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Journal Article•DOI•

Alginate dressings for treating pressure ulcers

Jo C Dumville1, Samantha Keogh2, Zhenmi Liu1, Nikki Stubbs3, Rachel Walker2, Mathew Fortnam4 •
University of Manchester1, Griffith University2, Leeds Community Healthcare NHS Trust3, University of York4
21 May 2015-Cochrane Database of Systematic Reviews (John Wiley & Sons, Ltd)-Vol. 2015, Iss: 5
TL;DR: The relative effects of alginate dressings compared with alternative treatments are unclear and decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.
Abstract: Background: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type. Objectives: To assess the effects of alginate dressings for treating pressure ulcers in any care setting. Search methods: For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. Selection criteria: Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above). Data collection and analysis Two review authors independently performed study selection, risk of bias assessment and data extraction. Main results: We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was of low or very low quality. Where data were available there was no evidence of a difference between alginate dressings and alternative treatments in terms of complete wound healing or adverse events. Authors' conclusions: The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.

Summary (1 min read)

Jump to: [Background] – [Main results] and [Authors’ conclusions]

Background

  • Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both.
  • Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
  • A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers.
  • Each review will focus on a particular dressing type.

Main results

  • The authors included six studies (336 participants) in this review; all studies had two arms.
  • The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy.
  • Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times.
  • All the evidence was of low or very low quality.
  • 1Alginate dressings for treating pressure ulcers Copyright © 2015 The Cochrane Collaboration.

Authors’ conclusions

  • The relative effects of alginate dressings compared with alternative treatments are unclear.
  • Pressure ulcers can be painful, may become infected, and so affect people’s quality of life.
  • Generally, the studies the authors found did not have many participants and the results were often inconclusive.
  • More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings or other treatments.
  • The mean reduction in ulcer size (compared to baseline) was 42.5%.

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Content maybe subject to copyright    Report

Alginate dressings for treating pressure ulcers (Review)
Author
Dumville, Jo C, Keogh, Samantha J, Liu, Zhenmi, Stubbs, Nikki, Walker, Rachel M, Fortnam,
Mathew
Published
2015
Journal Title
Cochrane Database of Systematic Reviews
Version
Version of Record (VoR)
DOI
https://doi.org/10.1002/14651858.CD011277.pub2
Copyright Statement
© 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is
published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2015,
Issue 5. Cochrane Reviews are regularly updated as new evidence emerges and in response
to comments and criticisms, and the Cochrane Database of Systematic Reviews should be
consulted for the most recent version of the Review.
Downloaded from
http://hdl.handle.net/10072/81471
Griffith Research Online
https://research-repository.griffith.edu.au
Cochrane Database of Systematic Reviews
Alginate dressings for treating pressure ulcers (Review)
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M.
Alginate dressings for treating pressure ulcers.
Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277.
DOI: 10.1002/14651858.CD011277.pub2.
www.cochranelibrary.com
Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .
5BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
20ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . .
28DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29AUTHORS’ CON CLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . .
56INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iAlginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
[Intervention Review]
Alginate dressings for treating pressure ulcers
Jo C Dumville
1
, Samantha J Keogh
2
, Zhenmi Liu
1
, Nikki Stubbs
3
, Rachel M Walker
2
, Mathew Fortnam
4
1
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
2
NHMRC Centre of Research Excellence
in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
3
Wound Prevention and Management Service, Leeds Community Healthcare NHS Trust, St Mary’s Hospital, Leeds, UK.
4
Cochrane
Wounds Group, University of York, York, UK
Contact address: Jo C Dumville, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL,
UK.
jo.dumville@manchester. ac.uk.
Editorial group: Cochrane Wounds Group.
Publication s tatus and date: New, published in Issue 5, 2015.
Review content assessed as up-to-date: 14 April 2015.
Citation: Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M. Alginate dressings for treating pressure ulce r s. Cochrane
Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277. DOI: 10.1002/14651858.CD011277.pub2.
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
Background
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying
tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of
pressure ul cers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers.
Each review will focus on a particular dressing type.
Objectives
To assess the effects of alginate dressings for treating pressure ulce r s in any care setting.
Search methods
For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other
Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.
Selection criteria
Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or
no dressing in the treatment of pressure ulcers (stage II or above).
Data collection and analysis
Two review authors independently performed study selection, risk of bias assessment and data extraction.
Main results
We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings
with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of
the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was
of low or very low quality. Where data were available there was no evidence of a diff erence between alginate dressings and alternative
treatments in terms of complete wound healing or adverse events.
1Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
Authors’ conclusions
The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration
and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties
offered by each dressing type, for example, exudate management.
P L A I N L A N G U A G E S U M M A R Y
Alginate dressings for treating pressure ulcers
What are pressure ulcers, and who is at risk?
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are wounds involving the skin and sometimes the
tissue th at lies underneath. Pressure ulcers can be painful, may become infected, and so affect people’s quality of life. People at risk of
developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as
elderly people and people who are ill as a result of short-term or long-term medical conditions.
In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent
to 4% of the total National Health Service expenditure. Pe ople with pressure ulcers have longer stays in hospital, and this increases
hospital costs. Figures from th e USA for 2006 suggest that hal f a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the
total hospital costs of these stays was USD 11 billion.
Why use alginate dressings to treat pressure ulcers?
Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used; these can vary considerably
in cost. Alginate dressings are a type that is highly absorbant and so can absorb the fluid (exudate) that is produced by some ulcers.
What we found
In June 2014 we searched for as many relevant studies as we could find that had a robust design (randomised controlled trials) and
compared alginate dressings with other treatments for pressure ulcers. We found 6 studies involving a total of 336 participants. Alginates
have been compared with hydrocolloid dressings, another type of alginate dressing, dextranomer paste dressing, silver-alginate dressing,
silver-zinc sulfadiazine cream and treatment with a radiant heat system in these studies. There was no evidence from these studies to
suggest that alginate wound dressings are more effective at healing pressure ulcers than other types of dressings or skin surface (topical)
treatments, or other interventions.
Generally, the studies we found did not have many participants and the results were often inconclusive. Some study reports did not
provide information about how they were conducted and it was difficult to tel l whether the results presented were likely to be true.
More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings
or other treatments. This review is part of a suite of reviews investigating dressings for the treatment of pressure ulcers
This plain language summary is up-to-date as of June 2014.
2Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
Citations
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Journal Article•DOI•
Engineered Biopolymeric Scaffolds for Chronic Wound Healing.

[...]

Laura E. Dickinson, Sharon Gerecht1•
Johns Hopkins University1
05 Aug 2016-Frontiers in Physiology
TL;DR: Key polymeric scaffold design criteria, including degradation, biocompatibility, and microstructure, and how they translate to inductive microenvironments that stimulate cell infiltration and vascularization to enhance chronic wound healing are discussed.
Abstract: Skin regeneration requires the coordinated integration of concomitant biological and molecular events in the extracellular wound environment during overlapping phases of inflammation, proliferation, and matrix remodeling. This process is highly efficient during normal wound healing. However, chronic wounds fail to progress through the ordered and reparative wound healing process and are unable to heal, requiring long-term treatment at high costs. There are many advanced skin substitutes, which mostly comprise bioactive dressings containing mammalian derived matrix components and/or human cells, in clinical use. However, it is presently hypothesized that no treatment significantly outperforms the others. To address this unmet challenge, recent research has focused on developing innovative acellular biopolymeric scaffolds as more efficacious wound healing therapies. These biomaterial-based skin substitutes are precisely engineered and fine-tuned to recapitulate aspects of the wound healing milieu and target specific events in the wound healing cascade to facilitate complete skin repair with restored function and tissue integrity. This mini-review will provide a brief overview of chronic wound healing and current skin substitute treatment strategies while focusing on recent engineering approaches that regenerate skin using synthetic, biopolymeric scaffolds. We discuss key polymeric scaffold design criteria, including degradation, biocompatibility, and microstructure, and how they translate to inductive microenvironments that stimulate cell infiltration and vascularization to enhance chronic wound healing. As healthcare moves towards precision medicine-based strategies, the potential and therapeutic implications of synthetic, biopolymeric scaffolds as tunable treatment modalities for chronic wounds will be considered.

144 citations

Cites background from "Alginate dressings for treating pre..."

  • ...…numerous alginate-based wound dressings approved for use in managing variety of wound types in which exudate is present, such as chronic wounds, including TegagenTM (3M), AlgisiteTM (Smith and Nephew), and Algi-Fiber (CoreLeader Biotech) to name a few (Dumville et al., 2015; O’Meara et al., 2015)....

    [...]

Journal Article•DOI•
Review of the Current Management of Pressure Ulcers.

[...]

Tatiana Boyko1, Michael T. Longaker1, George P. Yang1, George P. Yang2•
Stanford University1, Veterans Health Administration2
27 Sep 2016-Advances in wound care
TL;DR: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming.
Abstract: Significance: The incidence of pressure ulcers is increasing due to our aging population and the increase in the elderly living with disability. Learning how to manage pressure ulcers appropriately is increasingly important for all professionals in wound care. Recent Advances: Many new dressings and treatment modalities have been developed over the recent years and the goal of this review is to highlight their benefits and drawbacks to help providers choose their tools appropriately. Critical Issues: Despite an increased number of therapies available on the market, none has demonstrated any clear benefit over the others and pressure ulcer treatment remains frustrating and time-consuming. Future Directions: Additional research is needed to develop products more effective in prevention and treatment of pressure ulcers.

141 citations

Journal Article•DOI•
First-Line Interactive Wound Dressing Update: A Comprehensive Review of the Evidence.

[...]

Carolina D Weller1, Victoria Team1, Geoffrey Mendes Sussman1•
Monash University1
28 Feb 2020-Frontiers in Pharmacology
TL;DR: There is lack of high quality evidence and the need for future well designed trials on physical properties of wound dressing products, including semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels.
Abstract: Wound management is a significant and growing issue worldwide. Knowledge of dressing products and clinical expertise in dressing selection are two major components in holistic wound management to ensure evidence-based wound care. With expanding global market of dressing products, there is need to update clinician knowledge of dressing properties in wound care. Optimal wound management depends on accurate patient assessment, wound diagnosis, clinicians' knowledge of the wound healing process and properties of wound dressings. We conducted a comprehensive review of the physical properties of wound dressing products, including the advantages and disadvantages, indications and contraindications and effectiveness of first-line interactive/bioactive dressing groups commonly used in clinical practice. These include semipermeable films, foams, hydroactives, alginates, hydrofibers, hydrocolloids, and hydrogels. In making decisions regarding dressing product selection, clinicians need to ensure a holistic assessment of patient and wound etiology, and understand dressing properties when making clinical decisions using wound management guidelines to ensure optimal patient outcomes. This review has highlighted there is lack of high quality evidence and the need for future well designed trials.

107 citations

Journal Article•DOI•
Silver in Wound Care—Friend or Foe?: A Comprehensive Review

[...]

Ibrahim Khansa1, Anna R. Schoenbrunner2, Casey T. Kraft2, Jeffrey E. Janis2•
Nationwide Children's Hospital1, The Ohio State University Wexner Medical Center2
12 Aug 2019-Plastic and reconstructive surgery. Global open
TL;DR: In infected wounds, silver is beneficial for the first few days/weeks, after which nonsilver dressings should be used instead, and for clean wounds and closed surgical incisions, silver confers no benefit.
Abstract: The usefulness of silver for wound treatment has been known since 69 B.C.1 While silver metal (Ag) has no medicinal activity, silver ion (Ag+) has a broad antimicrobial spectrum, and is cytotoxic to bacteria, viruses, yeast, and fungi.2 Ag+ binds to DNA, RNA, and various proteins, leading to cell death via multiple mechanisms,3 such as protein and nucleic acid denaturation, increased membrane permeability, and poisoning of the respiratory chain.4 For this reason, resistance against the silver ion has only rarely been reported.5–7 The past few decades have seen a renewed interest in silver as a topical antimicrobial agent. Silver sulfadiazine (SSD) is a very widely used silver formulation, especially in burns. More recently, dressing with nanocrystalline silver has been developed. These novel dressings release silver ions into the wound in a sustained fashion. While the silver ion has great antimicrobial and bactericidal properties, it is also toxic to fibroblasts when present in high concentration.1,16,17 Injudicious use of silver-containing dressings can lead to impaired wound healing.45 It is imperative, therefore, that guidelines be developed on the proper use of silver-containing dressings. Our purpose in this study was to evaluate the existing evidence on the use of silver in wound care. The questions that we sought to answer were: 1) What is the quality of the published studies on the use of silver in wound care? 2) What are the advantages and disadvantages of various silver delivery systems? 3) What is the evidence for the use of silver-containing dressings in infected and heavily contaminated wounds? 4) What is the evidence for the use of silver-containing dressings in clean and clean-contaminated wounds? 5) What is the evidence for the use of silver-containing dressings in burns? 6) What is the evidence for the use of silver-containing dressings over closed surgical incisions? 7) What is the optimal strategy for the use of silver-containing dressings? 8) How does silver compare to alternative, lesser known agents? METHODS A PubMed literature search was performed using the following search parameters: silver AND (antimicrobial OR antibacterial) AND wound AND randomized; Silver AND epithelialization AND randomized; Silver AND negative pressure. The results were screened manually to exclude articles that were not relevant to our study (not about wound care), not in English, or which did not compare a silver-containing product to another product. We also excluded clinical studies with fewer than 20 patients. The articles were manually screened and duplicates were excluded. The remaining articles were analyzed in detail qualitatively, to extract answers to our study questions. The articles analyzed in this study are shown in Table ​Table11. Table 1. Summary of the Articles Included in This Study

90 citations

Journal Article•DOI•
Hydrolytically-degradable click-crosslinked alginate hydrogels.

[...]

Aline Lueckgen1, Daniela S. Garske1, Agnes Ellinghaus1, Rajiv Desai2, Alexander G. Stafford2, David J. Mooney2, Georg N. Duda1, Amaia Cipitria1, Amaia Cipitria3 •
Charité1, Wyss Institute for Biologically Inspired Engineering2, Max Planck Society3
01 Oct 2018-Biomaterials
TL;DR: Degradable biomaterials with tunable and decoupled mechanical and degradation behavior could be useful in many tissue engineering applications.

71 citations

References
More filters
Journal Article•DOI•
A longitudinal study of risk factors associated with the formation of pressure ulcers in nursing homes

[...]

Gary H. Brandeis1, Wee Lock Ooi, Monir Hossain, John N. Morris, Lewis A. Lipsitz2 •
Boston University1, Brigham and Women's Hospital2
01 Apr 1994-Journal of the American Geriatrics Society
TL;DR: The objective of this study is to determine risk factors associated with the formation of stage II—IV pressure ulcers in nursing homes.
Abstract: Objective: To determine risk factors associated with the formation of stage II—IV pressure ulcers in nursing homes. Design: Since the incidence rate for pressure ulcer formation varies among nursing homes, the homes were divided into tertiles based on these rates. Pooled logistic regression was used to model which factors are associated with the formation of pressure ulcers in both high and low incidence homes. Setting: 78 National HealthCorp nursing homes. Subjects: We studied 4232 nursing home residents free of pressure ulcers on admission to a nursing facility and at 3-months follow-up. All remained in the home for at least 3 additional months to a maximum of 21 months. Measurements: The effects of age, gender, race, antipsychotic drug use, urinary incontinence, fecal incontinence, body mass index, diabetes mellitus, disorientation, ambulation, physical restraints, activities of daily living of bathing, feeding, or transferring, and nursing home bed size on the formation of a stage II—IV pressure ulcer while the subject was a resident in the nursing home were studied. Main Results: Significant factors associated with the formation of pressure ulcers in high incidence homes (21-month incidence = 19.3%) were ambulation difficulty (OR = 3.3; CI = 2.0, 5.3), fecal incontinence (OR = 2.5; CI = 1.6, 4.0), diabetes mellitus (OR = 1.7; CI = 1.2, 2.5), and difficulty feeding oneself (OR = 2.2; CI = 1.5, 3.3). In the low incidence homes (21-month incidence = 6.5%), significant factors associated with pressure ulcer incidence were ambulation difficulty (OR = 3.6; CI = 1.7, 7.4), difficulty feeding oneself (OR = 3.5; CI = 2.0, 6.3), and male gender (OR = 1.9; CI = 1.2, 3.6). Conclusions: Although low and high incidence homes share similar risk factors, such as ambulation and feeding activities of daily living, the main difference was that diabetes and fecal incontinence played a major role only in high risk homes, while male gender was an important discriminator only in low incidence homes. Yet, it is unclear if these factors explain the three-fold difference in the incidence rates for pressure ulcers in these facilities. Baseline or resident clinical characteristic differences of any one factor between the high and low incidence homes varied by no more than 5%. While we identified certain conditions which are associated with pressure ulcer formation, there may be unknown or unmeasured facility effects in addition to the characteristics of a given resident in a particular home.

222 citations

Journal Article•DOI•
Serial surgical debridement: a retrospective study on clinical outcomes in chronic lower extremity wounds.

[...]

Matthew Cardinal, David Eisenbud, David G. Armstrong1, Charles M. Zelen2, Vickie R. Driver3, Vickie R. Driver1, Christopher E. Attinger4, Tania J. Phillips3, Keith G Harding5 •
University of Arizona1, University of Virginia2, Boston University3, Georgetown University4, Cardiff University5
01 May 2009-Wound Repair and Regeneration
TL;DR: It is suggested that frequent debridement of DFUs and VLUs may increase wound healing rates and rates of closure, though there is not enough evidence to definitively conclude a significant effect.
Abstract: This investigation was conducted to determine if a correlation exists between wound healing outcomes and serial debridement in chronic venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). We retrospectively analyzed the results from two controlled, prospective, randomized pivotal trials of topical wound treatments on 366 VLUs and 310 DFUs over 12 weeks. Weekly wound surface area changes following debridement and 12-week wound closure rates between centers and patients were evaluated. VLUs had a significantly higher median wound surface area reduction following clinical visits with surgical debridement as compared with clinical visits with no surgical debridement (34%, p=0.019). Centers where patients were debrided more frequently were associated with higher rates of wound closure in both clinical studies (p=0.007 VLU, p=0.015 DFU). Debridement frequency per patient was not statistically correlated to higher rates of wound closure; however, there was some minor evidence of a positive benefit of serial debridement in DFUs (odds ratio-2.35, p=0.069). Our results suggest that frequent debridement of DFUs and VLUs may increase wound healing rates and rates of closure, though there is not enough evidence to definitively conclude a significant effect. Future clinical research in wound care should focus on the relationship between serial surgical wound debridement and improved wound healing outcomes as demonstrated in this study.

172 citations

Journal Article•
Quality of life in patients with stomas: the Montreux Study.

[...]

Patrick Marquis, Alexia Marrel, Bernard Jambon
01 Feb 2003-Ostomy Wound Management
TL;DR: The results of this study suggest that stoma patient quality of life can be assessed, that it changes over time, and that patient access to specialist ostomy care nurses is particularly important during the first 3 to 6 months following surgery.
Abstract: Ostomy surgery profoundly affects a person's life. To determine the extent of the effect, the Stoma Care Quality of Life Index instrument was developed from a quality-of-life index. After ascertaining its validity and reliability, the instrument was used to measure patient quality of life in a European-wide study (16 countries). Six hundred, eighteen (618) stoma care nurses recruited 4,739 patients following stoma surgery. The self-administered questionnaire was completed immediately following surgery and after 3,6, 9, and 12 months. The mean age of patients was 61.6 years (+/- 13.4 years), 53.7% were men, and the majority (66.5%) had a colostomy. Stoma Care Quality of Life Index scores were fairly consistent in all patients throughout Europe immediately following surgery. While scores improved steadily over time, only the difference between the postoperative and 3-month scores was significant (P < 0.001). Stoma Care Quality of Life Index scores were significantly higher in patients who were satisfied with the care received than in those who were not satisfied. Similarly, patients who had a good relationship with the stoma care nurse and felt confident about changing the appliance had significantly higher Stoma Care Quality of Life Index scores than those who did not have a good relationship or feel confident. The results of this study suggest that stoma patient quality of life can be assessed, that it changes over time, and that patient access to specialist ostomy care nurses is particularly important during the first 3 to 6 months following surgery.

166 citations

Journal Article•DOI•
Evaluation of a silver-releasing hydroalginate dressing in chronic wounds with signs of local infection.

[...]

S Meaume, D Vallet, M Nguyen Morere, L Téot
01 Oct 2005-Journal of Wound Care
TL;DR: This study suggests that the use of silver-releasing dressings in the management of wounds at high risk of infection may have a clinically favourable influence on wound prognosis; the dressings also appeared to be well tolerated.
Abstract: Objective: To evaluate the clinical impact of using a silver-releasing hydroalginate dressing to minimise the risk of local infection in colonised chronic wounds. Method: This was a randomised (stratification according to wound type) open-label multicentre comparative two-arm parallel-group study. Thirteen centres recruited 99 patients with either a venous leg ulcer or a pressure ulcer. None of the wounds required systemic antibiotics or were associated with lymphangitis and/or fever, but at least two of the following criteria had to be present: continuous pain; erythema; oedema; heat; and moderate to high levels of serous exudate. Patients were allocated to receive either a silver-releasing hydroalginate dressing (Silvercel, the test group) or a pure calcium alginate dressing (Algosteril, the control group). Wounds were assessed daily over 14 days to complete a modified ASEPSIS index to evaluate risk of infection, and then weekly for two additional weeks. A global wound severity score and area tracings w...

140 citations

Journal Article•DOI•
Healing properties of calcium alginate dressings.

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J Sayag, S Lieaume, Serge Bohbot
02 Sep 1996-Journal of Wound Care
TL;DR: In a prospective, randomised, controlled trial of 92 patients with full-thickness pressure ulcers, the efficacy of an alginate wound dressing was compared to that of an established local treatment with dextranomer paste and a striking healing efficacy was obtained.
Abstract: In a prospective, randomised, controlled trial of 92 patients with full-thickness pressure ulcers, the efficacy of an alginate wound dressing was compared to that of an established local treatment with dextranomer paste. During treatment, a minimal 40% reduction in wound area was obtained in 74% of the patients in the alginate group and in 42% of those in the dextranomer group. The median time taken to achieve this goal was four weeks with alginate and more than eight weeks in the control group. Mean surface area reduction per week was 2.39cm2 (sd 3.54) and 0.27cm2 (sd 3.21) in the alginate and dextranomer groups respectively (p=0.0001). This difference was still highly significant when the sub-groups of almost completely healed subjects at the end of the study were considered. This striking healing efficacy of an alginate dressing suggests it possesses pharmacological properties which require further investigation.

127 citations

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Frequently Asked Questions (6)
Q1. What are the types of people at risk of developing pressure ulcers?

People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as elderly people and people who are ill as a result of short-term or long-term medical conditions. 

In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total National Health Service expenditure. 

Published by John Wiley & Sons, Ltd.A B S T R A C TPressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. 

Figures from the USA for 2006 suggest that half a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the total hospital costs of these stays was USD 11 billion. 

For this review, in April 2015 the authors searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. 

GRADE Working Group grades of evidence High quality: further research is very unlikely to change their confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on their confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on their confidence in the estimate of effect and is likely to change the estimate Very low quality: the authors are very uncertain about the estimate1