Wound Cleansing Research Articles

Literature review on selected Ayurvedic formula in the management of wound healing

Wounds have been widespread issues since ancient times. Although the restoration of tissue is a normal reaction to any form of injury, the healing of an open wound is delayed by bacterial contamination. In the medical science of Ayurveda, there are numerous pearls that can be used to cure wounds without any complications. Our Āchāryās (teachers) categorized the medications related to Vrana Shōdhana (wound cleaning) and Vrana Rōpana (wound healing) and provided a general description of the treatment concepts of wound management. Six plants with various therapeutic properties, cow ghee, and rock salt make up a particular Ayurveda formula. In order to manage wound healing, this study reviewed a few Ayurvedic formulas that are mentioned in the Bhāvaprakāsha (classical text) based on their pharmacological and pharmacodynamics capabilities. The main goal of this investigation is to examine how the chemicals in this recipe affect wound healing. Information about wound was acquired from Ayurvedic scriptures, contemporary texts, and earlier research studies (from primary and secondary sources). Afterwards a survey of the literature was done on those six herbs. Also, these selected herbs were examined for their Pancha Padārtha (5 elements of the herb) and pharmacological qualities. Due to the fact that the chosen formula was primarily made up of Kapha, Pitta and Vāta Shamana (pacify humors of body) it was noted that the Ayurvedic pharmacodynamics qualities and actions (karmas) for wound healing were found. As a result, the effectiveness of the chosen Ayurvedic formula in managing wound healing can be demonstrated.

ThTP8.6 A novel method for stoma isolation in a complex abdominal wound treated with vacuum assisted closure

Abstract Introduction Vacuum assisted closure (VAC) is a well established method in the treatment of abdominal wounds where the fascia is intact. The presence of one or multiple intestinal stomas or fistulae may present challenges in successful application of VAC therapy. Key concerns with the presence of intestinal stomas alongside open abdominal wounds is the risk of contamination with stoma effluent or the potential for the negative pressure to create enterocutaneous fistulae. Here we describe a novel method for isolating a small bowel stoma existing within a large abdominal wound, allowing successful resolution having failed conventional management. Method No device currently exists to allow a functioning stoma to be isolated within an abdominal wound requiring VAC therapy. This method relies on modification of a standard silicone fistula crown, this is then integrated into the standard VAC dressing, using stoma seals to provide successful vacuum. Stoma output is then successfully isolated, protecting surrounding tissue and supporting wound granulation without concern of wound effluent contamination. Discussion Of key importance in this case is the proximity of clean wounds with skin grafts done by plastic surgeons also being managed with VAC therapy and the importance of preventing contamination to allow successful granulation without further debridement of an already large wound. Conclusion Although this situation is rare with the increasing use of vacuum assisted closure devices for the management of wounds across many specialities this scenario is certainly not unprecedented. The technique described allowed successful treatment of a complex wound with significant existing comorbidities allowing resolution of a very challenging situation.

Antimicrobial or Antiseptic Cleansers for Wounds


 For chronic wound care, the majority of evidence suggested that antiseptic agents do not add additional clinical benefits compared with saline. No differences were observed between antiseptics and saline in the incidence of adverse events.
 For surgical wound care, irrigation with antibiotic agents is likely associated with lower rates of surgical site infections compared with saline irrigation. Depending on the type of antiseptic agent, type of surgery, and depth of infection, antiseptic irrigation may have superior or similar efficacy compared with saline in surgical site infection and wound healing rates. Indirect evidence suggested antibiotics were not superior to antiseptics for prevention of surgical site infections. No differences were observed between antiseptic irrigation and saline irrigation in the incidence of adverse events and length of hospital stay.
 For acute traumatic wound care, a limited number of studies provided mixed results on the effectiveness of povidone-iodine compared with saline for preventing infection. The effect of antiseptic agents on bacterial load was unclear. No robust conclusions could be drawn due to very low certainty of the evidence.
 The economic evaluation study showed that irrigation with hypochlorous acid preserved wound cleanser was a cost-effective strategy in the short term compared with saline for the treatment of severely complex wounds during ultrasonic debridement. However, we have little confidence in the findings due to several limitations in the methods of the study.
 We did not identify any studies that compared the clinical effectiveness and cost-effectiveness of antimicrobial or antiseptic wound cleansers with antimicrobial dressings or of different types of antimicrobial or antiseptic wound cleansers for the management of wounds.
 We did not identify any evidence-based guidelines regarding the use of antimicrobial or antiseptic wound cleansers for the management of wounds.

A Case Study of Karanja Tail in the Management of Dushta Vrana

Healing of Vrana is a physiological process of regeneration and repair after injury. Frequency of injury is more common and management of wound is basic surgical skill. The wound is the biggest challenge to medical profession since vedic era . The wound is healed by three way first is primary intention , second is secondary intention third is by tertiary intention .Sushruta Samhita classical text of Ayurveda has elaborately explained Shashthi ( sixty types of procedures) for the management of wounds to achieve good early healing without complication. His techniques are broadly classified as Vrana Shodhana (wound cleaning) and Vrana Ropana (wound healing). Karanja Taila due to its shodhana and ropana properties plays a important role in Dushta vrana . In Dushta vrana vata and kapha dosha has predominant and Karanja Taila has vataghana and kaphagna properties that help in dosha shamana in Dushta vrana.

Efficacy of wound cleanser 25% based on indonesian medicine plants on chronic wound healing


 ABSTRACT
 Background: Chronic wounds are a challenge for wound care professionals and a global economic burden that has increased morbidity and mortality in patients worldwide.
 Purpose: This study aims to determine the efficacy of wound cleanser with guava leaf extract (Psidium guajava Linn) and betel leaf extract (Piper betle L) 25% on the inhibition of bacterial growth in chronic wounds.
 Methods: The research conducted was laboratory experimental in nature. Guava leaf extract (Psidium guajava Linn) and betel leaf extract (Piper betle L) were formulated in the form of liquid soap with a concentration of 25% then evaluation of the physical preparations, allergy tests and bacterial tests were carried out in the form of the inhibition of liquid soap against Pseudomonas aeruginosa bacteria, Staphylococcus aureus, Escherichia coli in chronic wounds, Bacillus subtilis, Bacillus cereus, Staphylococcus epidermidis and Yeast Candida Albicans. Data collection is carried out after passing the ethical test.
 Results: This proves that liquid soap preparations of ethanol extract of guava leaves (Psidium guajava Linn) and betel leaf extract (Piper betle L) have medium, strong and very strong inhibition against Pseudomonas aeruginosa (12.28 mm), Staphylococcus aureus (19.48 mm), Escherichia coli (13.94 mm), Bacillus subtilis (27.58 mm), Bacillus cereus (11.11 mm), Staphylococcus epidermidis (14.44 mm) and category of respond medium inhibition on Yeast Candida Albicans (8.13 mm).
 Conclusion: Based on the results of the study, it can be concluded that the formulation of liquid soap preparations of ethanol extract of guava leaves (Psidium guajava Linn) and betel leaf extract (Piper betle L) with a concentration of 25% fulfills the quality requirements for liquid soap preparations. The results of this liquid soap antibacterial test had a strong response in inhibiting the growth of the bacteria Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Bacillus cereus, Staphylococcus epidermidis.
 
 Keywords: Liquid soap, Psidium guajava Linn, Piper betle L, Bacteria

Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models.

Antiseptics are widely used in wound management to prevent or treat wound infections, and have been shown to have antibiofilm efficacy. The objective of this study was to assess the effectiveness of a polyhexamethylene biguanide (PHMB)-containing wound cleansing and irrigation solution on model biofilm of pathogens known to cause wound infections compared with a number of other antimicrobial wound cleansing and irrigation solutions. Staphylococcus aureus and Pseudomonas aeruginosa single-species biofilms were cultured using microtitre plate and Centers for Disease Control and Prevention (CDC) biofilm reactor methods. Following a 24-hour incubation period, the biofilms were rinsed to remove planktonic microorganisms and then challenged with wound cleansing and irrigation solutions. Following incubation of the biofilms with a variety of concentrations of the test solutions (50%, 75% or 100%) for 20, 30, 40, 50 or 60 minutes, remaining viable organisms from the treated biofilms were quantified. The six antimicrobial wound cleansing and irrigation solutions used were all effective in eradicating Staphylococcus aureus biofilm bacteria in both test models. However, the results were more variable for the more tolerant Pseudomonas aeruginosa biofilm. Only one of the six solutions (sea salt and oxychlorite/NaOCl-containing solution) was able to eradicate Pseudomonas aeruginosa biofilm using the microtitre plate assay. Of the six solutions, three (a solution containing PHMB and poloxamer 188 surfactant, a solution containing hypochlorous acid (HOCl) and a solution containing NaOCl/HOCl) showed increasing levels of eradication of Pseudomonas aeruginosa biofilm microorganisms with increasing concentration and exposure time. Using the CDC biofilm reactor model, all six cleansing and irrigation solutions, except for the solution containing HOCl, were able to eradicate Pseudomonas aeruginosa biofilms such that no viable microorganisms were recovered. This study demonstrated that a PHMB-containing wound cleansing and irrigation solution was as effective as other antimicrobial wound irrigation solutions for antibiofilm efficacy. Together with the low toxicity, good safety profile and absence of any reported acquisition of bacterial resistance to PHMB, the antibiofilm effectiveness data support the alignment of this cleansing and irrigation solution with antimicrobial stewardship (AMS) strategies.

DIAGNOSIS AND TREATMENT OF ODONTOGENIC PHLEGMONS OF THE ORAL FLOOR AND NECK

The treatment of odontogenic phlegmons of the maxillofacial area is still remaining an urgent problem of oral and maxillo-facial surgery due to the steady increase in their frequency, tendency to generalization of the process and adverse consequences. In this regard, there is a constant search for ways to elevate the effectiveness of managing patients with odontogenic phlegmons of the maxillofacial area, to elaborate new technologies for diagnosis, surgical and medical treatment approaches and to put them into practice. The purpose of this study is to analyze the methods of diagnosis and treatment outcomes among patients with phlegmon of the oral floor and neck based on the records of the maxillofacial department. Materials and methods. We analyzed 71 case histories of phlegmon of the oral floor and neck in patients who received treatment at the maxillofacial department from 2017 to 2022 year. The analysis reveals that the primary cause behind the occurrence of deep phlegmons in the oral floor and neck was odontogenic inflammatory processes, accounting for 37 cases; tonsillogenic lesions accounted for 9 cases, foreign bodies of the esophagus accounted for 12 cases, and adenophlegmons accounted for 13 cases. 12 patients out of 71 underwent tracheotomy followed by the intubation through a tracheostomy. All patients experienced urgent surgical intervention, including dissection and drainage of the tissue spaces in the oral floor and neck. Due to the unique structure of the fibrous spaces in the neck and the high hydrophilicity of mediastinal tissues, wide incisions were made on one or both sides of the neck to ensure adequate drainage and treatment with antiseptic solutions. Following wound cleansing, secondary delayed sutures were applied for a period of 11-18 days. Adequate medical therapy was provided to patients from the time of admission to the hospital until clinical recovery. Microbiological examination of the exudate from the wound in 54 patients revealed various pathogens, while no growth of microflora was observed in 17 patients. The isolated microflora included hemolytic streptococcus in 20 patients, various types of staphylococci in 12 patients, mixed flora in 14 patients, and anaerobes in 8 patients, all of which were identified as causative agents of purulent-septic processes. Nevertheless, a high frequency of purulent-necrotic lesions in the cellular spaces of the oral floor and neck persists, and can result in fatal consequences in some cases. The use of modern, highly effective diagnostic tools, such as computed tomography and magnetic resonance imaging, can aid in early diagnosis and determine the indications and volume of surgical intervention required for phlegmon formation.

COOLED BOILED WATER VERSUS STERILE NORMAL SALINE IN WOUND CLEANSING, A RANDOMIZED CONTROLLED TRIAL

Introduction: Wound cleansing plays a vital role in wound management. Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and is not thought to interfere with the normal healing process. Cooled boiled water is commonly used in community settings for cleansing wounds because it is easily accessible, efcient and cost-effective; however, there is an unresolved debate about its use. The aim of the study was to test whether there are differences in wound infection and w Aims And Objectives: ound healing rates when wounds are irrigated with cooled boiled water compared to sterile normal saline. Can this approach be used in a community environment without risk? Subjects were randomly assigned to wound cleansing with cooled Method: boiled water (experimental group) or sterile normal saline (control group). Wound assessment was conducted at each hospital visit, and an assessment of wound size was conducted once a week. The main outcome measures, occurrence of a wound infection and wound healing, were assessed over a period of 6 weeks. Study ndings indicate that cooled b Conclusion: oiled water is a safe alternative to sterile normal saline for wound cleansing and this method can be safely applied to community setting.

524 Traveling Pediatric Burn Care on Wheels

Abstract Introduction Many burn patients initially seek treatment at a community hospital after suffering a burn injury and are then transferred to various hospitals before being evaluated by a burn specialist. Due to the increased volume of patients in the emergency department, pediatric burn patients in the past have waited on average 90 minutes to be assessed by a burn provider. A new process was implemented to decrease wait times and increase overall patient and family satisfaction. A breakdown in the process, noted by burn care staff, was the availability of burn care supplies located in the emergency department. Methods • A process developed for burn unit nurses to respond to the emergency department to evaluate all pediatric burn patients was implemented. • A survey was sent to burn nurses looking for the most used supplies while caring for a pediatric burn patient. • Collaborative efforts with the pharmacy department to obtain space in the medication pyxis for the most used ointments in burn care. • Collaborative efforts with the Child Life Specialist to stock the cart with stickers, small toys, and distraction items for pediatric patients. • Collaborative efforts with the attending burn surgeon to develop and implement a protocol for burn team response. • Collaborative efforts with infection control department to ensure proper regulation standards of the cart. Cart Contents: • Gauze • Securement wraps • Wound cleansers • Silver impregnated foam dressing • Non-stick petroleum gauze • Staplers • IV start supplies • Paper tracking tool • Discharge & dressing change instructions • Stickers, small toys, & distraction items Results The Hydro on Wheels cart was implemented in January 2022. A retrospective study of data including pediatric burn patients seen in 2021 was completed. The average wait time to be seen by a burn provider in the emergency department decreased from 90 minutes in 2021 to 34 minutes in the first 6 months of 2022. A follow up survey was sent to hydrotherapy burn nurses to assess the satisfaction of the new process and equipment available. Conclusions Overall decreased wait time for pediatric burn patients to be evaluated by a burn care provider. Burn care nurses felt prepared when responding to a pediatric burn patient in the emergency department. Applicability of Research to Practice The burn unit plans to continue this approach to improve patient and family satisfaction & patient outcomes Future considerations to further improve the process would be to include a patient and family follow up satisfaction survey.

577 Impact of the Bismuth Tribromophenate Stick-down Method on Pediatric Burns

Abstract Introduction Burn injuries are a leading cause of morbidity and mortality in the pediatric population. Patients require frequent dressing changes to minimize infection risk and promote wound healing via re-epithelialization. Bismuth Tribromophenate, an affordable petrolatum-based dressing, has been shown to have rapid re-epithelization of skin grafts and low infection rates in clean wound environments. A stick-down (SD) protocol has been developed to minimize the frequency of dressing changes. This SD protocol involves daily assessment and changing of the dressing until it begins to adhere to the underlying wound bed, where the dressing is then left in place as a protective layer as re-epithelialization occurs. The objective of this study is to characterize baseline features and compare outcomes associated with the SD dressing compared to non-stick-down (NSD) Bismuth Tribromophenate dressing. Methods Patients under 18 years treated at our institution for partial thickness burn injuries were retrospectively identified using our medical records. Demographic data, injury characteristics, dressing type, length of hospitalization, and outpatient outcomes were collected from these records. Statistical analysis between dressing types was achieved using Fisher’s exact test and Mann-Whitney U test, with statistical significance defined as p < 0.05. Results A total of 106 individuals receiving Bismuth Tribromophenate were identified. 36 patients received the Bismuth Tribromophenate SD dressing and 70 patients received NSD dressing. SD patients had a higher hospital admission rate compared to NSD patients (52.8% versus 33.3%, p = 0.088), though not statistically significant. 47.3% of admitted SD patients were admitted for burn severity compared to 25% in NSD patients. SD patients also had higher PICU admission rates compared to NSD patients (36.8% versus 4.8%, p = 0.017). SD patients also required initial debridement sedation more often (63.6% versus 36.7%, p = 0.017). SD and NSD patients had re-epithelialization rates of 66.7% and 65.6% (p = 1), respectively. Median time to re-epithelialization was 13 (10.8-17.2) days in SD patients compared to 12 (10-20) days in NSD patients (p = 1). Conclusions SD-receiving patients were more likely to be admitted to the hospital and admitted for burn severity. In contrast, patients receiving NSD were less likely to be admitted, but more commonly admitted for pain. SD-receiving patients were also more likely to be admitted to the PICU and require sedation for debridement. Despite this difference in baseline characteristics, re-epithelialization rates and time to re-epithelialization between SD and NSD patients were not statistically distinct, with comparable rates and days to healing. Applicability of Research to Practice Identifying cost-effective, efficacious, and convenient dressing protocols for the treatment of pediatric burns.

772 Bismuth Tribromophenate Gauze is Superior to Silver Sulfadiazine Cream for Mixed-depth Scald Burns in Children

Abstract Introduction Silver sulfadiazine 1% cream was historically the mainstay initial treatment for burn wounds at our pediatric burn center. Over the last several years, we transitioned to using closed dressings of 3% bismuth tribromophenate petrolatum gauze in the initial care of partial thickness burns with the goal of reducing the pain experienced with daily wound cleaning necessitated when using silver sulfadiazine. The gauze adheres to the wound, allows exudate to drain through, and acts as a scaffold for re-epithelialization after which it falls off without traumatizing the healed burn. The purpose of this study is to compare our burn patient outcomes with the initial use of bismuth tribromophenate gauze to those in patients treated with silver sulfadiazine cream. Methods A retrospective chart review was conducted of our patients aged 5 years and younger presenting with mixed-depth scald injuries within two time frames: 1) years 2004-2008, during which silver sulfadiazine 1% cream was the standard initial choice for wound care at our institution, and 2) years 2015-2018, when 3% bismuth tribromophenate petrolatum gauze had become standard. Data collected included demographics, burn total body surface area (TBSA), length of hospital stay, need for excision or grafting, time to grafting, and graft size. Results Three hundred forty-seven patients were included, 200 of whom were treated with silver sulfadiazine cream and 147 treated with only bismuth tribromophenate gauze. Burn TBSA and rates of skin grafting were similar between the two groups; however, the mean area of the skin graft was significantly smaller (p = 0.027) among the patients in the bismuth tribromophenate group (147 cm2) compared to those in the silver sulfadiazine group (336 cm2). On the other hand, the time from injury to skin grafting was significantly longer in the bismuth tribromophenate group (24 days vs. 9.9 days, p = 0.002), with a larger proportion of these patients returning for elective grafting in the outpatient setting. Conclusions The percentage of patients who required skin grafting in both groups was similar; however, initial treatment with a closed dressing of 3% bismuth tribromophenate petrolatum gauze promotes healing in the zone of stasis, resulting in smaller skin grafts and hence smaller donor sites. The mechanical forces of daily wound cleaning when using silver sulfadiazine cream likely harm those areas at risk, leading to the need for larger skin grafts for coverage. Although time to grafting was longer when using gauze, these patients were in closed dressings with fewer painful changes. Applicability of Research to Practice Bismuth tribromophenate petrolatum gauze remains on a wound bed for up to three weeks, whereas silver sulfadiazine cream must be changed regularly resulting in constant disruption of the healing tissue. Fewer dressing changes combined with later skin grafting could allow burn wounds to demarcate and heal more effectively, benefiting both graft and donor sites.

OC-111 FIVE YEARS OUTCOME OF LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH PHASIX ST

Abstract Background Repair of ventral and incisional hernias (VIHR) is a standard procedure; newly introduced resorbable mesh biomaterials provide an attractive option to reduce the use of permanent synthetic mesh in hernia surgery and reduce its complications. Indeed the data of Phasix resorption started to occur post-maturation of the wound tissue. However, data on the use of slowly resorbable mesh materials remain scarce, and this study aims to evaluate the use of Phasix ST in the laparoscopic repair of VIHR. Methods This is a retrospective study of a sequential cohort of patients undergoing laparoscopic VIHR utilizing a Phasix ST mesh. Perioperative characteristics and clinical outcomes were collected. Results In total, 26 patients, including 19 females and 7 males, underwent laparoscopic VIHR using Phasix ST from April 2016 to January 2023. All surgeries were performed in a single institution by the same surgeon. The average patient age was 52.6, and the mean BMI was 35.5. All patients had a clean wound classification. The average defect size was 136.4 cm2. All patients were seen in the clinic with a median follow-up of 48 months. We observed four wound seromas, no wound infections, and three recurrences during the five years follow-up period. All occurred in the center of the mesh with severe adhesions to the mesh and tacker Conclusion Five years of follow-ups showed 11% recurrence in the same site note, which needs to be reviewed. Further, ten years of follow-up results need to be assessed.

MODERN CHITOSAN-BASED WOUND DRESSINGS IN LOCAL WOUND TREATMENT: PRECLINICAL STUDIES

One of the priorities of modern medicine is the development of biomaterials for tissue engineering, transplantation and vascular surgery. Such materials should facilitate the regeneration of damaged body organs and tissues. The problem of regeneration of wound lesions affecting various skin and soft tissues is related to a high rate of secondary infection, deep metabolic shifts in the conditions of severe inflammations, activated oxygen-independent phagocytosis and intensified free-radical response. In patients with wounds of various etiologies, modern clinical practice widely employs numerous wound dressings, where properties are specified in advance according to the stage the wound is going through. The principle of a wound coating is the provision of a moist abacterial environment, which is optimal for accelerated healing. The subjects of our experimental studies were 45 white laboratory rats (males, outbred, each weighing 250-300 g) with soft tissue wounds developed by a specifically designed method. As materials for wound treatment we used chitosan-based multilayer wound dressings of different structure and porosity degree. They were introduced into simulated wounds in the back area between the shoulder blades in rats. The experimental part of the study focused on the sorption capacity of the wound exudate obtained after extraction and weighing of the samples within the control time. The laboratory part of the experiment involved studying the sorption capacity of wound dressing samples in relation to distilled water and blood serum. The morphological assessment of the dressing samples surface was performed on a Helios NanoLab 600electron-ion scanning microscope. It was observed that chitosan-based multilayer wound dressings, had different morphological parameters and molecular structure as well as high sorption activity. Chitosan samples with a so-called loose structure and high porosity should be used in a clean (aseptic) wound at the initial stages of treatment, with no inflammation, where initially high adhesion to surrounding tissues is required, thus, ensuring tightness and keeping a blood clot within the wound. Chitosan samples with a tight-packed structure and a smaller diameter of pores showed good results in purulent inflammation (exudative phase) with a large amount of wound exudate. Due to its dense outer layer, their structure is capable of retaining the skeleton functions for a long time, thus offering effective drainage of the wound.

Efficacy of Jatyadi, Madhughrita and honey tulle in wound management: a three-arm randomized controlled clinical trial

BackgroundAyurveda underlines the significance of wounds and wound healing. Acharya Susruta has highlighted the need for shastiupakramas in the management of the wound. Even with a multitude of therapeutic concepts and formulations in Ayurveda, wound management has yet to gain acceptance. ObjectiveTo evaluate the effect of Jatyadi tulle, Madhughrita tulle, and honey tulle in the management of Shuddhavrana (clean wound). Materials and methodsA three-arm randomized, parallel group, active-controlled, open-label clinical trial. Randomization was done through online random number generator software to allocate 45 patients treatment into three groups. Trial groups were treated with Jatyadi tulle (JT), Madhughrita tulle (MG), and control group was treated with Honey tulle (HT) for 10 days, and assessment was done on the 5th and 10th day. The wound was assessed using the Bates Jensen wound assessment tool, and the efficacy of the dressing material was assessed using the Worcestershire tissue viability team dressing assessment form. The study outcomes were early wound healing and clinical cure. ResultsWithin-group results were assessed using the Wilcoxon matched pairs test, and between-group results were assessed by Kruskal–Wallis ANOVA and Mann–Whitney U test. Significant results were obtained within-group (p value < 0.05) from day 0 and at various time points. The results between groups were found to be comparable; JT and MG were found to be significant in ease of application, removal, and patient comfort. No adverse drug events were identified throughout the study. ConclusionJT and MG tulle have shown significant results in the management of shuddhavrana.

MP25-16 EVALUATING THE LEARNING CURVE FOR IN-OFFICE COGNITIVE FREEHAND TRANSPERINEAL PROSTATE BIOPSY

You have accessJournal of UrologyCME1 Apr 2023MP25-16 EVALUATING THE LEARNING CURVE FOR IN-OFFICE COGNITIVE FREEHAND TRANSPERINEAL PROSTATE BIOPSY Sofia Gereta, Michael Hung, and Jim C. Hu Sofia GeretaSofia Gereta More articles by this author , Michael HungMichael Hung More articles by this author , and Jim C. HuJim C. Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In-office MRI-ultrasound cognitive fusion targeted transperineal biopsy (CTPB) is a cost-effective approach to a percutaneous, clean wound classification approach to biopsy. However, because transrectal biopsy remains the predominant U.S. approach to CTPB, the barriers to the adoption of the relatively novel CTPB include the learning curve to proficiency and comparative detection rates of clinically significant prostate cancer (csPC, Gleason Grade Group (GG) ≥2). Therefore, our study objective was to define the CTPB learning curve, which is heretofore unstudied, by assessing cancer detection, biopsy core quantity, procedure times, and adverse events (AEs) over time. METHODS: We performed a retrospective review for 110 consecutive CTPB performed using PrecisionPoint (Cumberland, MD) without antibiotic prophylaxis between March 2021 and September 2022, excluding biopsies performed after focal therapy. All CTPB were performed by a single urologist (JCH) without prior experience with the platform. The cohort was divided into quarters and analyzed by univariate methods. RESULTS: There was no significant difference in demographic or MRI characteristics between quarters. There was no difference in the detection of csPC (Q1 50%, Q2 52%, Q3 50%, Q4 48%, p=0.99) or GG upgrading by targeted biopsy across quarters (Figure 1B, 1D). The median number of cores sampled per biopsy significantly decreased after approximately 28 cases (Q1 18, Q2 16, Q3 16, Q4 15, p=0.01). There was no change in the proportion of fibromuscular (non-prostate) cores sampled across quarters (Figure 1B). Total procedure time decreased from a median of 4:06 min in Q3 to 3:00 min in Q4 (p=0.04). Rates of AEs did not differ and remained low across quarters. A single patient reported UTI with irritative voiding symptoms was found to have a negative urine culture (Figure 1C). CONCLUSIONS: Our novel study demonstrates that MRI-ultrasound cognitive fusion targeted transperineal biopsy is safe and effective without a significant learning curve, as shown by consistent csPC detection across the study period. There was a significant decrease in the number of cores obtained after approximately 28 cases with a shorter procedure time, suggesting greater procedural efficiency or refinement in the core sampling approach. Source of Funding: There was no direct funding from an outside organization or sponsor. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e349 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sofia Gereta More articles by this author Michael Hung More articles by this author Jim C. Hu More articles by this author Expand All Advertisement PDF downloadLoading ...

COMPARATIVE STUDY OF PLACENTREX GEL DRESSING'S VS AMORPHOUS HYDROGEL WITH COLLOIDAL SILVER IN CHRONIC CLEAN WOUNDS

Background: The process of cutaneous wound healing is incredibly complex, dependent on an intricate interplay between number of highly regulated factors working in concert to restore injured skin towards repaired barrier function.Any surgical practice primarily depends upon the healing of wounds without serious complications and infection occurring ,It accounts for considerable patient morbidity, discomfort and prolonged hospitalization. Objective :To compare between the use of Placentrex gel dressingvs Amorphous Hydrogel with colloidal silver in Patients who having chronic clean wounds Methodology:This comparative study was conducted among 140 patients with chronic clean wounds came getting admitted in the department of General Surgery,AVMC with Informed consent were included in the study. Placentrex gel dressing and Amorphous Hydrogel with colloidal silver dressing's was done .Patients were monitored daily and Data was calculated and analysed byusing SPSS version 22.0 (IBM SPSS, US) software operating on windows 10 Result:Total of 140 patients included in the study and divided into two groups of 70 based on the type of dressings done for the Patients .Found signicant lower duration of the hospitalization and cost for the Patients whoreceived Placentrex gel compared to Amorohous hydrogel with colloidal silver .Number of dressings needed for Patients who received placentrex is less comparedwith Amorophous hydrogel with colloidal silver . The patients who given placentrex gel were found to have Signicantly fast wound healing 20 vs 30 days (P&lt;0.005). Conclusion: Placentrex gel is more effective in wound healing than hydrogel and the duration of hospital stay is decreased for patients who have chronic wounds. This study results found that placentrex gel ismore effective against acute and chronic clean wounds.

Emergency hernia repair: a retrospective cross-sectional study on the treatment modalities and adherence to guidelines in a tertiary public hospital.

Emergency presentations of hernias can pose significant morbidity. In addition, providing optimal surgical intervention can be challenging due to patient and disease factors with multiple treatment modalities available. Recently there have been several guidelines written to help standardize practices in hernia management. The aim of our study was to review emergency hernia operations at our tertiary level teaching hospital, the method of repair and how this matched to international guidelines. We performed a retrospective chart review of all the patients who underwent emergency hernia surgery for strangulated/incarcerated hernias in our department over a 3-year period. Adherence to guidelines was assessed looking at appropriateness of mesh utilization, as well as the appropriateness of antibiotic usage. A total of 184 cases from April 1st 2018 to March 31st 2021 were included. Of these hernias 12% contained necrotic or perforated bowel, 42% contained viable incarcerated bowel, and 45% contained just incarcerated fat. The compliance to the appropriate use of mesh overall was 85%, with a variation by hernia type. The global compliance to appropriate antibiotic therapy was high, at 89.7%. With antibiotic use compliance being very high in clean wounds (95.6%), and dirty wounds (100%). But lower in clean/contaminated or contaminated wounds (36.8%). Compliance at our hospital was globally good. Areas of decreased compliance seem to be mostly regarding mesh use and antibiotic use in potentially contaminated fields and the concept of risk of bacterial translocation versus actual contamination, as well as in mesh use in smaller umbilical hernias.

Cost-Effectiveness of PHMB & betaine wound bed preparation compared with standard care in venous leg ulcers: A cost-utility analysis in the United Kingdom

BackgroundWounds cost £8.3 billion per year in the United Kingdom (UK) annually. Venous leg ulcers (VLUs) account for 15% of wounds and can be complicated to heal, increasing nurse visits and resource costs. Recent wound bed preparation consensus recommends wound cleansing and biofilm disrupting agents. However, inert cleansers such as tap water or saline are inexpensive, an evaluation of evidence is required to justify the higher upfront costs of treatment with active cleansers. We undertook a cost-effectiveness analysis of the use of a biofilm disrupting and cleansing solution and gel, Prontosan® Solution and Gel X, (PSGX) (B Braun Medical), as compared to the standard practice of using saline solution, for treating VLUs. MethodsA Markov model was parameterised to one-year costs and health-related quality of life consequences of treating chronic VLUs with PSGX versus saline solution. Costs are viewed from a UK healthcare payer perspective, include routine care and management of complications. A systematic literature search was performed to inform the clinical parameters of the economic model. Deterministic univariate sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were undertaken. ResultsFor PSGX an Incremental Net Monetary Benefit (INMB) of £1,129.65 to £1,042.39 per patient (with a Maximum Willingness to Pay of £30k and £20k per QALY respectively), of which cost savings are £867.87 and 0.0087 quality-adjusted life years (QALYs) gain per patient. PSA indicates a 99.3% probability of PSGX being cost-effective over saline. ConclusionsPSGX for the treatment of VLUs is dominant compared with saline solution in the UK with expected cost-savings within a year and improved patient outcomes.

Antiseptics and Cleansing the Chronic Wound: Best Practice

In the management of chronic wounds, the concept of “wound hygiene” has emerged to effectively manage biofilms, an obstacle to wound healing. The core principles of wound hygiene are wound cleansing, debridement, edge refashioning, and dressing. Cleansing is the first step in wound hygiene and should be performed at every dressing change to reduce the bacterial load and prevent biofilm formation. It is also performed to remove remaining debris after debridement. Cleansing should be performed not only on the wound but also on the surrounding skin. In addition, in order to break down rigid biofilm barriers, surfactants or antiseptics should be actively used at an early stage. Antiseptics should have excellent broad-spectrum antibacterial activity and low cytotoxicity while also being hypoallergenic. Octenidine dihydrochloride, polyhexanide, and povidone-iodine have these properties and are suitable for use as cleansing solutions. To effectively manage chronic wound biofilms, it is important to select an appropriate antiseptic and cleanse vigorously with sufficient time for the antiseptic to work. In addition, taking wound hygiene procedures for granted and repeating them regularly and frequently will lay the foundation for promoting wound healing.

Novosorb® Biodegradable Temporising Matrix (BTM) and its Applications

The NovoSorb® Biodegradable Temporising Matrix (BTM) (PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) is a fully synthetic dermal matrix that can be used to reconstruct complex wounds. It consists of a 2mm-thick NovoSorb® biodegradable polyurethane open-cell foam covered by a non-biodegradable scaling member. Application involves a two-stage procedure. In the first stage, BTM is laid onto a clean wound bed, and in the second stage, the sealing membrane is removed and a split skin graft is applied to the neo-dermis. BTM has been used to reconstruct deep dermal and full-thickness burns, necrotising fasciitis, and free flap donor sites in the early phase. This review documents examples from a comprehensive series of cases in which BTM was applied to a wide range of complex wounds, ranging from hand and fingertip injury, to Dupuytren’s surgery, chronic ulcers, post excision of cutaneous malignancies, and hidradenitis suppurativa. BTM can be applied to a wide range of complex wounds which may otherwise require a more challenging reconstruction. It should be considered an important adjunct to the reconstructive ladder.