Packing Therapy Research Articles

The Use of Autologous Fat Grafting and Platelet Rich Plasma in the Treatment of Chronic Wounds

Chronic wounds resulting in tissue loss/necrosis present a difficult clinical challenge. Traditional techniques such as wound packing and vacuum therapy are not always sufficient to result in complete closure of the wound.

Lobbying by association: The case of autism and the controversy over packing therapy in France

The controversy over packing therapy used in psychiatry was studied here to illustrate how leading associations can influence public health policies. The main French associations of parents with autistic children succeeded in obtaining the prohibition of packing, announced by the French Secretary of State to the Ministry of Health in April 2016. Parents and professionals who had observed the positive effects of packing when nothing else worked for their part wondered what could be done for self-harming patients. The political authorities followed the opinion of the main associations of parents with autistic children at the expense of that of professionals. In this paper, the actions and discourse of the associations against packing are explored, as are the arguments of the psychiatrists who defend packing therapy. The different phases in the controversy from the first opposition in 2005 and the role of opinion leaders in associations are analyzed. The strategies to discredit psychiatry and to promote behavioral methods are also studied to understand the shift in the balance of power from professionals to association leaders. The mobilization of the associations prompted some psychiatrists to conduct evidence-based research and to formalize their practice. The controversy over packing, involving political decision-making processes, ethical issues and clinical questions, enables us to illustrate a case of lobbying by associations.

Bleeding in cancer patients and its treatment: a review

Bleeding is a common problem in cancer patients, related to local tumor invasion, tumor angiogenesis, systemic effects of the cancer, or anti-cancer treatments. Existing bleeds can also be exacerbated by medications such as bevacizumab, nonsteroidal anti-inflammatory drugs (NSAIDs), and anticoagulants. Patients may develop acute catastrophic bleeding, episodic major bleeding, or low-volume oozing. Bleeding may present as bruising, petechiae, epistaxis, hemoptysis, hematemesis, hematochezia, melena, hematuria, or vaginal bleeding. Therapeutic intervention for bleeding should start by establishing goals of care, and treatment choice should be guided by life expectancy and quality of life. Careful thought should be given to discontinuation of medications and reversal of anticoagulation. Interventions to stop or slow bleeding may include systemic agents or transfusion of blood products. Noninvasive local treatment options include applied pressure, dressings, packing, and radiation therapy. Invasive local treatments include percutaneous embolization, endoscopic procedures, and surgical treatment.

Traumatismes complexes et thérapeutique par la méthode des enveloppements humides (« packing »). Étude psychopathologique à partir de trois cas

AimsThis article had two objectives: first to position the historical, clinical approach to a particular traumatic profile, complex post-traumatic stress disorder (C-PTSD or “complex trauma”) (which concerns, rather than a single trauma in adulthood, repeated trauma in childhood inflicted by a person close who would normally protect the child). The second was to describe the benefit obtained by “packing therapy” (the technique is explained) in three female patients presenting a “complex trauma” profile. A psychopathological view of complex trauma and of the effects of the therapy is proposed, calling on psychoanalytic concepts. MethodThree patients were offered this therapeutic alternative late in their psychiatric itinerary, after numerous methods had been tried and had failed. The childhood of two of these subjects was characterised by repeated intra-familial rape. The third subject had experienced a single instance of sexual abuse, but we noted an underlying traumatic past of the insecure type. Each of these three subjects exhibited typical, chronic symptoms that were serious and debilitating, with numerous suicide attempts, which they fortunately survived despite clear intention to put an end to their lives. Around fifteen sessions were conducted in the institution over a period allowing for a year-long overview. The Herman diagnostic scale was altered to enable retrospective hetero-evaluation, since it contains all the observable symptoms. This evaluation however remains descriptive, since the scale has not been validated. ResultsPacking therapy enables a reduction of 30 to 50% in symptom intensity. Two of the patients experienced manifestations of an escape from the traumatic splits. Memories that had remained buried surfaced, sometimes in the form of olfactory hallucinations, as well as images. Their abilities for mentalisation, associations and elaboration appeared considerably improved, while at the same time their medication was unchanged. Finally an “aftermath” or delayed effect was observed for the onset of the disorder, occurring after an asymptomatic period, which we will examine. DiscussionThe psycho-corporeal approach of wet packing appears to enable the return of “psychic vacuoles” previously split and fragmented under the effect of the distress generated by the trauma. Complex trauma is not repressed or projected, but split and fragmented, leading to a non-schizophrenic dissociation hindering psychic functioning overall. As mentioned, the associative abilities of the three patients were considerably enhanced, going as far as to enable psychotherapeutic elaboration. ConclusionThe clinical benefit of packing evidenced in this study is worthy of note: alleviation of symptoms, return of memories, improvement in psychic fluency, and in elaborative and associative abilities, etc. These results could contribute to the present debate concerning the application if this method to autistic children, whose psychic functioning, involving the non-integration of multi-sensorial flows, could have points in common with the functioning of “complex trauma”.

Role of topical tranexamic acid in the management of idiopathic anterior epistaxis in adult patients in the emergency department

The role of topical tranexamic acid in the management of anterior epistaxis in adult patients in the emergency department (ED) is examined. The use of alternative agents for the treatment of epistaxis before the use of nasal packing may be reasonable due to patient discomfort, potential complications, and the need for follow-up with a healthcare provider for packing removal. One such agent is tranexamic acid. Two published studies evaluated the off-label use of topical tranexamic acid for the treatment of epistaxis. The first trial compared the efficacy of a topical gel containing 10% tranexamic acid with a placebo gel containing glycerin for the treatment of epistaxis. The percentage of patients whose bleeding ceased within 30 minutes of the intervention did not significantly differ between the tranexamic acid and placebo groups (p = 0.16). The second trial compared the efficacy of cotton pledgets soaked in the i.v. formulation of tranexamic acid inserted into the bleeding naris with standard nasal packing therapy. Bleeding cessation occurred within 10 minutes in 71% of the tranexamic acid group versus 31.2% of the standard treatment group (odds ratio, 2.28; 95% confidence interval, 1.68-3.09; p < 0.001). Additional information is necessary to fully evaluate the role of topical tranexamic acid in treatment algorithms; however, the use of topical tranexamic acid may be beneficial in select populations. Topical tranexamic acid may have a role in the treatment of anterior epistaxis in select ED patients, though additional studies are needed to confirm its role in treatment algorithms.

Vacuum-packing temporary abdominal closure in post laparotomy wound sepsis and wound dehiscence

Background/Aim: Post-laparotomy wound sepsis and dehiscence occur in 0.25% to 3% of patients. Frequently, definitive fascial and/or cutaneous reconstructions cannot be performed in an immediate setting due to the wound condition or the general condition of the patient. Commercial VAC (Kinetic Concepts, Inc, San Antonio, TX) have been predominantly used for treatment of the open abdomen and in abdominal sepsis. However, commercial devices are either not available or prohibitively expensive for most patients in resource-poor regions. The method described herein is a relatively crude and low cost one applying the principals of topical negative pressure and temporary abdominal wound closure and our aim is to check its foasibility, safety and efficacy as a temporary abdominal closure method in post laparotomy wound sepsis and wound dehiscence. Patients and methods: This prospective study included 17 patients with significant post laparotomy wound dehiscence admitted to surgery department between June 2008 and May 2011. Vacuum packing closure therapy was administered for the whole 17 patients. Eleven patients (64 %) had complete fascial dehiscence with exposed bowel and six patients (36 %) had partial thickness fascial dehiscence. The evaluations included descriptive characteristics of the patients, rate of primary fascial closure and vacuum packing related morbidity and mortality. Results: Of these 11 patients with full thickness wound dehiscence and bowel exposure, two patients died of vacuum packing unrelated problems, six patients underwent successful primary fascial closure. In those 6 patients with partial thickness wound dehiscence. vacuum packing therapy achieved satisfactory wound healing in all the patients, Problems related to vacuum packing therapy included necrosis of fascial edges (2 patients) and blister under the adhesive tape (2 patients). No variables had a significant influence on vacuum packing wound therapy specific morbidity or primary closure rate in the univariate analysis. Three variables showed a significant influence on mortality: age (P<O.OOJ), adult respiratory distress syndrome (P=O.Ol), multiorganfailure (P=O.Ol) andMPI(P=O.Ol). Conclusion: Vacuum-packing therapy is safe and effective temporary abdominal closure in post laparotomy wound sepsis and dehiscence. Its effectiveness is similar to the known commercial device but the cost is much less which could be advisable in health care systems with limited funds in poor developing countries.

Effectiveness of Wet Sheet Packs in Children and Adolescents with Severe Auto/Hetero Aggressive Behaviors: An Exploratory Approach

Objective: To explore the effectiveness of wet sheet packs on auto/hetero aggressive behaviors in children and adolescents hospitalized in a psychiatric setting. Method: We reviewed the charts of all patients (N=8) who received packing therapy in the context of resistance to behavioral interventions, milieu therapy and medications from 2005-2009. We scored the level of auto/hetero aggressive behaviors per patient for each day they were hospitalized. Inter-rater reliability was good (Intraclass correlations=0.91). We used a mixed generalized linear model to assess whether the following explanatory variables (time, typical and atypical antipsychotics, mood stabilizer, sedative drug, stimulant and wet sheet pack) influenced the course of aggression over time, the dependant variable. Results: Using univariate analysis, the only variables that were found to be associated with a significant decrease in auto/hetero aggressive score were time (p=8 10-3), atypical antipsychotics (p=.027) and packing therapy (p=10-9). Effect of packing therapy remained significant after adjustment for atypical antipsychotics (p=1.8 10-9) and for time (p=.0017). Conclusion: In addition to atypical antipsychotics and milieu therapy, the results of this exploratory study suggest that wet sheet packs may be effective in relieving auto/hetero aggressive behaviors.

Lorazepam, fluoxetine and packing therapy in an adolescent with pervasive developmental disorder and catatonia

Packing therapy is an adjunct symptomatic treatment used for autism and/or catatonia. Here, we report the case of a 15-year-old boy with pervasive developmental disorder who developed catatonia. At admission, catatonic symptoms were severe and the patient required a feeding tube. Lorazepam up to 15 mg/day moderately improved the catatonic symptoms. On day 36 we added fluoxetine and on day 62 we added packing therapy (twice per week, 10 sessions). After three packing sessions, the patient showed a significant clinical improvement ( P < 0.001). At discharge (day 96), he was able to return to his special education program. Although we do not consider packing as a psychodynamic treatment, this case challenges the concept of embodied self that has opened new perspectives on a dialogue between psychoanalysis and neuroscience. Indeed, better body representation following packing sessions, as shown in patient’s drawing, paralleled clinical improvement, and supports the concept of embodied self. This concept may serve as a link between psychoanalysis and attachment theory, developmental psychology with the early description of “sense of self”, and cognitive neurosciences that more and more support the concept of embodied cognition. Further clinical studies are necessary to clarify the efficacy and underlying mechanism of packing treatment and to understand how patient’s experience may illustrate the concept of embodied self.

Packing therapy in children and adolescents with autism and serious behavioural problems

Packing therapy is a part of therapeutic approach for children and adolescents with autistic disorder, especially in the case of self-injurious behaviour, and who do not respond to usual psychotropic drugs or who cannot tolerate them. This method consists in wrapping the patient with his under-clothes several times a week, using towels previously wet in cold water. The patient is then wrapped with blankets to help the body warm up in a few minutes. Members of staff are always looking after the patient and are carefully attentive to the quality of the relation with the patient who achieve a greater perception and integration of his body, and a growing sense of containment.Self-injurious behaviours have previously been related to pain reactivity in autism. The effectiveness of packing could rest on the mobilization of thermo-algic sensitivity. There is a short-circuit of the painful sensations on which the child seems to focus his attention. A sensation, to which the patient has become particularly dependent, is therefore replaced by another type of sensation, which uses the same neuro-physiological pathway.As there is currently no scientific data available, a randomized, blind and controlled study (supported by the National Grant “Programme Hospitalier de Recherche Clinique PHRC 2007/1918”) is taking place to confirm the effectiveness of packing in clinical practice. We have chosen the methodology used to verify the effectiveness of risperidone in children with autism suffering of severe behavioural disorders. This study should help us specify the therapeutic indications of packing in autism.