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Development of extramural health care for chronic wounds is still in its infancy in China, and thus it is urgent and vital to establish a correct concept and practicable principles. The authors reviewed recent domestic and international literature and summarized the following treatment procedures and principles for extramural health care of chronic wounds. (1) The patient needs to do self-assessment of the wound by using available simple methods; (2) The patient consults with professional physicians or nurses on wound care to define the severity and etiology of the non-healing wound; (3) Professionals evaluate the existing treatment strategies; (4) Etiological treatments are given by professionals; (5) Patients buy needed dressings via the more convenient ways from pharmacies, e-commerce platform or others; (6) Professionals provide a standardized and reasonable therapeutic plan based on the patient's wound conditions; (7) Both professionals and the patient pay attention to complications to prevent adverse outcomes; (8) Professionals strengthen the public education on wound care and integrated rehabilitation. This review expected to provide new perspectives on the therapeutic strategies for chronic wounds in an extramural setting.
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Humans , Wound Healing , Health Facilities , Delivery of Health Care , China , Wounds and Injuries/therapyABSTRACT
Calciphylaxis is a vascular disease caused by a combination of multiple factors, and the calcified ischemic lesion results in the severe skin damage accompanied by unbearable pain. Calciphylaxis tends to occur in patients with end-stage renal disease, and the treatment of this disease faces enormous challenges. Current treatment recommendations are mainly based on clinical experience and observational research reports, and there is still a lack of clinical practice standards or consensus for managing calciphylaxis. Therefore, this paper will review the effective treatment methods and off-label use of calciphylaxis based on literature reports, providing reference for the clinical treatment of the disease.
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Background and Objectives: To evaluate the role and efficiency of vacuum dressing in thehealing of wounds and to assess the benefits and limitations of using vacuum dressing indifferent types/categories of wound.Methods: The study of 25 cases was conducted in the Department of Surgery of atertiary care teaching hospital over a period of 2 years.Results: Vacuum dressing had a significant effect on the final outcome of wounds.Wounds which seemingly needed a flap surgery in the first impression, withsuccessive application of vacuum dressing cycles, could be covered with a simplesplit thickness skin graft. Many patients were salvaged of a revision amputation asshowed by the decrease in overall amputation rates.Interpretation and Conclusion: Based on the data from the present study and otherstudies available, vacuum dressing results in better healing, with minimalcomplications, and thus looks to be a promising alternative for the management ofvarious wounds. Vacuum dressing leads to faster healing of the wounds, thereforedecreasing the overall hospital stay. Hence, it is cost effective also. It reduces theinconvenience and discomfort caused to the patient by frequent change in dressings.It helps in reducing size of the wounds, has profound effect on wound depth andgranulation as seen in our study. It promotes granulation tissue completely coveringthe tendon, thus enabling simple techniques (e.g., skin graft) rather than formal flapclosure in few cases. Wounds with exposed underlying bone and chronic nonhealing ulcers can be managed well with vacuum dressing. It reduces the number ofamputations and re-debridement required. More number of wounds can be managedsuccessfully with secondary closure or skin grafting after multiple cycles of vacuumdressing. This reduces patient morbidity and minimizes the overall effect on hisquality of life. Good outcome of vacuum dressing also depends on its properapplication.
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Introduction: Rabies is a vaccine-preventable viral disease. Every year, Rabies causes 18 000-20 000 deaths in India and dogs are responsible for 99 % of all human deaths.Objectives: 1) To assess the knowledge and attitude about rabies among the nursing students.2) To assess whether there is any difference of knowledge and attitude about Rabies among different academic year of the nursing students.3) To assess whether there is any relation between scores of knowledge and attitude.Material & Methods: A cross sectional study was conducted among 142 students of B.Sc. Nursing College, Dibrugarh, Assam in January 2022 using Google form containing pre designed structured closed ended questionnaire by convenience sampling. Knowledge and attitude was assessed by a scoring system. Results were expressed in proportion, percentage, mean, standard deviation. ANOVA and Spearman”s correlation was applied. Results: Mean knowledge & attitude score was 15.7±3.6 and 23.6±2.6.Majority (82.4%) of the students had good knowledge about rabies.Almost all (97.9 %) students had positive attitude towards rabies. There was no significant difference between knowledge score and attitude score among different academic year of the students. Knowledge was positively correlated with attitude of the students.Conclusion: The study revealed good knowledge and positive attitude regarding rabies among the students
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Background: The incidence of diabetes and its complications is rising as a result of the lifestyle changes. The foot is most frequent site for complication in patients with diabetes. Dressings have a vital part to play in the management of wounds. The ideal antiseptic is one that is lethal to all forms of bacteria, has no deleterious effect on healing tissues, delineates the operative areas, easily applied and has wide spectrum of activity and absence of acquired bacterial resistance. Nanotechnology makes it possible to expand the surface area of silver particles markedly to nanoscale. They expand the surface area of silver particles increasing their contact with bacteria.Methods: In the proposed study, over a period of 18 months, 60 cases (30-30 in 2 groups) of diabetic foot ulcers were studied with respect to response (healing) to nano silver dressing and betadine dressing after dividing them randomly. Assessment was based on various parameters like size reduction, healthy granulation tissue, etc.Results: It was seen that percentage reduction in size, was more in nano silver group as compared to betadine group. Wounds were managed successfully, early in nano silver group and wound healing was better in nano silver group as compared to betadine group. Also, nano silver was better antimicrobial.Conclusions: The prospective study showed nano silver gel is safe and effective in wound management and gives better efficacy and faster response as compared to traditional betadine dressing.
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Lower limb reconstruction following trauma, chronic infection and cancer ablation remains challenging. However various options are now possible for lower limb reconstruction due to the more details available today about perforators. In recent years, the management of lower extremity has evolved with numerous new techniques and innovations and thus extremities are salvaged that would have been amputated in the past. Today we are able to cover various complex defects with the help of free flaps due to more of research and knowledge in this field which was previously unknown. In developed countries, all these procedures can be used because of the availability of good resources, good manpower, and the latest technologies. But in developing countries like India in spite of being aware of many of this methods, there is a limitation on using all these methods due to the limitation of resources, economic burden, limited manpower, and surgery time. The concept of the reconstructive ladder was proposed to achieve wounds with adequate closure using a stepladder approach from simple to complex procedures. The reconstructive elevator requires creative thoughts and consideration of multiple variables to achieve the best form and function rather than a sequential climb up the ladder. However, this paradigm of thought does not eliminate the concept of the reconstructive ladder but replaces it with a ladder of wound closure that makes its mark in the field where a variety of advanced reconstructive procedures and techniques is not readily available. Therefore the model of step ladder pattern of soft tissue defect management remains the good option for developing countries like ours. Also, various lower limb defects from simple to complex can be covered with simple methods rather than going for the most complex ones first. It helps in fast management and low economic burden to society with a lesser hospital stay.
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The construction of wound treatment specialty (center) with Chinese characteristics began in the early 21st century. Based on my personal experience, this paper systematically reviews the key points and characteristics of the specialty (center) construction of wound treatment with Chinese characteristics and its phased progress. Its future development is also prospected.
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Tetanus is an acute specific infection caused by obligate anaerobes, which is still a serious public health problem. Tetanus bacterium is an obligate anaerobic bacterium, widely distributed in nature, which can exist in dust, soil, human or animal excrement. The bacteria invade the body primarily through the skin or mucosal wounds, and most commonly in trauma and burn patients, unclean newborns, and unsafe surgical instruments. Exotoxin produced by tetanus bacteria can cause temporary changes in the central nervous system, manifested as systemic skeletal muscle persistence and paroxysmal spasm, severe cases of laryngospasm, asphyxia, lung infections and organ failure, which is a very serious and potentially fatal disease. This article is an expert consensus on the tetanus immunologic defense, aiming to aid the clinical decision making after open injury. According to epidemiological investigation of tetanus, types of injured population, wound exposure and misunderstandings of immunologic defense, the key measures to prevent tetanus are good wound management and immunization. This statement describes a preventive framework of tetanus immunization, including the tetanus immunization programs of infants, pregnant women, potentially high-risk population, immunodeficiency patients and children born to HIV-infected mothers. This consensus only provides academic guidance, the treatment of the patient must be based on the prevailing medical conditions.
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Tetanus is an acute specific infection caused by obligate anaerobes, which is still a serious public health problem. Tetanus bacterium is an obligate anaerobic bacterium, widely distributed in nature, which can exist in dust, soil, human or animal excrement. The bacteria invade the body primarily through the skin or mucosal wounds, and most commonly in trauma and burn patients, unclean newborns, and unsafe surgical instruments. Exotoxin produced by tetanus bacteria can cause temporary changes in the central nervous system, manifested as systemic skeletal muscle persistence and paroxysmal spasm, severe cases of laryngospasm, asphyxia, lung infections and organ failure, which is a very serious and potentially fatal disease. This article is an expert consensus on the tetanus immunologic defense, aiming to aid the clinical decision making after open injury. According to epidemiological investigation of tetanus, types of injured population, wound exposure and misunderstandings of immunologic defense, the key measures to prevent tetanus are good wound management and immunization. This statement describes a preventive framework of tetanus immunization, including the tetanus immunization programs of infants, pregnant women, potentially high-risk population, immunodeficiency patients and children born to HIV-infected mothers. This consensus only provides academic guidance, the treatment of the patient must be based on the prevailing medical conditions.
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With our country going into the aging society, burns in the elderly often occur. Studies have shown that the number of elderly burn patients has reached 13% to 20% of the total number of burn patients. As the sensory and cognitive functions are low, skin is thinning, the functions of heart, lung, and kidney are reduced, the immunity is impaired, and other physiological characteristics exist in the elderly, the wounds of elderly burn patients often heal slowly, and the mortality is high. At present, there is still a lack of enough attention to the elderly burn patients. In this review, according to the physiological characteristics of the elderly, for reference to our peers, we make a summary of the treatment of elderly burn patients, such as fluid resuscitation, wound treatment, acute kidney injury management, infection management, and nutritional support.
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Early precise diagnosis and reasonable management of burn wound are the foundation of burn treatment. They determine not only the outcome of the wound but also the prognosis of the burn patient. This article expounds how to diagnose the burn wound objectively and precisely at early stage. On the other hand, the reasonable management such as cooling therapy, escharectomy or tangential excision, and negative pressure wound therapy in the early stage of burn wound is mainly discussed.
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Background: Correct wound management and vaccination following animal bite prerequisite for prevention of rabies. Objective: To find out knowledge and practice about the correct wound management and vaccination following animal bite among the individuals in a selected urban area of Pondicherry. Methods: This explorative study was conducted in the field practice area of a tertiary care institution in urban Pondicherry. A total of 156 individuals one each from 156 households were selected and included after obtaining verbal informed consent. Using a pretested semi structured questionnaire, we obtained information on knowledge about wound care following animal bite and vaccination against rabies, and details of animal bite to any household members anytime in the past. Results: Only 19% of the respondents could name “Rabies” as the cause of death following animal bite. All the respondents had known about immediate initiation of anti-rabies vaccine following animal bite and its free availability in government hospitals. However, only one third of the respondents were aware of immediate washing of wound with soap and water following animal bite. The last one year incidence of animal bite was found to be 0.87% (6/682). Majority of the animal bite cases belonged to Class II (58%) and, involved dogs (88%), males (79.2%) and people from low socio-economic status (96%). All the individuals with animal bites had initiated anti-rabies vaccine within 24 hours of bite, however only two third had washed their wound with soap and water immediately following animal bite. About 17% of the animal bite victims had applied oil or turmeric over the wound. Conclusions: Incorrect immediate wound care following animal bite is a concern for prevention of rabies in this area. Health education should be strengthened on certain aspects like disease causation, wound care following animal bite and before coming in contact with a health facility to this population.
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PURPOSE: The purpose of this study is to evaluate clinical outcomes and complications after fasciotomy in acute compartment syndrome. MATERIALS AND METHODS: Seventeen cases diagnosed as compartment syndrome and underwent fasciotomy from January 2011 to February 2015 were evaluated retrospectively. We investigated the causes and regions of acute compartment syndrome, the methods of wound management, the necessity of skin graft, and the complications including amputation and infection. RESULTS: According to the causes of acute compartment syndrome, there were 7 fractures, 1 traumatic hematoma, 6 reperfusion injury, and 3 rhabdomyolysis. The regions of acute compartment syndrome were 3 cases of thigh, 10 cases of leg, and 3 cases of foot. One case had acute compartment syndrome involving thigh, leg, and foot. Of 17 cases, 3 cases died due to reperfusion injury and one case with severe necrosis of soft tissues underwent amputation. Among the 13 cases excluding 4 cases with death or amputation, 3 cases underwent split thickness skin graft. Shoelace technique and/or vacuum-assisted closure (VAC) was used for 9 cases, and wound closure without skin graft was achieved in all except one case, while 2 cases required skin graft among 4 cases without shoelace technique or VAC. There were 2 cases of infection. CONCLUSION: Acute compartment syndrome caused by reperfusion injury had poor outcomes. Shoelace technique and/or VAC were useful for management of wound after fasciotomy.
Subject(s)
Amputation, Surgical , Compartment Syndromes , Foot , Hematoma , Leg , Necrosis , Negative-Pressure Wound Therapy , Reperfusion Injury , Retrospective Studies , Rhabdomyolysis , Skin , Thigh , Transplants , Wounds and InjuriesABSTRACT
Acute wounds are a common presenting complaint of patients in the primary care setting. These can result from a variety of mechanisms ranging from lacerations and abrasions to stings, bites or burns. The management of acute wounds involves a proper evaluation with history, physical examination, and adequate management with local wound care, and consideration for the need for specialist review or systemic treatment. The general principles of wound management and special wounds like bite wounds and stings will be discussed.
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BACKGROUND: As the number of dermatologic surgical procedures increases, home care wound management is growing in frequency. OBJECTIVE: The aim of this study was to evaluate the efficacy and surgical site infection rate of home care wound management according to the use of oral antibiotics and the characteristics of the wound and of the patient. METHODS: Our study included 207 patients that had undergone a dermatologic surgical procedure and the subsequent management of their wounds in the home. We checked overall infection rate of home care wound management and compared the result according to the use of oral antibiotics. We evaluated surgical site infection rate after we classified each surgical wound based on age, sex, surgical method, site, size, and depth. In addition, we surveyed efficacy of home care wound management. RESULTS: Overall surgical site infection rate was 1.86%, and the infection rate was not significantly different between the group that utilized home care wound management without oral antibiotics and the group with oral antibiotics (p>0.05). There was no statistically significant difference of surgical site infection rate according to sex, age, wound's size and depth (p>0.05). However, patients with younger age, male sex, greater size, and depth of wounds showed a numerical increase in surgical site infection rate. Staged partial excision for nevus sebaceous in scalp showed significantly higher rate of surgical site infection (p<0.05). In our survey, most patients preferred home care wound management after dermatologic surgical procedures and patients were able to perform the wound care well. CONCLUSION: We expect to utilize home care wound management after dermatologic surgical procedures, provided that physicians appropriately educate patients and their caretakers on proper dressings.
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Humans , Male , Anti-Bacterial Agents , Bandages , Dermatologic Surgical Procedures , Home Care Services , Nevus , ScalpABSTRACT
PURPOSE: The biggest problem of wound healing is a possible occurrence of lesion. Especially, in the case of patients who have a skin injury around exposed body parts, if their treatment period drag on for long time, they can suffer from after-effects and the costs can be passed on to a society. Therefore, in this research, we investigated the need to develop the effective medicine and appliances for the patients by examining which therapy methods are being applying to the skin damage and what is the advantage and limit by evaluating the patient's satisfaction level. METHODS: We carried out an online and offline survey targeting medical teams in order to analyze device for wound care. A total of 125 medical teams applied to the research, and investigate the level of customer satisfaction. RESULTS: The moist dressings are the most used method for wound healing. When it comes to the level of customer satisfaction, biological dressing product also has a high satisfaction level. However its high cost tends to limit the use. CONCLUSION: This research reached a conclusion that it is need to develop a low cost and high efficiency wound care product considering the fact that its high cost and low efficiency induced economic problems. Generally, it is needed to develop a product for skin regeneration based on biological technologies, not a product just for damage cure.
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Humans , Bandages , Biological Dressings , Human Body , Methods , Regeneration , Skin , Wound Healing , Wounds and InjuriesABSTRACT
Instead of haemostatic effect, feracrylum provides antibacterial activity; wound improvement has been clinically proven. Feracrylum is a water soluble mixture of incomplete ferrous salt of polyacrylic acid containing 0.05 to 0.5% of iron in physiologic solution (0.85% solution of sodium chloride). A clinical study on safety and efficacy of feracrylum compared to silver sulfadiazine (SSD) was conducted in burn management, since with the widely use of SSD, the sulfadiazine’s disadvantages lead to wound healing impairment. In this open, randomized, controlled study, feracrylum and SSD were topically applied, each on different side of the burnt areas in parts of body for a treatment period of eleven days. Of eight enrolled patients, seven patients completed the study; one patient withdrew due to acute burn complication. On day 7th and 11th, the re-epithelialization in group receiving feracrylum increased as the raw surface area reduced. Mean percentages of epithelialization on both evaluation days in Feracrylum group were 70.53±24.298 and 81.71±28.922, respectively, which were higher than SSD group (66.15±25.080 and 64.64±74.684 respectively). Feracrylum was found to be safe and well tolerated. This study showed a clinical difference although it was not significant statistically.
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Burns , Silver SulfadiazineABSTRACT
Objective: To study the effect of moist therapy on dermal radio lesions. Methods:13 located dermal radio lesions about Ⅲ-Ⅳ stage from 12 cases were treated with moist therapy. Wound managing steps for each time: The first step was to measure the size of wounds and take photos, and then evaluate individual pain level by a numeric pain scale. The second step was to assess and analyze the factors affecting wounds healing, including nutrition, sleeping, activity, psychological condition. After that the individualized plans about nutrition, activity, and psychological care were made. While exchanging dressings, the implementation and effects of the plans must be evaluated and adjusted. The mechanical debridement combined with autolyzing debridement was used for wounds managing. Then the wounds were saturated with bFGF and normal saline, and wetly covered with occlusive dressings. Wounds were managed every two days until wounds healed. Results: All 13 wounds were cured. The average healing time was (10?6)d and the average cost was (202?48)yuan. The pain level after moist therapy was significantly lowered than before(P