers, pharmacologists and manufacturers. We included 262 stakeholders. Doctors preferred conventional antiseptics (e.g. iodine), while specialised nurses and manufacturers favoured popular products (e.g. silver). Most stakeholders considered silver‐containing products as evidence‐based effective antiseptics. These were mostly used by specialised nurses (47/57; 82%), although only few of them (9/55; 16%) thought using silver is evidence‐based. For burns, silver sulfadiazine and hydrofibre were most popular. The majority of professionals considered using silver sulfadiazine to be evidence‐based, which contradicts scientific results. Awareness and use of the Cochrane Library was lower among nurses than among doctors (P < 0·001). Two thirds of the manufacturers were unaware of, or never used, the Cochrane Library. Available compelling evidence in wound care is not equally internalised by stakeholders, which is required to ensure evidence‐based decision making.     

Prospective randomized study of the efficacy of hydrogel, hydrocolloid, and saline solution—moistened dressings on the management of pressure ulcers

A total of 67 patients with pressure ulcers were randomized into one of three treatment modalities: hydrogel sheet dressing, hydrocolloid, or wet-to-moist gauze. Safety, efficacy, and physical attributes of the three dressings were evaluated. No statistical significance was found in wound healing rate among the three treatments. Hydrogel sheets were advantageous in allowing wound visualization without dressing or wound disruption.     

Negative‐pressure wound therapy for III/IV pressure injuries: A meta‐analysis

This meta‐analysis was conducted to identify the potential benefits and the efficacy of negative‐pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32‐1.70). There were significant differences in wound healing time (WMD = ?16.47 days, 95% [CI (?22.36, ? 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = ?2.39, 95% CI [?3.47, ?1.30], P ≤ .001); (SMD = ?2.55, 95% CI [?4.07, ?1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = ?3.61, 95% [CI (?4.57, ? 2.66) times, P ≤ .001]). Our meta‐analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high‐quality multicenter RCTs.     

不同敷料组合对烧伤患者供皮区创面微环境的影响

目的 了解不同敷料组合对烧伤创面微环境及愈合的影响.方法 选择烧伤后需行手术植皮的患者186例,供皮区创面取皮厚度均为0.3 mm.将200个供皮区创面按表格随机法进行分组,分为藻酸盐棉垫组(藻酸盐敷料+棉垫)、凡士林棉垫组(凡士林油纱+棉垫)、藻酸盐泡沫组(藻酸盐敷料+泡沫敷料)、凡士林泡沫组(凡七林油纱+泡沫敷料).观察各种敷料对患者创面水分蒸发量及pH值的影响,比较各组创面的细菌定植情况、揭除敷料时患者疼痛程度及创面愈合时间.结果 共有184例患者的198个创面完成试验全过程,4种组合敷料可造成不同的创面微环境.藻酸盐棉垫组、凡士林棉垫组、藻酸盐泡沫组、凡士林泡沫组患者创面的敷料表面水分蒸发量分别为(35.5±3.2)、(31.3±2.8)、(23.1±2.9)、(18.1±2.3)mL·h-1·m-2,保湿性能以凡士林泡沫组为佳;创面pH值分别为7.22±0.06、7.41±0.03、7.05±0.03、7.34±0.06.创面细菌培养阳性率以藻酸盐泡沫组(4.0%)最低,凡士林泡沫组(22.4%)最高.揭除患者创面敷料时疼痛程度以藻酸盐泡沫组最轻(0.98±0.12),凡士林棉垫组最重(8.14±0.82).创面愈合时间藻酸盐泡沫组最短,为(6.7±0.8)d;凡士林泡沫组最长,为(15.6±3.5)d.结论 不同敷料在同样创面上使用,会营造不同的创面微环境;该环境与创面愈合时间密切相关,湿度对创面愈合的影响比pH值更为重要.     

Competencies of specialised wound care nurses: a European Delphi study

Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e‐Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9‐point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain ‘scholar’ (n = 19), whereas few addressed those associated with being a ‘health advocate’ (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses.     

Recent advances in topical wound care

There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ‘magical dressings’. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.KEY WORDS: Moist healing, topical wound care, wet dressings     

三联疗法对混合痔术后肛门水肿、疼痛及创面愈合时间的影响

为观察三联疗法对混合痔术后肛门水肿、疼痛及创面愈合时间的影响,将126例拟行外剥内扎术的混合痔患者随机分为观察组和对照组,各63例。对照组患者术后常规换药,观察组患者术后在常规换药基础上,口服地奥司明片、静脉输注七叶皂苷钠、用复方角菜酸酯栓纳肛。对比观察两组患者术后肛门疼痛、水肿评分及创面愈合时间。结果显示,观察组患者术后第3人、第7天肛门疼痛、水肿评分均明显低于对照组,P〈0．05;创面愈合时间明显短于对照组,P〈0．05;用药6d,两组均末见明显不良反应。结果表明,三联疗法可有效减轻混合痔患者外剥内扎术后肛门疼痛及水肿程度,促进创面愈合。     

A randomized,controlled trial of Promogran (a collagen/oxidized regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers

HYPOTHESIS: Promogran, a wound dressing consisting of collagen and oxidized regenerated cellulose, is more effective that standard care in treating chronic diabetic plantar ulcers. DESIGN: Randomized, prospective, controlled multicenter trial. SETTING: University teaching hospitals and primary care centers. PATIENTS: A total of 276 patients from 11 centers were enrolled in the study. The mean age of the patients was 58.3 years (range, 23-85 years). All patients had at least 1 diabetic foot ulcer. INTERVENTIONS: Patients were randomized to receive Promogran (n = 138) or moistened gauze (control group; n = 138) and a secondary dressing. Dressings were changed when clinically required. The maximum follow-up for each patient was 12 weeks. MAIN OUTCOME MEASURE: Complete healing of the study ulcer (wound). RESULTS: After 12 weeks of treatment, 51 (37.0%) Promogran-treated patients had complete wound closure compared with 39 (28.3%) control patientss, but this difference was not statistically significant (P =.12). The difference in healing between treatment groups achieved borderline significance in the subgroup of patients with wounds of less than 6 months' duration. In patients with ulcers of less than 6 months' duration, 43 (45%) of 95 Promogran-treated patients healed compared with 29 (33%) of 89 controls (P =.056). In the group with wounds of at least 6 months' duration, similar numbers of patients healed in the control (10/49 [20%]) and the Promogran (8/43 [19%]; P =.83) groups. No differences were seen in the safety measurements between groups. Patients and investigators expressed a strong preference for Promogran compared with moistened gauze. CONCLUSIONS: Promogran was comparable to moistened gauze in promoting wound healing in diabetic foot ulcers. It showed an additional efficacy for ulcers of less than 6 months' duration that was of marginal statistical significance. Furthermore, Promogran had a safety profile that was similar to that of moistened gauze, with greater user satisfaction. Therefore, Promogran may be a useful adjunct in the management of diabetic foot ulceration, especially in ulcers of less than 6 months' duration.     

What is the paradigm: hospital or home health care for pressure ulcers?

A home health care (HHC) referral should link the patient in a cost-effective fashion to the physician, home care, and instructions regarding ulcer management. Twenty-one patients (mean age, 74.6 years) had stage III pressure ulcers (<100 cm2) and an involved family member at home. Risk and contributing factors included cardiac disease (n = 9), hypertension (n = 14), end-stage renal disease (n = 7), smoking (n = 11), diabetes (n = 8), chronic brain syndrome (n = 14), cerebrovascular accident (n = 5), and above-the-knee amputation (n = 2). Treatment regimens included standard wound care, pressure relief and, where appropriate, culture-specific antibiotics, as well as a rehabilitation program. Home care progressively decreased the frequency of the nurse HHC and physician office visits. Resolution of the pressure ulcer varied from 6 to 32 weeks. Only two patients had progression of their wound and required hospital readmission. The billable fees included: 1) an office visit, $30.00 (medicare reimbursement, $14.00); 2) the HHC nurse visit, $159.00 (medicare reimbursement, $105.00); 3) supplies, $75.00 to $150.00/week (variable reimbursement); 4) hospitalization, $400.00 to $900.00/day; and 5) a chronic-care bed, $400.00 to $750.00/day. HHC, given a responsible support team and an involved family member, was more socially and financially acceptable than an inpatient facility. Intermittent physician visits with HHC proved safe and reliable, with 90 per cent successfully healing their wounds.     

Treatment of Superficial Surgical Wounds after Removal of Seborrheic Keratoses: A Single-Blinded Randomized-Controlled Clinical Study

BACKGROUND: For the treatment of superficial surgical wounds, there are a number of options, including topical antibiotic ointments, dressings, and specialized wound care materials, such as hydrocolloid dressings. OBJECTIVE: To evaluate the wound-healing activity of a commercially available hydrocolloid wound dressing (Avery H2460, Avery Dennison, Turnhout, Belgium) in comparison with a control treatment (Fucidine cream with Cutiplast sterile dressing) in superficial wounds after surgical removal of seborrheic keratoses. METHODS: In a single-blinded, randomized, controlled trial, the hydrocolloid wound dressing (Avery H2460) was compared with healing by secondary intention as a control. Sixteen patients between 18 and 80 years of age with seborrheic keratoses were enrolled. Wound healing was evaluated after 7 and 10 days and then daily until complete closure of the wound area. In 7 of 16 patients, biopsies were taken after 14 days of reepithelization. RESULTS: The hydrocolloid wound dressing (Avery H2460) induced a significantly (p<.05) faster healing (median: 8.5 days) in comparison with the control treatment (median: 10 days). The histologic investigations showed no significant differences for the investigated parameters in both groups. CONCLUSION: The faster healing in comparison with the control treatment supports the use of the hydrocolloid wound dressing (Avery H2460) for the treatment of superficial surgical wounds.     

Development of an evidence-based protocol for care of pilonidal sinus wounds healing by secondary intent using a modified Reactive Delphi procedure. Part 2: methodology, analysis and results

This is the second part of the article based on the thesis work for a Masters of Science in Wound Healing and Tissue Repair, Cardiff University, to develop an evidence-based protocol for the care of pilonidal sinus wounds (PSWs) healing by secondary intent, using a modified Reactive Delphi process. The sample included surgeons, clinic physicians, nurses and enterostomal therapy nurses experienced in the care of these wounds. Item generation involved an extensive review of the literature to identify key aspects of evidence-based wound care essential to wound healing, infected wounds and pilonidal wounds healing by secondary intent and drawing on clinical experience. The participants responded via an electronic Delphi website, using a 4-point Likert rating scale and a ranking system. Comments were invited. Feedback was provided to the participants at the end of each round, that included comments, consensus scores, content validity index and additional information that provided rationale and references, or minor revision if requested. This project successfully achieved the objectives, which were to identify the areas of care that negatively or positively influences healing of postoperative PSWs and to inform, educate and broaden the considerations regarding these factors for health care professionals.     

A systematic review of randomized controlled trials of wound dressings for chronic venous ulcer

OBJECTIVE: To determine whether more "modern" complex wound dressings further improve the healing of venous ulcers over that with simple wound dressings, we conducted a systematic review of randomized controlled trials (RCTs) of wound dressing trials that were published from October 1, 1997, through September 1, 2005. METHODS: We searched MEDLINE, CINAHL, and the Cochrane Controlled Trials Registry Database to identify RCTs. Criteria for ultimate selection included treatment with compression and an objective outcome describing the proportion of wounds healed. Twenty RCTs were identified that satisfied these criteria and were classified into three wound dressing classes: semiocclusive/occlusive group (n = 8), growth factor group (n = 7), and human skin equivalent group (n = 5). RESULTS: Assessment of study design quality for the 20 RCTs showed a low percentage (<49%) of RCTs that incorporated at least 3 of 7 indicators of trial quality, but it seemed better in the 5 RCTs that showed significance for ulcer healing; 4 of the studies used at least 6 of the 7 characteristics of adequate study design. Five (25%) of the 20 RCTs had a statistically significantly improved proportion of ulcers healed in the experimental dressing group over control values: zinc oxide paste bandage (79% vs 56%) and Tegasorb (59% vs 15%) in the semiocclusive/occlusive group and perilesional injection of granulocyte-macrophage colony-stimulating factor (57% vs 19%) and porcine collagen derived from small-intestine submucosa (Oasis; 55% vs 34%) in the growth factor group. In the sole significant RCT from the human skin equivalent group, Apligraf (63%) was superior to Tegapore (48%). Four of these five studies also showed an improved time to complete healing by Kaplan-Meier estimate. CONCLUSIONS: Certain wound dressings can improve both the proportion of ulcers healed and the time to healing over that achieved with adequate compression and a simple wound dressing. The selection of a specific dressing, however, will depend on the dressing characteristics for ease of application, patient comfort, wound drainage absorption, and expense.     

Clinical evaluation of hydrocolloid dressings for neurosurgical wounds

BACKGROUND: Empirical methods in postoperative wound care have been performed by individual neurosurgeons. We evaluated a hydrocolloid dressing for neurosurgical wounds according to the modern concept of wound healing. METHODS: From May 2005 to March 2007, we performed 117 cranial neurosurgical procedures in consecutive 100 patients. Karayahesive (ALCARE, Tokyo, Japan), a transparent hydrocolloid dressing, was affixed onto all wounds immediately postoperatively. Clinical evaluations were performed for wound healing, wound infection, and cost-effectiveness. RESULTS: Excellent wound healing and cosmetic results were obtained in all patients. There was no incisional surgical site infection. Analysis of cost-effectiveness suggested Karayahesive as superior to conventional gauze-and-tape dressings. CONCLUSION: Karayahesive fits with the modern concept of wound healing and is a useful dressing for neurosurgical wounds.     

Chitin and chitosan: biopolymers for wound management

Chitin and chitosan are biopolymers with excellent bioactive properties, such as biodegradability, non‐toxicity, biocompatibility, haemostatic activity and antimicrobial activity. A wide variety of biomedical applications for chitin and chitin derivatives have been reported, including wound‐healing applications. They are reported to promote rapid dermal regeneration and accelerate wound healing. A number of dressing materials based on chitin and chitosan have been developed for the treatment of wounds. Chitin and chitosan with beneficial intrinsic properties and high potential for wound healing are attractive biopolymers for wound management. This review presents an overview of properties, biomedical applications and the role of these biopolymers in wound care.     

复方紫草膏对肛周脓肿术后创面愈合的影响

为观察复方紫草膏纱条用于肛周脓肿术后创面换药的临床疗效,将151例肛周脓肿患者随机分为观察组75例采用复方紫草膏纱条换药;对照组76例采用凡士林纱条换药,观察两组创缘红肿消失时间、脓性分泌物消失时间、肉芽组织生长情况、创口愈合时间、平均住院时间。结果显示,观察组以上指标均明显优于对照组。结果表明,复方紫草膏纱条用于肛周脓肿术后创面换药,疗效明显,可缩短疗程,无毒副作用。