Patricia Coutts

Bacteriology, inflammation, and healing: a study of nanocrystalline silver dressings in chronic venous leg ulcers.

BACKGROUND: Healing of venous leg ulcers (VLUs) is often stalled despite compression therapy. Increased bacterial burden and chronic inflammation are 2 factors that may prevent these chronic VLUs (CVLUs) from healing. There is evidence that nanocrystalline silver dressings may reduce bacterial levels, decrease the chronic inflammatory response, and thus promote wound healing. OBJECTIVE: To determine the effects of a nanocrystalline silver barrier dressing on wound microflora, wound inflammation, and healing in CVLUs. METHOD: Stalled VLUs in 15 patients were managed using nanocrystalline silver dressings under 4-layer compression bandages. Paired skin biopsies at baseline and at an average of study week 6.5 were analyzed for bacteria and inflammatory infiltrates. Serum silver levels were monitored, and wound healing was assessed using planimetry. RESULTS: VLUs in 4 patients healed, and 8 other patients completed the 12-week study. There was a significant reduction in the log10 total bacterial count between baseline and final biopsies (P = .011). Greater numbers of lymphocytes were associated with an increased reduction of ulcer size at week 6.5 and final assessment at week 12 (P < .05). Heavy neutrophilic infiltration in skin biopsies at week 6.5 was associated with high bacterial counts and delayed healing (P = .037). The median reduction in ulcer surface area for all patients was 83.5%. Serum silver levels increased slightly, but values were within the normal range. CONCLUSION: A nanocrystalline silver dressing combined with 4-layer bandaging was safe and successful in promoting healing in stalled CVLUs. Healing was associated with a reduction in wound bacteria and neutrophilic inflammation with an associated persistent or high lymphocyte count, as determined by wound biopsy.

Reduction of Bacterial Burden and Pain in Chronic Wounds Using a New Polyhexamethylene Biguanide Antimicrobial Foam Dressing-clinical Trial Results

OBJECTIVE:A randomized controlled trial to evaluate the effectiveness of a polyhexamethylene biguanide (PHMB) foam dressing compared with a similar non-antimicrobial foam for the treatment of superficial bacterial burden, wound-associated pain, and reduction in wound size. SETTING AND PARTICIPANTS:This study was conducted in 2 wound healing clinics-a university hospital-based clinic and a community-based clinic. Forty-five chronic wound subjects, stratified to either foot or leg ulcers, were followed for 5 weeks. METHODS:A multicenter, prospective, double-blind, pilot, randomized controlled clinical trial with 3 study visits (Weeks 0, 2, 4) documented pain and local wound characteristics using NERDS and STONEES clinical criteria to determine superficial bacterial damage or deep/surrounding infection. RESULTS:The use of PHMB foam dressing was a significant predictor of reduced wound superficial bacterial burden (P = .016) at week 4 as compared with the foam alone. Pain reduction was also statistically significant at week 2 (P = .0006) and at week 4 (P = .02) in favor of the PHMB foam dressings. Polymicrobial organisms were recovered at week 4 in 5.3% in the PHMB foam dressing group versus 33% in the control group (P = .04). Subjects randomized to the PHMB foam dressing had a 35% median reduction in wound size by week 4, compared with 28% in the control group. CONCLUSIONS:PHMB foam dressing successfully reduced chronic wound pain and bacterial burden.

Peristomal skin complications and management.

PURPOSE: To provide the wound care practitioner with an overview of practical approaches to prevent and treat common peristomal skin conditions. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to: Describe the common types of peristomal skin problems and their causes. Identify treatment options for common peristomal skin problems.

A pilot (real-life) randomised clinical evaluation of a pain-relieving foam dressing: (ibuprofen-foam versus local best practice)

The aim of the study was to evaluate a novel foam dressing with continuous low‐level release of ibuprofen (Biatain‐Ibu foam dressing, Coloplast A/S, Humlebaek, Denmark) in persons with leg ulcers compared to local best practice. An open comparative and prospective block‐randomised study of 24 patients was conducted in a Canadian wound clinic. Twelve patients were randomised to ibuprofen–foam and 12 patients to local best practice. The study population consisted of patients with chronic, painful exudating leg ulcers. The patients rated their wound pain intensity at baseline and after the first dressing application. Pain intensity in the morning and evening was rated during a period of 1 week using a numeric box scale (NBS). A t‐test compared the main differences in pain intensity and a five‐point verbal rating scale measured the patients’ pain relief. At the last clinical visit, pain after dressing change was assessed using an NBS. In addition, wound size, percentage of healthy granulation tissue and the presence of peri‐ulcer erythema, were (all) evaluated at inclusion and the end of the study. The nurses and patients both evaluated the relative dressing performance and exudate management at the last study visit. This study demonstrates that the ibuprofen–foam dressing decreased wound pain in patients with leg ulcers compared to best practice. The ibuprofen–foam dressing was associated with: diminished chronic pain between dressing changes, reduced acute pain at dressing change, increased healthy granulation tissue, decreased peri‐wound erythema and excellent exudate handling capacity. It can be concluded from the results of the study that the combination of foam with a continuous low‐dose release of ibuprofen may offer a valuable new therapeutic approach to the reduction of wound pain.

A Randomized Crossover Investigation of Pain at Dressing Change Comparing 2 Foam Dressings

INTRODUCTION: Pain at dressing change is the result of several factors including trauma and skin stripping caused by the repeated removal of adhesive dressings. GOALS: To evaluate pain during dressing changes comparing a soft silicone foam dressing (Mepilex Border; Mölnlycke Health Care AB, Gothenburg, Sweden) with an adhesive hydrocellular polyurethane foam dressing (Allevyn Adhesive; Smith & Nephew, Hull, United Kingdom). METHODS: In this randomized crossover study, subjects were randomized to 1 of the 2 foam dressings for the first 2 scheduled follow-up visits. At visit 3, local wound treatment was switched to the alternate dressing until the end of the study (visits 4 and 5). Pain was measured with a visual analog scale and the Short-Form McGill Pain Questionnaire. The characteristics of the wound and the occurrence of adverse events were documented at each scheduled visit. RESULTS: A total of 32 patients entered into the study, and 26 patients completed all 5 follow-up study visits. Results indicated lower levels of pain at dressing removal and less periwound maceration in patients who were randomized to the silicone dressings. CONCLUSIONS: The results of this study indicate that soft silicone dressing is associated with less pain before and during dressing changes along with decreased periwound maceration.

A randomized controlled trial to evaluate an antimicrobial dressing with silver alginate powder for the management of chronic wounds exhibiting signs of critical colonization.

OBJECTIVE: The primary objective of this study was to evaluate if a topical silver dressing that consists of silver alginate powder is effective in managing chronic wounds that exhibit signs of critical colonization and promoting wound healing. METHOD: This was a prospective, open-label, 4-week randomized controlled trial. The primary end points of the study were changes in signs associated with critical colonization and in wound surface areas. All subjects were evaluated at weeks 0, 2, and 4 at the end of the study. SUBJECT AND SETTINGS: Participants between 18 and 85 years of age were recruited from 2 wound care clinics in Canada. The study was reviewed and approved by research ethics boards. DATA ANALYSIS: Analyses of this study were carried out based on intent-to-treat principle; t tests were used to determine if the means were statistically different between treatment groups. RESULTS: Thirty-four subjects participated and completed in the study. In the control group, the mean infection checklist score was 2.2 at baseline and 2.3 at week 4 (t 9 = −0.36, P = .73). In the silver alginate powder group, the infection score reduced from 3.3 at baseline to 1.3 at week 4; the result was significant (t 23 = 7.62, P < .00). The difference in average surface reduction over time between the 2 groups was statistically significant (t 32 = 3.56, P < .001). Subjects randomized to the silver group achieved a greater surface reduction than those who were randomized to the use of foam dressing as the control. CONCLUSION: Silver alginate powder is an effective treatment option for wounds with increased bacterial burden.

The use of a novel oxygenating hydrogel dressing in the treatment of different chronic wounds.

A novel oxygenating hydrogel dressing, Oxyzyme Sterile Wound Dressing with Iodine (Insense, Ltd, Sharnbrook, UK) was evaluated during a 4-week trial in Toronto, Ontario, Canada, for its performance in the treatment of chronic wounds. The dressing has not yet received Food and Drug Administration approval in the United States. The authors present several cases demonstrating the flexibility in use of this new wound care treatment. Its demonstrated benefits include pain management, exudate management, and the creation of a healing environment.

Continuous Topical Oxygen for the Treatment of Chronic Wounds: A Pilot Study

ABSTRACT Oxygen is essential for all stages of wound healing. Previous research has shown topical administration of oxygen to have positive effects on wound healing. In this study, the application of transdermal continuous topical oxygen therapy (TCOT) was evaluated for its effect on chronic wound healing in 9 patients. After 4 weeks of treatment, mean wound surface area and wound infection checklist scores were significantly reduced. Signs of bacterial damage were also reduced. Findings from this study suggest TCOT may be beneficial in promoting chronic wound healing.

Validation of commercially available infrared thermometers for measuring skin surface temperature associated with deep and surrounding wound infection.

OBJECTIVE:Increased local skin temperature is a classic sign of wound infection, repetitive trauma, and deep inflammation. Noncontact infrared thermometers can help to detect increases in skin surface temperatures; however, most scientifically tested devices are far too expensive for everyday wound care providers to use in routine clinical practice. This noninferiority study was conducted in an attempt to determine whether 4 less expensive, commercially available noncontact infrared thermometers have a similar level of accuracy as the scientifically accepted Exergen DermaTemp 1001 (Exergen Products, Watertown, Massachusetts). DESIGN, SETTING, AND PARTICIPANTS:Using an observational study design, participants with open wounds were randomly selected from a chronic wound clinic (n = 108). Demographic data and wound location were documented for all participants. Skin temperatures were recorded using 5 noncontact infrared thermometers under consistent environmental conditions. The thermometer brands were as follows: Exergen DermaTemp, Mastercool MSC52224-A (Mastercool Inc, Randolph, New Jersey), ATD Tools 70001 Infrared Thermometer (ATD Tools Inc, Wentzville, Missouri), Mastercraft Digital Temperature Reader (Mastercraft Canada, Toronto, Ontario, Canada), and Pro Point Infrared Thermometer (Princess Auto, Winnipeg, Manitoba, Canada). Data analysis was based on the skin surface temperature difference (&Dgr;T in degrees Fahrenheit) between the wound site and an equivalent contralateral control site. OUTCOME MEASURES:One-way analysis of variance was used to compare the mean &Dgr;T values for all the 5 thermometers, followed by post hoc analysis. Demographic data were analyzed using descriptive statistics. Interrater reliability was assessed for consistency using the intraclass correlation coefficient. MAIN RESULTS:No statistical difference was reported between the &Dgr;T values for the 5 different thermometers (F4,514 = 0.339, P = .852). Post hoc analysis showed no significant difference when the thermometers were compared with the Exergen DermaTemp 1001, and Mastercool MSC52224-A (P = .987), ATD Tools 70001 Infrared Thermometer (P = .985), Mastercraft Digital Temperature Reader (P = .972), and Pro Point Infrared Thermometer (P = .774). The results for intraclass correlation demonstrated a high reliability and agreement between raters, as the intraclass correlation coefficient values for all thermometers were greater than 0.95. CONCLUSIONS:The results of this study demonstrate that less expensive, industrial-grade noncontact infrared thermometers have reliable temperature readings to identify and quantify the temperature gradients that along with other signs may be associated with deep and surrounding wound infection or tissue injury due to repeated microtrauma.

Clinical Features and Patient Outcomes of Hidradenitis Suppurativa: A Cross-Sectional Retrospective Study.

Background: Despite the high burden of disease associated with hidradenitis suppurativa (HS), epidemiologic data are scarce. Objective: The objective was to review demographic features and clinical findings in 80 HS patients from 2 referral centres in Ontario, Canada, from October 2013 to September 2014, and to assess for factors that are associated with more advanced disease. Methods: Multicentre cross-sectional study. The data on demographic and clinical features were obtained by questionnaires and chart review. Results: Of a total of 80 patients (67.5% females), percentages of patients in Hurley stages I, II, and III were 15.4%, 55.8%, and 28.9%, respectively. Most patients were not diagnosed for more than 1 year (70.1%). Patients with more severe disease were more likely to be females and to have a greater number of lesions and were less likely to be diagnosed initially by a dermatologist. Conclusions: This study documents the common demographic and clinical features of HS to optimize resource allocation and patient outcomes.