Family Matters: Trauma and the Legacy of War in James Allen Moad II’s Outside Paducah: The Wars at Home

Outside Paducah: The Wars at Home (2016), a play written and performed solo by James Allen Moad II, a former Air Force pilot, explores the enduring effects of war on American veterans and their families after soldiers return home from the battleground. The play moves beyond the individual representation of a traumatized veteran by addressing two intertwined issues: the collective and transgenerational burden of war, both in the form of physical wounds and/or moral injuries. Outside Paducah contributes to promoting the stage as a dynamic place to think about the war legacy and to question and challenge war itself by stressing the importance of understanding the cost of war on both personal and societal levels. The play shows that the scenes of war fought in foreign lands are brought back to the home territories and families, who become equally demoralised by the perpetuation of war in their homelands. The soldiers return as ghosts of their previous selves and haunt their families and friends from one generation to the next. Therefore, war remains an open wound at the core of the American nation. At the same time, the play sheds some light on the harsh realities of the underprivileged and how joining the military often seems to provide a way out of the world of poverty and lack of resources.

EP.TU.854Happy Patients and Updated Open Wound Management Protocols

Introduction Open injuries have a potential for serious bacterial wound infections and may lead to long term disabilities, chronic wound or bone infection, and even death. This QI study was undertaken to ring in changes to the current management protocol and align them as per WHO guidelines. Method Implementing changes through a Plan-Do-Study-Act (PDSA) cycle post an initial clinical audit among 38 patients of the organization. Re-audits were done to measure the outcome against the standard and establish a new protocol. Results Initial audit showed only a dismal 37% (n = 14) of patients being managed as per WHO protocol. Patient satisfaction percentage (as measured by a questionnaire) was also low with only 54% of patients satisfied with the treatment. Significant variations were noted post implementation of changes after the first PDSA cycle where >90% (n = 35) of patients reported that they noticed better wound healing, transition to optimal performance and were satisfied with treatment outcomes. Conclusions Timely wound dressings, appropriate antibiotic prophylaxis and increased patient’s awareness on wound hygiene through means of regular educational sessions and updated management protocols have led to healthier patients, lesser long term disabilities and happy patients.

Human Infections by Wohlfahrtiimonas chitiniclastica: A Mini-Review and the First Report of a Burn Wound Infection after Accidental Myiasis in Central Europe

Wohlfahrtiimonas chitiniclastica are bacteria that cause rare infections, typically associated with the infestation of an open wound with fly larvae. Here, we present a unique case report of the first W. chitiniclastica isolation from a burn wound with accidental myiasis in a 63-year-old homeless man and a literature review focused on human infections caused by these bacteria. So far, 23 cases of infection with W. chitiniclastica have been reported; in 52% of these, larvae were found in the wound area. Most of these cases suffered from chronic non-healing wound infections but none of these were burn injuries. The overall fatality rate associated directly with W. chitiniclastica in these cases was 17%. Infections with parasitic larvae occur in moderate climates (especially in people living in poor conditions); therefore, an infection with rare bacteria associated with accidental myiasis, such as W. chitiniclastica, can be expected to become more common there. Thus, in view of the absence of recommendations regarding the treatment of patients with accidental myiasis and, therefore, the risk of infection with W. chitiniclastica or other rare pathogens, we provide a list of recommendations for the treatment of such patients. The importance of meticulous microbial surveillance using molecular biological methods to facilitate the detection of rare pathogens is emphasized.

Filling the vacuum: Role of negative pressure wound therapy in open wound management in cats

Practical relevance: Open wounds and their treatment present a common challenge in veterinary practice. Approaching 15 years ago negative pressure wound therapy (NPWT) started to be incorporated into clinical veterinary medicine, and its availability is becoming more widespread in Europe and the USA. Use of this therapy has the potential to significantly increase the healing rate of open wounds as well as free skin grafts in small animals, and it has been occasionally described for the management of feline wounds. Aim: This review describes the mechanisms of action of, and indications for, NPWT, and offers recommendations for NPWT specific to feline patients. Evidence base: The information presented is based on the current evidence and the author’s clinical experience of the technique gained over the past 12 years. Comparative studies of different treatment options are lacking and, since wound healing in cats and dogs differs, cat-specific studies are especially needed. Well-designed wound healing studies comparing different advanced techniques will improve open wound healing in cats in the future, and potentially allow better understanding of the role of NPWT in this setting.

Use of micro-grafts in a chronic infected open wound after limb amputation in a cat

In human medicine, skin grafting is an innovative surgical technique widely used in reconstructive surgery to repair skin loss. This case evaluated the effectiveness of a treatment with dermal micro-grafting obtained through the Rigenera^® technology in a chronic open wound resulting from a suture dehiscence of a limb amputation in a cat. Significant differences were observed between the aesthetic aspects of the injury using traditional treatments (cleaning and curettage) and the regenerative technology. The results showed that the healing periods were significantly reduced after the Rigenera^® treatment and that, moreover, a perfect skin status and a complete reduction in the wound area (100%) were achieved in one month. Given these results, Rigenera^® has proven to be a simple yet highly effective method in the treatment of inactivated chronic wounds.