Emergency management of chronic wounds

As America's emergency departments witness an increase in care provided to an aging population, the emergency physician increasingly evaluates and treats manifestations of chronic disease. Nonhealing wounds are often a presenting manifestation of chronic disease. They are a source of pain and disability for this population. Emergency physicians should possess a fundamental knowledge in the management of chronic wounds. This article familiarizes the emergency physician with the epidemiology of chronic wounds, the physiology of tissue repair, the pathophysiology involved in wound healing failure, the common types of chronic wounds, and specific management strategies.     

Urgosorb dressing: management of acute and chronic wounds

This article illustrates the outcomes of a 10-patient prospective case study series. The aim of the study was to evaluate the use of Urgosorb in the management of acute and chronic wounds. (Urgosorb is a dressing comprising calcium alginate fibres and hydrocolloid, and is recommended for sloughy and granulating wounds with moderate to high levels of exudate.) Parameters assessed were the effectiveness of exudate management and integrity of surrounding tissue, ease of removal, patient comfort, effectiveness of odour control and observation for any adverse reactions. Data were collected over a period of 6 weeks with weekly evaluations. Healing was not included in the study objectives as it was recognized this would be difficult on a range of highly variable wounds. Although healing was not assessed, 50% of the wounds did heal during the study period. Dressing removal was considered easy in the majority of cases, and patients experienced none, or only mild discomfort. Levels if exudate were well managed and there were no reports of any adverse events.     

Platelet gel for healing cutaneous chronic wounds.

Wound healing is a specific host immune response for restoration of tissue integrity. Experimental studies demonstrated an alteration of growth factors activity due to their reduced synthesis, increased degradation and inactivation. In wound healing platelets play an essential role since they are rich of alpha-granules growth factors (platelet derived growth factor--PDGF; transforming growth factor-beta--TGF-beta; vascular endothelial growth factor--VEGF). Topical use of platelet gel (PG), hemocomponent obtained from mix of activated platelets and cryoprecipitate, gives the exogenous and in situ adding of growth factors (GF). The hemocomponents are of autologous or homologous origin. We performed a technique based on: multicomponent apheretic procedure to obtain plasma rich platelet and cryoprecipitate; manual processing in an open system, in sterile environment, for gel activation. Every step of the gel synthesis was checked by a quality control programme. The therapeutic protocol consists of the once-weekly application of PG. Progressive reduction of the wound size, granulation tissue forming, wound bed detersion, regression and absence of infective processes were considered for evaluating clinical response to hemotherapy. 24 patients were enrolled. They had single or multiple cutaneous ulcers with different ethiopathogenesis. Only 3 patients could perform autologous withdrawal; in the others homologous hemocomponent were used, always considering suitability and traceability criteria for transfusional use of blood. Complete response was observed in 9 patients, 2 were subjected to cutaneous graft, 4 stopped treatment, 9 had partial response and are still receiving the treatment. In each case granulation tissue forming increased following to the first PG applications, while complete re-epithelization was obtained later. Pain was reduced in every treated patient. Topical haemotherapy with PG may be considered as an adjuvant treatment of a multidisciplinary process, useful to enhance therapy of cutaneous ulcers.     

Optimal pressures and irrigation techniques used in small-animal wound management

Wound management is a vital aspect of veterinary nursing. This article reflects on common wound management techniques and when they should be applied in practice. Owners are the first to identify when their pet has a wound so when they bring them into the practice for treatment is crucial; wound management should occur in the first 6 hours post-injury to encourage optimal healing. This article will discuss cleansing techniques, as well as ideal irrigating pressures and the appropriate solutions to be used when presented with a wound.     

Differences between acute and chronic wounds and the role of wound bed preparation

There are major differences in the way acute and chronic wounds heal. An understanding of these differences enables practitioners to plan more appropriate care and management for patients. A simple framework such as wound bed preparation can be used to identify problems and plan realistic and appropriate outcomes of care.     

Pain assessment and management in patients with chronic wounds

Pain is a frequent symptom in patients with chronic wounds. It contributes to significant levels of suffering and distress, as well as reduced quality of life. This article considers interventions and procedures for managing pain in patients with chronic wounds.     

湿性外敷疗法治疗6例深度慢性伤口的护理

慢性伤口是指愈合时限延长、不能正常自愈而需要借助外力才能愈合的伤口。慢性伤口的迁延不愈,给患者带来身心痛苦。传统治疗慢性伤口以干性疗法为主,弊端较多。2008年1月-2009年3月,我科对部分门诊患者采用湿性敷料对慢性伤口实施湿性疗法护理,效果显著。现将护理体会报告如下。     

Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations

Background

As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence‐based approach and consider each wound individually in order to create the optimal conditions for wound healing.

Aims

A comprehensive evidence‐based approach to acute wound management is an essential skill set for any emergency physician or acute care practitioner. This review provides an overview of current evidence and addresses frequent pitfalls.

Methods

A systematic review of the literature for acute wound management was performed.

Results

A structured MEDLINE search was performed regarding acute wound management including established wound care guidelines. The data obtained provided the framework for evidence‐based recommendations and current best practices for wound care.

Conclusion

Acute wound management varies based on the wound location and characteristics. No single approach can be applied to all wounds; however, a systematic approach to acute wound care integrated with current best practices provides the framework for exceptional wound management.     

Pulsed electromagnetic energy in management of chronic wounds: a systematic review

Abstract

Objectives: To assess the evidence regarding effectiveness of pulsed electromagnetic energy (PEME) on the healing of chronic wounds; to explore whether there is an optimum treatment regime with regards to total current, pulse amplitude, pulse duration, and duration and frequency of treatments.

Methods: A computerised literature search of the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and PubMed was performed. Only randomised clinical trials (RCT), controlled trials, and clinical trials that studied a population aged 18 years of age or more and investigated the effects of a type of PEME in the management of a chronic wound were included. The methodological quality of the included trials was assessed qualitatively using a set of formal criteria as recommended by van Tulder et al.

Results: Eleven studies (n=360) out of 40 were included of which six were of high methodological quality. Methodological scores ranged from one to nine (maximum 11) with a mean score of 5·5 (SD=1·73). For venous ulcers, there is strong evidence that PEME is more effective than sham PEME. For pressure and plantar ulcers, there is moderate evidence that PEME, in combination with conventional wound care is better than conventional wound care alone. The heterogeneity in duration, frequency, voltage and magnetic field made it difficult to make detailed comparisons or specific recommendations regarding its application.

Discussion: Further research should focus on controlling baseline recruitment parameters within an RCT, studying vital outcomes, and exploring combinations of parameters regarding optimum usage of PEME.     

Overview: acute and chronic wounds

Knowledge of normal wound healing and the changes associated with chronic wounds have advanced significantly. Distinct characteristics identified through basic and clinical studies are found in nonhealing wounds, including bacterial and growth factor imbalances, increased inflammatory responses, and proteolytic forces that tip the balance toward tissue degradation rather than repair.This article describes the alterations that reduce healing and that also have important implications for the management of chronic wounds and presents a focus for future developments in wound therapy.     

创面敷料封闭负压引流治疗慢性创面

背景：前期研究发现采用生物材料创面敷料封闭负压引流装置治疗创面后期由于局部创面的血污、组织分泌物或细菌滋生原因会出现堵管,而堵管区域下方的软组织修复往往不能获得满意效果. 目的：观察采用间隙冲洗式生物材料创面敷料封闭负压引流治疗慢性创面的临床效果. 方法：36例慢性创面患者采取自愿选择治疗的方式,分为间隙冲洗式生物材料创面敷料封闭负压引流、合成敷料封闭负压引流、常规换药处理治疗. 结果与结论：与合成敷料封闭负压引流组及常规换药处理组比较,间隙冲洗式生物材料创面敷料封闭负压引流组创面细菌检出率明显降低（P〈0.05）,愈合时间明显缩短（P〈0.05）;间隙冲洗式生物材料创面敷料封闭负压引流组治疗期间疼痛目测类比评分明显优于常规换药组（P 〈0.05）,与合成敷料封闭负压引流组比较差异无显著性意义（P 〉0.05）.提示采用间隙冲洗式生物材料创面敷料封闭负压引流能有效促进慢性创面愈合,降低创面感染率,减轻患者治疗时的痛苦,且无不良反应.     

负压伤口治疗技术用于53例慢性伤口的效果评价

目的 评价负压伤口治疗技术用于各类慢性伤口的效果.方法 入选Ⅳ度压疮、外伤伤口、术后切口和糖尿病足溃疡共计53例69处,清创后采用一致性操作流程和- 125mmHg(1 mmHg=0.133kPa)负压及间歇吸引模式治疗21d,有手术指征者转外科治疗,无手术指征者按标准湿性疗法治疗至愈合.观察治疗7d、14d、21d后伤口面积、深度、温度、pH值变化及100％肉芽覆盖时间和治愈率.结果 负压封闭辅助闭合(VAC)治疗后伤口治愈率78.26％(54/69),平均愈合时间(94.00±63.26)d,其中30例43处伤口负压治疗结束后继续接受湿性疗法治愈,10例11处伤口负压治疗结束后转外科手术治愈.12例负压治疗好转后回家继续治疗,随访5个月,愈合5例5处.总治愈率85.51％(59/69).负压治疗4类慢性伤口21d时的伤口温度较治疗前明显升高,pH值明显降低,差异均有统计学意义(P＜0.01);100％肉芽覆盖时间平均为(22.96±12.20)d.结论 VAC治疗对不同类型慢性伤口均有效,能够营造有利于伤口愈合的温度和酸碱度,促进肉芽组织生长和伤口收缩及愈合.     

Malignancy and chronic wounds: Marjolin's ulcer

Malignancy in chronic wounds is not uncommon and has been reported as occurring in chronic scars of diverse causes. We report an unusual case of bilateral thermal injuries of the lower extremities that 40 years later presented as very large, painful, fungating wounds of both lower legs. After histologic confirmation of squamous cell carcinoma, eradication of the disease required amputations of both the lower extremities and reconstructive procedures. In addition, we discuss current theories regarding the mechanism of malignant degeneration in chronic wounds and evaluate treatment on the basis of information currently available in the literature.