Frequency Of Dressing Changes Research Articles

Xeroform Stick-Down Dressing: A Novel Treatment for Pediatric Partial-Thickness Burns.

Burns traditionally require frequent, painful dressing changes to minimize infection risk and promote wound healing. To improve care for our pediatric population, our institution adapted a skin graft donor site dressing into a "stick-down" burn dressing consisting of a one-time application of bacitracin and 3% bismuth tribromophenate/vaseline impregnated gauze (Xeroform) that adheres to the burn and peels off as new epithelialized skin forms. The goal of which is to minimize dressing change frequency and patient discomfort in a cost-effective, widely available manner. This study aimed to compare clinical outcomes of the stick-down versus traditional topical dressings. A retrospective cohort study of pediatric patients (age <18 year) with partial-thickness burns treated at a level I pediatric trauma center for 4 years was conducted. One hundred eleven patients were included: 74 patients treated with daily silver sulfadiazene (Silvadene) dressings matched to 37 patients treated with the Xeroform stick-down dressing using 2:1 propensity score matching. Univariate analyses used Wilcoxon rank sum and Fisher exact tests. The cohorts had similar demographics and burn characteristics. Both groups had similar hospitalization rates (31.1% Silvadene, 32.4% Xeroform), most commonly for pain control (54.5% Silvadene, 58.3% Xeroform), with similar average daily narcotic usage (7.7 ± 12.1 morphine milliequivalents Silvadene, 5.1 ± 9.5 Xeroform; P = 0.91). The Xeroform cohort had a shorter but statistically similar hospital stay (median, 1 vs 2 days). In addition, the Xeroform cohort required significantly less dressing changes with a median of 0.5 changes compared with 12 for the Silvadene cohort ( P < 0.0001). There was no difference in time to burn reepithelialization (median, 13.0 days for Silvadene and 12.0 days for Xeroform; P = 0.20) or wound healing complications (12.5% Silvadene, 2.7% Xeroform; P = 0.15). The Xeroform stick-down dressing has equivalent clinical outcomes to that of standard Silvadene dressings for the treatment of pediatric partial-thickness burns with the major advantages of decreasing dressing change frequency, minimizing patient distress and pain, and streamlining clinical care.

Examining the Clinical Outcomes of a Soft Silicone Multilayer Foam Dressing for Exudate Management in US Hospitals: It Is Time to Optimize Dressing Change Frequency

Background. Acute and chronic wounds in the acute hospital setting are commonly managed with soft silicone multilayer foam dressings (SSMFDs). While many SSMFDs are indicated for wear time of up to 7 days, they are often changed more frequently. Objective. To use real-world data on dressing change practices and clinical outcomes to examine whether a built-in indicator on a proprietary SSMFD could reduce unnecessary dressing changes. Materials and Methods. Health care professionals (HCPs) were screened and recruited from a health care research panel to complete per wound data capture forms. Outcomes reported included dressing wear time, healing rates, dressing change frequency, user satisfaction, and adverse events. Outcomes were reported as an aggregated data set. Results. A total of 53 wounds were analyzed. The mean treatment period was 23.83 days, which included dressing changes every 2 to 3 days on average. Of the 53 cases analyzed, the unique change indicator on the SSMFD was used to guide dressing change frequency 98% of the time. Overall, 21% of wounds completely healed (n = 11), 70% (n = 37) showed improvement, 9% (n = 5) were static, and 0% deteriorated. Conclusion. Real-world data on use of the proprietary SSMFD in an acute setting indicates that the SSMFD can allow for the optimization of dressing change protocols to enable appropriate dressing change frequency, allowing for undisturbed healing and maximizing HCP and dressing resources.

Clinical evaluation of continuous irrigation with Bikerui combined with negative pressure closed drainage and platelet-rich plasma technique for treatment of stage III-IV pressure ulcer.

As a catastrophic complication of bedridden and elderly patients, pressure ulcer usually continuously affects patients' health and quality of life, so the daily care of wounds is attached great importance in clinic. This work investigated the effect of Bikerui disinfectant + vacuum sealing drainage (VSD) + platelet-rich plasma (PRP) therapy on patients with stage III ~ IV pressure sore. In this work, 110 patients with pressure ulcer (PU) treated in our hospital were enrolled and were randomly divided into an experimental group (Exp group) and a control group (Ctrl group) by a blind selection method, with 55 cases in each group. Patients in the Ctrl group received surgical debridement + VSD for treatment, while those in the Exp group were treated with Bikerui disinfectant + VSD + PRP. Inflammatory response (IR) score, PU healing (PUH) score, healing time, dressing change frequency (DCF), dressing interval time (DIT), and scar recovery (SR) score of patients in different groups were compared. The results revealed that the positive rate of bacterial culture in wound secretions in the Exp group was greatly lower than that in the Ctrl group 1 or 2 weeks after treatment (p < 0.05). The IR score in the Exp group was much lower at week 1 and 2 after treatment (p < 0.05). The total effective rate (TER) in the Exp group was obviously higher than that in the Ctrl group (94.55% vs. 76.36%). The results suggested that Bikerui disinfectant + VSD + PRP therapy could effectively improve the inflammatory degree of PU patients, promote the wound repair and scar recovery of patients, and greatly improve the clinical efficacy of PU patients.

Making dressings stick: Securement of jugular central venous catheter dressings with liquid adhesive reduces dressing change frequency

Making dressings stick: Securement of jugular central venous catheter dressings with liquid adhesive reduces dressing change frequency

Effectiveness of Negative Pressure Wound Therapy During Aeromedical Evacuation Following Soft Tissue Injury and Infection.

Negative pressure wound therapy (NPWT) is utilized early after soft tissue injury to promote tissue granulation and wound contraction. Early post-injury transfers via aeromedical evacuation (AE) to definitive care centers may actually induce wound bacterial proliferation. However, the effectiveness of NPWT or instillation NPWT in limiting bacterial proliferation during post-injury AE has not been studied. We hypothesized that instillation NPWT during simulated AE would decrease bacterial colonization within simple and complex soft tissue wounds. The porcine models were anesthetized before any experiments. For the simple tissue wound model, two 4-cm dorsal wounds were created in 34.9 ± 0.6 kg pigs and were inoculated with Acinetobacter baumannii (AB) or Staphylococcus aureus 24 hours before a 4-hour simulated AE or ground control. During AE, animals were randomized to one of the five groups: wet-to-dry (WTD) dressing, NPWT, instillation NPWT with normal saline (NS-NPWT), instillation NPWT with Normosol-R® (NM-NPWT), and RX-4-NPWT with the RX-4 system. For the complex musculoskeletal wound, hind-limb wounds in the skin, subcutaneous tissue, peroneus tertius muscle, and tibia were created and inoculated with AB 24 hours before simulated AE with WTD or RX-4-NPWT dressings. Blood samples were collected at baseline, pre-flight, and 72 hours post-flight for inflammatory cytokines interleukin (IL)-1β, IL-6, IL-8 and tumor necrosis factor alpha. Wound biopsies were obtained at 24 hours and 72 hours post-flight, and the bacteria were quantified. Vital signs were measured continuously during simulated AE and at each wound reassessment. No significant differences in hemodynamics or serum cytokines were noted between ground or simulated flight groups or over time in either wound model. Simulated AE alone did not affect bacterial proliferation compared to ground controls. The simple tissue wound arm demonstrated a significant decrease in Staphylococcus aureus and AB colony-forming units at 72 hours after simulated AE using RX-4-NPWT. NS-NPWT during AE more effectively prevented bacterial proliferation than the WTD dressing. There was no difference in colony-forming units among the various treatment groups at the ground level. The hypoxic, hypobaric environment of AE did not independently affect the bacterial growth after simple tissue wound or complex musculoskeletal wound. RX-4-NPWT provided the most effective bacterial reduction following simulated AE, followed by NS-NPWT. Future research will be necessary to determine ideal instillation fluids, negative pressure settings, and dressing change frequency before and during AE.

The efficacy of negative-pressure wound therapy for head and neck wounds: A systematic review and update.

Despite the established benefits of negative-pressure wound therapy (NPWT) in various wound healing contexts, its application in head and neck surgical cases remains under-explored. This study aimed to systematically review its effectiveness, safety, and comparative efficacy. Thirty-one studies from a systematic literature search were identified and analyzed for wound healing response, overall success rate, improvements compared to conventional wound care, and variation in pressure settings, treatment lengths, and dressing change frequency. NPWT showed enhanced outcomes across diverse head and neck wounds, particularly complex post-reconstructive wounds and severe infections. Despite the predominantly case report/series evidence and lack of standardized NPWT protocols, its benefits over conventional care were clear. NPWT emerges as a promising approach for head and neck wound management, potentially improving patient outcomes and reducing complications. More randomized controlled trials are needed to solidify the evidence and standardize NPWT application protocols.

The observation of the curative effect of silver-containing dressings combined with hydrogel on healing of immunosuppression-induced skin ulcerations.

Local inflammatory reaction is the basis of wound healing. Inappropriate inflammatory reaction will delay wound healing. This study aimed to investigate the effect of silver-containing dressings combined with hydrogel on healing of immunosuppression-induced skin ulcerations (IISU). A retrospective analysis was conducted on 48 cases of patients with IISU admitted to The First People's Hospital of Jiande from March 2018 to March 2019. According to the different treatment methods, the patients were divided into the observation group and the control group, with 24 cases in each group. Patients in the observation group were treated with silver-containing dressings combined with hydrogel, while patients in the control group were treated with silver-containing dressings alone. Initially, patients in the observation group and control group were treated with the same method of debridement and cleaning. Afterwards, for patients in the observation group, the wounded surface was coated with a layer of hydrogel. Both groups had the wound covered with a silver-containing dressing as the inner dressing, and gauze was used as the outer dressing to wrap and fix the wound. The dressing change frequency was the same for both groups. The effective rate, basic healing rate, and complete healing rate of the two groups were compared after one week and two weeks of treatment. The effective rate of dressing application and wound healing rate in the observation group were significantly better than those in the control group, and the differences were statistically significant (P< 0.05). A silver-containing dressing combined with hydrogel as the inner dressing can provide a better environment for wound healing, significantly shorten the course of treatment of patients with IISU, promote the early recovery of patients, and improve the quality of life of patients. Therefore, it can be applied in clinical practice.

Transnasal negative pressure therapy for accelerating healing and improving the prognosis of pharyngocutaneous fistula.

Pharyngocutaneous fistula (PCF) is one of the most common complications of total laryngectomy. This study is to investigate the efficacy of a novel platform called transnasal negative pressure therapy (TNPT) in the management of PCF. We retrospectively reviewed 47 patients who underwent total laryngectomy between April 2015 and February 2021 and developed PCF in our hospital. We focused on the healing rate, dressing change frequency, and healing time between the TNPT and non-TNPT groups. The 2 years overall survival (OS) was compared through the log-rank test. There were 18 patients in the TNPT group and 29 in the non-TNPT group. There was no significant between-group difference in the healing rate (chi-square test). However, the frequency of dressing changes was significantly lower (p < 0.001) and the healing time was significantly shorter (p = 0.0194) in the TNPT group than in the non-TNPT group. The 2-year OS rate was significantly higher in the TNPT group (p = 0.0473, log-rank test). TNPT promoted wound healing after surgery for PCF and improved the 2-year OS rate. This tool is worthy of clinical application and promotion.

Multivariate analysis of medical adhesive-related skin injury at the site of peripherally inserted central catheter insertion in cancer patients: A prospective cohort study.

At the site of peripherally inserted central catheter (PICC) catheterization in tumor patients, medical adhesive-related skin injury (MARSI) was reported related to patient age, infusion of certain chemotherapeutic agents, and tumor type, but did not review its relation to the use of clear patches and the puncture site of PICC. This study aims to analyze the risk factors for MARSI in more detail to provide supported data for reducing MARSI. Total 382 cancer patients receiving catheterization via PICC were involved in this study from March 1, 2021, to September 28, 2021. According to MARSI occurrence or not, they were assigned into MARSI or non-MARSI group. Univariate and multivariate logistic regressions were used to analyze the risks of MARSI occurrence at PICC insertion site. 15% (60 of 382 cases) resulted in MARSI, out of which 8.1% (31/382) was categorized as contact dermatitis, and 7.1% (27/382) as mechanical injuries. The univariate analysis showed that there were significant differences in six aspects of the study, including BMI, MARSI history, dressing types, treatment by paclitaxel or 5-FU versus oxaliplatin, dressing frequency, and catheterization at biceps brachii medial (p < 0.05). Via multivariate logistic regression analysis, it was discovered that except for previously reported risk factors, dressing change frequency (OR (95% CI) = 7.49 (2.36-23.80), p = 0.001), catheterization at biceps brachii medial (OR (95% CI) = 4.07 (1.82-9.10), p = 0.001), and breast cancer (OR (95% CI) = 3.27 (1.05-10.15), p = 0.041), there were significant risk factors for MARSI occurrence in tumor patients with PICC catheterization. Our study revealed a high incidence of MARSI at the PICC insertion site of cancer patients, presenting with contact dermatitis and mechanical injury. Independent risk factors were previous history of MARSI, a diagnosis of breast cancer, frequent dressing replacement, use of paclitaxel or 5-FU, and PICC catheterization at biceps brachii medial.

Policy Proposals for Infection Control in Patients with Chronic Wounds

South Korea is seeing a steady increase in its aging population. One in five people in the Republic of Korea will be at least 65 years old by 2025, putting more pressure on healthcare and social spending. Various geriatric diseases such as cancer, arthritis, and stroke are major contributors to disabilities in aging populations. Compounded with an increase in diabetes mellitus, the number of patients with pressure ulcers and diabetic foot ulcers is growing. Therefore, considerations for treating chronic wounds such as pressure ulcers and diabetic wounds are emerging as an urgent public health need in South Korea. The treatment of chronic wounds increases medical expenses, placing a significant social, economic, and practical burden on individuals. When complications related to chronic wounds occur, the patient’s quality of life deteriorates, threatening public health. Therefore, strategies for managing chronic wounds are clinically important; South Korea should begin to recognize the importance of chronic wound care. Social attention and government support with the establishment of proper medical insurance policies, as well as efficient medical expense budget execution, are essential for the management of chronic wounds. Silver has been known to inhibit infections for many centuries and is widely used around the world. Previous studies reported the clinical and cost-effectiveness of silver-impregnated dressings. The majority of randomized controlled studies found the positive effects of silver-impregnated dressings on chronic wound healing. A number of studies found that silver-impregnated dressings reduced wound healing time, dressing change frequency, the need for pain medication during dressing changes, and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia resulting from MRSA-infected wounds, thereby shortening hospital stays. Despite evidence of the positive effects of silver-impregnated dressings on chronic wound healing, medical insurance policies and government support fall far short of expectations. This is because government officials, who often lack the required knowledge and understanding of chronic wound care, impose impossibly strict regulations on the use of silver-impregnated dressings. The regulations that enable use of silver-impregnated dressings only on major burns prohibitively limit the use of silver-impregnated dressings to a few indications and low-volume uses. Currently, silver-impregnated dressings cannot be used for chronic wounds such as pressure ulcers, diabetic wounds, venous ulcers, and cancerous wounds, even though patients are willing to bear the full costs without any government subsidies. As South Korea has one of the fastest rates of population aging in the world, a continued rise in the economic, clinical, and social impacts of chronic wounds warrants a more structured approach and proportionate investment in chronic wound care. Medical expense budget providers should be encouraged to think broadly about the potential for wider cost savings in terms of reducing wound healing time, hospital stays, and nursing time by using appropriate dressings. Therefore, there is an urgent need for better communication and mutual understanding among wound specialists, policy makers, and working-level public servants on insured dressings for chronic wound care. This white paper is a policy proposal composed by senior members of the Board of Directors of the Korean Wound Management Society for chronic wound care using silver-impregnated dressings and will hopefully contribute to a better understanding of silver-impregnated dressings for chronic wound care.

Effect of Vacuum Sealing Drainage on Soft Tissue Injury of Traumatic Fracture and Its Effect on Wound Recovery.

Purpose The current work is mainly to explore the effect of vacuum sealing drainage (VSD) on soft tissue injury (STI) caused by traumatic fractures (TFs) and its effect on wound recovery. Methods We first selected 90 patients with TF STI from May 2019 to May 2021, of which 40 patients (control group) received routine treatment, and the other 50 patients (observation group) were treated with VSD. The curative effect, rehabilitation (changing dressing frequency, healing time, and hospitalization time), pain severity, patient comfort, and complications were evaluated and compared. Results The observation group exhibited a higher total effective rate, lower dressing change frequency, complication rate, and shorter healing time and hospital stay than the control group, which are statistically significant. Statistically milder pain sensation and better patient comfort were also determined in the observation group. Conclusions VSD is effective and safe in the treatment of TF-induced sexually transmitted infections, which can effectively accelerate wound recovery while reducing pain sensation and improving patient comfort, with clinical promotion value.

LB970 Effect of Oleogel-S10 (birch triterpenes) on dressing change frequency and wound infection in epidermolysis bullosa: Analysis from the EASE study

EASE (NCT03068780) was a randomized, Phase 3, double-blind, controlled study evaluating Oleogel-S10 efficacy and safety in patients with dystrophic or junctional EB. The primary endpoint was met with a higher percentage of target wound closure by Day 45 with Oleogel-S10 vs control gel (p=0.013). We report analyses of dressing change frequency and wound infection in patients treated with Oleogel-S10 vs control gel (n=205). A reduction in the frequency of weekly dressing changes was observed with Oleogel-S10 (–0.5; equating to one dressing change every two weeks) compared with no change for control gel (0.1) by Day 90.

96 Poly-dl-lactide Copolymer-dressing Use on Burn Wounds and Skin Graft Donor Sites - An Institutional Review

IntroductionIn burn surgical care, wound coverage and the corresponding dressing are paired to maximize the ability to promote re-epithelization, minimize pain and patient discomfort, dressing change frequency and overall cost. This dressing, a copolymer material based on DL lactic acid, has been described as a reliable alternative dressing for partial thickness burns as well as skin graft donor sites with comparable wound-healing quality and duration. Our aim is to assess outcomes results of this copolymer dressing at our institution, as applied to partial thickness burn wounds and graft donor sites.MethodsWe performed a retrospective analysis of 55 adult patients admitted between January 1, 2020 to August 25, 2021 for the treatment of partial thickness burns that were managed with a poly-DL-lactide copolymer skin substitute at the burn wound and/or autograft donor site. Three study groups were established based on application site: wound only (group 1), donor site only (group 2), and both (group 3). We assessed operative times, infections rates, complications, length of stay, readmission rates, and mortality.ResultsPreliminary data of 40 patients shows clinically similar results for analgesic requirements, operative length, and hospital LOS between group 1 and group 3. Group 2 showed higher analgesic requirements, lower operative times, a lower LOS, and lower readmission rates. Group 3 shows higher pain levels and longer operative times, when compared with groups 1 and 2, but lower readmission rates than group 1.ConclusionsThe poly-DL-lactide copolymer skin substitute offers reliable wound coverage for a partial thickness burns while also reducing frequency of dressing changes and associated pain correlating to reduced length of hospital stay and wound healing interval.

Amniotic membrane dressing versus nitrofurazone-impregnated dressing in the treatment of second-degree burn wounds: a randomized clinical trial.

Both the amniotic membrane biologic dressing and nitrofurazone-impregnated dressing are treatment options for burn wounds. To compare the efficacy of these treatments in healing second-degree burns, a randomized clinical trial was conducted among patients with second-degree burns who had no comorbidities or history of addiction and were referred to a burn center in Urmia, Iran, between December 2017 and September 2019. Patients were randomly assigned to one of 2 study groups. Wounds were dressed in either amniotic membrane covered with moistened gauze/petrolatum or nitrofurazone-impregnated gauze. Comparative groups were matched according to percentage of burn (total body surface area). The dressing application occurred once daily in the nitrofurazone group and once weekly in the amniotic membrane group. The study was conducted until all wounds healed. The study outcomes included the infection rate of the wound, pain severity related to dressing changes, dressing change frequency, epithelialization rate, hospitalization length of stay, morphine use, and scarring. Data were collected in real time by the researcher via observation, interview, examination of the patient, and, eventually, completion of a checklist. Analyzed quantitative and qualitative variables were reported as mean ± standard deviation and percentage (frequency). Each group included 35 participants (24 men, 11 women; age, 20.05 ± 3.60 years in the amniotic dressing group; and 20 men, 15 women; age, 21.60 ± 2.02 years in the nitrofurazone-impregnated gauze group). Assessment was performed on days 1, 7, 14, and 30 from the initial treatment and at discharge. No significant difference was noted in the rate of infection between the 2 groups. Epithelialization was complete (100%) by day 7 in the amniotic membrane group, versus 77% in the nitrofurazone group. Pain following dressing application, length of hospitalization, morphine use, and scarring at day 14 were significantly lower (P < .05) in the amniotic membrane group. This study indicated that the use of amniotic membrane dressing improved factors key to healing in second-degree burn wounds compared with nitrofurazone-impregnated dressing. Further research with a larger sample is warranted.

Wound bed preparation: a case series using polyhexanide and betaine solution and gel-a UK perspective.

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.

Effects of vacuum sealing drainage to improve the therapeutic effect in patients with orthopedic trauma and to reduce post-operative infection and lower-limb deep venous thrombosis.

The present study investigated the effects of vacuum sealing drainage (VSD) to improve the therapeutic efficacy in patients with orthopedic trauma (OT) and reduce post-operative infection and lower-limb deep venous thrombosis (DVT) through a retrospective analysis. A total of 76 patients with OT treated at our hospital were selected for observation. The patients were divided into the control group (CG; n=37) and the experimental group (EG; n=39) according to the treatment administered. For patients in the CG, routine dressing changes were applied. Patients in the EG underwent VSD treatment. The dressing change frequency, time between the first and second operation, hospital stay, treatment efficacy, wound healing time, interleukin-6 (IL-6) serum level, tumor necrosis factor-α (TNF-α) serum level, incidence of post-operative infection and incidence of lower-limb DVT were compared between the two groups. The dressing change frequency in the EG was less than that in the CG. The time between the first and second operation and hospital stay were shorter in the EG than in the CG (P<0.05). The total effective rate in the EG was 97.44%, which was higher than that in the CG (78.38%; P<0.05). The wound healing time in the EG was 1.72±0.73 weeks and shorter than that in the CG (2.23±0.85 weeks; P<0.05). With the progression of treatment, the serum IL-6 and TNF-α levels decreased in the two groups, but the levels in the EG were lower than those in the CG (P<0.05). The incidence of post-operative infection and lower-limb venous thrombosis in the EG were 7.69 and 0.00%, respectively, and lower than those in the CG (27.03 and 13.01%, respectively; P<0.05). In the treatment of OT, VSD may reduce the dressing change frequency, shorten the operation time and hospital stay, accelerate wound healing and reduce post-operative infection and lower-limb DVT. Thus, the VSD treatment method is worthy of promotion and implementation in clinic.

Dressing change frequency following anterior cruciate ligament reconstruction: a pilot study

Dressing change frequency following anterior cruciate ligament reconstruction: a pilot study

Topical Management of Enterocutaneous and Enteroatmospheric Fistulas: A Systematic Review.

A systematic literature review was conducted to identify topical management interventions used in ECF/EAF care and to explore the role of these interventions in fistula closure and long-term fistula management. A search of PubMed, the Cumulative Index of Nursing and Allied Health Literature, and Scopus was conducted to identify English-language articles published from January 2004 to January 2019. The keywords enterocutaneous fistula, enteroatmospheric fistula, negative pressure wound therapy, NPWT, vacuum-assisted closure, VAC, pouch or pouching, troughing, bridging, collection device, dressing, and wound care were used to identify all publications pertaining to the topical management of adult and mixed adult/pediatric patients with an ECF or EAF. Single-person case studies, exclusively pediatric studies, surgical treatment-based, and duplicate publications were excluded. Abstracts were screened for relevance to the research questions, and eligible publications were abstracted and categorized using The Oxford Centre for Evidence-Based Medicine Levels of Evidence. The Joanna Briggs Institute (JBI) critical appraisal checklist for case series was used to assess each article for risk of bias and methodological quality. Outcomes of interest included patient demographics, closure rates, fistula classification (type of fistula, fistula output, fistula origin), type of topical treatment, adverse events (pain, new fistula formation, fistula recurrence, mortality), follow-up, long-term management, perifistula skin protection, effluent management, dressing change frequency, and quality of life. Descriptive statistics were presented; no statistical analysis was performed. Of the 983 articles identified, 57 underwent critical appraisal using the JBI checklist for case series. Forty-two (42) did not meet the inclusion criteria, leaving 15, level IV, case-based publications (N = 410 patients). No randomized controlled trials were found. All studies included some form of negative pressure wound therapy. JBI results found that each study was at high risk of bias in more than 2 domains. Interventions were categorized as intubation, occlusion, or isolation of the fistula. Of the 559 fistulas treated, spontaneous closure was reported in 164 cases, with rates ranging from 0% to 100%. Adverse events to treatment included pain (n = 33 patients), new fistula formation (n = 12), and fistula recurrence (n = 1). Sepsis was the leading cause of mortality (n = 29), with reported rates ranging from 0% to 44%. Due to the high risk of study bias and low quality of evidence, the exact contribution of any one intervention could not be established. Results also suggest a high risk of publication bias, and patient-centered outcomes were reported in only 1 study. Although topical management might play a role in fistula closure, it is only as part of a comprehensive plan of care. Future research should focus on developing and using standardized reporting tools, classifications, and outcomes and include patient-centered outcomes such as acceptance, tolerability, pain, and quality of life relating to any one intervention. At this time, the evidence base for management recommendations is limited, suggesting that interventions should mainly be based on practical considerations such as resources and clinician skill.

Abstract 173: 3D Transglutaminase Fibronectin Hydrogel For The Treatment Of Skin Wounds

Purpose: Over the past decade, there has been a concerted effort to develop new artificial wound coverings that effectively treat major skin wounds. Hydrogels have emerged as novel drug delivery vehicles and wound dressing adjuncts, with a clinical dressing change frequency of 3 days given their unique moisture-conferring properties at the wound site. The topical application of fibronectin (FN) in a murine irradiated skin model has demonstrated improved wound healing by >20%. FN additionally has reported wound healing efficacy at the nanogram to microgram level. However, there is no reported application of hydrogel-facilitated FN delivery to promote wound healing. In this study, the in vitro and in vivo dynamics of 3D-transglutaminase-hydrogel (3DTgH) FN release were evaluated to characterize optimal parameters for the development of a novel wound dressing. Methods: 4.5A and 7.5A stiffness 3DTgH with 1 ug FN were constructed and plated in either PBS or collagenase type 2 (Col2) to allow gel digestion. Digested samples were assayed with FN ELISA. Additionally, full-thickness 8 mm punch biopsy dorsal skin wounds were created in 8-week-old FVB/NJ mice (n=22) weighing between 20 and 25 grams. Experimental mice (n=10) were treated with 4.5A stiffness 3DTgH incorporating 31.25 ug human FN (31.25 ul volume), and control mice (n=12) were treated with 4.5A stiffness 3DTgH incorporating 31.25 ul PBS. The total volume of each hydrogel treatment construct was 50 ul, and this suspension was applied topically onto the wound surface. For wound harvest on POD1, POD2, and POD3, residual hydrogel was carefully excised from the wound surface, and wounds were then harvested with 1 mm margins. Mouse tissue was homogenized and 100 ul samples were analyzed with human FN ELISA for pharmacokinetic (PK) analysis of FN release via hydrogel enzymatic digestion in vivo. Results: Unlike 3DTgH plated in PBS, 3DTgH plated in Col2 gradually dissolved. 4.5A 3DTgH maximally released FN on day 4 and 7.5A 3DTgH maximally released FN on day 13 with an overall slower rate of FN release. When compared with controls, mice treated with FN 3DTgH demonstrated sustained and increasing FN release via hydrogel after wound creation, with an average release of 125.31 ug FN on POD1 (p=0.0039), 141.91 ug on POD2 (p=0.0145), and 167.78 ug on POD3 (p=0.0001). Mice treated with control 3DTgH treatment did not display detectable levels of human FN via ELISA. Conclusion: 3DTgH is a suitable construct for gradual FN release in vitro and in vivo. Hydrogel constructs of differing stiffnesses demonstrate differential rates of FN release and thus have the potential to be tailored to wound healing environments for incremental FN delivery. As a result, hydrogel-based dressings incorporating FN have promise for clinical translation and sustained FN delivery in the treatment of skin wounds.

Fluorescence imaging guided dressing change frequency during negative pressure wound therapy: a case series.

Knowledge of wound bioburden can guide selection of therapies, for example, the use of negative pressure wound therapy (NPWT) devices with instillation in a heavily contaminated wound. Wound and periwound bacteria can be visualised in real-time using a novel, non-contact, handheld fluorescence imaging device that emits a safe violet light. This device was used to monitor bacterial burden in patients undergoing NPWT. Diverse wounds undergoing NPWT were imaged for bacterial (red or cyan) fluorescence as part of routine wound assessments. We assessed 11 wounds undergoing NPWT. Bacterial fluorescence was detected under sealed, optically-transparent (routine) adhesive before dressing changes, on foam dressings, within the wound bed, and on periwound tissues. Bacterial visualisation in real-time helped to guide: (1) bioburden-based, personalised treatment regimens, (2) clinician selection of NPWT, with or without instillation of wound cleansers, and (3) the extent and location of wound cleaning during dressing changes. The ability to visualise bacteria before removal of dressings led to expedited dressing changes when heavy bioburden was detected and postponement of dressing changes for 24 hours when red fluorescence was not observed, avoiding unnecessary disturbance of the wound bed. Fluorescence imaging of bacteria prompted and helped guide the timing of dressing changes, the extent of wound cleaning, and selection of the appropriate and most cost-effective NPWT (standard versus instillation). These results highlight the capability of bacterial fluorescence imaging to provide invaluable real-time information on a wound's bioburden, contributing to clinician treatment decisions in cases where bacterial contamination could impede wound healing.