https://cmapspublic3.ihmc.us/rid=1266358861321_2027852911_13457/Wound%20Healing%20Dressings%20and%20Drug%20Delivery%20Systems.pdf

Wound healing dressings and drug delivery systems: a review.

The healing process in acute wounds has been extensively studied and the knowledge derived from these studies has often been extrapolated to the care of chronic wounds, on the assumption that nonhealing chronic wounds were simply aberrations of the normal tissue repair process. However, this approach is less than satisfactory, as the chronic wound healing process differs in many important respects from that seen in acute wounds. In chronic wounds, the orderly sequence of events seen in acute wounds becomes disrupted or “stuck” at one or more of the different stages of wound healing. For the normal repair process to resume, the barrier to healing must be identified and removed through application of the correct techniques. It is important, therefore, to understand the molecular events that are involved in the wound healing process in order to select the most appropriate intervention. Wound bed preparation is the management of a wound in order to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures. Experts in wound management consider that wound bed preparation is an important concept with significant potential as an educational tool in wound management.

This article was developed after a meeting of wound healing experts in June 2002 and is intended to provide an overview of the current status, role, and key elements of wound bed preparation. Readers will be able to examine the following issues;

• the current status of wound bed preparation;

• an analysis of the acute and chronic wound environments;

• how wound healing can take place in these environments;

• the role of wound bed preparation in the clinic;

• the clinical and cellular components of the wound bed preparation concept;

• a detailed analysis of the components of wound bed preparation.

(WOUND REP REG 2003;11:1–28)

Wound bed preparation: a systematic approach to wound management.

ObjectiveThe aim of this study was to assess the safety and performance of ReWalk in enabling people with paraplegia due to spinal cord injury to carry out routine ambulatory functions.DesignThis was an open, noncomparative, nonrandomized study of the safety and performance of the ReWalk pow

The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury.

Silver first gained regulatory approval for use as an antimicrobial agent in the early 20th century, but its usage diminished with the introduction of antibiotics in the 1940s. Recently, however, topical silver has gained popularity once again, principally in the management of open wounds. This has been largely due to the spread of methicillin-resistant Staphylococcus aureus and the resultant reduction in first-line antibiotic prescribing. The increase in the use of topical silver has raised issues concerning silver resistance, together with questions about the standardization of antimicrobial testing methods for silver. Issues related to silver product testing include a failure to establish standard procedures for determining MIC values, an absence of recognized breakpoints, a lack of conformity in the way different products release silver and variations in the effects of microbiological media on silver release and the measurement of inhibitory activity. The clinical incidence of silver resistance remains low, and emergence of resistance can be minimized if the level of silver ions released from products is high and the bactericidal activity rapid.

/pdf/the-increasing-use-of-silver-based-products-as-antimicrobial-2b7lzxr9se.pdf

The increasing use of silver-based products as antimicrobial agents: a useful development or a cause for concern?

Objectives To identify the impact of pressure ulcers (PUs) and PU interventions on health-related quality of life (HRQL). Design Systematic review and metasynthesis of primary research reporting the impact of PU and PU interventions on HRQL according to direct patient reports. Quality assessment criteria were developed and applied. Data extraction identified findings in the form of direct quotes from patients or questionnaire items and domain results. Combined synthesis of qualitative and quantitative research was performed using content analysis to generate categories and themes from findings. Thirteen electronic databases were searched, and hand searching, cross-referencing, contact with experts, and an online search was undertaken. No language restrictions were applied. Setting Adults with PUs in acute, community, and long-term care settings across Europe, the United States, Asia, and Australia. Participants Thirty-one studies including 2,463 participants with PUs were included in the review. Ages ranged from 17 to 96. Results The review included 10 qualitative and 21 quantitative studies; 293 findings, 46 categories, and 11 themes emerged. The 11 HRQL themes were physical impact, social impact, psychological effect, PU symptoms, general health, and other impacts of PUs: healthcare professional-client relationships, need for versus effect of interventions, impact on others, financial impact, perceived etiology, and need for knowledge. Conclusion There is evidence that PUs and PU interventions have a significant impact on HRQL and cause substantial burden to patients.

Impact of pressure ulcers on quality of life in older patients: a systematic review.

Successful diagnosis and treatment of patients with chronic wounds involve holistic care and a team approach. The integration of the work of an interdisciplinary care team that includes doctors, nurses, and allied health professionals with the patient, family, significant others, and caregivers offers an optimal formula for achieving wound resolution. Such an approach challenges practitioners and everyone participating in wound care to integrate data and information that arise from a number of sources and mitigating factors. In this article, the authors define the changing paradigm that links treatment of the cause and focuses on three components of local wound care: debridement, wound-friendly moist interactive dressings, and bacterial balance. The authors demonstrate that the treatment of chronic wounds can be accomplished through a series of recommendations and rationales based on the literature and their experience. These recommendations lay the groundwork for thorough assessment and evaluation of the wound.

Preparing the wound bed--debridement, bacterial balance, and moisture balance.

Wound bed preparation is the promotion of wound closure through diagnosis of the cause, attention to patient-centered concerns, and correction of systemic and local factors that may delay healing. To enhance the evidence base that may be lacking, a review of relevant literature was conducted and combined with input from the International Wound Bed Preparation Advisory Board and the Canadian Chronic Wound Advisory Board to create an updated examination of practices. A template based on expert opinion of the clinical actions corresponding to each step in the paradigm of preparing the wound bed is presented and the effects of local factors (tissue debridement, infection or inflammation, moisture balance, and edge effect [TIME]) are discussed. This review differentiates increased bacterial burden/infection in the superficial and deep wound bed compartments from inflammation and provides a topical approach to treatment. Inflammatory conditions causing leg ulcers, including pyoderma gangrenosum and vasculitis are reviewed. The topical combination of silver with absorptive dressings has led to new therapeutic options for increased bacterial burden in the surface wound compartment. A compilation of the available systematic reviews for the treatment of infection has been included as a background for the expert opinion.

Preparing the wound bed 2003: focus on infection and inflammation.

The effective management of nonhealing wounds is based on a complete patient history, a detailed initial assessment of the wound, and an analysis of probable causative factors. This information is used to individualize a management strategy to the underlying pathophysiology preventing healing and to implement appropriate wound interventions. Regular reassessment of progress toward healing and appropriate modification of the intervention are also necessary. Accurate and clinically relevant wound assessment is an important clinical tool, but this process remains a substantial challenge. Wound assessment terminology is nonuniform, many questions surrounding wound assessment remain unanswered, agreement has yet to be reached on the key wound parameters to measure in clinical practice, and the accuracy and reliability of available wound assessment techniques vary. This article, which resulted from a meeting of wound healing experts in June 2003, reviews clinically useful wound measurement approaches, provides an overview of the principles and practice of chronic wound assessment geared to a clinical audience, and introduces a simple mnemonic, MEASURE. MEASURE encapsulates key wound parameters that should be addressed in the assessment and management of chronic wounds: Measure (length, width, depth, and area), Exudate (quantity and quality), Appearance (wound bed, including tissue type and amount), Suffering (pain type and level), Undermining (presence or absence), Reevaluate (monitoring of all parameters regularly), and Edge (condition of edge and surrounding skin). This article also provides some preliminary recommendations targeted to developing best practice guidelines for wound assessment.

MEASURE: A proposed assessment framework for developing best practice recommendations for wound assessment.

Background and Purpose. Electrical current has been recommended for use on chronic pressure ulcers; however, the ability of this modality to improve healing of other types of chronic ulcers is less well established. The purpose of this study was to examine the effect of high-voltage pulsed current (HVPC) on healing of chronic leg ulcers. Subjects. Twenty-seven people with 42 chronic leg ulcers participated in the study. Methods. The subjects were separated into subgroups according to primary etiology of the wound (diabetes, arterial insufficiency, venous insufficiency) and then randomly assigned to receive either HVPC (100 microseconds, 150 V, 100 Hz) or a sham treatment for 45 minutes, 3 times weekly, for 4 weeks. Wound surface area and wound appearance assessed during an initial examination, following a 1- to 2-week period during which subjects received only conventional wound therapy, after 4 weeks of sham or HVPC treatment, and at 1 month following treatments. Results The results indicated that HVPC applied to chronic leg ulcers reduced the wound surface area over the 4-week treatment period to approximately one half the initial wound size (mean decrease=44.3%, SD=8.8%, range=2.8%-100%), which was over 2 times greater than that observed in wounds treated with sham units (mean decrease=16.0%, SD=8.9%, range=-30.3%-83.7%). Discussion and Conclusion. The results of the study indicate that HVPC administered 3 times a week should be considered to accelerate wound closure of chronic leg ulcers.

http://www.heilpraktiker-telefon.de/index_htm_files/houghton2003.pdf

Effect of electrical stimulation on chronic leg ulcer size and appearance.

https://www.archives-pmr.org/article/S0003-9993(08)01553-0/pdf

David Keast

Papers

Preparing the wound bed--debridement, bacterial balance, and moisture balance.

Preparing the wound bed 2003: focus on infection and inflammation.

MEASURE: A proposed assessment framework for developing best practice recommendations for wound assessment.

Effect of electrical stimulation on chronic leg ulcer size and appearance.

A Systematic Review of Therapeutic Interventions for Pressure Ulcers After Spinal Cord Injury