Take another look at the up and coming wound management website. http://www.woundguru.com/blog/2012/may/why-product-companies-need-active-presence-last-call-beta-testers
Wounds Magazine Feed- Chest Wall Defect With an Extensively Encroached Heart and Severely Impaired Cardiac FunctionAbstract: A chest wall defect that penetrates deep into the heart is rare, but life threatening. Reconstructing a defect such as this presents challenges regarding timing and surgical approach. The patient in the present case had a chest wall defect with an extensively encroached heart and severely impaired cardiac function as a result of radiation injury af […]
- Use of Equine Derived Pericardium as a Biological Cover To Promote Closure of a Wound With Associated Scleroderma and Raynaud’sAbstract: A 39-year-old man with previously undiagnosed scleroderma was admitted to the UCSD Medical Center with bilateral, limb-threatening necrotic lower extremity ulcers extending to underlying fascia and muscle. Rather than amputate the extremities, the patient requested alternative treatment and underwent extensive tissue debridement followed by placeme […]
- Daptomycin for the Treatment of Osteomyelitis Associated With a Diabetic Foot UlcerAbstract: This report describes a case of Staphylococcus aureus osteomyelitis associated with a chronic foot ulcer that was successfully treated with surgical debridement and 6 weeks of daptomycin therapy. Daptomycin was chosen because of its excellent activity against the causative organism and the patient’s history of penicillin allergy. Its tolerability a […]
- Chest Wall Defect With an Extensively Encroached Heart and Severely Impaired Cardiac Function
- Wounds Research Review
- Review of Small Intestine Submucosa Extracellular Matrix Technology in Multiple Difficult-To-Treat Wound TypesIndex: WOUNDS. 2013;25(5):113–120. Abstract: The extracellular matrix (ECM) of the dermis is a critical structural component required for normal wound healing. The ECM, along with its key signaling components, provides the support structure necessary for fibroblasts, immune cells, and keratinocytes. When ECM activity is dysfunctional, the normal wound heal […]
- Bullosis Diabeticorum: Is There a Correlation Between Hyperglycemia and This Symptomatology?Index: WOUNDS. 2012;24(12):350–355. Abstract: Bullosis diabeticorum (bullous disease of diabetes or diabetic bullae) is a noninflammatory, blistering disease occurring spontaneously in diabetic patients.The bullae are usually located on acral skin surfaces, particularly the feet. While this disease is unique to patients with diabetes, it may mimic other bl […]
- Doxycycline as a Modulator of Inflammation in Chronic WoundsIndex: WOUNDS. 2012;24(12):339–349. Abstract: Doxycycline is a semisynthetic, chemically modified tetracycline compound that is rapidly absorbed and exerts biological effects independent of its antimicrobial activity. One such effect includes the inhibition of matrix metalloproteinases. Doxycycline has a long history as a collagenase inhibitor. This articl […]
- Scientific and Clinical Support for the Use of Dehydrated Amniotic Membrane in Wound ManagementIndex: WOUNDS. 2012;24(10):299–307. Abstract: Amniotic membrane has been employed in the treatment of wounds for almost 100 years, beginning with early application of natural amniotic membrane obtained from labor and delivery to various types of burns and wounds. Amniotic membrane is rich in collagen and various growth factors that support the healing proc […]
- Autonomic Dysreflexia: Be Aware and Be PreparedIndex: WOUNDS. 2012;24(6):160–167. Abstract: Autonomic dysreflexia (AD) is an acute, life-threatening syndrome of uncontrolled sympathetic discharge that occurs in patients with spinal cord injury at T6 or higher. Despite a high incidence in tetraplegics, the condition is under-recognized, putting both the practitioner and patient at risk. This report pres […]
- Review of Small Intestine Submucosa Extracellular Matrix Technology in Multiple Difficult-To-Treat Wound Types
- Podiatry Today Feed
- Treating Chronic Sesamoiditis With ESWTThese authors discuss the use of ESWT to treat a professional football player who previously failed various conservative modalities for chronic sesamoiditis. read more
- Why It Pays To Pursue A Fellowship This author discusses her experience in a diabetic limb salvage research fellowship and the rewards residents can gain if they choose a fellowship. read more
- When Patients Ask About Barefoot Running And Minimalist ShoesChances are that you have had a patient or two ask for your opinion on barefoot running or minimalist shoes. Accordingly, these panelists share their perspectives on the recent surge of interest in these topics, review pertinent keys to patient assessment and discuss common injuries they have seen. read more
- Keys To Managing Severe OnychomycosisGiven the prevalence of onychomycosis and its varied clinical presentation, this author discusses the evolution of diagnostic testing and offers insights on the roles of various modalities in the treatment of severe onychomycosis. read more
- A Guide To Using Bilobed Flaps In Lower Extremity SurgeryBilobed flaps can preserve tissue and facilitate primary closure in various surgical procedures as the flaps do not require skin grafts and have predictable long-term reproducibility and functional outcomes. Accordingly, this author presents his own experience with bilobed flaps and discusses how they can have an impact in closing lower extremity defects. re […]
- A Closer Look At Foot Orthoses For Chronic Ankle InstabilityIn light of an increasing body of research on the effect of orthoses on chronic ankle instability and postural sway, this author discusses essential biomechanical considerations and recommends orthotic prescriptions and modifications to treat unstable ankles. read more
- Point-Counterpoint: Are Acellular Dermal Matrices More Effective Than Fibroblast-Derived Dermal Substitutes? Yes. Citing the literature, enhanced sterility and ease of use, Howard Kimmel, DPM, says human acellular dermal matrices are an effective option for wound care. No. Alexander Reyzelman, DPM, says the role that fibroblasts play in facilitating the healing of chronic wounds is well established whereas questions abound for acellular dermal matrices, which lack […]
- A Closer Look At Cryosurgery For NeuromasCan cryosurgery be an effective alternative treatment for neuromas? This author offers keys to diagnosis, shares pertinent pearls on cryosurgical techniques and emphasizes the benefits of ultrasound injection guidance. read more
- May 2013Although a recent study concludes that hyperbaric oxygen therapy (HBOT) is not effective for healing diabetic wounds, several physicians note that HBOT does have a benefit as an adjunctive treatment for non-healing diabetic foot ulcers. read more
- Treating Chronic Sesamoiditis With ESWT
Wound Guru!!!
May 15, 2012 — Matthew Livingston R.N. C.W.S.
Take a look at Wound Guru http://youtu.be/KevzI_kC7KM . This is a great website concept for all wound care professionals. Enjoy!
Pulse Lavage for Full Thickness Wounds
February 10, 2012 — Matthew Livingston R.N. C.W.S.Matt, a question for you: Have you had any experiences with pulse lavage therapy as a treatment for wounds? In particular, stage III and IV wounds. If so, what are your thoughts on the therapy?
K, I have a lot of experience with pulse lavage in deep full thickness wounds (mostly in the early 2000s). I believe that pulse lavage has lost favor related to the high risk for spreading microorganisms via water droplets that inevitably spray back out of the wound. Two other developments have lead to the reduction in pulse lavage use including VAC instill (NPWT) and Celleration Mist therapies. That being said pulse lavage does have a place in the care of patient’s if the wound is grossly contaminated (say status post traumatic injury to flush debris).
I would review the goals that you expect to achieve when treating the patient with pulse lavage. Typically, pulse lavage helps to reduce slough and clean a contaminated wound bed. Depending on your goals I think there are better solutions. To reduce or loosen slough in high draining wounds I recommend DrawTex (SteadMed). If you fear contamination (and in a hospital setting) I would recommend VAC instill with Microcyn as the irrigant. If the patient is at an ECF, Home Care, or being seen at a wound clinic I would consider going with our classic antimicrobial silver (We use a ton of Silvadene) , but opt for an silver alginate if the patient can’t get the dressing changed daily.
Thanks again for the question,
Matthew
Negative Pressure Wound Therapy (NPWT) Contraindications and Risk Factors
February 8, 2012 — Matthew Livingston R.N. C.W.S.| Table 1: NPWT is contraindicated for these wound types/conditions: |
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| Table 2: Patient risk factors/characteristics to consider before NPWT use: |
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FDA Safety Communication: UPDATE on Serious Complications Associated with Negative Pressure Wound Therapy Systems
Date Issued: February 24, 2011
Retrieved: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm244211.htm
Pressure Ulcer Evidence Based Treatment Pathway
February 7, 2012 — Matthew Livingston R.N. C.W.S.This Pressure Ulcer Evidence Based Treatment Pathway is based from documents such as the NPUAP/EPUAP and WOCN guidelines. I have revised them in a time related format that is based on predictive modeling evidence.
Week 1 Pressure Ulcer Evidence Based Treatment Pathway
- Relieve Pressure Support Surfaces / Other Offloading Devices
- Manage Infection Culture / Antimicrobials
- Remove Avascular tissue Debride (Leave heel wounds intact unless infected)
- Optimize Nutrition Pre-albumen / Dietary consultation
- Control Moisture Absorbent dressing
- Reduce Healing Delays Treat Co-morbid Conditions
- Fill Dead Space Fill to volume of wound (Don’t over pack)
- Resolve aggravating conditions Treat friction, shear, moisture, and incontinence
- Sponsor Granulation Consider NPWT
Week 4 Pressure Ulcer Evidence Based Treatment Pathway – If the pressure ulcer heals less than 75% over the first 4 weeks* then consider the following adjunctive therapies or treatments:
- Sponsor Granulation NPWT (Revisit use if not previously ordered)
- Fill volume Apply Dermal substitutes
- Revise tissue Surgical Intervention
- Treat Chronic Conditions Debride and Treat with Collagen
10 Week Benchmark: The median days to healing is 73 days for large (>4cm2) ulcers¹.
* Note: Wounds that did not decrease in area by 77% after 4 weeks were significantly less likely to heal² (a 75% closure rate at 4 weeks was selected due to wound measurement conventions)
Sources
- Bergstrom et al., 2008. NPUAP & EPUAP. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009. Pg 54.
- Van Rijswijk L. Full-thickness pressure ulcers: patient and wound healing characteristics. Decubitus. 1993;6:16–2
