Electrically charged bandages help to heal burn wounds, combat antibiotic resistance

Ohio State University Wexner Medical Center researchers have created electrically charged bandages that can combat antibiotic resistance, enable healing in burn wounds, and help prevent infections. When the dressing comes in contact with bodily fluids it becomes electrically activated.

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How to benefit from electrical stimulation for the treatment of chronic wounds

Electrical Stimulation Therapy

One of the most amazing things about the human body is its ability to repair itself. Lacerations, punctures, abrasions all heal with little or no care. Chronic wounds, those that persist day after day, are a small subset of wounds but they compose a troublesome minority. They include, but are not limited to, diabetic foot ulcers (DFU), venous leg ulcers (VLU), and pressure ulcers (colloquially known as bedsores). These represent the body’s failure to fix itself. (more…)

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A new way of healing wounds in the future discovered by scientists

Scientists at Ohio State University have developed a new method that has the capability of changing the body’s existing cells into new cells to promote healing. The method, called Tissue Nanotransfection (TNT), reprograms cells through a device that uses nanotechnology. The way it would work: First, doctors would apply a light electrical stimulation to the surface of the skin. They would then place a small chip about the size of a cuff link onto the site of the wound. In less than a second, this chip would deliver reprogramming factors (pre-programmed DNA or RNA) non-invasively into living skin cells via a high-intensity, focused electric field, converting them into whatever type of cells a scientist or doctor may choose. (more…)

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New Approach to Wound Healing Easy on Skin, Tough on Bacteria

wound healing

Washington, D.C. — In a presentation  to the American Chemical Society meeting, Ankit Agarwal, a postdoctoral researcher at the University of Wisconsin-Madison, described an experimental approach to wound healing that could take advantage of silver’s anti-bacterial properties, while sidestepping the damage silver can cause to cells needed for healing.

Silver is widely used to prevent bacterial contamination in wound dressings, says Agarwal, “but these dressings deliver a very large load of silver, and that can kill a lot of cells in the wound.” (more…)

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2016 Journal: Best of the Best Vol. 5 No. 5

Wound Care Advisor Best of the Best 2016

Clinical Notes: Healing SCI Patients, antiseptics on mahout, diabetes

Electrical stimulation and pressure ulcer healing in SCI patients A systematic review of eight clinical trials of 517 patients with spinal cord injury (SCI) and at least one pressure ulcer indicates that electrical stimulation increases the healing rate of pressure ulcers. Wounds with electrodes overlaying the wound bed seem to have faster pressureulcer healing than wounds with electrodes placed on intact skin around the ulcer.

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Case study: Peristomal pyoderma gangrenosum

As a wound care specialist, you have learned about many skin conditions, some so unusual and rare that you probably thought you would never observe them. I’ve been a nurse for 38 years, with the last 10 years in wound care, and that’s certainly what I thought. But I was wrong. Let me tell you about my challenging patient with…

Causes, prevention, and treatment of epibole

As full-thickness wounds heal, they begin to fill in from the bottom upward with granulation tissue. At the same time, wound edges contract and pull together, with movement of epithelial tissue toward the center of the wound (contraction). These epithelial cells, arising from either the wound margins or residual dermal epithelial appendages within the wound bed, begin to migrate in leapfrog or train fashion across the wound bed. Horizontal movement stops when…

Electrical stimulation

Clinical Notes: Healing SCI Patients, antiseptics on mahout, diabetes

Electrical stimulation and pressure ulcer healing in SCI patients A systematic review of eight clinical trials of 517 patients with spinal cord injury (SCI) and at least one pressure ulcer indicates that electrical stimulation increases the healing rate of pressure ulcers. Wounds with electrodes overlaying the wound bed seem to have faster pressureulcer healing than wounds with electrodes placed on intact skin around the ulcer.

Clinician Resources: Pressure-Injuries, Ostomy, Lymphedema, Delirium

Here is a round-up of resources that you may find helpful in your practice. New illustrations for pressure-injury staging The National Pressure Ulcer Advisory Panel (NPUAP) has released new illustrations of pressure injury stages. You can download the illustrations, which include normal Caucasian and non-Caucasian skin illustrations for reference. There is no charge for the illustrations as long as they are being used for educational purposes, but donations to…

Cutaneous candidiasis

By Nancy Morgan, RN, BSN, MBA, WOC, WCC, DWC, OMS Each issue, Apple Bites brings you a tool you can apply in your daily practice. Here’s an overview of cutaneous candi­diasis. Cutaneous candidiasis is an infection of the skin caused by the yeast Candida albicans or other Candida species. Here’s a snapshot of this condition.

How to apply silver nitrate

Topical application of silver nitrate is often used in wound care to help remove and debride hypergranulation tissue or calloused rolled edges in wounds or ulcerations. It’s also an effective agent to cauterize bleeding in wounds. Silver nitrate is a highly caustic material, so it must be used with caution to prevent damage to healthy tissues.

How to manage peristomal skin problems

For an ostomy pouching system to adhere properly, the skin around the stoma must be dry and intact. Otherwise, peristomal skin problems and skin breakdown around the stoma may occur. In fact, these problems are the most common complications of surgical stomas. They can worsen the patient’s pain and discomfort, diminish quality of life, delay rehabilitation, increase use of ostomy supplies, and raise healthcare costs. Peristomal skin problems also perpetuate a…

Immobility as the root cause of pressure ulcers

By Jeri Lundgren, BSN, RN, PHN, CWS, CWCN Many factors can contribute to the formation of a pressure ulcer, but it’s rare that one develops in an active, mobile patient. As the National Pressure Ulcer Advisory Panel 2014 guidelines state, “Pressure ulcers cannot form without loading, or pressure on the tissue. Extended periods of lying or sitting on a particular…

No more skin tears

Imagine watching your skin tear, bleed, and turn purple. Imagine, too, the pain and disfigurement you’d feel. What if you had to live through this experience repeatedly? That’s what many elderly people go through, suffering with skin tears through no fault of their own. Some go on to develop complications. A skin tear is a traumatic wound caused by shear, friction, or blunt-force trauma that results in a partial-…

Our gold medal issue: Best of the Best 2016

This issue marks the fourth anniversary of the “Best of the Best” issue of Wound Care Advisor, the official journal of the National Alliance of Wound Care and Ostomy. Fittingly, it comes during an Olympics year. Since 1904, the Olympics have awarded gold medals to athletes whose performance makes them the “best of the best.” This year, we’re proud to present our own “Best…

Preventing pressure ulcers in pediatric patients

By Roxana Reyna, BSN, RNC-NIC, WCC, CWOCN As wound care clinicians, we are trained—and expected—to help heal wounds in patients of any age and to achieve positive outcomes. Basic wound-healing principles apply to all patients, whatever their age or size. The specific anatomy and physiology of vulnerable pediatric patients, however, requires detailed wound care. Unfortunately, little evidence-based research exists to…

Pros Cons Hydrocolloid Foot Ulcers

Pros and cons of hydrocolloid dressings for diabetic foot ulcers

Diabetic foot ulcers stem from multiple factors, including peripheral neuropathy, high plantar pressures, decreased vascularity, and impaired wound healing. Contributing significantly to morbidity, they may cause limb loss and death. (See Foot ulcers and diabetes.) Initially, hydrocolloid dressings were developed to function as part of the stomal flange. Based on their success in protecting peristomal skin, they were introduced gradually…

2016 Journal: Best of the Best Vol. 5 No. 5
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Clinical Notes: Healing SCI Patients, antiseptics on mahout, diabetes

Electrical stimulation

Electrical stimulation and pressure ulcer healing in SCI patients

A systematic review of eight clinical trials of 517 patients with spinal cord injury (SCI) and at least one pressure ulcer indicates that electrical stimulation increases the healing rate of pressure ulcers. Wounds with electrodes overlaying the wound bed seem to have faster pressureulcer healing than wounds with electrodes placed on intact skin around the ulcer. (more…)

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Palliative wound care: Part 2

This approach brings patient-centered care to life.

 By Gail Rogers Hebert, MS, RN, CWCN, WCC, DWC, OMS, LNHA

Editor’s note: This article is the second in a two-part series on palliative wound care. For the first part, click here.

By preventing and relieving suffering, palliative care improves the quality of life for patients facing problems associated with life-threatening illness. This care approach emphasizes early identification, impeccable assessment, and treatment of pain and other issues—physical, psychosocial, and spiritual. (more…)

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Role of rehab in wound care

 By Bill Richlen, PT, WCC, DWC, and Denise Richlen, PT, WCC, DCCT

How many times have you heard someone say, “I didn’t know PTs did wound care”? Statements like this aren’t uncommon. The role of physical therapists (PTs), occupational therapists, and speech therapists in wound care is commonly misunderstood by and even a mystery to many clinicians. Sometimes the therapists themselves are confused about reimbursement or what their role on the wound care team can be. (more…)

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Managing venous stasis ulcers

Managing chronic venous leg ulcers — what’s the latest evidence?

By Kulbir Dhillon, MSN, FNP, APNP, WCC

Venous disease, which encompasses all conditions caused by or related to diseased or abnormal veins, affects about 15% of adults. When mild, it rarely poses a problem, but as it worsens, it can become crippling and chronic.

Chronic venous disease often is overlooked by primary and cardiovascular care providers, who underestimate its magnitude and impact. Chronic venous insufficiency (CVI) causes hypertension in the venous system of the legs, leading to various pathologies that involve pain, swelling, edema, skin changes, stasis dermatitis, and ulcers. An estimated 1% of the U.S. population suffers from venous stasis ulcers (VSUs). Causes of VSUs include inflammatory processes resulting in leukocyte activation, endothelial damage, platelet aggregation, and intracellular edema. Preventing VSUs is the most important aspect of CVI management. (more…)

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Clinical Notes: diabetic foot osteomyelitis, BIA, footwear

Antibiotics and conservative surgery yield similar outcomes in patients with diabetic foot osteomyelitis

A study in Diabetes Care finds that anti­biotics and surgery have similar outcomes related to rate of healing, time of healing, and short-term complications in patients who have neuropathic forefoot ulcers and osteomyelitis, but no ischemia or necrotizing soft-tissue infections.

Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis. A randomized comparative trial” compared two groups: an antibiotics group and a surgery group. Patients in the antibiotics group received antibiotics for 90 days, and patients in the surgery group received conservative surgery with postoperative antibiotics for 10 days. (more…)

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Clinical Notes

Study finds less-invasive method for identifying osteomyelitis is effective

Researchers have found that using hybrid 67Ga single-photon emission computed tomography and X-ray computed tomography (SPECT/CT) imaging combined with a bedside percutaneous bone puncture in patients with a positive scan is “accurate and safe” for diagnosing osteomyelitis in patients with diabetes who have a foot ulcer without signs of soft-tissue infection.

The new method, which avoids an invasive bone biopsy, has a sensitivity of 88% and a specificity of 93.6%. In the study of 55 patients, antibiotic treatment was avoided in 55% of suspected cases.

Diagnosing diabetic foot osteomyelitis in patients without signs of soft tissue infection by coupling hybrid 67Ga SPECT/CT with bedside percutaneous bone puncture,” published by Diabetes Care, followed patients for at least a year.

MRSA strains will likely continue to coexist in hospitals and communities

The strains of methicillin-resistant Staphylococcus aureus (MRSA) differ in the hospital and community settings, and both are likely to coexist in the future, according to a study in PLOS Pathogens.

Hospital-community interactions foster coexistence between methicillin-resistant strains of Staphylococcus aureus” notes that previously it was thought that the more invasive community strains would become more prevalent (and even eliminate) hospital strains. This new information could have significant consequences for public health because of the differences in the resistance of the two strains.

C. difficile prevention actions fail to stop spread

Despite increasing activities to prevent the spread of Clostridium difficile, infection from C. difficile remains a problem in healthcare facilities, according to a survey of infection preventionists by the Association for Professionals in Infection Control and Epidemiology (APIC).

The survey found that 70% of preventionists have adopted additional interventions in their healthcare facilities since March 2010, but only 42% have seen a decline in C. difficile infection rates; 43% saw no decline.

A total of 1,087 APIC members completed the survey in January 2013. The survey also found that more than 92% of respondents have increased emphasis on environmental cleaning and equipment decontamination practices, but 64% said they rely on observation, rather than more accurate and reliable monitoring technologies, to assess cleaning effectiveness.

In addition, 60% of respondents have antimicrobial stewardship programs at their facilities, compared with 52% in 2010. Such programs promote the appropriate use of antibiotics, which can help reduce the risk of C. difficile infection.

According to the Centers for Disease Control and Prevention, diarrhea caused by C. difficile is linked to 14,000 American deaths each year.

Mast cells may not play significant role in wound healing

Evidence that mast cells are not required for healing of splinted cutaneous excisional wounds in mice,” published in PLOS One, analyzed wound healing in three types of genetically mast-deficient mice and found they reepithelialized their wounds at rates similar to control mice. At the time of closure, the researchers found that scars in all the mice groups were similar in both “quality of collagen deposition and maturity of collagen fibers.” The findings fail to support the previously held belief that mast cells are important in wound healing.

Study identifies effective casting for diabetes-related plantar foot ulcers

Nonremovable casts that relieve pressure are more effective than removable casts or dressings alone for the treatment of plantar foot ulcers caused by diabetes, according to an analysis of clinical trials.

The authors of “Pressure-relieving interventions for treating diabetic foot ulcers,” published by The Cochrane Library, reviewed 14 randomized clinical trials that included 709 participants. Nonremovable pressure-relieving casts were compared to dressings alone, temporary therapeutic shoes, removable pressure-relieving devices, and surgical lengthening of the Achilles tendon.

The study also notes that when combined with Achilles tendon lengthening, nonremovable devices were more successful in one forefoot ulcer study than the use of a nonremovable cast alone.

Most studies were from the United States (five) and Italy (five), with Germany, the Netherlands, Australia, and India each contributing one study.

Prescriber preference drives use of antibiotics in long-term care

Prolonged antibiotic treatment in long-term care: Role of the prescriber,” published by JAMA Internal Medicine, found that the preferences of prescribers, rather than patient characteristics, drive antibiotic treatment.

The study of 66,901 patients from 630 long-term care facilities found that 77.8%
received a course of antibiotics. The most common length (41%) was 7 days, but the length exceeded 7 days in 44.9% of patients. Patient characteristics were similar among short-, average-, and long-duration prescribers.

The study authors conclude: “Future trials should evaluate antibiotic stewardship interventions targeting prescriber preferences to systematically shorten average treatment durations to reduce the complications, costs, and resistance associated with antibiotic overuse.”

Electrophysical therapy may be helpful for diabetic foot ulcers

Electrophysical therapy for managing diabetic foot ulcers: A systematic review” concludes that electrophysical therapy is potentially beneficial because in each randomized clinical trial it outperformed the control or sham electrical stimulation.

The authors of the study in International Wound Journal reviewed eight trials with a combined total of 325 patients. Five studies were on electrical stimulation, two on phototherapy, and one on ultrasound. Because of the small number of trials, the possibility of harmful effects can’t be ruled out, and the authors recommend “high-quality trials with larger sample sizes.”

Significant geographic variations in spending, mortality exist for diabetic patients with foot ulcers and amputations

Geographic variation in Medicare spending and mortality for diabetic patients with foot ulcers and amputations” reports healthcare spending and mortality rates vary “considerably” across the United States.

The study in Journal of Diabetes and Its Complications found that higher spending wasn’t associated with a significant reduction in 1-year patient mortality. In addition, rates of hospital admission were associated with higher per capita spending and higher mortality rates for patients.

Home-based exercise program improves life for lymphedema patients

An individualized, home-based progressive resistance exercise program improves upper-limb volume and circumference and quality of life in postmastectomy patients with lymphedema, according to a study published in the Journal of Rehabilitation Research and Development.

Effect of home-based exercise program on lymphedema and quality of life in female postmastectomy patients: Pre-post intervention study” included 32 women who participated in an 8-week program. The women received education about the program and an initial training session from a physiotherapist. They practiced the exercise sequence and received a program and logbook once their performance was satisfactory. Patients were told to increase weight only when two sets of 15 repetitions became easy to perform.

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