And Materials For The Clinical Studies Involving Patients
Seven patients with chronic venous ulcers of at least 30 weeks duration were selected. Inclusion criteria were: clinical evidence of infection, moderate to severe exudation, ankle brachial pressure indices of over 0.8 , no clinical evidence of silver allergy, and patients who did not have diabetes. Patients were excluded if they were being subjected to other therapies or conditions that might influence the action of sustained silver-release dressings.
The wounds were assessed and dressings were selected by the lead vascular nurse. Secondary four-layer bandages were used and the dressings were changed every three to four days. At dressing changes, samples of wound fluid/exudate and wound scale were sampled using sterile forceps. Microbiological swabs were also taken.
Guidelines For Surgery In The Treatment Of Diabetic Ulcers
Preamble: The mainstays of dressings and offloading are not successful in healing all diabetic ulcers. Over the years, multiple surgical procedures have been attempted to treat diabetic ulcers with varying degrees of success. True randomized clinical trials comparing operative techniques are difficult, but data are available supporting surgery in selected patients.
Guideline #6.1: Achilles tendon lengthening improves healing of diabetic forefoot wounds. Lengthening the Achilles tendon reduces pressure on forefoot plantar ulcers in patients with limited dorsiflexion of the ankle joint. Achilles tendon lengthening has been associated with a reduction in ulcer recurrence .
Principle: A tight Achilles tendon contributes to increased forefoot pressures. Lengthening the Achilles tendon reduces pressure on forefoot plantar ulcers in patients with limited dorsiflexion and may be of benefit in healing certain DFUs.
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When Would I Use Silver Alginate Wound Dressings
A silver antimicrobial alginate dressing may be used in a variety of situations. They can be used to help speed the healing of bedsores, diabetic foot ulcers, cavity wounds, venous leg ulcers, post-operative wounds such as incisions, trauma wounds, and burns. They are also frequently used for chronic wounds and acute wounds, or even wounds that are already infected. Silver alginate dressings are very strong, water-resistant, and powerful, yet delicate enough to help reduce trauma to a delicate injury. Touching sensitive wounds can be extremely painful. A silver antimicrobial alginate dressing can reduce pain by speeding up the healing of the outer layer of skin.
With A Simple Band Aid
This is not always recommended as most foot ulcers are bigger than what a band aid can cover. But if you want to reduce cost by not buying a larger medical gauze or bandage for a minor foot ulcer, a band aid will do. Note that the use of band aid is only temporary, as it is not guaranteed that the foot ulcer will remain small. Here are the steps to dress the diabetic foot ulcer with a band aid:
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Clinical And Translational Relevance
Sixty to 80% of chronic wounds harbor bacterial structures in a biofilm . For the clinician, the main difficulty is to distinguish between infecting and colonizing bacteria. Misclassification can lead to inappropriate antibiotic prescriptions that contribute to promoting the emergence of MDR bacteria, a major DFU health issue . Better understanding of the bacterial organization of biofilms in chronic wounds would allow development of tailored antimicrobial strategies and improving wound healing. In this context, a large majority of current fundamental studies on DFUs focuses on bacterial cooperation and the impact of local microenvironment on microorganisms. Thus, the host-microorganism interface plays a major role in DFI development. In DFU, bacteria are classically organized in functionally equivalent pathogroups where pathogenic and commensal bacteria co-aggregate symbiotically in a pathogenic biofilm to maintain a chronic infection . Polymicrobial biofilms have been observed both in pre-clinical studies using animal models and in clinical research on DFU. They represent the main cause of healing delay. Recently, some approaches have targeted biofilm formation with the aim of controlling infections . Better understanding of the host-bacterial interactions is essential to develop new therapeutic solutions that take into account the biofilm to limit the diffusion of MDR bacteria.
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Why Is Silver Used In Wound Care
Known for its antibacterial properties, silver is commonly used in a variety of medical applications, most commonly, wound care. Silver wound dressings slowly release a steady stream of positively charged ions at the surface of the wound. This positive action promotes wound healing and prevents infection in the wound. Silver dressings can also help to prevent scarring by quickly healing the outermost layer of the skin. The key to the healing power of silver is that it must be released slowly and steadily. Using products that offer a controlled release of silver ions will maximize the potential benefits of this type of wound dressing.
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Optimal Conformability Adapts To All Kinds Of Wound Shapes
Askina® Calgitrol® Paste® may also be used for other wounds such as deep cavity or difficult-to-dress wounds.
Regarding flat, superficial, low exuding wounds Askina® Calgitrol® Paste® may be spread on the entire surface of the wound bed by using a sterile glove or a sterile spatula. It must be covered with an appropriate secondary dressing depending on the amount of exudate.
Askina® Calgitrol® Paste® should be reapplied after each dressing change or if wound exudate leakage occurs through the secondary dressing.5) Askina® Calgitrol® Paste® is easy to remove by simple rinsing with sterile saline or Prontosan® Wound Irrigation Solution.5)
Define The Scope Of The Ebp
VLU is a common chronic condition affecting nearly 2.5 million individuals annually, characterized by an extended healing trajectory and a high risk of recurrence. According to the statistics, only 58 percent of patients heal, and 4 percent undergo amputation . Thus, the condition poses great clinical and economic challenges and requires an effective approach to its treatment.
Nowadays, practitioners may choose various methods for the healing of VLUs. Foam dressing is one of them, but it is not utilized so often compared to other products . Currently, there is not enough evidence on the efficacy of foam dressings in the treatment of the condition. Thus, the EBP research in this area is of great importance as it may contribute to the expansion of the existing knowledge base.
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Alginate Dressings For Venous Leg Ulcers
Venous leg ulcers are a common and recurring type of chronic or complex wound which can be distressing for patients and costly to healthcare providers. Compression therapy, in the form of bandages or stockings, is considered to be the cornerstone of venous leg ulcer management. Dressings are applied underneath bandages or stockings with the aim of protecting the wound and providing a moist environment to aid healing. Alginate dressings contain substances derived from seaweed and are one of several types of wound dressings available. We evaluated the evidence from five randomised controlled trials that compared either different brands of alginate dressings, or alginate dressings with other types of dressings. In terms of wound healing, we found no good evidence to suggest that there is any difference between different brands of alginate dressings, nor between alginate dressings and hydrocolloid or plain non-adherent dressings. Adverse events were generally similar between treatment groups . Overall, the current evidence is of low quality. Further, good quality evidence is required before any definitive conclusions can be made regarding the use of alginate dressings in the management of venous leg ulcers.
To determine the effects of alginate dressings compared with alternative dressings, non-dressing treatments or no dressing, with or without concurrent compression therapy, on the healing of venous leg ulcers.
Dressings Used Within The Trial
The most common silver-donating dressing used was Urgotul® SSD followed by Acticoat 7 and Aquacel® Ag . Most patients remained on the same dressing throughout the 12-week treatment, or until the ulcer had healed. The type of silver-donating dressing was changed in three patients during the trial because of lack of availability of a particular dressing, or nurse preference.
Most patients in the non-silver group were treated with low-adherence knitted viscose dressings throughout the initial 12-week treatment. The other non-antimicrobial dressings used for some or all of the treatment interval in the other cases were Urgotul® , Biatain , Atrauman® and Allevyn .
There were geographical differences in preferences for particular types of silver dressing: Urgotul® was more commonly used in South Yorkshire, and Acticoat 7 or Aquacel® Ag was more commonly used in Devon .
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Description Of The Condition
Venous leg ulcers are common and recurring complex wounds that heal by secondary intention . Problems with the leg veins reduce the efficient return of blood to the heart and increase the pressure in the veins , which may result in venous leg ulcers. The precise chain of events that links high venous pressures with skin breakdown and a chronic wound is not fully understood .
Venous leg ulcers commonly occur on the gaiter region of the lower leg . A venous leg ulcer is defined as any break in the skin that has either been present for longer than six weeks or occurs in a person with a history of venous leg ulceration. Differential diagnosis of the type of leg ulcer is made by taking a clinical history, physical examination, laboratory tests and haemodynamic assessment . True venous ulcers are moist, shallow and irregularly shaped and lie wholly or partly within the gaiter area of the leg. Leg ulcers can be associated with venous disease in combination with vascular disease, which impairs arterial blood supply in these instances they are said to have a ‘mixed’ aetiology . Open skin ulceration due solely to limb ischaemia from vascular disease is less common.
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Challenges Of Developing Therapeutics For Dfus
As an organ, the skin is readily accessible and thus uniquely suited to routine visual assessment and minimally invasive manipulation. This is advantageous when the skin incurs injury, permitting rapid diagnostic assessment and simple procedural interventions such as debridement. Moreover, external behavior modifications such as pressure off-loading can more directly modulate skin injury compared to injuries involving other organ systems. Such procedures and modifications can be and are routinely done as best-practice standard care, but an unintended consequence is that these opportunities create an additional layer of variance that complicates evaluation of new therapeutics.
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How The Intervention Might Work
Animal experiments conducted over 40 years ago suggested that acute wounds heal more quickly when their surfaces are kept moist rather than left to dry and scab . A moist environment is thought to provide optimal conditions for the cells involved in the healing process with faster revascularisation , and development of granulation tissue , as well as allowing autolytic debridement , which is thought to be an important part of the healing pathway .
The desire to maintain a moist wound environment is a key driver for the use of wound dressings and related topical agents. Whilst a moist environment at the wound site has been shown to aid the rate of epithelialisation in superficial wounds, excess moisture at the wound site can cause maceration of the surrounding skin , and it has also been suggested that dressings that permit fluid to accumulate might predispose wounds to infection . Wound treatments vary in their level of absorbency, so that a very wet wound can be treated with an absorbent dressing to draw excess moisture away and avoid skin damage, whilst a drier wound can be treated with a more occlusive dressing or a hydrogel to maintain a moist environment.
Some dressings are now also formulated with an ‘active’ ingredient .
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Activheal Foam Adhesive Is An Absorbent Foam Dressing Ideal For Moderate To High Exuding Wounds
FEATURESEXCELLENT ABSORPTION OF EXUDATE // VERSATILE // PROMOTES HEALING THROUGH A MOIST WOUND ENVIRONMENT // REDUCES THE RISK OF MACERATION // WATERPROOF // BACTERIAL BARRIER // SOFT AND COMFORTABLE //
ActivHeal® Foam Adhesive is a two layer dressing indicated for moderate to heavily exuding wounds. Each layer of the ActivHeal® Foam Adhesive contributes to the performance of the dressing.
The dressing comprises of a polyurethane absorbent foam pad and a polyurethane membrane. The core of the dressing is a layer of absorbent polyurethane foam which absorbs wound exudate vertically into the dressing. The absorbent pad retains the exudate within the dressing preventing the exudate from re-entering the wound and preventing maceration to the peri wound and surrounding skin. The polyurethane membrane provides an effective barrier function and is waterproof whilst allowing the transpiration of exudate which aids the total fluid handling capacity of the dressing.
Indicated for moderate to heavily exudating wounds. The dressing offers a pressure sensitive acrylic adhesive border ensuring the dressing remains in place allowing the patient to continue everyday activities confidently. The dressing conforms to the contours of the body which reduces the risk of rucking or catching on clothing and bedding.
Introduction And Current Guidance
Over the past 20 years, studies have generated much evidence to show that a moist wound environment is essential for wound healing. This has caused a proliferation of wound dressings with a higher acquisition cost than standard dressings and has left wound care providers confused about when it is appropriate to use these more expensive dressings .
Advanced wound dressings regulate the wound surface by retaining moisture or absorbing exudate, so protecting the wound base and tissue surrounding the wound. Maintaining a good moisture balance minimises patient discomfort before, during and after dressing changes. Some dressings are used for their antimicrobial properties . Choice of dressing may change as the nature of the wound base and wound exudate changes. Therefore, the selection of dressings requires training and expertise in wound care .
The advanced wound dressings section of the BNF provides information on the types and properties of different advanced dressings, and a table that suggests choices of primary dressing depending on the nature of the wound. Factors that should be considered when choosing a dressing include:
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the stage of wound healing
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amount of exudate
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the adhesiveness of a dressing
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irritation caused by the adhesive
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the frequency of dressing changes
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ease of use of the dressing
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amount of pain at dressing changes
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protection of the surrounding skin
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patient preference.
Full text of introduction and current guidance.
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