scholarly journals Wound bed preparation: a case series using polyhexanide and betaine solution and gel—a UK perspective

2020 ◽  
Vol 29 (7) ◽  
pp. 380-386
Author(s):  
Leanne Atkin ◽  
John Stephenson ◽  
Dawn M Cooper
Keyword(s):  
Chronic Wounds ◽  
Wound Care ◽  
Case Series ◽  
Wound Irrigation ◽  
Irrigation Solution ◽  
New Treatment ◽  
The Uk ◽  
Wound Bed Preparation ◽  
Dressing Change ◽  
Observation Period

Objective: The burden of wound care within the NHS is estimated at a cost of £5.3 billion per year and is set to rise annually by 30%. This case series describes the results of using polyhexanide (PHMB) and betaine wound irrigation solution and gels (Prontosan, B.Braun Medical Ltd., UK) across the UK in hard-to-heal (also described as chronic) wounds up to 20 years' duration, with an observation period of greater than one month. Over half of the hard-to-heal wounds were healed and vast improvements to all other wounds were observed. Improvements to wound bed condition were reported as early as two days after commencing initial treatment, with decreases in malodour, exudate, slough and pain reported across the case series. In addition to wound bed improvements, a reduction in dressing change frequency of 55% was observed in hard-to-heal wounds under the new treatment regime.

scholarly journals Prontosan® soluzione e Prontosan® Debridement Pad nel trattamento di diversi tipi di ferite cutanee: dichiarazioni basate su opinioni di esperti, serie di casi e revisione della letteratura/Prontosan® solution and Prontosan® Debridement Pad in the treatment of different types of cutaneous wounds: expert-based statements, case series and review of the literature

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Angela Peghetti ◽  
Diletta Olivari ◽  
Silvia Tedesco ◽  
Andrea Bellingeri ◽  
Marino Ciliberti ◽  
...  
Keyword(s):  
Literature Review ◽  
Chronic Wounds ◽  
Wound Care ◽  
Evidence Synthesis ◽  
New Technology ◽  
Case Series ◽  
Sono State ◽  
Review Of The Literature ◽  
Combined System ◽  
New Device

Prontosan® Debridement Pad (PDP; B. Braun) è un nuovo presidio disegnato per migliorare il processo di debridement meccanico. In questo lavoro riportiamo i risultati di un complesso progetto condotto al fine di sviluppare consenso tra gli esperti sul migliore modo di impiegare questa nuova tecnologia nella pratica clinica. Il progetto si è articolato in tre fasi. Nella prima è stata condotta una estesa revisione della letteratura che ha condotto ad identificare, analizzare criticamente e a riassumere in formato strutturato 27 studi clinici pertinenti. Nella seconda fase le evidenze disponibili sono state discusse in modo sistematico con un pannello di 10 esperti, i quali hanno formulato 12 raccomandazioni per l'impiego clinico del PDP. Queste raccomandazioni sono state quindi sottoposte a votazione formale attraverso il metodo GRADE. Infine, nei mesi successivi, 13 casi clinici provenienti dalla pratica clinica routinaria e trattati in accordo con le raccomandazioni stabilite sono stati raccolti e vengono qui presentati. Nel complesso, i dati disponibili in letteratura e quelli raccolti dalla pratica clinica confermano l'efficacia del PDP come strumento per il debridement meccanico, offrendo vantaggi significativi per una ottimale Wound Bed Preparation e per il controllo del dolore. Il nostro progetto può inoltre essere utile per ottimizzare l'impiego pratico di questo nuovo promettente dispositivo. Prontosan® Debridement Pad (PDP; B. Braun) is a new device designed for mechanical debridement. This paper summarizes the results of a complex initiative aimed to develop consensus among a panel of wound care experts about the optimal use of this new technology. An extensive review of the literature found 27 pertinent papers, which underwent a formal process of critical appraisal and evidence extraction by two independent methodologists. Results are displayed in an evidence report. 12 practical recommendations, concerning management of acute and chronic wounds, have been developed and approved. Main point of strength of this project is the use of a systematic approach to literature review, evidence synthesis and presentation, development and measurement of expert consensus. Moreover, expert panel provided further clinical data, through the reporting of 13 clinical cases managed according to abovementioned recommendations, with a particular focus on burns and chronic ulcers treatment, both in adult and pediatric patients. Overall, results from literature review and from clinical experience confirm that the combined system Prontosan® Solution and PDP is a promising tool useful in the critical phase of debridement in acute and chronic wounds treatment. Efficacy in debris removal and pain reduction are the main points of strength. Our project may contribute to optimize clinical use of this innovative device.

Outcomes of Conventional Wound Treatment in a Comprehensive Wound Center

2006 ◽  
Vol 72 (4) ◽  
pp. 314-317 ◽  
Author(s):  
Gabriel Akopian ◽  
Susan P. Nunnery ◽  
Jenny Piangenti ◽  
Pam Rankin ◽  
Chugo Rinoie ◽  
...  
Keyword(s):  
Growth Factor ◽  
Chronic Wounds ◽  
Wound Care ◽  
Case Series ◽  
Wound Treatment ◽  
Care Clinic ◽  
Treatment Type ◽  
Diabetic Wounds ◽  
Human Skin Equivalent ◽  
Growth Factor Treatment

Conventional wound care is the elementary treatment modality for treating chronic wounds. However, early treatment with topical growth factors may be needed for a subset of chronic wounds that fail to heal with good wound care alone. A prospective nonrandomized case series from a single-community outpatient wound care clinic is presented here in an effort to identify the subset of chronic wounds that may require early adjuvant intervention. There were 378 consecutive patients with 774 chronic wounds of varying etiology. All patients received 4 weeks of conventional wound care, including weekly debridement and twice-daily dressing changes. Wounds not reduced by 50 per cent volume at 4 weeks were nonrandomly treated with human skin equivalent (Apligraf®), platelet-derived wound healing factor, or platelet-derived growth factor isoform BB (becaplermin gel, Regranex®). A total of 601 of 774 (78%) wounds healed regardless of treatment type. The median time to heal for all wounds was 49 days (interquartile range = 26–93). More women than men healed (85% vs 71%, respectively, P < 0.0001). Diabetic wounds were as likely to heal as nondiabetic wounds (78% vs 80%, P = 0.5675). Wounds that did not heal had larger volumes and higher grade compared with wounds that healed (P < 0.0001 for both variables). The data presented here show that the majority of chronic wounds will heal with conventional wound care, regardless of etiology. Large wounds with higher grades are less responsive to conventional wound care and will benefit from topical growth factor treatment early in the treatment course.

Effect on healing rates of wounds treated with direct cold atmospheric plasma: a case series

2021 ◽  
Vol 30 (11) ◽  
pp. 904-914
Author(s):  
Jennifer Ernst ◽  
Murat Tanyeli ◽  
Thomas Borchardt ◽  
Moses Ojugo ◽  
Andreas Helmke ◽  
...  
Keyword(s):  
Wound Care ◽  
Trauma Surgery ◽  
Case Series ◽  
Observation Time ◽  
Atmospheric Plasma ◽  
Wound Age ◽  
Ministry Of Education ◽  
Cold Atmospheric Plasma ◽  
Consulting Services ◽  
Observation Period

Objective: The response of different critical acute and hard-to-heal wounds to an innovative wound care modality—direct application of cold atmospheric plasma (CAP)—was investigated in this clinical case series. Method: Over an observation period of two years, acute wounds with at least one risk factor for chronification, as well as hard-to-heal wounds were treated for 180 seconds three times per week with CAP. CAP treatment was additional to standard wound care. Photographs were taken for wound documentation. The wound sizes before the first CAP treatment, after four weeks, after 12 weeks and at wound closure/end of observation time were determined using image processing software, and analysed longitudinally for the development of wound size. Results: A total of 27 wounds (19 hard-to-heal and eight acute wounds) with a mean wound area of 15cm2 and a mean wound age of 49 months were treated with CAP and analysed. All (100%) of the acute wounds and 68% of the hard-to-heal wounds healed after an average treatment duration of 14.2 weeks. At the end of the observation period, 21% of hard-to-heal wounds were not yet closed but were reduced in size by >80%. In 11% of the hard-to-heal wounds (n=2) therapy failed. Conclusion: The results suggested a beneficial effect of additional CAP therapy on wound healing. Declaration of interest: This work was carried out within the research projects ‘Plasma for Life’ (funding reference no. 13FH6I04IA) with financial support from the German Federal Ministry of Education and Research (BMBF). In the past seven years AFS has provided consulting services to Evonik and has received institutional support by Heraeus, Johnson & Johnson and Evonik. There are no royalties to disclose. The Department for Trauma Surgery, Orthopaedics and Plastic Surgery received charitable donations by CINOGY GmbH. CINOGY GmbH released the di_CAP devices and electrodes for the study. WV and AH were involved in the development of the used di_CAP device (Plasmaderm, CINOGY GmbH). WV is shareholder of the outsourced start-up company CINOGY GmbH.

The Evidence for Antimicrobial and Hard to Infect Regenerative Matrices

2021 ◽  
Author(s):  
Keval Ray ◽  
◽  
Nazanin Khajoueinejad ◽  
So Park ◽  
Mabel Chan ◽  
...  
Keyword(s):  
Fatty Acids ◽  
Basic Science ◽  
Antimicrobial Agents ◽  
Chronic Wounds ◽  
Wound Care ◽  
Antimicrobial Properties ◽  
Omega 3 Fatty Acids ◽  
Omega 3 ◽  
Full Understanding ◽  
Wound Bed Preparation

Preparation of the wound bed is a key step in the use of cell- and tissue-based therapy (CTP). In particular, good pre-application debridement is an essential component of CTP. However, there are many situations in which the wound bed is not adequately debrided, including trauma, burn, and in cases of chronic wounds with significant biofilm. In the setting of inadequate wound bed preparation, the use of a CTP that has either added or intrinsic antimicrobial properties is attractive. Some CTPs include added antimicrobial agents such as PHMB or silver, while others have intrinsic antimicrobial components, such as Omega 3 fatty acids. In addition, some wound-covering dressings are completely synthetic, and therefore simply do not become infected. A full understanding of the basic science and clinical data supporting the use of these therapies is important for the advanced wound care practitioner.

Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study

2020 ◽  
Vol 29 (Sup7) ◽  
pp. S44-S52 ◽  
Author(s):  
Windy Cole ◽  
Stacey Coe
Keyword(s):  
Wound Healing ◽  
Fluorescence Imaging ◽  
Imaging System ◽  
Wound Care ◽  
Point Of Care ◽  
Bacterial Load ◽  
Case Series ◽  
Wound Area ◽  
Wound Debridement ◽  
Wound Bed Preparation

Objective: Optimal wound-bed preparation consists of regular debridement to remove devitalised tissues, reduce bacterial load, and to establish an environment that promotes healing. However, lack of diagnostic information at point-of-care limits effectiveness of debridement. Method: This observational case series investigated use of point-of-care fluorescence imaging to detect bacteria (loads >104CFU/g) and guide wound bed preparation. Lower extremity hard-to-heal wounds were imaged over a 12-week period for bacterial fluorescence and wound area. Results: A total of 11 wounds were included in the study. Bacterial fluorescence was present in 10 wounds and persisted, on average, for 3.7 weeks over the course of the study. The presence of red or cyan fluorescent signatures from bacteria correlated with an average increase in wound area of 6.5% per week, indicating stalled or delayed wound healing. Fluorescence imaging information assisted in determining the location and extent of wound debridement, and the selection of dressings and/or antimicrobials. Elimination of bacterial fluorescence signature with targeted debridement and other treatments correlated with an average reduction in wound area of 27.7% per week (p<0.05), indicative of a healing trajectory. Conclusion: These results demonstrate that use of fluorescence imaging as part of routine wound care enhances assessment and treatment selection, thus facilitating improved wound healing.

Rinsing Chronic Wounds with a Nitric Oxide Containing Solution – A Safe Treatment Approach to Support Wound Healing

2020 ◽  
Vol 16 (4) ◽  
pp. 394-406
Author(s):  
Thorsten U. Meyer
Keyword(s):  
Nitric Oxide ◽  
Wound Healing ◽  
Chronic Wounds ◽  
Safety Data ◽  
Wound Irrigation ◽  
Beneficial Effects ◽  
Physiological Processes ◽  
Therapeutic Benefits ◽  
Irrigation Solution ◽  
Mediator Agent

Background: Nitric oxide (NO) is known for decades to play a crucial role in many physiological processes: this includes acting as an anti-microbial mediator/agent, vasodilator, inhibitor of platelet aggregation, immune modulator, and tissue regeneration via regulation of epidermal cell migration, collagen deposition and cytokine/chemokine microenvironment, making it a key player in wound healing. Methods: In order to demonstrate the therapeutic benefits as well as the safety of a NO wound irrigation solution, a broad literature review summarizing efficacy and safety data was conducted. Results: Beneficial effects on wound healing have been demonstrated in several non-clinical and clinical studies. The combination of NO and wound rinsing seems to be a promising approach in terms of improved wound healing of chronic wounds. Conclusion: Based on the results, no safety concerns are expected for a daily 15 minutes use of a NOgenerating rinsing solution system for wound irrigation of diabetic foot ulcers in adults.

Wound Bed Preparation 2012

2013 ◽  
Vol 17 (4_suppl) ◽  
pp. S12-S22 ◽  
Author(s):  
R. Gary Sibbald ◽  
Laurie Goodman ◽  
Persaud Reneeka
Keyword(s):  
Chronic Wounds ◽  
Wound Care ◽  
Scientific Evidence ◽  
Holistic Approach ◽  
Evidence Base ◽  
Opinion Leaders ◽  
Patient Centered ◽  
Clinical Criteria ◽  
Moisture Balance ◽  
Wound Bed Preparation

Background: The concept of wound bed preparation is a holistic approach to wound diagnosis and treatment of the cause, patient-centered concerns and optimizing the components of local wound care (débridement, infection and persistent infection, moisture balance) before edge effect for healable but stalled chronic wounds. This article has introduced the concepts of healable, nonhealable and maintenance wounds. Additionally, clinical criteria (mnemonic NERDS and STONEES) are provided on the use of topical agents for critical colonization or systemic antimicrobials for deep and surrounding infection. Objective: To present a holistic, evidence-informed approach to chronic wound care management. Methods: This article reviews the scientific evidence base, and forms an expert consensus of key opinion leaders to the Wound Bed Preparation model. Results and Conclusion: This article provides clinicians with evidence-informed wound caring approaches translating the evidence base into practice.

scholarly journals Wound bed preparation from a clinical perspective

2012 ◽  
Vol 45 (02) ◽  
pp. 193-202 ◽  
Author(s):  
A. S. Halim ◽  
T. L. Khoo ◽  
A. Z. Mat Saad
Keyword(s):  
Time Management ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wounds ◽  
Wound Care ◽  
Scientific Basis ◽  
Tissue Necrosis ◽  
Wound Assessment ◽  
Moisture Balance ◽  
Wound Bed Preparation ◽  
Dressing Materials

ABSTRACTWound bed preparation has been performed for over two decades, and the concept is well accepted. The ′TIME′ acronym, consisting of tissue debridement, i nfection or inflammation, moisture balance and edge effect, has assisted clinicians systematically in wound assessment and management. While the focus has usually been concentrated around the wound, the evolving concept of wound bed preparation promotes the treatment of the patient as a whole. This article discusses wound bed preparation and its clinical management components along with the principles of advanced wound care management at the present time. Management of tissue necrosis can be tailored according to the wound and local expertise. It ranges from simple to modern techniques like wet to dry dressing, enzymatic, biological and surgical debridement. Restoration of the bacterial balance is also an important element in managing chronic wounds that are critically colonized. Achieving a balance moist wound will hasten healing and correct biochemical imbalance by removing the excessive enzymes and growth factors. This can be achieved will multitude of dressing materials. The negative pressure wound therapy being one of the great breakthroughs. The progress and understanding on scientific basis of the wound bed preparation over the last two decades are discussed further in this article in the clinical perspectives.

Embedding National Institute for Health and Care Excellence guidance into a leg ulcer pathway

2019 ◽  
Vol 24 (Sup9) ◽  
pp. S6-S11
Author(s):  
Julie Mullings
Keyword(s):  
Chronic Wounds ◽  
Wound Care ◽  
Compression Therapy ◽  
Leg Ulcer ◽  
Evidence Based ◽  
Leg Ulcers ◽  
Correct Treatment ◽  
Treatment Choices ◽  
Venous Leg Ulcers ◽  
The Uk

Research has shown that leg ulcers represent the largest category of wound type treated within the UK. Venous leg ulcers are often classified as chronic wounds with increased protease levels causing the wound to become suspended in the inflammatory stage, which leads to delayed healing. If treatment choices are not evidence-based and appropriate regimens are not instigated early on in the wound care journey, the cost to both the patient and the healthcare service is substantial. Recent guidance from the National Institute of Health and Care Excellence (NICE) recommends UrgoStart (Urgo Medical) for treating venous leg ulcers as an adjunct therapy to the gold standard of compression therapy. Correct treatment choices must be made by clinicians using up-to-date relevant wound care knowledge. Evidence-based treatment algorithms and pathways can assist with correct product and therapy placement, assisting decision-making to improve patient outcomes. The present article describes a patient-centred leg ulcer pathway that embeds NICE guidance.

Efficacy of Hydromechanical Therapy in Nonhealing, Chronic Wounds as a Cost- and Clinically Effective Wound Care Modality

2021 ◽  
Vol 33 (11) ◽  
pp. 296-303
Author(s):  
Haley DesJardins ◽  
Sydney Char ◽  
Patrick Marasco ◽  
Yung-Chang Hsu ◽  
Lifei Guo
Keyword(s):  
Chronic Wounds ◽  
Chronic Wound ◽  
Wound Care ◽  
Tap Water ◽  
Case Series ◽  
Cost Savings ◽  
Clinical Results ◽  
Potential Cost ◽  
Term Care ◽  
Pressurized Irrigation

Introduction. Chronic wounds pose a widespread challenge to health care, with many new, costly wound care modalities introduced in recent years with varying degrees of success. Bacterial biofilms have been postulated as one of the main culprits of the stagnation of chronic wound healing. For years, surgical fields have used pressurized irrigation for cleansing surgical wounds, but its utility in managing nonhealing chronic wounds has often been overlooked. Objective. In this case series, the authors aimed to demonstrate that hydromechanical therapy with pressurized irrigation can be a cost-effective and clinically effective wound care modality. Materials and Methods. The authors present 6 clinical cases of difficult nonhealing wounds managed with hydromechanical therapy with pressurized irrigation, a follow-up from the initial case report. Other, often more expensive modalities, had previously failed. In all 6 cases, irrigation was performed using tap water or saline either at home or long-term care facilities. Literature that focused on the mechanism of healing from hydromechanical therapy was reviewed. Results. All chronic wounds in the series reached stable healing. The authors speculate that such healing was achieved through biofilm disruption and tissue stimulation with a mechanical impact. Literature supporting this hypothesis is presented. Conclusions. The current clinical results offer a new perspective on the role of a traditional surgical modality of hydromechanical therapy in chronic wound care and on the associated opportunity of potential cost savings.

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