ABSTRACT
PURPOSE: To provide information about product selection for the management of skin tears. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Explain skin tear (ST) risk factors and assessment guidelines.2. Identify best practice treatments for STs, including the appropriate dressings for each ST type. ABSTRACT: To aid healthcare professionals in product selection specific for skin tears, the International Skin Tear Advisory Panel conducted a systematic literature review and 3-phase Delphi consensus with a panel of international reviewers to provide the best available evidence for product selection related to the treatment of skin tears.
ABSTRACT
Increased bacterial burden and formation of biofilm has been recognized as one of the key factors contributing to delayed wound healing. There is a toolbox of topical antimicrobial wound dressings that incorporate silver, iodine, polyhexamethylene biguanide, methylene blue/gentian violet, and honey. This article reviews a diverse range of evidence to discuss the advantages and disadvantage of topical antimicrobial dressings. Discussion will provide guidance on when and how to use topical antimicrobial dressings to achieve optimal outcomes and cost-effective wound care. Chronic wounds do not follow a predictable and expected healing trajectory, and they may persist for months or years due to underlying disease processes, recurrent injury, and comorbidities.1 With an aging population and increased prevalence of chronic diseases, the majority of wounds are refractory to healing, placing a significant burden on the health system and individual patients. Bacterial burden and biofilm have been recognized as key factors contributing to persistent inflammation, tissue destruction, delayed wound healing, and other serious complications (especially in individuals who are frail and immune-compromised).2 It has been demonstrated that when bacterial growth reaches a critical threshold of 105 bacteria per gram of tissue, bacterial toxins can cause tissue damage in the superficial wound compartment, delaying healing.2 In the literature, this phenomenon is referred to as critical colonization, increased bacterial burden, superficial infection, or localized infection. According to a recent review, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized infection.3.
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UNLABELLED: xBxxaxcxkground. In addition to prevention guidelines already in place, the effectiveness of an antimicrobial dressing on the occurrence of surgical site infections (SSIs) among adult patients undergoing cardiac surgery was evaluated. METHODS: A house-wide replacement of the plain postoperative gauze dressing with a sterile dressing impregnated with 0.2% polyhexamethylene biguanide directly on the incision after closure in the operation room was performed. From May 2005 to March 2007, 1658 patients were enrolled in this study. Surgical site infections were identified using the Centers for Disease Control and Prevention standard criteria. RESULTS: Of the 1658 patients enrolled, 1399 patients were included in the analysis, 692 with the plain dressing and 707 with antimicrobial dressing. The overall and leg site infection rate was significantly higher in the plain dressing group compared to the antimicrobial group but similar in the sternal site. Overall, the antimicrobial dressings significantly reduced infection (OR 0.58 [0.38-0.89]). Obesity was also a strong independent predictor of SSI regardless of the site of surgery. Increasing age at surgery and left ventricular ejection fraction of 30%-49% were also independent predictors of infection. CONCLUSION: The antimicrobial dressing had a positive effect by reducing the infection rate, especially for leg incisions using conventional open techniques, and could be a worthwhile addition in conjunction with a strategic program. .
ABSTRACT
An ileal conduit is the most common urinary diversion following radical cystectomy for invasive bladder cancer. Unlike internal complications commonly described in urological literature, reports about the incidence of external complications are sparse. A Medline database review (1996-2008) of English-language literature was conducted to: 1) describe and compare external stoma and peristomal complications and complication rates among outpatients with ileal conduit diversion following radical cystectomy, and 2) summarize commonly used prevention and management strategies. Fourteen publications (mostly retrospective, single-center studies) met inclusion criteria. The reported incidence of complications ranged from 15% to 65%. Divided according to pathogenesis, the most commonly reported complications are 1) stoma or abdominal wall-related changes--parastomal hernia, stoma prolapse, stenosis, and retraction; and 2) peristomal skin changes--chemical injury: irritant contact dermatitis, pseudoverrucous lesions, and alkaline crustations; mechanical injury: pressure ulcers, skin stripping injuries, mucocutaneous separation; infection: candidiasis, folliculitis; immunologic disorders: allergic contact dermatitis; and disease-related lesions: varices, pyoderma gangrenosum, malignancy. Peristomal complications also appear to be under-recognized and under-reported. Research to establish the validity and reliability of assessment tools and long-term follow-up studies are needed to improve the evidence-base of prevention and care.
