Since its introduction almost 20 years ago, negative-pressure wound therapy (NPWT) has become a leading technology in the care and management of acute, chronic, dehisced, traumatic wounds; pressure ulcers; diabetic ulcers; orthopedic trauma; skin flaps; and grafts. NPWT applies controlled suction to a wound using a suction pump that delivers intermittent, continuous, or variable negative pressure evenly through a wound filler (foam or gauze). Drainage tubing adheres to an occlusive transparent dressing; drainage is removed through the tubing into a collection canister. NWPT increases local vascularity and oxygenation of the wound bed and reduces edema by removing wound fluid, exudate, and bacteria. (more…)
Here are some resources of value to your practice.
National Guideline Clearinghouse
The National Guideline Clearinghouse, supported by the Agency for Healthcare Research and Quality, summarizes many guidelines of interest to wound care, ostomy, and lymphedema clinicians. Here are some examples:
Navigating through the thousands of wound care products can be overwhelming and confusing. I suspect that if you checked your supply rooms and treatment carts today, you would find stacks of unused products. You also would probably find that many products were past their expiration dates and that you have duplicate products in the same category, but with different brand names. Many clinicians order a product by brand name, not realizing that plenty of the product is already in stock under a different brand name. (more…)
Wound Care Advisor, is dedicated to delivering succinct insights and information that multidisciplinary wound team members can immediately apply in their practice and use to advance their professional growth. If you’re considering writing for us, please use these guidelines to help choose an appropriate topic and learn how to prepare and submit your manuscript. Following these guidelines will increase the chance that we’ll accept your manuscript for publication
About the journal
Wound Care Advisor serves as a practical resource for multidisciplinary skin and would care specialists. The journal provides news, clinical information, and insights from authoritative experts to enhance skin and wound care management. Wound Care Advisor is written by skin and wound care experts and presented in a reader-friendly electronic format. Clinical content is peer reviewed. It also serves as a resource for professional development and career management.
The journal is sent to Certificants of the National Alliance of Wound Care and Ostomy and other healthcare professionals, who are also dedicated to improving skin and wound care.
Editorial profile
Each issue of Wound Care Advisor offers compelling feature articles on clinical and professional topics, plus regular departments. We publish articles that present clinical tips and techniques, discuss new or innovative treatments, provide information on technology related to wound care, review medical conditions that affect wound healing such as diabetes and cardiovascular disease, address important professional and career issues, and other topics of interest to wound care specialists.
We accept submissions for these departments:
Best Practices, which includes case studies, clinical tips from wound care specialists, and other resources for clinical practice
Business Consult, which is designed to help wound care specialist manage their careers and stay current in relevant healthcare issues that affect skin and wound care.
We also welcome case studies. Please use the WCA Case Study Template as a guide
Before you submit an article…
Please send a brief email query to [email protected]. In the email, state 1) the topic of your proposed article, 2) briefly describe what the article will include, 3) provide a short summary of your background, and 4) explain why you’re qualified to write on this topic. We will respond whether or not we are interested in the article you have proposed.
Tips on writing for Wound Care Advisor
Our journal is written in simple, concise language. The tone is informal, and articles are short to medium in length (about 600 words for departments and 1200 words for feature articles). When writing the manuscript, follow these guidelines:
Wound Care Advisor is a clinical practice journal, so keep your information practical. Give examples that readers will relate to.
Although our tone is informal, the content of your article must be evidence-based, including key research findings, clinical practice guidelines and relevant standards as applicable.
Address readers directly, as if you’re speaking to them. Here are some examples:”As a wound care specialist, you’re probably familiar with …..””After removing the dressing, measure the wound….”
Use active—not passive—verbs. Active verbs engage the reader and make the writing more interesting.Sentence with a passive verb: Wound edges should be assessed for undermining.Sentence with active verb (preferred): Assess the wound edges for undermining.
Don’t use acronyms or abbreviations, except those you’re sure every reader is familiar with (such as “I.V.”). Instead, spell out the full term.
When mentioning a specific drug, give the drug’s generic name first, followed by the brand name in parentheses (if relevant).
Consider using boxed copy (a sidebar) for points you’d like to emphasize, clarify, or elaborate on. Also consider putting appropriate information in tables (in MS Word format). DO NOT USE MS Word’s “Insert text box” feature for sidebars. Instead, label the sidebar appropriately and put it at the end of your manuscript, after the article itself.
Wound Care Advisor is a digital journal, a format that encourages reader interaction. If possible, please include in your manuscript at least two links to websites, videos, or other electronic resources that would be helpful to readers.
Do not cite references within the text. List them in alphabetical order. References must be from professionally reliable sources and should be no more than 5 years old.
For reference style, use the American Medical Association Manual of Style: A Guide for Authors and Editors (10th ed). If you don’t have access to this book, include at least the following information for each reference you cite:
For a book: author(s), book title, edition (if appropriate), place of publication, publisher, and publication date
For a print journal article: author(s); article title; journal name; year, volume; inclusive page numbers
For online references: URL (web address) and the date you accessed the website.
About tables, photos, and illustrations
We encourage you to submit tables, photographs, and illustrations for your article (although we can’t guarantee we’ll publish them).
Submit them in a separate electronic file. Identify the source of each table, photo, or illustration and include a brief caption or label (e.g., “Illustration #1: Preventing complications from diabetes. From American Diabetic Association, 2006″). In the body of your article, indicate where the photo or illustration should be placed (e.g., “Insert Illustration #1 here.”) If you believe specific items in the photo or illustration should be identified, tell us this in a note. (Be aware that any person whose image is shown in a photograph must sign a consent form that gives us permission to publish it.)
Do not embed tables, figures, or images in the same file as the body of your article. Also, do not submit any text in a box or otherwise put rules around it, above, or below it. Instead, label this copy as a sidebar and submit it in a separate word file or at the end of the main article.
Authors are responsible for obtaining permission for material with a copyright. That includes figures, tables, and illustrations from other journals. It’s best to obtain permission before you submit the article and include documentation that you’ve received permission and any specific credit line that must be printed with the image. However, in cases where you must pay to use an image, note in the submission that you will obtain permission if the article is accepted for publication.
Important cautions
The article must be your own original work. Do not submit material taken verbatim from a published source.
How to submit your article
Submit your manuscript electronically as an MS Word file. Follow these guidelines:
At the top of the first page of the document, place the article title, your initials (not yourname), and the date.
DO NOT include extra hard returns between lines or paragraphs, extra spaces between words, or any special coding.
Send a separate cover letter that includes your name; credentials; position; address; home, cell, and work telephone numbers; email address; and your employer’s name, city, and state.
If your manuscript contains clinical information and we believe it has publication potential, we will send it out for blind peer review (neither you nor the reviewers will know who wrote the article). All manuscripts also receive an internal editorial review. After the review, we’ll let you know whether the manuscript has been accepted, accepted pending revisions, or declined.
If we accept your manuscript for publication, we’ll ask you to sign an agreement that gives HealthCom Media (publisher of Wound Care Advisor) the rights to your article so that it can be published. Each author must sign a separate agreement.
Your article will go through our in-house editorial process, where professional editors ensure consistency with our editorial style. You will have a chance to review the edited version before it’s published.
We will email you if we decide not to publish your manuscript.
Thank you for considering publishing in Wound Care Advisor, the official journal of the National Alliance of Wound Care and Ostomy, the official. If you have any questions, please email: Cynthia Saver, RN, MS, at [email protected] or [email protected].
Hansen’s disease, also called leprosy, is treatable today – and that’s partly thanks to a curious tree and the work of a pioneering young scientist in the 1920s. Centuries prior to her discovery, sufferers had no remedy for leprosy’s debilitating symptoms or its social stigma.
This young scientist, Alice Ball, laid fundamental groundwork for the first effective leprosy treatment globally. But her legacy still prompts conversations about the marginalization of women and people of color in science today.
Alice Augusta Ball, born in Seattle, Washington, in 1892, became the first woman and first African American to earn a master’s degree in science from the College of Hawaii in 1915, after completing her studies in pharmaceutical chemistry the year prior.
After she finished her master’s degree, the college hired her as a research chemist and instructor, and she became the first African American with that title in the chemistry department.
Doctors now understand that leprosy, also called Hansen’s disease, is minimally contagious. But in 1865, the fear and stigma associated with leprosy led authorities in Hawaii to implement a mandatory segregation policy, which ultimately isolated those with the disease on a remote peninsula on the island of Molokai. In 1910, over 600 leprosy sufferers were living in Molokai.
Doctors had attempted to use nearly every remedy imaginable to treat leprosy, even experimenting with dangerous substances such as arsenicand strychnine. But the lone consistently effective treatment was chaulmoogra oil.
Chaulmoogra oil is derived from the seeds of the chaulmoogra tree. Health practitioners in India and Burma had been using this oil for centuries as a treatment for various skin diseases. But there were limitations with the treatment, and it had only marginal effects on leprosy.
The oil is very thick and sticky, which makes it hard to rub into the skin. The drug is also notoriously bitter, and patients who ingested it would often start vomiting. Some physicians experimented with injections of the oil, but this produced painful pustules.
Dr. Isabel Kerr, a European missionary, administering to a patient a chaulmoogra oil treatment in 1915, prior to the invention of the Ball Method. George McGlashan Kerr, CC BY
The Ball Method
If researchers could harness chaulmoogra’s curative potential without the nasty side effects, the tree’s seeds could revolutionize leprosy treatment. So, Hollmann turned to Ball. In a 1922 article, Hollmann documents how the 23-year-old Ball discovered how to chemically adapt chaulmoogra into an injection that had none of the side effects.
The Ball Method, as Hollmann called her discovery, transformed chaulmoogra oil into the most effective treatment for leprosy until the introduction of sulfones in the late 1940s.
In 1920, the Ball Method successfully treated 78 patients in Honolulu. A year later, it treated 94 more, with the Public Health Service noting that the morale of all the patients drastically improved. For the first time, there was hope for a cure.
Ball’s death meant she didn’t have the opportunity to publish her research. Arthur Dean, chair of the College of Hawaii’s chemistry department, took over the project.
Dean mass-produced the treatment and published a series of articles on chaulmoogra oil. He renamed Ball’s method the “Dean Method,” and he never credited Ball for her work.
Ball’s other colleagues did attempt to protect Ball’s legacy. A 1920 article in the Journal of the American Medical Association praises the Ball Method, while Hollmann clearly credits Ball in his own 1922 article.
Ball is described at length in a 1922 article in volume 15, issue 5, of Current History, an academic publication on international affairs. That feature is excerpted in a June 1941 issue of Carter G. Woodson’s “Negro History Bulletin,” referring to Ball’s achievement and untimely death.
Joseph Dutton, a well-regarded religious volunteer at the leprosy settlements on Molokai, further referenced Ball’s work in a 1932 memoir broadly published for a popular audience.
Historians such as Paul Wermager later prompted a modern reckoning with Ball’s poor treatment by Dean and others, ensuring that Ball received proper credit for her work. Following Wermager’s and others’ work, the University of Hawaii honored Ball in 2000 with a bronze plaque, affixed to the last remaining chaulmoogra tree on campus.
In 2019, the London School of Hygiene and Tropical Medicine added Ball’s name to the outside of its building. Ball’s story was even featured in a 2020 short film, “The Ball Method.”
The Ball Method represents both a scientific achievement and a history of marginalization. A young woman of color pioneered a medical treatment for a highly stigmatizing disease that disproportionately affected an already disenfranchised Indigenous population.
In 2022, then-Gov. David Ige declared Feb. 28 Alice Augusta Ball Day in Hawaii. It was only fitting that the ceremony took place on the Mānoa campus in the shade of the chaulmoogra tree.
The word “leprosy” conjures images of biblical plagues, but the disease is still with us today. Caused by infectious bacteria, some 200,000 new cases are reported each year, according to the World Health Organization. In the United States, leprosy has been entrenched for more than a century in parts of the South where people came into contact with armadillos, the principle proven linkage from animal to humans. However, the more recent outbreaks in the Southeast, especially Florida, have not been associated with animal exposure.
The Conversation talked with Robert A. Schwartz, professor and head of dermatology at Rutgers New Jersey Medical School, to explain what researchers know about the disease.
What is leprosy and why is it resurfacing in the US?
Leprosy is caused by two different but similar bacteria — Mycobacterium leprae and Mycobacterium lepromatosis — the latter having just been identified in 2008. Leprosy, also known as Hansen’s disease, is avoidable. Transmission among the most vulnerable in society, including migrant and impoverished populations, remains a pressing issue.
Leprosy is beginning to occur regularly within parts of the southeastern United States. Most recently, Florida has seen a heightened incidence of leprosy, accounting for many of the newly diagnosed cases in the U.S.
Traditional risk factors include zoonotic exposure and having recently lived in leprosy-endemic countries. Brazil, India and Indonesia have each noted more than 10,000 new cases since 2019, according to the World Health Organization data, and more than a dozen countries have reported between 1,000 to 10,000 new cases over the same time period.
From that time until the mid-20th century, limited treatments were available, so the bacteria could infiltrate the body and cause prominent physical deformities such as disfigured hands and feet. Advanced cases of leprosy cause facial features resembling that of a lion in humans.
Many mutilating and distressing skin disorders such as skin cancers and deep fungal infections were also confused with leprosy by the general public.
Fear of contagion has led to tremendous stigmatization and social exclusion. It was such a serious concern that the Kingdom of Jerusalem had a specialized hospital to care for those suffering from leprosy.
How infectious is leprosy?
Research shows that prolonged in-person contact via respiratory droplets is the primary mode of transmission, rather than through normal, everyday contact such as embracing, shaking hands or sitting near a person with leprosy. People with leprosy generally do not transmit the disease once they begin treatment.
Armadillos represent the only known zoonotic reservoir of leprosy-causing bacteria that threaten humans. These small mammals are common in Central and South America and in parts of Texas, Louisiana, Missouri and other states, where they are sometimes kept as pets or farmed as meat. Eating armadillo meat is not a clear cause of leprosy, but capturing and raising armadillos, along with preparing its meat, are risk factors.
The transmission mechanism between zoonotic reservoirs and susceptible individuals is unknown, but it is strongly suspected that direct contact with an infected armadillo poses a significant risk of developing leprosy. However, many cases reported in the U.S. have demonstrated an absence of either zoonotic exposure or person-to-person transmission outside of North America, suggesting that transmission may be happening where the infected person lives. But in many cases, the source remains an enigma.
Leprosy primarily affects the skin and peripheral nervous system, causing physical deformity and desensitizing one’s ability to feel pain on affected skin.
It may begin with loss of sensation on whitish patches of skin or reddened skin. As the bacteria spread in the skin, they can cause the skin to thicken with or without nodules. If this occurs on a person’s face, it may rarely produce a smooth, attractive-appearing facial contour known as lepra bonita, or “pretty leprosy.” The disease can progress to causing eyebrow loss, enlarged nerves in the neck, nasal deformities and nerve damage.
The onset of symptoms can sometimes take as long as 20 years because the infectious bacteria have a lengthy incubation period and proliferate slowly in the human body. So presumably many people are infected long before they know that they are.
Fortunately, worldwide efforts to screen for leprosy are being enhanced thanks to organizations like the Order of Saint Lazarus, which was originally founded in the 11th century to combat leprosy, and the Armauer Hansen Research Institute, which conducts immunologic, epidemiological and translational research in Ethiopia. The nongovernmental organization Bombay Leprosy Project in India does the same.
How treatable is it?
Leprosy is not only preventable but treatable. Defying stigma and advancing early diagnosis via proactive measures are critical to the mission of controlling and eradicating it worldwide.
Notably, the World Health Organization and other agencies provide multi-drug therapy at no cost to patients.
In addition, vaccine technology to combat leprosy is in the clinical trials stage and could become available in coming years. In studies involving nine-banded armadillos, this protein-based vaccine delayed or diminished leprous nerve damage and kept bacteria at bay. Researchers believe that the vaccine can be produced in a low-cost, highly efficient manner, with the long-term prospect of eradicating leprosy.
If health care professionals, biomedical researchers and lawmakers do not markedly enhance their efforts to eliminate leprosy worldwide, the disease will continue to spread and could become a far more serious problem in areas that have been largely free of leprosy for decades.
The World Health Organization launched a plan in 2021 for achieving zero leprosy.
Flesh-eating bacteria sounds like the premise of a bad horror movie, but it’s a growing – and potentially fatal – threat to people.
In September 2023, the Centers for Disease Control and Prevention issued a health advisory alerting doctors and public health officials of an increase in flesh-eating bacteria cases that can cause serious wound infections.
There are several types of bacteria that can infect open wounds and cause a rare condition called necrotizing fasciitis. These bacteria do not merely damage the surface of the skin – they release toxins that destroy the underlying tissue, including muscles, nerves and blood vessels. Once the bacteria reach the bloodstream, they gain ready access to additional tissues and organ systems. If left untreated, necrotizing fasciitis can be fatal, sometimes within 48 hours.
The bacterial species group A Streptococcus, or group A strep, is the most common culprit behind necrotizing fasciitis. But the CDC’s latest warning points to an additional suspect, a type of bacteria called Vibrio vulnificus. There are only 150 to 200 cases of Vibrio vulnificus in the U.S. each year, but the mortality rate is high, with 1 in 5 people succumbing to the infection.
How do you catch flesh-eating bacteria?
Vibrio vulnificus primarily lives in warm seawater but can also be found in brackish water – areas where the ocean mixes with freshwater. Most infections in the U.S. occur in the warmer months, between May and October. People who swim, fish or wade in these bodies of water can contract the bacteria through an open wound or sore.
Vibrio vulnificus can also get into seafood harvested from these waters, especially shellfish like oysters. Eating such foods raw or undercooked can lead to food poisoning, and handling them while having an open wound can provide an entry point for the bacteria to cause necrotizing fasciitis. In the U.S., Vibrio vulnificus is a leading cause of seafood-associated fatality.
Why are flesh-eating bacteria infections rising?
Vibrio vulnificus is found in warm coastal waters around the world. In the U.S., this includes southern Gulf Coast states. But rising ocean temperatures due to global warming are creating new habitats for this type of bacteria, which can now be found along the East Coast as far north as New York and Connecticut. A recent study noted that Vibrio vulnificus wound infections increased eightfold between 1988 and 2018 in the eastern U.S.
Climate change is also fueling stronger hurricanes and storm surges, which have been associated with spikes in flesh-eating bacteria infection cases.
Aside from increasing water temperatures, the number of people who are most vulnerable to severe infection, including those with diabetes and those taking medications that suppress immunity, is on the rise.
What are symptoms of necrotizing fasciitis? How is it treated?
Early symptoms of an infected wound include fever, redness, intense pain or swelling at the site of injury. If you have these symptoms, seek medical attention without delay. Necrotizing fasciitis can progress quickly, producing ulcers, blisters, skin discoloration and pus.
Treating flesh-eating bacteria is a race against time. Clinicians administer antibiotics directly into the bloodstream to kill the bacteria. In many cases, damaged tissue needs to be surgically removed to stop the rapid spread of the infection. This sometimes results in amputation of affected limbs.
Researchers are concerned that an increasing number of cases are becoming impossible to treat because Vibrio vulnificus has evolved resistance to certain antibiotics.
People who have a fresh cut, including a new piercing or tattoo, are advised to stay out of water that could be home to Vibrio vulnificus. Otherwise, the wound should be completely covered with a waterproof bandage.
People with an open wound should also avoid handling raw seafood or fish. Wounds that occur while fishing, preparing seafood or swimming should be washed immediately and thoroughly with soap and water.
Anyone can contract necrotizing fasciitis, but people with weakened immune systems are most susceptible to severe disease. This includes people taking immunosuppressive medications or those who have pre-existing conditions such as liver disease, cancer, HIV or diabetes.
It is important to bear in mind that necrotizing fasciitis presently remains very rare. But given its severity, it is beneficial to stay informed.
Winning the battle of skin tears in an aging population
This April 25th, 2017 webinar overviews a significant challenge that healthcare providers encounter daily.
“Skin tears” may sound like a relatively minor event, but in reality, these injuries can have a significant impact on the quality of patients’ lives in the form of pain, infection, and limited mobility. The incidence of skin tears has been reported to be as high as 1.5 million annually, and with an aging population, this number is likely to go higher. In this webinar, experts will explain how nurses can use an evidence-based approach—including following practice guidelines to assess the wound and select the proper dressing—for managing skin tears and minimizing their negative effects.
Our Speakers
The skin tear challenge
Kimberly LeBlanc
MN, RN, CETN(C)
Advanced practice nurse, KDS Professional Consulting President, International Skin Tear Advisory Panel An expert in skin tears, Kimberly will briefly set the stage by addressing the seriousness of skin tears and briefly addressing assessment such as classification.
The main focus will be on management, including goals of care, wound cleaning, wound bed preparation, and dressing selection.
Content will include information from the 2016 consensus statement on skin tears published in Advances in Skin & Wound Care.
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Tips and techniques for managing dressings for skin tears
Shannon Cyphers
RN, BSN, WCC
Clinical Account Manager, ConvaTec, Inc. Shannon will present wound and skin care product applications to help manage skin tears.
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Antibiotic overuse contributes to the problems of antibiotic resistance and healthcare acquired infections, such as Clostridium difficile. Antibiotic stewardship programs improve patient outcomes, reduce antimicrobial resistance, and save money. These programs are designed to ensure patients receive the right antibiotic, at the right dose, at the right time, and for the right duration. (more…)
Healing Wounds with Collagen: Knowing the Difference Makes All the Difference
This 30-minute presentation features learning opportunities that will provide in-depth instruction and demonstration in wound care treatments. After this webinar, the learner will be able to:
The Indications and Contraindications for Collagen
What a Wound Wants and Needs; and Why
Considerations of Collagen in Treating & Healing Wounds
Innovations in Wound Care: The role of wound cleansing in the management of wounds
This 30-minute presentation features learning opportunities that will provide in-depth instruction and demonstration in wound care treatments. After this webinar, the learner will be able to:
Identify the role of proper wound cleansing
Discuss how to select and use non-toxic wound cleansers
Describe advantages of collagen for managing a chronic wound
"Skin tears" may sound like a relatively minor event, but in reality, these injuries can have a significant impact on the quality of patients' lives in the form of pain, infection, and limited mobility.
The incidence of skin tears has been reported to be as high as 1.5 million annually, and with an aging population, this number is likely to go higher.
In this webinar, experts will explain how nurses can use an evidence-based approach -- including following practice guidelines to assess the wound and select the proper dressing -- for managing skin tears and minimizing their negative effects.
One of many dreaded tags from a Centers for Medicare & Medicaid Survey is F-Tag 314 — Pressure ulcers.
CMS writes, “Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being, in accordance with the comprehensive assessment and plan of care.” (more…)
Winning the battle of skin tears in an aging population
"Skin tears" may sound like a relatively minor event, but in reality, these injuries can have a significant impact on the quality of patients' lives in the form of pain, infection, and limited mobility.
The incidence of skin tears has been reported to be as high as 1.5 million annually, and with an aging population, this number is likely to go higher.
In this webinar, experts will explain how nurses can use an evidence-based approach -- including following practice guidelines to assess the wound and select the proper dressing -- for managing skin tears and minimizing their negative effects.
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Skin Damage Associated with Moisture and Pressure
• Identify how wounds are classified according to wound depth and etiology
• Describe the etiology of pressure injury and incontinence- associated skin damage (IAD)
• Understand evidenced-based protocols of care for prevention and management of IAD and pressure injuries
• Recognize and describe NPUAP-EPUAP Pressure Injury Classification System
• Understand appropriate ConvaTec products that can be used for prevention and treatment of IAD and pressure injuries
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