Pressure Ulcer Healing Research Articles

A prospective cohort study of prognostic factors for the healing of heel pressure ulcers

pressure ulcers, 25-30% of which are on the heels are a major burden to patients and healthcare systems. A better understanding of factors associated with healing is required to inform treatment and research priorities. to identify patient and pressure ulcer characteristics associated with the healing of heel pressure ulcers. patients with heel pressure ulcers were recruited to a prospective cohort study in a large teaching hospital in the UK, with a maximum 18-month follow-up. Cox proportional hazards model regression analysis was used to identify prognostic factors for healing. one hundred and forty of 148 patients recruited were analysed. They had 183 pressure ulcers: 77 ulcers healed, 5 were on limbs amputated prior to ulcer healing, 88 were on patients who died prior to healing, 11 were present at the end of the study and 2 were lost to follow-up. The median time to healing was 121 (range 8-440) days. Of 12 variables associated with healing (P ≤ 0.2), multi-variable analysis identified two factors which were independently predictive of healing including the presence of a severe (versus superficial) ulcer (hazard ratio = 0.48, P < 0.1) and the presence of peripheral arterial disease (hazard ratio = 0.40, P < 0.1). increased ulcer severity and the presence of peripheral arterial disease significantly reduced the probability of healing. Treatments for heel pressure ulcers should consider the severity of the ulcer and the presence of peripheral arterial disease.

The mechanisms and evidence of efficacy of electrical stimulation for healing of pressure ulcer: A systematic review

The objective of this article is to provide a systematic review of the efficacy of electrical stimulation in healing pressure ulcer and to review its mechanism of action. The Cochrane Library, PubMed, CINAHL, Medline, EMBASE, and NHS EED were searched for relevant interventional studies including randomized controlled trials (RCTs) and observational studies. A best-evidence synthesis was performed to summarize the results of the included studies. A total of seven RCTs and two observational studies met the inclusion criteria. Moderate level of evidence of efficacy with low risk of bias was shown in all seven RCTs. Although some studies have used continuous direct current, most other investigators opted to use high-voltage pulsed current to minimize the risk of skin burn and to achieve greater current penetration. Overall, the incidence of adverse effects was very low. Two studies that assessed the economic impacts of electrical stimulation revealed substantial health care cost savings. The mechanisms through which electrical stimulation exerts a positive effect on pressure ulcer healing are reasonably well established. Clinical trials have revealed a moderate level of evidence to support its use as an ancillary treatment modality for healing pressure ulcer. Recommendations regarding the optimal electrical stimulation parameters and dosage of use are provided. Further studies to investigate potential barriers that may impede widespread use in different clinical settings are needed.

A Case of Electroacupuncture Therapy for Pressure Ulcer

Pressure ulcers (also known as bedsores or decubitus ulcers) are areas of localised injury to the skin and underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear forces. This type of ulcer is one of the most common complications in patients with spinal cord injury. Treatment with transcutaneous electrical stimulation, and with acupuncture combined with moxibustion, have been reported to be effective for pressure ulcers.1 ,2 The use of electroacupuncture (EA) specifically for pressure ulcers has not been reported.3 Here, we report a case of the successful use of EA to promote wound healing of pressure ulcers. A 42-year-old woman was admitted to our acupuncture department with a …

Clinical Parameters Associated With Pressure Ulcer Healing in Patients With Advanced Illness

ContextPressure ulcers are the most prevalent wounds affecting patients with advanced illness. Although complete wound healing is the most desired outcome, it remains unlikely in the setting of patients with limited life expectancy. Realistic goal setting may be enabled using objective clinical parameters. ObjectivesTo identify clinical parameters associated with complete healing of Stage II pressure ulcers. MethodsUnivariable and multivariable competing risk analyses were used to assess the association of complete healing with the following six clinical parameters, namely gender, age, total number of pressure ulcers, total number of other wounds, number of failing organ systems, and Palliative Performance Scale (PPS) scores. ResultsA total of 147 patients with 245 Stage II pressure ulcers were followed until death; 9.4% of Stage II pressure ulcers achieved complete healing. Univariable analyses showed hazard ratios (HRs) for complete healing in favor of higher levels of PPS scores (HR 1.82–5.99, P<0.001) and age younger than 80 years (HR 3.28, P=0.031). Multivariable analyses showed HRs for complete healing in favor of higher levels of PPS scores (HR 1.49–3.34, P=0.003). ConclusionHigher levels of PPS scores are associated with complete healing of Stage II pressure ulcers in patients with advanced illness.

Effects of L‐Carnosine and Its Zinc Complex (Polaprezinc) on Pressure Ulcer Healing

L-carnosine (CAR) is an endogenous dipeptide. We aimed to determine the effects of CAR and its zinc complex polaprezinc (PLZ) on pressure ulcer healing in institutionalized long-term care patients. This study was a nonrandomized controlled trial with a maximum 4-week follow-up. Forty-two patients with stage II-IV pressure ulcers for 4 or more weeks were allocated to 1 of 3 groups in order of recruitment: the control group (n = 14) was untreated, the PLZ group (n = 10) orally received 150 mg/d PLZ (containing 116 mg CAR and 34 mg zinc), and the CAR group (n = 18) orally received 116 mg/d CAR. Pressure ulcer severity was measured weekly using the Pressure Ulcer Scale for Healing (PUSH) score. At baseline, no significant differences were found among groups in demographic and nutrition parameters and pressure ulcer characteristics (severity, size, and staging). After 4 weeks, the rate of pressure ulcer healing, assessed by the mean weekly improvement in PUSH score, was significantly greater in the CAR (1.6 ± 0.2, P = .02) and PLZ groups (1.8 ± 0.2, P = .009) than in the control group (0.8 ± 0.2). The difference between the CAR and PLZ groups was not significant (P = .73). Actual dietary intakes over this period did not differ significantly among groups. Our results suggest that CAR and PLZ may almost equally accelerate pressure ulcer healing during 4 weeks. The results need confirmation by randomized controlled trials with larger sample sizes.

Pressure Ulcer Treatment Strategies

Pressure ulcers affect as many as 3 million Americans and are major sources of morbidity, mortality, and health care costs. To summarize evidence comparing the effectiveness and safety of treatment strategies for adults with pressure ulcers. MEDLINE, EMBASE, CINAHL, Evidence-Based Medicine Reviews, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Health Technology Assessment Database for English- or foreign-language studies; reference lists; gray literature; and individual product packets from manufacturers (January 1985 to October 2012). Randomized trials and comparative observational studies of treatments for pressure ulcers in adults and noncomparative intervention series (n > 50) for surgical interventions and evaluation of harms. Data were extracted and evaluated for accuracy of the extraction, quality of included studies, and strength of evidence. 174 studies met inclusion criteria and 92 evaluated complete wound healing. In comparison with standard care, placebo, or sham interventions, moderate-strength evidence showed that air-fluidized beds (5 studies [n = 908]; high consistency), protein-containing nutritional supplements (12 studies [n = 562]; high consistency), radiant heat dressings (4 studies [n = 160]; moderate consistency), and electrical stimulation (9 studies [n = 397]; moderate consistency) improved healing of pressure ulcers. Low-strength evidence showed that alternating-pressure surfaces, hydrocolloid dressings, platelet-derived growth factor, and light therapy improved healing of pressure ulcers. The evidence about harms was limited. Applicability of results is limited by study quality, heterogeneity in methods and outcomes, and inadequate duration to assess complete wound healing. Moderate-strength evidence shows that healing of pressure ulcers in adults is improved with the use of air-fluidized beds, protein supplementation, radiant heat dressings, and electrical stimulation.

Undermining incision and healing of deep pressure ulcers: A prospective cohort study of pressure ulcers by the Japanese National Hospital Organization

Undermining is one of the most challenging complications of deep pressure ulcers. Recommendations in most guidelines are based only on expert opinions. Here, we examined the relationship between surgical incision of the undermined space and pressure ulcer healing through a Japanese multicenter prospective cohort study. A total of 162 patients with undermining in 40 national hospitals in Japan were enrolled from July 2007 to June 2009. The incision group included 39 patients (24.1%) whose undermining was surgically incised during the observational period. Their 4-week follow-up data on pressure ulcer severity and areas of healthy granulation tissue were recorded as outcome variables using the DESIGN-R pressure ulcer assessment tool. The 4-week follow-up was restarted after the incision in the incision group. The outcome variables over time were compared between the two groups using a linear mixed model with or without adjustment for demographic and other variables. The incision group showed more rapid improvement in the total and granulation DESIGN-R scores compared with the nonincision group (p < 0.001 and p = 0.007, respectively, in the crude models). This study may provide the first considerable evidence to support that surgical incision of undermining may promote healing of deep pressure ulcers.

Sildenafil in the treatment of pressure ulcer: a randomised clinical trial

Pressure ulcer (PrU)-related hospitalisation and mortality are critical issues in medical and surgical patients. Although animal studies have suggested the beneficial effects of sildenafil on wound healing, related clinical data are lacking. This is the first clinical study that has evaluated the effects of topical sildenafil on PrU healing in human subjects. Enrolled patients were randomly allocated to receive topical sildenafil (10%) ointment or placebo daily. Wound healing was assessed visually and photographically by the change in wound score according to two-digit Stirling scale. Decreases in grades of the PrUs were significantly higher in sildenafil group compared with placebo group (P < 0·001). In addition, surface areas of ulcers in sildenafil group were significantly reduced compared to the control group at day 14 of intervention (P = 0·007). It appears that these effects may be mediated by improvement of microvascular reperfusion in the skin and soft tissue. Further study to emphasise the role of topical sildenafil in the prevention or treatment of PrUs in hospitalised patients is required.

Elektrostymulacja wysokonapięciowa we wspomaganiu leczenia odleżyn: wyniki randomizowanego, kontrolowanego eksperymentu klinicznego – doniesienie wstępne

W leczeniu odleżyn coraz większe znaczenie zyskują stymulacje elektryczne. Są one szczególnie zalecane w leczeniu przewlekłych ubytków, które nie goją się pomimo stosowania leczenia standardowego. Dokładne poznanie wpływu różnych rodzajów prądów elektrycznych na procesy gojenia tkanek jest niezbędny

The Effect of Oxandrolone on the Healing of Chronic Pressure Ulcers in Persons With Spinal Cord Injury

Anabolic steroids have been reported to improve wound healing. To determine whether oxandrolone increases the percentage of target pressure ulcers (TPUs) that heal compared with placebo and whether healed ulcers remain closed 8 weeks after treatment. Parallel-group, placebo-controlled, randomized trial conducted from 1 August 2005 to 30 November 2008. Patients, clinical care providers, study personnel, and statisticians were blinded to treatment assignment. (ClinicalTrials.gov: NCT00101361). 16 inpatient spinal cord injury (SCI) services at Veterans Affairs medical centers. 1900 prescreened, 779 screened, and 212 randomly assigned inpatients with SCI and stage III or IV TPUs. Oxandrolone, 20 mg/d (n = 108), or placebo (n = 104) until the TPU healed or 24 weeks. The primary outcome was healed TPUs. The secondary outcome was the percentage of TPUs that remained healed at 8-week follow-up. 24.1% (95% CI, 16.0% to 32.1%) of TPUs in oxandrolone recipients and 29.8% (CI, 21.0% to 38.6%) in placebo recipients healed (difference, -5.7 percentage points [CI, -17.5 to 6.8 percentage points]; P = 0.40). At 8-week follow-up, 16.7% (CI, 9.6% to 23.7%) of oxandrolone recipients and 15.4% (CI, 8.5% to 22.3%) of placebo recipients retained a healed TPU (difference, 1.3 percentage points [CI, -8.8 to 11.2 percentage points]; P = 0.70). No serious adverse events were related to oxandrolone. Liver enzyme levels were elevated in 32.4% (CI, 23.6% to 41.2%) of oxandrolone recipients and 2.9% (CI, 0.0% to 6.1%) of placebo recipients (P < 0.001). Selection of severe wounds may have reduced treatment response. Approximately one third of patients did not complete the study in the treatment and placebo groups. The study was terminated after a futility analysis showed a low probability of detecting a significant difference between the groups. Oxandrolone showed no benefit over placebo for improving healing or the percentage of TPUs that remained closed after 8 weeks of treatment. U.S. Department of Veterans Affairs.

Nutritional treatment of pressure ulcers: What is the evidence?

To review the literature on the nutritional treatment of pressure ulcers, with an emphasis on long-term care issues. The focus is on studies that have used high energy or high protein diets, supplementation with vitamin C, zinc, or arginine, or some combination of those four approaches. The goal of this review is to clarify the evidence (if any) supporting each nutritional treatment. A search of the literature was conducted including PubMed, CINAHL, and MEDLINE. Search terms included "pressure ulcers," in combination with "treatment," "nutrition," "supplements," "Vitamin C," "zinc," and "arginine." Studies of high energy and high protein intake provide some evidence that those may be useful interventions, but the evidence is not strong. Although we have basic science providing evidence of the role of vitamin C, zinc, and arginine in wound healing processes, data on those nutrients related to pressure ulcer healing is equivocal. Nurse practitioners should assess the nutritional status of patients with pressure ulcers and treat deficiencies within current guidelines. At this time, there is not strong evidence to support the use of specific nutritional supplements.

Wound cleansing for pressure ulcers.

Pressure ulcers (also called pressure sores, bed sores and decubitus ulcers) are areas of tissue damage that occur in the elderly, malnourished or acutely ill, who cannot reposition themselves. Pressure ulcers impose a significant financial burden on health care systems and negatively affect quality of life. Wound cleansing is considered an important component of pressure ulcer care. This systematic review seeks to answer the following question: what is the effect of wound cleansing solutions and wound cleansing techniques on the rate of healing of pressure ulcers? For this third update, we searched the Cochrane Wounds Group Specialised Register (searched 3 January 2013); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to November Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations December 31, 2012); Ovid EMBASE (2010 to 2012 Week 52); and EBSCO CINAHL (2010 to 21 December 2012). Randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or different wound cleansing solutions, or different cleansing techniques, were eligible for inclusion if they reported an objective measure of pressure ulcer healing. Two review authors extracted data independently and resolved disagreements through discussion. A structured narrative summary of the included studies was conducted. For dichotomous outcomes, risk ratio (RR), plus 95% confidence intervals (CI) were calculated; for continuous outcomes, mean difference (MD), plus 95% CI were calculated. Meta analysis was not conducted because of the small number of diverse RCTs identified. Two review authors independently assessed each included study using the Cochrane Collaboration tool for assessing risk of bias. One additional eligible study was identified from the updated searches, one study was added to the table of excluded studies. A total of three studies (169 participants) met the inclusion criteria for the review. No studies compared cleansing with no cleansing. Two studies compared different wound cleansing solutions. A statistically significant improvement in Pressure Sore Status Tool scores occurred for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline (P value = 0.025), but no statistically significant change in healing was seen when water was compared with saline (RR 3.00, 95% CI 0.21 to 41.89). One study compared cleansing techniques; for pressure ulcers cleansed with pulsatile lavage, compared with sham (the lavage flow was directed into a wash basin positioned adjacent to the wound and not visible to the participants), there was a statistically significant reduction in ulcer volume at the end of the three week study period in the lavage group compared with the sham group (MD -6.60, 95% CI-11.23, -1.97). We identified three small studies addressing cleansing of pressure ulcers. One reported a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline solution, a further study reported no statistically significant change in healing was seen when wounds were cleaned with water was compared with saline. A final study compared pulsatile lavage with sham and found a significantly greater reduction in ulcer volume at the end of the study period in the lavage group compared with the sham group. The authors conclude that there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.

A prospective window into medical device‐related pressure ulcers in intensive care

The aim of this study was to determine the prevalence, severity, location, aetiology, treatment and healing of medical device-related pressure ulcers (PUs) in intensive care patients for up to 7 days. A prospective repeated measures study design was used. Patients in six intensive care units of two major medical centres, one each in Australia and the USA, were screened 1 day per month for 6 months. Those with device-related ulcers were followed daily for up to 7 days. The outcome measures were device-related ulcer prevalence, pain, infection, treatment and healing. Fifteen of 483 patients had device-related ulcers and 9 of 15 with 11 ulcers were followed beyond screening. Their mean age was 60·5 years, and most were men, overweight and at increased risk of PU. Endotracheal (ET) and nasogastric (NG) tubes were the cause of most device-related ulcers. Repositioning was the most frequent treatment. Four of 11 ulcers healed within the 7-day observation period. In conclusion, device-related ulcer prevalence was 3·1%, similar to that reported in the limited literature available, indicating an ongoing problem. Systematic assessment and repositioning of devices are the mainstays of care. We recommend continued prevalence determination and that nurses remain vigilant to prevent device-related ulcers, especially in patients with NG and ET tubes.

The effectiveness of nutritional intervention(s) and the treatment of pressure ulcers— A systematic literature review

This review aims to evaluate the effectiveness of nutritional intervention in the treatment of pressure ulcers. Four databases were searched systematically using the keywords formulated and papers were selected according to inclusion and exclusion criteria. The literature search period included articles published from 1 January 2000 to 30 December 2011 (inclusive). Six papers on randomized controlled trials were retrieved. All six trials showed positive outcomes in pressure ulcer healing with nutritional interventions. Secondary outcomes such as lower number of dressings required, less time spent on dressing changes and lower occurrence of infections were reported. The main results emerged from this study generally supported the use of nutritional interventions in the treatment of pressure ulcers. Various methodological issues associated with these trials were highlighted. The implications for clinical practice need to bear in mind both the methodological problems raised and limitations of this review.

褥瘡を有する患者に対する栄養介入の影響～創面サイズの治癒速度と栄養～

The objective of this multicenter open-label randomized study was for evaluating nutrition intervention on pressure ulcer healing. Tube-fed patients with Stages III to IV pressure ulcers were enrolled. Target energy levels to be given were the same value as at the time of enrollment or BEE×1.1 (activity factor)×1.1-1.3 (stress factor) in the control group, and BEE×1.1×1.3-1.5 in the intervention group. Both groups received the feeding formula Racol(®) for 12 weeks, and were prescribed to have pressure relief mattresses, and to unify the repositioning method, treatment drugs, and wound dressing materials. Ulcer sizes (length×width), nutritional state, and adverse events were evaluated. Energy levels administered to the control (n=29) and intervention (n=21) groups were 29.1±4.9 (mean±SD) and 37.9±6.5 kcal/kg/day, respectively. Regarding pressure ulcer size, the interaction between the nutrition intervention and the courses during observational weeks was significant (P<0.001). Similarly, significant differences were observed with weight, waist circumference, Cu (P<0.001), suprailiac skinfold thickness (P<0.01), thigh circumference, and prealbumin (P<0.05), but not with the incidence of adverse events (P=0.360). Principal component analysis indicated remarkable decreases in ulcer size and improvement rates of waist circumference and suprailiac skinfold thickness in the intervention group. Covariance structure analysis showed that nutrition intervention has a direct effect on reduction in ulcer size. The results suggested that aggressive nutrient intervention accelerated the pressure ulcer of wound healing process and had a direct effect on reduction in ulcer size.

The Promotional Effect of Low-intensity Direct Current Stimulation with Electrode Placement of Negative Poles at Wound Site on Pressure Ulcer Healing

The Promotional Effect of Low-intensity Direct Current Stimulation with Electrode Placement of Negative Poles at Wound Site on Pressure Ulcer Healing

Effect of Laser Irradiation at Different Wavelengths (940, 808, and 658 nm) on Pressure Ulcer Healing: Results from a Clinical Study

The aim of the study was to assess the efficacy of laser therapy (at different wavelengths: 940, 808, and 658 nm) for treating pressure ulcers. The primary endpoint in this trial included both the percentage reduction of the ulcer surface area and the percentage of completely healed wounds after one month of therapy (ulcer healing rate). The secondary endpoint was the ulcer healing rate at the follow-up evaluation (3 months after the end of the study). In total, 72 patients with stage II and III pressure ulcers received laser therapy once daily, 5 times per week for 1 month using a (GaAlAs) diode laser with a maximum output power of 50 mW and continuous radiation emission. Three separate wavelengths were used for the laser treatment: 940 nm (group I), 808 nm (group II), and 658 nm (group III). An average dose of 4 J/cm2 was applied. In group IV, a placebo was applied (laser device was turned off). The laser therapy at a wavelength of 658 nm appeared to be effective at healing pressure ulcers. The wavelengths of 808 and 940 nm did not have any effect in our study.

Physicochemical Characterization of Tretinoin Tocoferil Emulsion and Povidone-Iodine Sugar Ointment Blend Developed for Improved Regulation of Wound Moisture

Maintenance of proper moisture and regulation of infection are simultaneously required to promote healing of pressure ulcers. Continuous use of water-rich ointment may often lead to excess moisture and induce edematous granulation tissue. Use of water soluble ointment may excessively absorb exudates and induce dry granulation tissue. Selection of appropriate topical ointment is desired to avoid worse clinical outcomes. For adjustment of wound moisture a novel blended ointment (tretinoin tocoferil-povidone-iodine (TR-PI)) was developed consisting of emulsion base, tretinoin tocoferil oil-in-water (o/w) emulsion (TR-cream), and sugar base, povidone-iodine and sugar (PI-sugar). For the characterization of TR-PI water absorption was tested using Franz diffusion cell with cellulose membrane. For rheological characteristics spreadability was tested using spread meter and yield value was calculated. Iodine permeation was tested using a permeation cell with silicon membrane. Water absorption rate constant of TR-PI with combination ratio of PI-sugar at 75% (TR-PI75, 18.5 mg cm(-2) min(-0.5)) was equivalent to that of TR-cream alone (16.4 mg cm(-2) min(-0.5)). The yield value of TR-PI75 (26.1 Pa) exhibited intermediate values as compared to those of TR-PI with combination ratio of PI-sugar at 50% (11.3 Pa) and TR-cream alone (46.8 Pa). The amount of released free-iodine from TR-PI75 was similar to that released from PI-sugar alone. TR-PI75 may have superior performance in keeping the moist environment in wounds and in preventing infection. TR-PI75 can be used to promote formation of favorable granulation tissue in pressure ulcers with moderate exudates.

Development of the Exclusive Electrical Stimulation Treatment Device to Promote Pressure Ulcer Healing

Development of the Exclusive Electrical Stimulation Treatment Device to Promote Pressure Ulcer Healing

Evaluation of the effect of ultrasound therapy on pressure ulcer healing

Evaluation of the effect of ultrasound therapy on pressure ulcer healing