Month: March 2018

Temperature-reading ‘smartmat’ catches diabetic foot ulcers early

Podimetrics, a startup created during an MIT “hackathon” in 2011, focuses on catching foot ulcers—a complication of diabetes that can lead to amputation—early. The company unveiled data showing its remote-monitoring technology caught a majority of foot ulcers well before they appeared.

 

A number of factors contribute to the development of diabetic foot ulcers, including nerve damage, which stops patients from feeling small injuries in their foot. A healthy person might change his or her movement or adjust a shoe, but a person with diabetes-related nerve damage will not notice the pain. Repetitive injury over time can lead to an ulcer, and early detection can help prevent an ulcer from forming or getting worse … read more

 

More:
Feasibility and Efficacy of a Smart Mat Technology to Predict Development of Diabetic Plantar Ulcers

Podimetrics website

 

 

Wound care education in the developing world

The increasing burden of wound care is a major challenge for healthcare systems worldwide (Sen et al, 2009). In developing countries, there is insufficient capacity to meet patient requirements. Inadequate wound care is not, however, without consequences. In many developing countries, treatable injuries and wounds are the leading cause of death and disability in the under 60s.

 

Extent of the wound care burden In 2013, over 10% of the world’s population lived in extreme poverty on less than $1.90 per day (World Bank Group, 2016). A minimum of US$44 per capita is required per year to provide basic life-saving health services, however 26 World Health Organization (WHO) states spend less than this, with Eritrea spending the least at US$12 per person (WHO, 2014). Moreover, it is estimated that up to half the world’s population lacks access to basic wound care (Meara et al, 2015), although there is scant literature concerning its epidemiology and natural history, cost-effectiveness or the delivery of services … read more

Case series: ALLEVYN LIFE Non-Bordered foam dressing for

managing moderate to heavily exuding wounds

 

Exudate is vital for moist wound healing; however, overproduction of exudate is detrimental to the wound healing trajectory. Under compression, the capacity of some dressings to absorb exudate can fall by more than 40% and leaks are common, requiring more frequent dressing changes (Körber et al, 2008). Non-bordered foam dressings present a flexible class of dressings that can be used under compression and for cushioning, can conform to awkward positions on the body and can be cut to shape for unusually shaped wounds. This series of six case studies describes the use of ALLEVYN LIFE Non-Bordered foam dressing (Smith & Nephew) in the management of moderate to heavily exuding diabetic foot, venous and pressure ulcers. ALLEVYN LIFE Non-Bordered foam dressing is designed to lock in exudate and minimise the risk of skin damage … read more

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Prevention of hospital-acquired foot pressure injuries

Assessment and consideration of foot risk factors is essential for proactive prevention of hospital-acquired foot pressure injuries

 

The research outlined in this article aimed to see if high-risk feet were also identified as ‘at risk of ulceration’ by the Braden Score. One-hundred-and-thirty-two patients had foot risk stratified by a podiatrist and their admission Braden pressure injury (PI) risk level was compared. Only 36% were decreed to be at the same level of risk by both methods. The lack of agreement was demonstrated by a very low Kappa score. The Braden score underestimated PI risk to feet for 52% of the study population. Therefore, the authors concluded that less reliance on the Braden score is needed for the implementation of prevention to reduce rates hospital-acquired foot PIs … read more

Multidrug-Resistant Organisms in Wound Management

Among the greatest triumphs of modern medicine were the identification and naming of the Penicillium mold by Alexander Fleming in 1928, and its ability to inhibit bacteria growth on culture medium. Penicillin was then developed by the team of Heatley, Chain, and Florey in England during the Second World War.1 This miracle brought about the ability to cure previously untreatable diseases and devastating infections that had high morbidity and mortality rates. Along with the great efficacy of penicillin was the added benefit of very few side effects. This area of research brought about the era of antibiotic production, which began in the 1950s.

 

Mechanisms of Antibiotic Resistance and Implications for Health Care
Antibiotics target one or multiple modes of cellular communication which allow microorganisms to proliferate. These include cell wall, membrane transport, RNA function, DNA synthesis, protein function, or enzyme activity.2 Interrupting cellular communication and thus proliferation has made antibiotics very effective against a broad range of microoganisms. In looking at the history of multidrug-resistant organisms (MDROs) we must remember that there are two sides to every coin, and with the positive side of clinical efficacy against microoganisms there is also a downside. To ensure their survival, it has become necessary for microorganisms to evolve and genetically mutate. These processes have caused the organisms of today to be much different from the organisms of yesterday, much more virulent, and more multidrug resistant … read more

Wound Care Education Institute Launches Pioneering Nutrition Wound Care Course

BROOKFIELD, Wis., March 20, 2018 /PRNewswire/ — To help Registered Dietitians (RD) and Registered Dietitian Nutritionists (RDN) prepare for board certification in wound care, Wound Care Education Institute (WCEI) has launched a tailored Skin and Wound Management course suited for the RD and RDN. The course reinforces knowledge with real-world, practical skin and wound management training while preparing the RD and RDN for the Nutrition Wound Care Certified (NWCC) certification.

 

“The course addresses the need for nutritionists on the wound care team and can help an RD or RDN become a nutrition wound care expert,” said WCEI Co-Founder/Clinical Instructor Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS.

 

Poor nutrition can have a substantial negative effect on the ability to build new tissue and defend against infection. A patient’s nutritional needs can change in the presence of wounds reinforcing the body’s requirement for a proper mix of both macro and micronutrients during wound healing. Patients with chronic and non-healing wounds often have special nutrient needs as well as other healing obstacles at play … read more

NPUAP Pressure Injury Stages

The National Pressure Ulcer Advisory Panel redefined the definition of a pressure injuries during the NPUAP 2016 Staging Consensus Conference that was held April 8-9, 2016 in Rosemont (Chicago), IL.

 

The updated staging definitions were presented at a meeting of over 400 professionals. Using a consensus format, Dr. Mikel Gray from the University of Virginia adeptly guided the Staging Task Force and meeting participants to consensus on the updated definitions through an interactive discussion and voting process. During the meeting, the participants also validated the new terminology using photographs.

 

The updated staging system includes the following definitions:

Pressure Injury:
A pressure injury is localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device. The injury can present as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities and condition of the soft tissue … read more

Diagnosing & Treating Bacterial Biofilm Infections

Dr. Randy Wolcott has been practicing medicine for almost thirty years and focusing on treating “unhealable” wounds the last twelve. His personal research at the Wound Care Center’s Research and Testing Laboratories and his collaboration with biofilm experts in the wound care field have earned him international recognition. I met “Randy” in October of 2010 and interviewed him, staff members and his patients to get a sense of how advanced their diagnostic & treatment methods really were. Their treatment approach has set a new (and badly needed) standard of care for treating chronic bacterial biofilm infections.


Behold The Future…The MolecuLight i:X Imaging Device allows clinicians to quickly, safely, and easily visualize bacteria and measure wounds at the point of care, so they have maximum insights for accurate treatment selection and accelerated healing. Visualize Bacteria MolecuLight i:X allows clinicians to focus on potentially harmful levels of bacteria with the guidance of fluorescence imaging. Measure Wound Size MolecuLight i:X provides clinicians with automatic wound border detection and instant wound area measurements. See Results Study shows an 89% cost reduction and 9X faster wound healing with the use of the MolecuLight i:X Wound Intelligence Device. Leveraging the principle of fluorescence, the MolecuLight i:X Wound Intelligence Device emits safe violet light which causes bacteria ≥ 104 CFU/g to fluoresce.4 The bacterial fluorescence signals detected by the device provide healthcare professionals with a visual indication of bacterial presence, load, and location within and around wounds in real-time to guide clinicians in their selection, application, and response monitoring of wound therapies. http://eu.moleculight.com/

How Activity Benefits the Healing Patient

Maintaining an active lifestyle is critical to good health; this is especially true for patients recovering from wounds or extended hospital stays. Robust activity can improve mental health, reduce the risk of infection, and accelerate wound healing.1 Staying active can be challenging for patients with wounds, however, and it is critical that health care professionals take steps to enable their patients to stay as active as possible.

 

The Healing Benefits of Activity

Aside from the long-term benefits to heart health, mental health, and longevity, exercise provides many direct and indirect benefits to patients healing from wounds. Physical activity can promote rapid wound healing, reduce oxidative damage, and promote a healthy lifestyle. This can improve patient outcomes and reduce the costs of treatment.


Exercise Benefits Mental Health – There is ample evidence that exercise promotes good mental health, reduces the effects of depression, and causes people to report a greater level of happiness. These effects are especially important for those who have had an extended stay in a hospital or who are in a long-term care facility because these populations may be at greater risk of developing mental health problems.


Exercise Reduces Inflammation – Inflammation is one of the major causes of delayed healing. Research shows that wounds with low levels of inflammation heal much more quickly and completely. Exercise and other physical activity have been shown to reduce the level of inflammatory markers in the blood, thus helping to reduce the level of inflammation and promote rapid healing. Reduced inflammation may also provide palliative benefits by decreasing pain and discomfort in wounds … read more

Prevent and manage wounds with this expert, all-inclusive resource! Acute & Chronic Wounds: Current Management Concepts, 5th Edition provides the latest diagnostic and treatment guidelines to help you provide quality care for patients with wounds. This textbook presents an interprofessional approach to maintaining skin integrity and managing the numerous types of skin damage including topics that range from the physiology of wound healing, general principles of wound management, vulnerable patient populations, management of percutaneous tubes, and specific care instructions to program development. Written by respected nursing educators Ruth Bryant and Denise Nix, this bestselling reference also provides excellent preparation for all wound certification exams.

 

  • A comprehensive approach to the care of patients with acute and chronic wounds guides students and health care providers to design, deliver and evaluate quality skin and wound care in a systematic fashion; the comprehensive approach includes the latest advances in diagnosis, differentiation of wound types, nutrition, prevention, treatment, and pharmacology.
  • Self-assessment questions and answers in each chapter help you assess your knowledge and prepare for all wound certification exams.
  • Checklists offer a concise, easy-to-read summary of the steps needed to achieve the best patient care outcomes.
  • Risk assessment scales help in determining a patient’s risk for developing a wound, and wound classification tools identify the proper terminology to be used in documentation.
  • Learning objectives at the beginning of each chapter focus your study on the most important content.
  • Principles for practice development boost outcomes and productivity in agencies and institutions, home care, acute care, long-term care, and long-term acute care settings.
  • NEW coverage includes the latest guidelines from WOCN, AAWC, NPUAP, EPUAP, and PPPIA, and the American College of Physicians.
  • New sections cover the prevention and management of biofilm, the new skin tear classification system, MASD and MARCI, CTP terminology and classification scheme, and integration of the Health Belief Model.
  • NEW! Additional full-color photographs show the differential diagnosis of types of skin damage, management of fistulas, and NPWT procedures.
  • NEW! Clinical Consult features help in applying concepts to clinical practice, showing students and health care professionals how to assess, manage, and document real-life patient and staff encounters using the ADPIE framework.
  • NEW two-color illustrations and design make the book more visually appealing.

Multi-resistant Infections: A Global Concern

A presentation by Associate Professor Geoff Sussman on antimicrobial resistence.

 

Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others … read more (pdf)

Efficacy of an imaging device at identifying the presence of bacteria in …

… wounds at a plastic surgery outpatients clinic

 

Current standard diagnostic practice of bacterial infections by visual inspection under white light is subjective, and microbiological sampling is suboptimal due to high false negative rates and the lengthy time needed for culture results to arrive. The MolecuLight i:X Imaging Device attempts to combat the issues faced in standard practice by providing a non-contact, real-time method of visualising bacteria within wounds. Our aim was to test this imaging device in a series of patients … read more

Risks and Diagnosis of Diabetic Foot Infections

Wound care clinicians deal with foot infections all the time, but when the patient is also diabetic, an infection can progress rapidly to a critical state. In fact, it is estimated that around 56% of diabetic foot ulcers become infected, and an infected foot wound precedes about two-thirds of amputations.  Being able to treat diabetic foot infections promptly – before they progress too far – helps prevent amputations, which is why your role is so crucial to a patient’s well-being.

What are the risk factors?

If you are treating a diabetic patient with a foot infection, there are a number of risk factors to consider. These include:

  • 30-day-old wounds
  • Wounds that go down to the bone
  • Recurrent foot infections
  • Peripheral vascular disease
  • An etiology from trauma

In particular, be on high alert with your diabetic patients for what they call an occult (hidden) infection … read more

Wound Care Education Institute and Vizient Work Together …

BROOKFIELD, Wis., March 21, 2018 /PRNewswire/ — Wound Care Education Institute (WCEI) and Vizient , the largest member-driven healthcare performance company in the United States, have partnered to reduce preventable hospital-acquired conditions and readmissions within the Vizient Hospital Improvement Innovation Network (HIIN) membership. As part of this campaign, Vizient is determined to achieve a 20-percent decrease in overall patient harm and a 12-percent reduction in 30-day hospital readmissions by 2019.

 

To support these goals, 50 clinicians from Vizient’s HIIN membership will attend WCEI’s Skin and Wound Management course during the week of April 23. The HIIN clinicians will be chosen from around the United States and meet in Irving, Texas, to complete the training.

 

“The Skin and Wound Management course is designed with patient-centered quality healthcare in mind,”

read more

 

Physical Training and Activity in People With Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (ie, walking and stair climbing). Although many beneficial effects of exercise for people with diabetes have been well established, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered to be a contraindication for walking or any weight-bearing exercise because of concerns about injuring a person’s insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people who have DPN but do not have severe foot deformity. Emerging research has revealed positive adaptations in response to overload stress in these people, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This perspective article reviews the evidence for peripheral neuroplasticity in animal models and early clinical trials, as well as adaptations of the integumentary system and the musculoskeletal system in response to overload stress. These positive adaptations are proposed to promote improved function in people with DPN and to foster the paradigm shift to including weight-bearing exercise for people with DPN. This perspective article also provides specific assessment and treatment recommendations for this important, high-risk group … read more

Amit Jain’s Triple Assessment of Foot in Diabetes

A rapid screening tool

Diabetic foot is on the increase with prevalence rates of diabetes growing around the world. In spite of this, it is frequently a neglected entity in many countries. Screening of the diabetic foot serves to identify any underlying problem and helps one to immediately institute preventive and therapeutic measures. There are few screening tools currently used for diabetic foot. Amit Jain’s Triple Assessment of Diabetic Foot is a new, fast and easy screening tool from the Indian subcontinent that addresses the classic triad of the diabetic foot (neuropathy, ischemia, and infection) both specifically and effectively … read more

The management of diabetic foot

A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine.

 

Major Recommendations
Definitions of the strength of the recommendations (Grade 1 or 2) and quality of the evidence (Level A–C) are provided at the end of the “Major Recommendations” field.

 

Prevention of Diabetic Foot Ulcers (DFUs)

1. The committee recommends that patients with diabetes undergo annual interval foot inspections by physicians (MD, DO, DPM) or advanced practice providers with training in foot care (Grade 1C).

2. The committee recommends that foot examination include testing for peripheral neuropathy using the Semmes-Weinstein test (Grade 1B).

3. The committee recommends education of the patients and their families about preventive foot care (Grade 1C).

4a. The committee suggests against the routine use of specialized therapeutic footwear in average-risk diabetic patients (Grade 2C).

4b. The committee recommends using custom therapeutic footwear in high-risk diabetic patients, including those with significant neuropathy, foot deformities, or previous amputation (Grade 1B).

5. The committee suggests adequate glycemic control (hemoglobin A1c <7% with strategies to minimize hypoglycemia) to reduce the incidence of DFUs and infections, with subsequent risk of amputation (Grade 2B).

6. The committee recommends against prophylactic arterial revascularization to prevent DFU (Grade 1C).

Off-Loading DFUs

1. In patients with plantar DFU, the committee recommends offloading with a total contact cast (TCC) or irremovable fixed ankle walking boot (Grade 1B).

2. In patients with DFU requiring frequent dressing changes, the committee suggests off-loading using a removable cast walker as an alternative to TCC and irremovable fixed ankle walking boot (Grade 2C). The committee suggests against using postoperative shoes or standard or customary footwear for off-loading plantar DFUs (Grade 2C).

3. In patients with nonplantar wounds, the committee recommends using any modality that relieves pressure at the site of the ulcer, such as a surgical sandal or heel relief shoe (Grade 1C).

read more

Researchers Examine Link Between Wound Healing and Time of Day

In addition to where a wound is located and how it developed, researchers now also believe that the time of day you get your wound may have something to do with how it heals and the type of wound care you receive as well.

 

Daytime and nighttime wounds
According to a team of British scientists, wounds (including burn wounds and cuts) healed almost 60 percent sooner if the injury originally occurred during the daytime as opposed to during the night, as reported by CNN.

 

The researchers from the Medical Research Council Laboratory of Molecular Biology in Cambridge, England, looked at the treatment records of more than 110 burn patients from facilities in Wales and England. The findings were published in Science Translational Magazine.

 

The scientists found that patients whose burn wounds occurred between 8 p.m. and 8 a.m.took more time to heal than those that happened between 8 a.m. and 8 p.m. More specifically, wounds that happened at night healed in approximately 28 days, compared to wounds incurred in the day, which healed in approximately 17 days … read more

Clinical Challenges in Diagnosing Infected Wounds

Given the impact of infection on delayed wound healing, determining the presence of colonization and infection is imperative to achieving healed outcomes. Chronic wounds are always contaminated, and timely implementation of management and treatment interventions is a key component of the plan of care.

 

Diagnosis of infection can be a very challenging task to say the least, and it is further complicated by the presence of biofilms for which no diagnostic tool is currently available. If not addressed in a timely manner, these local infections can become systemic, leading to sepsis, multiple organ failure, and death. The first steps are a complete and thorough history and a physical examination of the whole patient, not just the patient’s wound, while taking into account both primary and secondary findings to understand the host response.

 

Having a thorough understanding of the principles of chronic wound care and … read more

Managing inflammation by means of polymeric membrane dressings …

… in pressure ulcer prevention

 

Inflammation is the immediate normal response of the immune system to localised microscopic cell damage that precedes macroscopic tissue damage. Inflammation is triggered by secretion of chemokines that attract immune system cells to the sites of cell damage and facilitate their extravasation through increase in capillary permeability. The increased permeability of capillary walls in the inflammatory state consequently causes fluid leakage from the vasculature and, hence, oedema and associated pain. Polymeric membrane dressings (PolyMem®, Ferris Mfg. Corp.) are multifunctional dressings that focus and control the inflammation and oedema, and reduce pain. The literature reviewed in this article suggests that by having these effects on the inflammatory response, especially in fragile patients, the PolyMem dressing technology may facilitate repair of micro-damage in cell groups, which counteracts the evolution of damage to a macroscopic (tissue) level. Reducing the spread of inflammation and oedema in tissues appears to be a unique feature of PolyMem dressings, which supports repair of cell-scale damage under intact skin and tilts the delicate balance between the counteracting damage build-up and tissue repair mechanisms, thus promoting reversibility and self-healing … read more

Development of a generic wound care assessment minimum data set

At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment.

 

The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS … read more

Evaluation of the WIfI classification system in older patients with diabetes

There are numerous factors that have an impact on diabetic foot ulcer (DFU) healing, among them critical limb ischaemia (CLI) — a term that was not intended to include patients with diabetic foot wounds and neuropathy. The Society for Vascular Surgery, therefore, created a new classification system for threatened lower extremities in which the severity of ulceration and severity of limb ischaemia are both graded. They also added a grade or classification scheme for infection.

 

The need to reconsider how the threatened limb is classified is clear. Ischaemia, while of fundamental importance, is but one component among a triad of major factors that place a limb at risk for amputation. The proposed Society for Vascular Surgery Lower Extremity Threatened Limb Classification System is based on grading each of the three major factors: Wound extent, degree of Ischaemia, and foot Infection, or WIfI (Mills et al, 2014). The implementation of this classification system is intended to permit more meaningful analysis of outcomes for various forms of therapy in this challenging and complex heterogeneous population. During the 1990s, most DFUs were considered neuropathic (Armstrong et al, 2011). The Eurodiale Study, which included 1,229 patients presenting with a new DFU between September 2003 and October 2004, found non-plantar ulcers to be most frequent type of ulcers in this group …  read more

Silver-impregnated Dressings for the Treatment of Chronic Wounds

A Scoping Review of the Use of Silver-impregnated Dressings for the Treatment of Chronic Wounds

 

Topical silver agents and dressings are used to control infection and promote healing in chronic wounds, but reviews published from 2006 to 2011 found heterogeneous results regarding their effectiveness. A scoping review was conducted to examine the extent, range, and nature of research activity surrounding chronic wound care that employed silver-impregnated dressings; identify research gaps in the existing literature; and summarize the evidence to provide recommendations for future clinical studies.

 

Ten (10) electronic databases and additional sources were screened from their inception to May 2016; search terms for the different databases included but were not limited to silver, chronic, complications, wound, ulcer, and sore. English-language articles that compared silver dressings with an alternate treatment in adults with chronic wounds and that reported clinical outcome measures were included. Of 222 full-text reviewed studies, 27 were included for qualitative analysis. Qualitative analysis was guided by key findings identified among the included studies that were analyzed in aggregate form where appropriate. In comparative analyses of the 26 studies that investigated wound healing … read more

Diagnosis of diabetic neuropathy using the Neurothesiometer


This educational video shows you how to perform vibration perception threshold, VPT, testing.

 

VPT testing identifies peripheral nerve dysfunction in a quantifiable manner, staging the severity of peripheral neuropathy. The VPT is tested on the pulp of the large toe. The test needs to be repeated three times and the average value is recorded. The VPT score for normal, mild, moderate and severe sensory loss is 0-14 V, 15-24 V, 25-35 V and higher than 35 V, respectively.

 

Special thanks to Prof. Rayaz Malik and Mr. Georgios Ponirakis for presenting this educational video.

 

The video was made by Mr. Oliver Smith, courtesy of Weill Cornell Medicine in Qatar.

The Role of Hypochlorous Acid in Managing Wounds

Reduction in Antibiotic Usage

 

by Martha Kelso, RN, HBOT

Numerous brands of hypochlorous acid have emerged in the last few years and have been marketed as “ideal” products for use in wound cleansing. These statements, of course, should draw speculation because it is rare for a single product to be used on all wounds, all clients, in all care settings, all the time, thus making it “ideal.” Let’s explore the role of hypochlorous acid in wound management and wound healing and see how it assists with reduction in antibiotic usage.

 

In its true native natural state, hypochlorous acid is a biocide produced naturally by the human body through the process of phagocytosis during the oxidative burst pathway. Because hypochlorous acid is an oxidant, it leaves nothing behind for bacteria and viruses to create resistance to and therefore does not contribute to the superbug (multidrug-resistant organisms) dilemma. Manufacturers have found a way to create hypochlorous acid outside the human body and bottle it for commercial use. These products are non-cytotoxic when concentrations (parts per million) and pH levels are acceptable for human use … read more

 

The use of topical analgesics in the management of painful diabetic neuropathy

Miranda Tawfik

 

Painful diabetic neuropathy (PDN) affects up to half of patients with diabetes and is a major cause of functional impairment and increased mortality. Its clinical manifestations include sensations such as burning, stabbing and tingling and/or loss of sensation, and it increases the risk for injuries and foot ulceration. Oral pharmacological therapy is the standard approach to management. It is effective in some patients, but its use is limited due to unfavourable side-effect profiles, limited response rates and drug interactions. Increasing evidence of the localized, non-systemic treatment approach of topical analgesics aims to overcome these obstacles and provide valuable, efficacious and safe management of PDN. This article reviews the rapidly expanding field of topical analgesia in managing PDN … read more

The management of diabetic foot: A clinical practice guideline by the Society ….

A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine

 

Diabetes is one of the leading causes of chronic disease and limb loss worldwide, currently affecting 382 million people. It is predicted that by 2035, the number of reported diabetes cases will soar to 592 million.1 This disease affects the developing countries disproportionately as >80% of diabetes deaths occur in low- and middle-income countries. As the number of people with diabetes is increasing globally, its consequences are worsening. The World Health Organization projects that diabetes will be the seventh leading cause of death in 2030.3 A further effect of the explosive growth in diabetes worldwide is that it has become one of the leading causes of limb loss. Every year, >1 million people with diabetes suffer limb loss as a result of diabetes. This means that every 20 seconds, an amputation occurs in the world as an outcome of this debilitating disease. Diabetic foot disease is common, and its incidence will only increase as the population ages and the obesity epidemic continues … read more

Caring for the Diabetic Foot in Long-Term Care Facilities

by Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

 

As a Director of Nursing (DON) in a long-term care facility, do you know where the awareness level of diabetes and its complications is for your staff? Do they realize diabetes doesn’t stop? It is 24/7, 365 days a year. Knowing this reality of diabetes and understanding the disease process may assist with preventing serious health problems such as heart disease, stroke, blindness, kidney disease, and nerve damage that can lead to amputation.

 

Education is key. We cannot talk about this enough. Assuming someone knows or that common sense will tell people how to take care of these residents is a huge mistake. I don’t believe in common sense; I believe in common knowledge, but it is only common once it is taught. So, teach about diabetes and the care of residents with diabetes often.

 

Knowing the Risk of Diabetic Foot Ulcers and Diabetic Peripheral Neuropathy
In 2015, 30.3 million Americans, or 9.4% of the population, had diabetes. Approximately 1.25 million American children and adults have type 1 diabetes … read more

Yeti 3D Scanner


 

The YETI scanning software rapidly processes raw scan data into an accurate image with comprehensive measurement information. Full 3D shape, as well as a series of foot measurements are recorded.

Wound Debridement Products Market Synopsis 2018

Manufacturers are developing a wide range of products, like scalpels and pads to treat minor wounds. Innovative plans are underway to entice customers into knowing more about these products. The worldwide industry is segmented into products, end-users, and geographies.

 

The recent market developments has necessitated a ‘see through’ approach so as to avoid the slippery slope generated by the changing paradigms resulting from the powerful forces of economy, business models, competition and others. “Market Research future” presents its latest report titled “World Wound Debridement Products Market –forecast till 2023” to help clear the blur resulting from these developments and to give the reader a clear picture of the possibilities and nuisances lying ahead!

 

Industry Analysis:

The worldwide debridement products market is reported to be driven by major traumatic wounds and burgeoning aged population. However, it would experience a sole digit growth rate over the forecast period. Debridement products help clear up germs, microbes, dirt, and infections from human injuries. This helps in the faster treatment of the injuries, rendering patients comfortable.

 

Rising wound patients, chronic diseases, & product-usage are also driving the market. Apart from these, the need for innovative medical technologies and viability of wound care products add market sales … read more

Comparing the performance of mechanical wound debridement products …

Background: Mechanical wound debridement is an essential intervention in the treatment of slough pressure ulcers. Therefore, a lot of products are presented in the current local market as effective tools to perform that procedure. There is a need to revise the clinical performance of the available used products in one of the biggest governmental hospitals in Saudi Arabia to support efficient resource utilisation and suggest clinical practice protocols for pressure ulcer treatment. Objectives: The current retrospective cohort study compares the clinical performance of two products regarding mechanical debridement for sloughy sacral and heel pressure ulcer. Methods: The researchers retrospectively cohort the progress of 32 patients with more than 50% slough pressure ulcer, received mechanical debridement by wound care nurse during hospitalisation in the same setting and using the same pressure ulcer treatment protocols, by using either monofilament debridement pads (Debrisoft®; Lohmann and Rauscher) (16 patients) or mechanical debridement by using impregnated sterile gauze monofilaments (UCS™; WelCare Industries S.p.A) for a period of three continuous weeks. The research used PUSH tools as a data collection tool. The Hospital Institutional ReviewBoard approved the study. Results: Both products show the positive progress of pressure ulcer healing status after 3 weeks of application (P<0.01). Also, the progress mean among the monofilament group was significantly higher than the progress mean among the impregnated sterile gauze (P<0.05). Conclusion: The study recommends monofilament debridement pads for mechanical debridement on sloughy (more than 50% of wound bed) pressure ulcers … read more (log in required)

Understanding Debridement: An Important Part of Wound Healing

During wound healing, the affected area can become overrun with necrotic – or dead – tissue. This can be harmful to the body’s ability to recover and develop new skin, so debridement may be necessary to remove that dead material. In this way, debridement is essential for preparing the wound bed to promote speedy and efficient healing.

 

Why is debridement important?
Debridement promotes the wound healing process in a variety of ways. Not only does dead skin inhibit the development of healthy new tissue, but it makes the affected area more susceptible to infection. It can also hide the signs of infection, as dead tissue can increase odor and exudate, making it easier for bacteria and other harmful foreign invaders to spread.

 

How does debridement work?
Sometimes, debridement occurs naturally on its own thanks to the body’s own ability to shed off dead tissue. However, more often, it requires a medical procedure. There are two different categories of debridement: active and autolytic. Autolytic debridement involves application of hydrocolloids and hydrogels to enhance moisture in the affected area in order to degrade it so the body will naturally deslough the dead tissue. Active debridement involves the manual removal of necrotic material, and it comes in several types of procedures, such as … read more

Diabetic Wound Healing and LED Irradiation

Introduction: Light-Emitting Diode Therapy for Chronic Non-Healing Diabetic Wounds

 

Diabetes mellitus is frequently associated with chronic non-healing wounds, many of which result in amputation. The combination of peripheral vascular disease, neuropathy, and impaired immune function contributes to a higher risk of injury and deficiency in healing. Wound healing is a complex process comprising eight important factors: (1) collagen synthesis, (2) cell migration, (3) cell cycle and differentiation, (4) angiogenesis and growth hormone, (5) blood clotting, (6) extracellular matrix and focal adhesion, (7) calcium ion signaling, and (8) immune and inflammatory response. In the diabetic cell, all these processes malfunction, with the exception of collagen synthesis, cell migration, and cell cycle or differentiation.

 

Previous studies found an association between diabetes and the precursor protein pro-opiomelanocortin (POMC) gene. POMC is normally expressed in pituitary melanotroph and corticotroph cells and functions to control body weight. Studies have suggested that a mutation in the POMC gene leads to early-onset type 2 diabetes and obesity. This correlation is under investigation for its potential use in diabetic therapy.

 

Light-emitting diode (LED) phototherapy at 660 and 890nm has been shown to significantly accelerate wound healing in normal, healthy patients. This therapy works through molecules with porphyrin structures that are able to trap photon energy and subsequently activate downstream processes. The current study investigated the results of a range of different LED phototherapies on gene expression and cellular function of diabetic cells compared with normal, healthy cells … read more

Wound Care in Crisis

Chris Farley Wound Care, “Stupid, Stupid, Stupid!”

 

by Michael Miller DO, FACOS, FAPWCA, WCC

For those of you who cannot remember the now deceased comedian Chris Farley, did not find his humor funny or simply cannot remember any of his memorable performances; I suggest you move on to another, less controversial, “here’s how to use scissors” type of blog.

 

Michael Miller
Miller Care Group

Chris Farley was a genius. His insights covered many, many topics but their pertinence, I have found, is particularly suited to wound care. Those of you who work in the vicinity of a wound care dabbler, I invite you to cut this blog out and surreptitiously leave it where they cannot miss it or send them the link. I am betting that one or two of the following will strike home but even if not, at least they will get the message that someone (probably many-one) wants them to reconsider their current as-yet-unrecognized (you may substitute the words barbaric, substandard, fraudulent or wasteful) practices. Recently, the shenanigans of several 4-hour-per-week wound management company puppets have led a handful of patients to file complaints with their clinics, hospitals and in two cases, demand that they not be charged (believe it or not, with no coercion, suggestion or turbo charging and actually with a second or two of feigned disbelief on my part).

 

The basics are simple, so let’s get them out on the table. The keys to success are not just avoiding making mistakes but recognizing that one was made and avoiding making it again. While Mr. Farley inadvertently but repeatedly insults Sir Paul McCartney during an adoration-fueled interview, he rewards each faux pas he commits with a smack to his forehead accompanied by his self-acknowledged cry of “Stupid, Stupid, Stupid.” The resultant laughter from the audience and his embarrassment should result in Chris’ reminding himself not to act stupidly again. Of course, the key to the comedic bit is his ability to say the wrong thing again and again and punish himself for the wrong thing again and again. If only Chris had a check list on which to remind himself what things were safe to ask and what questions or actions would take him into treacherous territory. Fortunately for his audience, he just never got it right … read more

Hypochlorous Acid: an ideal wound care agent …

Abstract

INTRODUCTION:

Chronic wounds and the infections associated with them are responsible for a considerable escalation in morbidity and the cost of health care. Infection and cellular activation and the relation between cells are 2 critical factors in wound healing. Since chronic wounds offer ideal conditions for infection and biofilm production, good wound care strategies are critical for wound healing. Topical antiseptics in chronic wounds remain in widespread use today. These antiseptics are successful in microbial eradication, but their cytotoxcity is a controversial issue in wound healing.

OBJECTIVE:

The aim of this study was to investigate the effect of stabilized hypochlorous acid solution (HOCl) on killing rate, biofilm formation, antimicrobial activity within biofilm against frequently isolated microorganisms and migration rate of wounded fibroblasts and keratinocytes.

MATERIALS AND METHODS:

Minimal bactericidal concentration of stabilized HOCl solution for all standard microorganisms was 1/64 dilution and for clinical isolates it ranged from 1/32 to 1/64 dilutions.

RESULTS:

All microorganisms were killed within 0 minutes and accurate killing time was 12 seconds. The effective dose for biofilm impairment for standard microorganisms and clinical isolates ranged from 1/32 to 1/16. Microbicidal effects within the biofilm and antibiofilm concentration was the same for each microorganism.

CONCLUSION:

The stabilized HOCl solution had dose-dependent favorable effects on fibroblast and keratinocyte migration compared to povidone iodine and media alone. These features lead to a stabilized HOCl solution as an ideal wound care agent.

Original article appeared in PubMed.gov

Atypical Wounds: Causes and Management

Part 1 in a series discussing the etiology, assessment and management of atypical wounds.

 

As devoted clinicians to the field of wound management we take a responsibility to educate ourselves and others about wound etiologies and characteristics, as well as management of barriers to achieve positive outcomes. We spend a great deal of our careers learning about the most common offenders, such as pressure injuries, diabetic foot ulcers, venous stasis ulcers, arterial wounds, amputations, and traumatic wounds, to name a few. However, as our careers unfold we are faced with extra challenges, and atypical wounds are among them.

 

An atypical wound, also known as a wound of unknown etiology, is caused by a disease or condition that doesn’t cause a wound typically. Inflammatory diseases, infections, chronic illnesses, malignancies, or genetic disorders are examples of diseases that may result in the appearance of a wound. Atypical wounds can also arise from rare causes and usually share uncommon characteristics. In this two-part blog series, I discuss a few atypical wounds, to give you a view of this parallel universe … read more

The Diabetic Foot Syndrome (book)

Frontiers in Diabetes, Vol. 26

 

In recent years, “diabetic foot” has become the common name given to chronic complications of diabetes mellitus in the lower limb. This book provides an up-to-date picture of the clinical scenario, the latest understanding of the mechanisms in regard to pathology, the current standards of therapy, and the organizational tasks that a modern approach to such a complex pathology warrants. All contributors have delivered articles that are as informative and straight-to-the point as possible, including not only their own experience in the field, but also giving a wider picture to link each article to the other. The Diabetic Foot Syndrome is not only relevant to specialists, but also to all the caregivers involved in the management of the patients at risk for developing the pathology, those affected, and those who are at risk of recurrences.

The Best and Worst Ideas for Open Wounds

Using the right open wound treatment can mean the difference between quick recovery and prolonged healing, excess scars, intense pain, increased risk of infection, or more. Unfortunately, a number of misconceptions and confusions surround open wound care, mostly due to persistent common wound treatment myths and old wives’ tales.

 

To help set the record straight and ensure that you will have a favorable healing process, here are some of the right and wrong strategies to use when managing your open wound treatment.

 

Good Idea: Cleaning the Wound Immediately with Mild Solutions
Infections are caused not only by exposure to bacteria and pathogens, but also from contact with the surface that caused the wound. For example, a tree branch that caused an abrasion could have bacteria on its surface, as could a kitchen knife that caused an skin puncture.

 

Flush the wound surface and interior as you can with a mild solution. A saline solution made from a small amount of salt diluted in water works well since it mimics your body’s internal pH. You can also use mild or diluted soap in water works well or some purified water, then wipe the surface with clean gauze.

 

Take notice of any debris that may be lodged in the wound and remove it with sterile tweezers if possible. If the debris is deep or dispersed, you should seek emergency care.

 

Bad Idea: Using Strong Antiseptics to Wash Wounds
Conventional wisdom suggests using disinfectants and antiseptics like hydrogen peroxide, rubbing alcohol, or iodine to clean open wounds. Most of these substances are better suited for disinfecting household surfaces and are far too harsh for use on human tissue. They are more likely to damage tissue than help it heal … read more

Treating Hard-to-Heal Wounds

An Evidence-Based Approach for DFU and Chronic Wounds

 

This is a brief summary of a presentation given at the annual conference of Wounds Canada, in Mississauga, Ontario, on November 16th, 2017. It has been produced with the financial support of Integra Life Sciences. The presenter was Robert Fridman, DPM FACFAS CWSP, a fellowship-trained podiatric surgeon at the Department of Orthopaedic Surgery at New York-Presbyterian Columbia University Medical Center and the Department of Surgery at New York-Presbyterian Weill-Cornell Medical Center.

 

Normal Wound Healing
For health-care professionals, standard wound management consists of preparing the wound bed to support the healing process. When treating diabetic foot ulcers (DFUs), health-care professionals must work toward controlling infection, correcting ischemia, optimizing nutrition, correcting hyperglycemia and offloading of the wound.

 

Offloading
Offloading is one of the cornerstones of effective management of a diabetic foot ulcer, as it helps to minimize repetitive trauma to the area. Total contact casting (TCC) has been established as the gold standard to achieve offloading while enabling patients to ambulate. TCC enables pressure to be transmitted to the cast wall or rearfoot, resulting in decreased forefoot pressure. The device also reduces gait speed and shortens stride length, resulting in reduction of pressure. Ankle movement and the propulsive phase of gait are reduced, resulting in a reduction in vertical loading forces (see Figure 1). Ninety percent of DFUs have been shown to heal within six weeks when treated with a TCC … read more

Emerging Treatment for Necrotizing Infections

The National Necrotizing Fasciitis Foundation (NNFF), a 501c3 non-profit organization that seeks to raise public awareness of Necrotizing Fasciitis and offer support for those affected, is encouraging a new approach to treating necrotizing infections. The treatment and the referral initiative are crucial advances in the fight against this deadly threat, says Jacqueline Roemmele, executive director of the NNFF. Roemmele co-founded the organization in 1997 with fellow survivor, Donna Batdorff of Grand Rapids, Michigan, after her own years-long struggle with the disease and its aftermath, to offer information and emotional support to other patients and their families.

 

This approach calls for the use of NeutroPhase® Skin and Wound Cleanser in conjunction with Negative Pressure Wound Therapy. For the physicians who have utilized NeutroPhase with NPWT, not one of their patients has required amputation or suffered loss of life. As the late Dr. Crew described in a paper in the journal WOUNDS, NeutroPhase has been shown in laboratory testing to not only kill the bacteria that are known to be present in NF wounds, but also to neutralize the toxins produced by those bacteria. Unless they are neutralized, those toxins continue to destroy tissue even if the bacteria have been killed, explaining why so many patients lose body parts. Dr. Crew extrapolated from those laboratory results to try the NeutroPhase on patients with NF.  “No one I’ve been responsible for treating has lost an arm or leg, or a life,” said Dr. Crew. “We have something that will change the standard of care for this terrible disease.”

 

NeutroPhase, an FDA cleared 510(k) medical device, is the only skin and wound cleanser with a patented and pure form of hypochlorous acid (HOCl) that doesn’t contain bleach impurities. HOCl is produced by white blood cells as a first defense against microbial invaders. Lab tests show that, in solution, HOCl not only kills bacteria, it also neutralizes the toxins that kill tissue.

 

The NNFF is a founded in 1997 by two survivors of Necrotizing Fasciitis. The NNFF’s mission is to educate and raise public awareness of NF symptoms and preventative measures, to advocate research, and to offer support for those affected by necrotizing fasciitis. The NNFF supports a hotline where patients suffering from Necrotizing Fasciitis can get support from physicians familiar with treating NF and NeutroPhase to help save their limbs and lives.

 

 

Compression therapy for venous leg ulcers

Compression therapy is the mainstay of treatment of venous leg ulcers (VLU). Good wound care and compression therapy will heal majority of small venous ulcers of short duration.[] Goals of compression therapy are ulcer healing, reduction of pain and edema, and prevention of recurrence.[] Compression is used for VLU and narrows veins and restores valve competence and reduces ambulatory venous pressure, thus reducing venous reflux (VR). It also helps decrease inflammatory cytokines, accelerates capillary flow, and lowers capillary fluid leakage thereby alleviating limb edema. It also softens lipodermatosclerosis, improves lymphatic flow and function, and enhances fibrinolysis.

 

Indications

The aim of compression therapy is to improve the venous function without compromising arterial function.

 

Contraindications

The contraindications of compression therapy are the following[,]

  • Advanced peripheral obstructive arterial disease (ankle brachial pressure index [ABPI] <0.8) (Evidence level A)
  • Systemic arterial pressure <80 mm Hg at ankle
  • Phlegmasia cerulea dolens
  • Uncontrolled congestive heart failure
  • Abscesses
  • Septic phlebitis
  • Advanced peripheral neuropathy.

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The International Wound Infection Institute (IWII) is an organisation of
volunteer interdisciplinary health professionals dedicated to advancing
and improving practice relating to prevention and control of wound
infection. This includes acute wounds (surgical, traumatic and burns)
and chronic wounds of all types, although principally chronic wounds of
venous, arterial, diabetic and pressure aetiologies.

 

Wound infection is a common complication of wounds. It leads to delays in wound
healing and increases the risk of loss of limb and life. Implementation of effective
strategies to prevent, diagnose and manage, is important in reducing mortality and
morbidity rates associated with wound infection.

 

This second edition of Wound Infection in Clinical Practice is an update of the first edition
published in 2008 by the World Union of Wound Healing Societies (WUWHS). The
original document was authored by leading experts in wound management and endorsed
by the WUWHS. The intent of this edition is to provide a practical, updated resource that
is easy-to-use and understand.

read more (pdf)

Foot Sensation Testing in the Patient With Diabetes

Abstract: Introduction. Sensory testing of patients with diabetes is an integral part of preventing new and recurrent wounds. The Semmes-Weinstein monofilament (SWM) test is considered the gold standard to screen for loss of protective sensation; however, the authors’ experience has shown that it is not only time consuming, but is of negligible value for a patient with a diabetic foot ulcer (DFU).

 

Methods. This article discusses the shortfalls with regard to the SWM test and reviews other techniques for sensory evaluation. In addition, the Quick & Easy system is introduced, which combines sensory assessment with guidance for anesthesia requirements during wound debridements or other surgical interventions. Results. A scale ranging from grade 2 (normal sensation) to grade 0 (absent sensation) reflects the patient’s responses to wound manipulation, palpation of an underlying deformity, and/or evaluation of the difference between light touch sensation with the patient’s hands compared to the feet. For patients with total loss of sensation (grade 0), no anesthesia is needed for surgical procedures. If there is diminished sensation (grade 1), surgical intervention can be performed following administration of either topical or local anesthesia. For patients with normal sensation (grade 2), complete anesthesia of the surgical site will be required. A preliminary observation was conducted on 50 patients with DFUs using the Quick & Easy system. Anesthetic requirements were accurately predicted in all cases without the need to modify the type of anesthesia during the procedure. Conclusion. The Quick & Easy system serves as a simple sensory evaluation for a patient with a DFU and provides valuable anesthesia guidance for wound care procedures … read more

A clinical evaluation of manuka honey dressings for chronic wounds

This study reviews the literature on manuka honey and presents the results of an evaluation of Algivon® Plus with 100% medical grade manuka honey with a superabsorbent, secondary (Eclypse®) or foam dressing. Data were collected on the frequency of dressing changes and the products used. Dressing changes were performed by the tissue viability nurse consultant on days 1, 7, 14, 28, 35, 42, 49 and 56. Inpatient dressing assessments were performed twice weekly. Patients discharged to the community were assessed every Monday. The TIME framework was used to assess periwound skin, maceration, dermatitis and inflammation. All wounds were photographed. The volume, colour and odour of exudate were recorded using Likert-type scales and the wound pH was measured. Patient outcomes measured were pain, sleep, exudate odour and impact on quality of life. Following the use of Algivon® Plus, debridement to a clean wound bed generally occurred by day 7, with healing starting from day 14. The pH of the wound tissue was found to relate to the tissue type present. Patients slept for longer and were less affected by exudate and its associated odour as the study progressed. The dressings used were endorsed by best practice and resulted in positive clinical outcomes of healing or progression to healing … read more

Pressure Injury Prevention, Is It All About Protein?

by Nancy Munoz, DCN, MHA, RDN, FAND

 

The National Pressure Ulcer Advisory Panel (NPUAP) defines a pressure injury as localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can manifest as intact skin or an open ulcer and may be painful. The injury occurs as a result of intense and/or prolonged pressure, occasionally in combination with shear. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and the condition of the soft tissue.

 

Pathophysiologic and intrinsic factors at the core of pressure injury development include nutrition. Maintaining adequate nutrition is considered a best practice for both the prevention and treatment of pressure injuries. Individuals with or at risk for developing pressure injuries should strive to achieve or maintain adequate nutrition parameters … read more

Living with a Diabetic Foot Ulcer

Patient Perspective:
An Interview with Robert S. Meyer by Janet L. Kuhnke Robert Meyer lives with diabetes and a foot ulcer. He has attended multiple Wounds Canada events as both a speaker and to learn more about how he can manage his condition, heal his wound and prevent further foot complications. He is interviewed here by wound care clinician and educator Janet Kuhnke.

 

Janet L. Kuhnke: Robert, you attended the fall 2017 Wounds Canada conference in Mississauga, Ontario. Can you tell me what this was like for you as a patient?

 

Robert S. Meyer: I was there as a patient and a speaker, but it was not until I got back home that the depth of my message sank in. First, I wanted to do my talk as a tribute to my mother, who had a nasty death due to the complications of diabetes. Second, if my message could help someone, it would be worth it all. Not just for other patients but for other service providers who need to find their own inner voice and become advocates for themselves or others, no matter the issue. Third, telling my story has a profound impact on my own healing journey. Now I know why victims of trauma need to tell their story as part of their healing. The important part is knowing that someone has listened and heard … read more

Novel Approach to Chronic Wounds


Presentation on self-adaptive technology by Dr. Alex M. Reyzelman, the Co-Director of UCSF Center for Limb Preservation at RANDE 2015, International Wound Care Conference in Czech Republic.

Flow-through Instillation of Hypochlorous Acid in the Treatment of Necrotizing Fasciitis

Abstract: Introduction. Necrotizing fasciitis (NF) is a rare and rapidly progressing bacterial infection of soft tissues. Bacterial toxins cause local tissue damage and necrosis, as well as blunt immune system responses. A self-propagating cycle of bacterial invasion, toxin release and tissue destruction can continue until substantial amounts of tissue become necrotic. Neutralization of bacterial toxins should improve the results.

Materials and Methods. Pure hypochlorous acid (HOCl) (0.01% w/v) with no sodium hypochlorite impurity in saline pH 4-5, which was recently shown to both eradicate bacteria and neutralize bacterial toxins in vitro, was administered via flow-through instillation to 6 patients with NF 4-6 times daily as needed. Utilizing a vacuum-assisted closure, 5-10 mL of pure 0.01% HOCl with no sodium hypochlorite impurity was instilled and removed frequently to irrigate the wounds. Results. Of the 6 patients, no deaths or limb amputations occurred. All infected areas healed completely without major complications. Conclusion. The toxicity and immune dysfunction caused by bacterial toxins and toxins released from damaged cells may be mitigated by flow-through instillation with saline containing pure 0.01% HOCl with no sodium hypochlorite impurity. Randomized controlled clinical trial research of this relatively simple and inexpensive instillation protocol is suggested for identified cases of NF.

 

 

Necrotizing fasciitis (NF), commonly referred to in nonmedical discourse as “flesh-eating” inflammation, is a rapidly progressing involvement of the fascia and subcutaneous tissues that can subsequently extend to the muscles and skin. Type I NF is classified as a polymicrobial infection, whereas type II NF is classified as a monomicrobial infection.1 Bacterial toxins released during the course of necrotic inflammations produce direct cytotoxic effects on surrounding tissues, while also causing immune system dysfunction and localized immunosuppression. The authors’ new therapy incorporates the use of an instillation vacuum-assisted closure procedure, also known as negative pressure wound therapy (NPWT), with pure 0.01% hypochlorous acid (HOCl) with no sodium hypochlorite—commonly known as bleach—impurity.2 As pure 0.01% HOCl (ie, > 97% relative molar distribution of active chlorine species as HOCl) in a 0.9% saline solution at pH 4-5 has been shown to both rapidly kill bacteria and neutralize bacterial toxins in vitro, clinical administration of pure HOCl with no sodium hypochlorite impurity was recently explored … read more

High-above-knee open amputation due to necrotising fasciitis

Necrotising fasciitis is a rare but serious bacterial infection of the soft tissues. It usually affects immunocompromised individuals, and people with diabetes are at particular risk. The lesion often starts as a minor wound and rapidly progresses, becoming life-threatening if not recognised early and treated aggressively. The authors present a severe case of necrotising fasciitis of the right lower limb that led to a high-above-knee amputation with faecal diversion to prevent wound contamination. Split skin grafting was used to close the wound once it had granulated. Faecal diversion can be important in cases where there is inadequate skin cover close to the torso, as stumps can be contaminated with faecal organisms, resulting in sepsis and possibly death.

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Missouri university inventors have new creation to heal chronic wounds

ROLLA, Mo.–There’s a new way to heal chronic wounds that’s been invented in Missouri.

 

It’s a technique that inventors at Missouri University of Science and Technology are calling one of a kind.

 

The FDA approved the product called Mirragen and it uses bioactive glass to heal chronic wounds like people with diabetic foot ulcers and bed sores.

 

The inventors of the product told KOLR-TV of all the ways there are to heal chronic wounds, this is the most effective option for patients that they’ve seen.

 

Chad Lewis of ETS Wound Care says the bioactive glass product called Mirragen has received rave reviews …. read more

Mirragen info video

HBOT, sham procedure lead to similar wound healing rates

Adults with diabetes and chronic lower limb wounds randomly assigned to 6 weeks of hyperbaric oxygen therapy or a sham procedure met similar amputation criteria and experienced similar wound healing rates at the conclusion of treatment, according to research in Diabetes Care.

 

In a prospective, double blind, randomized controlled trial, Ludwik Fedorko, MD, PhD, FRCPC, of Toronto General Hospital and University Health Network in Ontario, Canada, and colleagues analyzed data from 107 adults with type 1 or type 2 diabetes and chronic lower limb wounds persisting for a minimum of 4 weeks. Within the cohort, 49 participants were randomly assigned to 30 daily sessions of hyperbaric oxygen therapy lasting 90 minutes each (breathing oxygen at 244 kPa); 54 participants were assigned to a sham procedure (breathing oxygen at 125 kPa; equivalent to breathing 27% oxygen by face mask), in addition to receiving comprehensive wound care …

 

“The adjuvant [hyperbaric oxygen therapy] care provided no incremental benefit in improving measures of wound healing,” the researchers wrote. “These results are in contrast to several cohort and open-label randomized trials where no sham placebo was used.” – by Regina Schaffer

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