|
 |
 |
 |
| |
Cellulitis
Cellulitis is inflammation of subcutaneous, loose connective tissue (formerly called cellular tissue).
An Overview of Dermatological Conditions Commonly Associated with the Obese Patient
Obesity is a chronic disease that may lead to skin problems, including acanthosis nigricans, skin tags, hyperandrogenism, striae distensae, plantar hyperkeratosis, and candidal intertrigo. Although some conditions (eg, skin tags and striae distensae) may simply be annoying or present cosmetic issues, conditions such as acanthosis nigricans and hyperandrogenism may be indicative of systemic diseases. Obesity also may contribute to poor healing of acute and chronic wounds that develop in this population. Some of the most common obesity-related skin disorders and factors affecting wound healing are described with suggestions on how to address these issues. With the continuing increase in the incidence of obesity, investigation into the specific care needs of this population is needed. In clinical practice, measures to reduce friction and shear and improve devices to move the obese patient would enhance care provision. Studies of the incidence of dermatological problems and the best treatments for these conditions are warranted.
|
Bacterial Swabs and the Chronic Wound: When, How, and What Do They Mean
Determining when is far more important than determining how to culture a wound. A wound should be cultured after wound infection has been clinically diagnosed. Wound infection by definition implies that replicating micro-organisms within a wound are having a detrimental effect on the host.
|
Topical Antimicrobials in the Control of Wound Bioburden?Part 2
Part 2 - Commonly Used Antiseptics Iodine. Silver. A topical antiseptic sustained-delivery system (dressing, cream, or ointment) may be indicated if: • one or more overt signs of infection or any less obvious signs such as increased exudate levels are present • local pain is increased &...
|
The Wound Infection Continuum and its Application to Clinical Practice
Four basic conditions exist in open wounds resulting from the level of bioburden present (bacterial contamination - normal but short-lived state, colonization - normal state, critical colonization - abnormal state, and infection - abnormal state). The two abnormal states have the potential to disrupt the orderly healing sequence, which results in the development of a chronic wound. In addition, the impact of the wound's anatomical position, duration, shape, or presentation; the patient's level of health and control of underlying pathologies; the presence of infection-potentiating factors such as foreign bodies, hematoma, and necrotic tissue; the sources and frequency of exogenous contamination; the considered virulence of the individual micro-flora species; and the potential synergism between different species all require consideration. This article discusses the states of bioburden and other aspects of microbiology relating to wound infection and their application to clinical practice.
|
Venous Leg Ulcer Pain
Venous disease and venous leg ulcers are frequently painful. The pain experienced may be constant or intermittent. Constant pain can originate from vascular structures (superficial, deep phlebitis), pitting edema, collagen (lipodermatosclerosis), infection, or scarring (atrophie blanche). Ulcer region pain is often episodic and may be due to surgical or other debridement procedures. Intermittent pain is often related to dressing removal or recent applications of new dressings. An approach to pain control will consider the cause of pain and utilize local measures, regional approaches to edema control, and systemic medication aimed at constant, episodic, or intermittent pain triggers.
|
Outcomes of Subatmospheric Pressure Dressing Therapy on Wounds of the Diabetic Foot
The purpose of this retrospective study was to evaluate outcomes of people with large diabetic foot wounds treated with subatmospheric pressure dressing therapy immediately following surgical wound debridement. Data were abstracted from the medical records of 31 consecutive patients with diabetes, 77.4% male (n = 24), aged 56.1 ± 11.7 years, presenting for care at two large multidisciplinary wound care centers. All patients received surgical debridement for indolent diabetic foot wounds and were subsequently started on a regimen of subatmospheric pressure dressing therapy delivered using a vacuum-assisted closure device for a mean of 4.7 ± 4.2 weeks (mode = 2 weeks) using a protocol that called for cessation of therapy when the wound bed approached 100% coverage with granulation tissue with no exposed tendon, joint capsule, or bone. Outcomes evaluated included time to complete wound closure, proportion of patients achieving wound healing at the level of initial debridement, and complications associated with use of the device. The mean duration of wounds before therapy was 25.4 ± 23.8 weeks. In patients treated with subatmospheric pressure dressing therapy, 90.3% (n = 28) of wounds healed at the level of debridement without the need for further bony resection in a mean 8.1 ± 5.5 weeks. The remaining 9.7% (n = 3) went on to higher level amputation (below knee amputation = 3.2%, [n = 1] and transmetatarsal amputation = 6.5% [n =2]). Complications included periwound maceration (19.4% [n = 6]), periwound cellulitis (3.2% [n = 1]), and deep space infection (3.2% [n = 1]). The authors concluded that appropriate use of subatmospheric pressure dressing therapy to achieve a rapid granular bed in diabetic foot wounds may have promise in treatment of this population at high risk for amputation and that a large, randomized trial is now indicated.
|
SAWC 2004 Abstract Preview
Methods: A prospective, comparative study was conducted over a 4-year period at our Wound Treatment Center. Results: In our study, 88 of the 99 patients (89%) had wound healing. Studies that have examined patients?
|
Vacuum-Assisted Closure Used for Healing Chronic Wounds and Skin Grafts in the Lower Extremities
Over the past several years, vacuum-assisted closure has been used as an adjunctive treatment in the management of many chronic and acute wounds. A chart review of chronic wounds in the authors' wound care practice was conducted to ascertain and document the effect of vacuum-assisted closure on the healing of chronic wounds. Over a 30-month period, 70 patients with chronic, nonhealing wounds were treated with vacuum-assisted closure. Of those, 50 had vacuum-assisted closure treatment following skin graft procedures. Using vacuum-assisted closure in addition to a protocol of general supportive and local wound care resulted in a high rate of closure during an average of 48 days. All (100%) of the skin grafts healed. These clinical results suggest that vacuum-assisted closure can be a useful adjunctive treatment in the management of open and grafted wounds and that additional research and documentation are warranted.
|
A Prospective, Randomized, Controlled Double-Blind Study of a Moisturizer for Xerosis of the Feet in Patients with Diabetes
Xerosis is frequently noted in the feet of people with diabetes. The presence of xerosis increases the risk of complications, including infection and ulceration, making it imperative to counteract its effects. A prospective, randomized, controlled double-blind study was conducted to compare the efficacy of a test moisturizer containing 10% urea and 4% lactic acid versus its emulsion base vehicle in the treatment of xerosis of the feet in patients with diabetes. Forty patients (mean age 62 +/- 11 years) with diabetes and moderate-to-severe xerosis of both feet were enrolled. Xerosis severity was assessed using a nine-point Xerosis Assessment Scale. The tested moisturizer was applied to one foot and the vehicle to the other, twice a day, for 4 weeks. The regression of xerosis also was evaluated 2 weeks following discontinuation of the treatments. Progress was noted weekly with photographs and examination. Feet treated with the vehicle cream (control) had an initial mean xerosis grading of 6.17 (+/- 0.79) and a final xerosis grading of 4.38 (+/- 2.20). In the treatment group, mean xerosis grading diminished from 6.13 (+/- 0.73) to 3.19 (+/- 2.23) after 4 weeks (P < 0.01).The difference between control and treatment remained statistically significant following discontinuation of cream application. In this study, regular use of a moisturizer was found to be beneficial in the treatment of moderate-to-severe xerosis of the feet in patients with diabetes. The cream containing 10% urea and 4% lactic acid provided faster and better improvement with significantly less xerosis regression.
|
Recurring and Antimicrobial-Resistant Infections: Considering the Potential Role of Biofilms in Clinical Practice
Micro-organisms commonly produce biofilm, a polymeric matrix that is adherent to inert or living substances and frequently forms on environmental surfaces, medical devices, and traumatized or compromised living and nonviable necrotic tissues such as wounds. The micro-organisms in a biofilm interact with each other and their environment. They are refractory to conventional therapy and resist conventional methods for culturing; their coordinated activities can lessen the effect of antimicrobials and the host?s defenses. The multifactorial mechanism of resistance varies and depends, in part, on the strain of the micro-organism. A biofilm is dynamic and may shed bacteria or bacteria may be released by trauma, resulting in local or systemic infectious disease. Released bacteria lose their protection ? they become responsive to appropriate levels of antimicrobials and may be cultured using conventional culturing methods. Micro-organisms in biofilms may remain dormant for weeks or years before causing local or systemic signs and symptoms of infection and are commonly responsible for recurring infections after repeated trials of antibiotics. Most biofilm infection?related research findings have not reached clinical practice yet. However, clinician knowledge about the development of and difficulties culturing micro-organisms in biofilms and their resistance to antibiotics and biocides may lead to improved clinical outcomes in soft tissue and bone infections and the treatment of wounds. KEYWORDS: infection, biofilms, wounds, micro-organisms
|
|
|
 |
 |
 |
|
|
|
|
|
|
|
