Management Of Wounds In Patients Research Articles

Resource Utilization and Economic Costs of Care Based on A Randomized Trial of Vacuum-Assisted Closure Therapy in the Treatment of Diabetic Foot Wounds

Conclusion: In diabetic patients with post-amputation wounds, negative pressure wound therapy heals a greater proportion of patients with less resource utilization than standard moist wound therapy. Summary: There were 162 patients with diabetes and post-amputation wounds entered into a 16 week randomized clinical trial. Seventy-seven patients were randomized to negative pressure wound therapy NPWT) and received dressing changes every 48 hours. Eighty-five patients received standard moist wound (MWT) therapy according to consensus guidelines (Wound Ostemy Continence Nursing Society. Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. WOCN Glennville, IL; 2004: 57). Direct costs, procedures, and resource utilization were analyzed in a post-op retrospective analysis. In the NPWT v. MWT groups, there were no differences in inpatient hospital stay either in terms of number of admissions or length of stay. There were more debridement procedures required in the MWT group (120 v. 43, p<0.001). The average number of dressing changes per patient in the MWT group was 118 (range 12-226) v. 41 (6-140) for NPWT, p=0.0001. The average direct cost per patient for 8 weeks of treatment or longer was $27,220 for the NPWT group and $36,096 for the MWT group. The average total cost to achieve healing was $25,954 in patients treated with NPWT (n=43) compared with $38,806 for the MWT group (n=33). Comment: It is very expensive to heal wounds. The study suggests negative pressure therapy for open diabetic wounds is cheaper and more effective than standard moist wound therapy. Costs in the MWT group were driven primarily by dressing changes and antibiotic costs. It is likely that the costs presented are conservative. Costs related to transportation, inpatient dressing changes, prosthesis and rehabilitation were not included in the analysis. Note the authors have affiliations with KCI, the manufacturer of the negative pressure device used in this study.

DOES RAPAMYCIN EFFECT WOUND HEALING?

A302 Aims: The use of rapamycin to prevent graft rejection in renal transplantation is well documented. However the inhibitory effect of rapamycin on fibroblasts has raised concerns about its effect on wound healing. Anecdotal reports have suggested an increased incidence of post transplant wound problems. In this study in pigs we investigated the effect of rapamycin on wound healing. Methods: Large White X Landrace pigs (n=12) weighing 22-30kg were subjected to a midline laparotomy. The sheath was closed with a continuous 0 Nylon suture and the skin with a continuous subcuticular 2/0 Nylon suture. The animals were randomized to receive either rapamycin 2mg orally daily or no treatment. The animals were sacrificed on the fifth postoperative day and the skin and fascia closure examined histologically (Haematoxylin-eosin and Chromotrop Aninline Blue [CAB]) and biochemically (hydroxyproline levels). The breaking strength of strips of skin and fascia were also measured. Results: One animal in the rapamycin treated group developed a full-thickness wound dehiscence on the 4th postoperative day and had to be sacrificed. The wounds of the remaining animals were intact at the time of sacrifice. The breaking strength of the fascia was lower in the rapamycin treated animals compared to the control animals (351±62g versus 444±54g). The breaking strength of the skin was the same in the two groups (239±34g versus 237±32g). The animals treated with rapamycin had lower hydroxyproline levels in both the fascia (28.7±11.8 versus 34.1±9.9 μg/ml) and the skin (12.3±3.7 versus 19.4±5.7 μg/ml) compared to control animals. On histological examination there were no differences in morphology or collagen staining between the two groups. Conclusions: These findings suggest that rapamycin impairs wound healing. Special attention should be given to wound closure and wound management in patients treated with rapamycin.

Wound management in patients with chronic wounds in ambulatory nursing--a pilot study

Currently relevant data about prevalence of chronic wounds and wound management in home care nursing services are not available for Germany. In this study 38 home care nursing services were surveyed by means of a questionnaire. Response rate was 61%. Results showed that almost 9% of the home care nursing services treated patients suffering from chronic wounds. The most common wound was the pressure ulcer with a prevalence of 4.1%, followed by leg ulcer (2.7%) and the diabetic foot (1%). The questionnaire about wound management was completed for 47 patients of 24 home care services. 29 of the patients were females and 18 males. The average age of the patients was 78 years. Important diagnostic information about the nature and the recurrence rate of the wounds was not available to the nursing staff. The average time that a wound existed was 6.7 years with a range of 3 weeks to 45 years. 87% of the patients had their wound dressings on a daily basis. The average time needed for wound dressing was 17 minutes. Wound management often occurred in a idiosyncratic way and did not always follow evidence based practice. Wound management can be significantly improved by the use of modern wound dressing, reduction of the frequency of wound dressings, standardized wound documentation and better co-operation with doctors, nursing experts and health insurance organisations. Basis on the convenience nature of the sample results of this survey should be generalized and interpreted with caution. This study gives clear indications of the significance of the problem. More studies with representative samples are needed.

Burn wound management in patients with epilepsy: adopting a multidisciplinary approach

Many burns that occur following an epileptic seizure are deep due to prolonged contact with the thermal source. Primary care staff need to be aware of this and ready to refer patients to a burns unit.

The influence of a structured guideline for wound management for patients who suffer from malignant ulcers. A prospective, explorative and descriptive study about nursing to breast cancer patients with ulceration

The influence of a structured guideline for wound management for patients who suffer from malignant ulcers. A prospective, explorative and descriptive study about nursing to breast cancer patients with ulceration

Wound management in patients with epidermolysis bullosa.

An examination of the treatment options available - including dressings and antimicrobial therapy - for patients with this condition.