Ostomy Wound Management 

About: Ostomy Wound Management is an academic journal. The journal publishes majorly in the area(s): Wound care & Population. It has an ISSN identifier of 0889-5899. Over the lifetime, 1576 publications have been published receiving 28492 citations.

Results of the 2008-2009 International Pressure Ulcer Prevalence Survey and a 3-year, acute care, unit-specific analysis.

Abstract: The National Quality Forum has identified a pressure ulcer as a hospital-acquired condition (HAC) that is high-cost and high-volume and may be preventable with implementation of evidence-based guidelines The Center for Medicare and Medicaid Services no longer reimburses acute care facilities for the ancillary cost of facility-acquired (FA) ulcers Benchmarking patient safety indicators, such as FA, may help facilities reduce pressure ulcer rates The purpose of this observational, cross-sectional cohort study was to report the International Pressure Ulcer Prevalence Survey (IPUP) in the United States in 2008 and 2009 In addition, previously collected data (2006/2007) were used to evaluate and report general and unit-specific prevalence rates in acute care facilities The overall prevalence and FA pressure ulcer rates were 135% and 6% (2008, N = 90,398) and 123 and 5% (2009, N = 92,408), respectively In 2008 and 2009, overall prevalence rates were highest in long-term acute care (22%) FA rates were highest in adult intensive care units (ICUs) and ranged from 92% (general cardiac care unit [CCU]) to 121% (medical ICU) in 2008 and from 88% (general CCU) to 103% (surgical ICU) in 2009 In 2009, 33% of ICU patients developed severe FA ulcers (Stage III, Stage IV, eschar/unable to stage, or deep tissue injury) In 2009, approximately 10% (n = 1,631) of all ulcers were described as device-related The most common anatomic locations for device-related ulcers were the ear (20%) and sacral/coccyx region (17%) Both the overall and FA pressure ulcer prevalence rates were lower in 2008 and 2009 than in 2006 and 2007 Results indicate that, although overall prevalence trends are encouraging, there is a stark contrast from the desired state, especially in adult ICUs

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

Abstract: 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.

A prospective, randomized, controlled trial of autologous platelet-rich plasma gel for the treatment of diabetic foot ulcers.

Abstract: Nonhealing diabetic foot ulcers are a common cause of amputation. Emerging cellular therapies such as platelet-rich plasma gel provide ulcer management options to avoid loss of limb. The purpose of this prospective, randomized, controlled, blinded, multicenter clinical study was to evaluate the safety and efficacy of autologous platelet-rich plasma gel for the treatment of nonhealing diabetic foot ulcers. One hundred, twenty-nine (129) patients were screened; 72 completed a 7-day screening period and met the study inclusion criteria. Patients were randomized into two groups - the standard care with platelet-rich plasma gel or control (saline gel) dressing group - and evaluated biweekly for 12 weeks or until healing. Healing was confirmed 1 week following closure and monitored for another 11 weeks. An independent audit led to the exclusion of 32 patients from the final per-protocol analysis because of protocol violations and failure to complete treatment. In this group, 13 out of 19 (68.4%) of the platelet-rich plasma gel and nine out of 21 (42.9%) of the control wounds healed. After adjusting for wound size outliers (n = 5), significantly more platelet-rich plasma gel (13 out of 16, 81.3%) than control gel (eight out of 19, 42.1%) treated wounds healed (P = 0.036, Fisher's exact test). Kaplan-Meier time-to-healing also was significantly different between groups (log-rank, P = 0.0177). No treatment-related serious adverse events were reported and bovine thrombin used in the preparation of PRP did not cause Factor V inhibition. When used with good standards of care, the majority of nonhealing diabetic foot ulcers treated with autologous platelet-rich plasma gel can be expected to heal.

Vacuum-assisted closure versus saline-moistened gauze in the healing of postoperative diabetic foot wounds.

Abstract: Diabetic foot wounds present a great challenge to wound care practitioners. The objective of this pilot study was to determine whether vacuum-assisted closure (V.A.C.) therapy would afford quicker wound resolution as compared to saline-moistened gauze in the treatment of postoperative diabetic foot wounds. Ten patients were randomized into either the experimental V.A.C. group or control saline gauze group. Included in the study were diabetic patients 18 to 75 years of age who had a nonhealing foot ulceration. Excluded were those patients with venous disease, coagulopathy, or those who had active infections not resolved by initial surgical debridement. All foot ulcers were surgically debrided prior to initiation of V.A.C. or gauze treatment. In the experimental group, V.A.C. dressings were applied in accordance with manufacturer's protocol for chronic wounds and changed every 48 hours. In the control group, saline gauze dressings were applied at the time of surgical debridement and changed twice a day thereafter. Measurements and photos were obtained to document wound progress. Main outcome measures included: 1) time to satisfactory healing (calculated from date of initial debridement to date of definitive closure, and 2) change in wound surface area (calculated from initial wound tracing to final tracing). Satisfactory healing in the V.A.C. group was achieved in 22.8 (+/- 17.4) days, compared to 42.8 (+/- 32.5) days in the control group. Surface area changes of 28.4% (+/- 24.3) average decrease in wound size in the V.A.C. group, compared to a 9.5% (+/- 16.9) average increase in the control group during measurement period.