Management Of Wounds In Patients Research Articles

Benefits of Collaboration Between the Wound, Ostomy, and Continence Nurse and Orthopedic Surgeon When Treating Skin Defects After Soft Tissue Sarcoma Resection: A Retrospective Case-Control Study.

The purpose of this study was to evaluate the benefits of collaborative management between orthopedic surgery and WOC nurses in patients undergoing resection of subcutaneous sarcomas. Retrospective case-control study. The sample comprised 25 patients who underwent wide resection for soft tissue sarcoma, followed by 2-stage split-thickness skin grafting. Data collection occurred between January 2015 and April 2021 in a university hospital based in Kagoshima, Japan. For comparison, we categorized these patients into 2 groups: intervention group participants were managed by an orthopedic surgeon and a WOC nurse; nonintervention group members were managed without WOC nurse participation. Patient background and treatment-related information was retrospectively collected from medical records and compared between the WOC nurse intervention group and the nonintervention group, including maximum tumor diameter, surgical time, maximum skin defect diameter, length of hospital stay, and time from surgery to complete wound healing. The average length of hospital stay was significantly shorter in the WOC nurse intervention group compared with the nonintervention group (38.3 days, SD = 8.0 vs 47.1 days, SD = 10.2; P = .023). Collaborative wound management with a WOC nurse resulted in a shorter hospital length of stay when compared to traditional management with WOC nurse involvement. Based on these findings, we assert that WOC nurses provide an important bridge between postoperative wound management in patients undergoing resection of subcutaneous sarcomas.

Enzymatic debridement with bromelain and development of bacteremia in burn injuries: A retrospective cohort study

BackgroundDebridement is crucial for effective wound management in patients with severe burn injuries, and bromelain, a proteolytic enzyme from pineapple stems, has emerged as a promising alternative for surgery. However, potential links of bromelain use to fever and sepsis have raised some concerns. Given the uncertainty as to whether this was caused by infection or other inflammatory sources, we aimed to investigate if the use of topical bromelain was associated with bacteremia. MethodsThis single-centre retrospective cohort study included critically ill adult patients with severe burn injuries hospitalised at the Burn Center of the University Hospital Zurich between January 2017 and December 2021. Data were collected from two in-hospital electronic medical records databases. Our primary outcome, the association between topical bromelain treatment and the development of bacteremia, was investigated using a competing risk regression model, taking into account the competing risk of death. As a secondary outcome, the relationship between bromelain treatment and overall ICU mortality was examined using a Cox proportional hazards model. ResultsThe study included 269 patients with a median age of 50 years and median burnt total body surface area of 19%. A first bacteremia occurred in 61 patients (23%) after a median time of 6 days. Bromelain treatment was given to 83 (31%) of patients, with 22 (27%) of these developing bacteremia. In the fully adjusted competing risk regression model, no evidence for an association between bromelain treatment and bacteremia was found (SHR 0.79, 95%CI 0.42–1.48, p = 0.47). During hospital stay, 40 (15%) of patients died. There was no significant difference in mortality between patients treated with bromelain and those who were not (HR 0.55, 95%CI 0.26–1.20, p = 0.14). Among the five multidrug-resistant (MDR) pathogens identified, three were found in patients with bromelain treatment. ConclusionOur study did not confirm an association between topical bromelain and bacteremia in patients with severe burn injuries. This finding can inform evidence-based practices by addressing concerns about potential risks of bromelain use, contributing to the development of more effective and safe burn wound management strategies.

Modification of fast-track surgery during partial nephrectomy

The present study aimed to assess the efficacy of the multimodal fast-track surgery (FTS) program supplemented with the exclusion of renal thermal ischemia, urinary tract drainage, and postoperative wound management in patients undergoing partial nephrectomy for localized T1 RCC.
 Methods. A total of 150 patients diagnosed with localized RCC in stage T1 N0 M0 were initially enrolled in this prospective randomized study, with 75 patients assigned to each study group. Patients undergoing perioperative management following the FTS program were randomly assigned to the main study group. The control group comprised patients receiving standard postoperative care. The study specifically involved patients with kidney neoplasms not exceeding 7 cm in the largest diameter based on computed tomography data. Tumor size, localization, and the volume of functioning parenchyma were considered in the assessment.
 Results. Among the patients included, 24 cases (16%) underwent radical nephrectomy due to technical difficulties arising from tumor spread to the kidney hilum, rendering them ineligible for further analysis. Consequently, the clinical analysis focused on 126 patients. Within the main group, 64 cases (50.8%) of RCC underwent randomization, and the multimodal FTS program was applied during partial nephrectomy. The control group comprised 62 patients (49.2%).
 The median postoperative bed day in the main group was 1.5 days less compared to the control group, with values of 3.2 [2; 4] days versus 5 [4; 7] days, respectively (p < 0.001). Intraoperative complications occurred in 5 cases (4.0%) involving blood loss exceeding 1 liter (4 cases in the main group and 1 case in the control group). Transfusion of blood components occurred only once when the hemoglobin level dropped below 70 g/l.
 In the early postoperative period, a total of 9 complications (7.1%) were observed with pyelonephritis lasting more than 3 days diagnosed in 4 cases (3.2%) and wound suppuration in 1 case (0.8%). Despite the absence of drainage in postoperative wounds within the main group, ultrasound examinations revealed small retroperitoneal hematomas (up to 100 ml) requiring drainage in 3% of cases.
 Conclusions. The multimodal FTS program for patients with localized RCC during partial nephrectomy, coupled with the exclusion of central thermal ischemia of the kidney, avoidance of retroperitoneal space drainage, and early patient activation, demonstrated a significant reduction in postoperative bed while maintaining a comparable level of perioperative complications.

Impact of hidradenitis suppurativa-specific wound dressing system on patient quality of life and dressing-related pain: pilot study.

It is theorised that adhesive-free wound care developed specifically for patients with hidradenitis suppurativa (HS) can improve their quality of life (QoL). Our study aimed to investigate the impact of a novel wound care device on Dermatology Life Quality Index (DLQI) scores, and other factors related to experienced pain, time spent changing dressings, comfort, ease of use and body image. A 21-day, single-arm, unblinded, pilot trial was conducted to assess ease of use and the impact of effective wound care on various aspects of wound management in patients with HS. Participants were provided two trial garments and trial dressings as required, to use over a 21-day period in the home setting. A seven-item questionnaire and the DLQI questionnaire was completed on days 0, 7, 14 and 21. All 15 participants were female, aged >18 years old and with a diagnosis of HS. Mean DLQI score at baseline (day 0) was 19.3, which was reduced to 4.53 on day 21, a significant improvement in 100% of participants (p<0.001). High levels of dressing-related pain, assessed using an 11-point Visual Analogue Scale, reduced from 5.53 at baseline to 0.8 on day 21. Other significant improvements in terms of patient comfort, time spent on changing dressings, body confidence and the dressing's ability to retain exudate were also noted. The results illustrated the improvement made to study participants' day-to-day activities and QoL when effective HS-specific wound care products were provided. Wound care is an essential component in the treatment journey of patients.

Primary Closure or Delayed Primary Closure? Assessment of Optimum Management of Surgical Wounds for Perforated Appendicitis

BACKGROUND: Open appendectomy is the treatment of choice for perforated appendicitis. Perforated appendicitis is associated with a 15–20% risk of developing post-operative wound infection, which the later associated with increased morbidity as increasing post-operative pain, longer hospital stay, suppurative wounds, patient dissatisfaction and increase cost of treatment. Some literatures revealed inconsistent results related to the incidence of surgical site infection (SSI) between delayed primary closures (DPC) and primary closure (PC) in open appendectomy for perforated appendicitis. AIM: The objective of the study is to define the best practice of wound management in patients operated on for perforated appendicitis. PATIENTS AND METHODS: One hundred and twenty patients having perforated appendicitis underwent open appendectomy enrolled in the study. The patients were randomly grouped according to the method of managing the surgical incisions into two groups; patients with their incisions closed primarily (PC) and those with their incisions left open to be frequently dressed for 5 days with Betadine-soaked gauze packing till it become clean then closed (DPC). An infected wound was assigned as such if purulent discharge yielded from the incision site. Results to be addressed were the incidence of SSI and the hospitalization length. RESULTS: Out of the total 120 patients, 19.17 % developed SSI following closure of the incision. Patients managed by PC revealed higher rate of SSI than DPC group (32.8% vs. 5.1%, p &lt; 0.001) and longer hospitalization (8.3 vs. 6.4 days, with a p &lt; 5%). CONCLUSION: DPC is preferred policy over PC when managing an open appendicectomy wounds for perforated appendicitis, as the former is associated with low incidence of wound infection and shorter hospitalization.

Comparison of Superficial Surgical Site Infection between Delayed Primary versus Primary Wound Closure in Complicated Appendicitis

Abstract Background: Acute appendicitis is the most common cause of acute abdomen in adults. Open appendicectomy is the treatment of choice for complicated appendicitis. Perforated appendicitis has an infection rate 15-20% post-operative surgical site infection can increase morbidity. Thus it can lead to increase in post-operative pain, hospital stay, sepsis and patient dissatisfaction, Surgical Site Infection (SSI) and its associated complications like wound dehiscence, stitch sinuses, incisional hernias, hypertrophic scar and keloid formation are not only a source of discomfort for the patients but also discouraging for the surgeons. These complications prolong the post-operative stay of patient and increase the cost of treatment. Aim of Study: To compare the efficacy of primary wound closure with delayed primary wound closure in terms of wound infection after surgery for perforated appendix and get local evidence of the effectiveness of either procedure. Patients and Methods: This study was done between May 2018 and December 2018 in the General Surgery Department in Ain Shams University Hospital and Damietta General Hospital. The study included 50 patients presented with complicated appendicitis. The patients were divided into 2 groups A and B using lottery method. Patient in group-A underwent primary closure of the skin immediately after surgery while patients in group-B were subjected to delayed primary closure of the skin for perforated appendix. Results: In our study, in delayed primary closure there was 2 patients with positive signs of superficial surgical wound infection but in primary closure there was 11 patients. The total post-operative hospital stay in delayed primary closure ranges from 4 to 9 days and in primary closure ranges from 3 to 9 days with no significant difference between the two groups. Conclusion: Our study suggested that patients undergoing open appendectomy for complicated appendicitis, DPC was the preferable method for wound management than primary closure because of a lower incidence of wound infection DPC could be considered for wound management in patients with perforated appendicitis.

Paraspinous Muscle Flaps for the Treatment of Complex Spinal Wounds.

Retrospective case series. To investigate the efficacy and complication profile of the use of paraspinous muscle flaps for closure of complex spinal wounds. Paraspinous muscle flap closure offers an innovative option in difficult-to-manage post-spinal surgery wounds. Current literature reports are mixed in terms of success and complication rates of these flap procedures, with most sources citing a wound complication rate of 20%. This case series investigated the hospital course of 58 patients undergoing paraspinous flap closure after spinal surgery between the years 2014 and 2018. Information gathered includes: demographics, surgery indication, location, and length of incision on the spine, nutrition labs, previous spinal surgeries, preoperative wound class, operative times, length of hospital stay, and complication rates including reoperation, wound infection, and other postoperative complications. Of the 58 patients undergoing spinal muscle flap closure, 51 (87.93%) had undergone previous spinal surgery with an average of 2.12 previous surgeries in these patients. Mean albumin and prealbumin were 2.62 and 13.75, respectively. 4/58 (6.90%) developed a wound infection or experienced a continuation of their chronic osteomyelitis. Of the 57 patients that had spinal instrumentation, three (5.26%) had spinal implants removed at the time of surgery and two (3.51%) had it removed or replaced later for mechanical complications. No patients had instrumentation removed for chronic infections. One (1.72%) experienced reoperation for wound-related complications. These rates are lower than most complication rates in the current literature. The plastic and reconstructive paraspinous muscle flap has promising results as a closure option for complex spinal wounds following neurosurgical cases. Further investigation is called for to determine the applicability of these results to the general population. 4.

2019 Guideline for Management of Wounds in Patients With Lower-Extremity Venous Disease (LEVD): An Executive Summary.

This article provides an executive summary of the 2019 Guideline for Management of Wounds in Patients with Lower-Extremity Venous Disease (LEVD) published by the Wound, Ostomy and Continence Nurses Society (WOCN). The executive summary presents an overview of the systematic process used to update and develop the guideline. It also lists the specific recommendations from the guideline for assessment, prevention, and management of LEVD and venous leg ulcers (VLUs). In addition, the guideline includes a new section regarding implementation of clinical practice guidelines. The LEVD guideline is a resource for WOC nurse specialists and other nurses, physicians, therapists, and health care professionals who work with adults who have or who are at risk for VLU.

Composite Alginate-Hyaluronan Sponges for the Delivery of Tranexamic Acid in Postextractive Alveolar Wounds

The management of wounds in patients on anticoagulant therapy who require oral surgical procedures is problematic and often results in a nonsatisfactory healing process. Here, we report a method to prepare an advanced dressing able to avoid uncontrolled bleeding by occluding the postextractive alveolar wounds, and simultaneously, capable of a fast release of tranexamic acid (TA). Composite alginate/hyaluronan (ALG/HA) sponge dressings loaded with TA were prepared by a straightforward internal gelation method followed by a freeze-drying step. Both blank and drug-loaded sponges were soft, flexible, and elegant in appearance and nonbrittle in nature. Scanning electron microscopy analysis confirmed the porous nature of these dressings. The integration of HA influenced the microstructure, reducing the porosity, modifying the water uptake kinetic, and increasing the resistance to compression. TA release from ALG/HA sponges showed a controlled release up to 3 h, and it was faster in the presence of HA. Finally, an in vitro clotting test performed on human whole blood confirmed that the TA-loaded sponges significantly reduce the blood clotting index by 30% compared with ALG/HA20 sponges. These results suggest that, if placed in a socket cavity, these dressings could give a relevant help to the blood hemostasis after dental extractions, especially in patients with coagulation disorders.

2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD): An Executive Summary.

The purpose of this article is to provide a summary of the recommendations from the 2014 Guideline for Management of Wounds in Patients With Lower-Extremity Arterial Disease (LEAD), published by the Wound, Ostomy and Continence Nurses Society (WOCN). This article provides an overview of the process used to update and develop the guideline, and specific recommendations from the guideline for assessment, referral for further evaluation, interventions (ie, debridement, dressings, infection, antibiotics, nutrition, pain management, compression issues, medications, surgical options, and adjunctive therapies), and patient education and risk-reduction strategies. The LEAD guideline is a resource for physicians, nurses, therapists, and other healthcare professionals who work with adults who have/or are at risk for wounds due to LEAD. The full text of the published guideline, which includes the available evidence supporting the recommendations and a complete reference list, is available from the WOCN Society, 1120 Rt. 73, Suite 200, Mount Laurel, NJ, 08054; Web site: www.wocn.org. Refer to the Supplemental Digital Content (Supplement Digital Content 1, http://links.lww.com/JWOCN/A31) associated with this article for the complete reference list for the guideline. The guideline has been accepted for publication by the National Guideline Clearinghouse (www.guideline.gov/).

Carica papaya Latex Accelerates Wound Healing in Diabetic Wistar Rats

Aim: The wound healing ability of Carica papaya latex in excisional wound of alloxan induced diabetic wistar rats was investigated. Methodology: The excisional wounds of 24 diabetic rats in four equal groups were dressed respectively with latex (LD), gentamicin (GD), normal saline (ND) and propylene glycol (PD). A composite four nondiabetic (control) groups were also established (LC, GC, NC, and PC). All the eight groups had daily dressing till healed. Wound dimensions were taken at an interval of four days and obtained values were used to calculate wound contraction rates for specific period. Granulation tissue biopsies taken on day 4, 8 and 12 were processed for light microscopy. The healed scars were also processed for light microscopy. Results: The latex control (LC) group had the shortest healing period (16 days) while the longest period of 32 days was recorded by the diabetic normal saline (ND) and diabetic propylene glycol (PD) groups. The differences in the healing duration amongst the groups were significant (P < 0.001). Original Research Article Ajani and Ogunbiyi; EJMP, 9(3): 1-12, 2015; Article no.EJMP.17758 2 Comparison of highest and lowest wound contraction rates within the same period The LC group had highest mean wound contraction rate of 21.56±7.04% on day 4 with the PD group being the lowest (6.45±2.32%). Similar pattern was observed on day 8; (LC: 55.71±4.87%) and (ND: 18.98±12.13%). For day 12, the results were LC: 84.86±5.11% and GD: 35.36±17.80%. All these paired values were of statistical significance. Intra and intergroup comparisons of contraction rates On day 4, LC had significantly higher contraction rate than LD (21.58±7.04; 11.06±2.82 respectively with P< 0.001). Also results for the same parameter on day 8 and day 12 were significant in LD vs GD (47.48±8.9 vs 21.06±5.83; P<0.001); LD vs ND (47.48±8.94 vs 18.98±12.13; P<0.001); LD vs PD (47.48±8.9 vs 23.12±5.77; P< 0.001) and GC vs GD (42.56±8.61 vs 21.06±5.83; P< 0.001). Light microscopy of the granulation tissue from all the control groups showed more cellular infiltration than the respective diabetic group which might be due to hyperglycemia. Conclusion: The study had been able to demonstrate that Carica papaya latex promotes wound healing in diabetic wistar rats. Possible mechanisms through which this was achieved include amelioration of the inhibitory effect of diabetes mellitus on wound healing, increased rapidity of wound contraction and reduction in the duration of healing. From the results of this study, the latex of Carica papaya appeared superior to gentamicin, normal saline and propylene glycol as materials for wound management in diabetic wistar rats. Latex is naturally occurring and its source (Carica papaya) is easily cultivated, readily available, affordable and cannot be adulterated. It may thus be considered as an alternative to the synthetic materials in the current management of wounds in patients with diabetes mellitus.

Wound management in patients with advanced illness

To emphasize that the management of wounds represents a significant component within the overall supportive and palliative care of patients with advanced illness. It is also intended to clarify the linguistics that are commonly used around patients with wounds. New paradigms for wound management, wound outcomes, and goal setting have been defined and graphically depicted. Recent studies show that wounds may be used as prognostic factors for patients with advanced illness. Data from recent studies also demonstrate that marginal levels of wound healing are possible for all wound classes affecting patients with advanced illness. When indicated, time-limited trials of wound healing strategies should be facilitated by the Wound Bed Preparation Paradigm. Wound palliation may be guided through the use of the Toronto Symptom Assessment System for Wounds (TSAS-W). Wound management must continue to evolve as a tenet within the overall supportive and palliative care of patients with advanced illness.

Guideline for the Management of Wounds in Patients With Lower-Extremity Neuropathic Disease

This article summarizes the WOCN Evidence-Based Clinical Practice Guideline for Management of Wounds in Patients with Lower Extremity Neuropathic Disease. It is intended for use by physicians, nurses, therapists, and other health care professionals who work with adults who have or are at risk for, lower-extremity neuropathic disease (LEND), and includes updated scientific literature available from January 2003 through February 2012. The full guideline contains definitions of lower extremity neuropathic disorders and disease, prevalence of the problem, relevance and significance of the disorders, as well as comprehensive information about etiology, the nervous system, pathogenesis, and the overall management goals for patients at risk for developing neuropathic foot ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. The guideline also provides two approaches to interventions. The first focuses on prevention strategies to reduce the risk of developing LEND wounds or recurrence, including life-long foot offloading, routine dermal temperature surveillance, use of adjunctive therapies, medication management, and implementing lower extremity amputation prevention measures and patient self-care education. The second approach summarized LEND wound management strategies including wound cleansing, debridement, infection management, maintenance of intact peri-wound skin, nutrition considerations, pain and paresthesia management, edema management, offloading and management of gait and foot deformity, medication management, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and several appendices regarding an algorithm to determine wound etiology, pharmacology, Lower Extremity Amputation (LEAP) Program, diabetes foot screening and other information is available at the end of the guideline.

Guideline for the Management of Wounds in Patients With Lower-Extremity Venous Disease

This article provides an executive summary of the lower extremity venous disease (LEVD) evidence-based guideline produced by the WOCN Wound Guidelines Task Force. The target audience for this guideline is health care professionals who specialize in, direct, or provide wound care for patients at risk for or with lower-extremity venous disease. The full guideline opens with an overview of definitions of LEVD, its prevalence, clinical relevance, etiology, related physiology and pathophysiology, and overall management goals for patients at risk for developing venous leg ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. Two approaches to interventions are provided: one addresses prevention strategies to reduce the risk of developing LEVD with ulcers. Methods to prevent ulcer recurrence are summarized including compression therapy, adjunctive therapies, medications, and patient education. A second approach presents treatment interventions including wound cleansing, debridement, infection control, antibiotic use, along with management of the periwound skin, nutrition, pain, and edema. This section also discusses limb elevation, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and appendices on cellulitis and venous eczema, types of edema, and compression therapy are available at the end of the guideline. This article provides an executive summary of the essential features of the guideline.

VAC® therapy for wound management in patients with contraindications to surgical treatment

The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient's general conditions contraindicate surgical procedures, topical negative pressure with vacuum assisted closure (VAC)) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC when surgical procedures are contraindicated.

Period Prevalence and Risk Factors for Postoperative Short-Term Wound Complications in Vulvar Cancer

Although clinicians recognize that postoperative wound management in patients with vulvar cancer (VC) is challenging, the prevalence and risk factors for different types of short-term wound complications (WCs) remain unclear. The aims of this study were: (1) to determine the period prevalence of postoperative short-term WCs and (2) to identify risk factors associated with short-term WCs in patients with VC. In a cross-sectional study in a Swiss University Hospital, a sample of 108 patients with VC treated surgically (and free of WCs at the time of admission) was included. Data were collected retrospectively from 2007 to 1997 from medical records using an investigator-developed data collection instrument to assess risk factors preoperatively and perioperatively and WCs that occurred within the first 30 postoperative hospital days. The period prevalence of WCs was calculated, and logistic regression was used to identify risk factors for WCs. The median age was 69 years (interquartile range [IQR], 21 years). The period prevalence of WCs was 45.4% (49/108), showing at least 1 of 8 assessed WCs per patient within the median hospital duration of 11 days (IQR, 12 days). The period prevalence for each type of WC was 31.5% for dehiscence, 12% for hematoma, 6.5% for necrosis, 5.6% for infections, 4.6% for seroma, 1.9% for lymph cysts, 1.9% for malignant wounds, and 0% for disturbed tissue formation. Two significant predictors of WCs were identified out of 14 risk factors examined (P < 0.05). The odds ratio (OR) for WC increased with the extent of surgical therapy, ie, from excision to hemivulvectomy and to radical vulvectomy, by a factor of 2.6 (OR, 2.6; 95% confidence interval [CI], 1.34-5.14), and, in the case of inguinofemoral lymphadenectomy, by a factor of 3 (OR, 3.0; 95% CI, 1.03-8.76). The high prevalence of short-term WCs (45.4%) indicates a need for systematic wound assessment and early risk management--especially after hemivulvectomy, radical vulvectomy, and inguinal lymphadenectomy.

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.