The Triangle of Wound Assessment: a holistic framework from wound assessment to management goals and treatments
<p>The negative impact of wounds on patients is significant, and includes pain, reduced quality of life and social isolation. Optimal wound healing can reduce the burden of chronic wounds on patients and the health economy. The Triangle of Wound Assessment is a holistic framework that clinicians can use to improve wound assessment, with particular focus […]
Patient education, self-care and medical grade honey — managing a diabetic ulcer
<p>The prevalence of diabetes is rising globally with increasing budgetary burdens from the disease and its complications. In resource-limited environments, affordable treatment strategies are urgently needed. Wound care utilises diverse modalities, such as hydrogel, polyurethane and alginate dressings, as well as silver-containing agents. Honey is a well established treatment and is cost-effective. In a resource-limited […]
Use of ALLEVYN◊ LIFE Non-Bordered foam dressing to manage a heavily exudating venous leg ulcer
<p>A 62-year-old man presented with a left lower leg venous ulcer on the shin. The ulcer had high exudate levels, which was resulting in strike-through of dressings and there was some evidence of surrounding skin maceration. Investigations revealed an ankle brachial pressure index (ABPI) of 1.4. ALLEVYN◊ LIFE Non-Bordered foam dressing (Smith & Nephew) was selected to […]
Meeting report: antimicrobial stewardship in wound management
<p>At the 27th conference of the European Wound Management Association (EWMA), which was held in Amsterdam on May 3–5, 2017, a joint symposium was held between EWMA and the British Society for Antimicrobial Chemotherapy. The symposium was organised into two sessions. The first focused specifically on wound care issues and the second concerned antimicrobial stewardship programmes.</p>
Wounds digest 8(4)
<p>In this section, a brief synopsis is presented of a range of recently published articles that may be of interest to health professionals working in the wound care setting. The aim of this round-up is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Full references are provided should […]
Rising to the global challenge of wound care
The data are stark. The annual cost associated with treating and managing the wounds and comorbidities of 2.2mn patients within the NHS in the UK stood at £5.3bn in 2012/13, according to the Burden of Wounds study (Guest et al, 2015). On top of this, The prevalence of wounds has been estimated to be increasing at 11% […]
Clinical innovation: the Sandy Grading System for Surgical Wound Dehiscence Classification — a new taxonomy
<p>The worldwide volume of surgery is considerable, with an estimated 234.2mn major surgical procedures carried out every year (Weiser et al, 2008). While contemporary surgical procedures are relatively safe, complications such as surgical wound dehiscence, although not commonplace, are a major disruptor to patient wellbeing and wound healing outcomes. Moreover, the importance of classification, documentation and […]
Top tips: skin and tissue trauma caused by self-harm
<p>Patients who deliberately self-harm and cause skin and tissue trauma are increasing in number across primary and secondary care settings (Nice, 2011b). Self-harm has often been considered a taboo subject and an unnecessary burden to the NHS (Kilroy-Findley and Bateman, 2016). Despite the growing need for effective care, services for assessment, diagnosis and intervention are often overstretched […]
Oxygen therapies for wound healing: EWMA findings and recommendations
<p>For wounds to heal, it is essential that macro- and microcirculation is restored in the surrounding tissue (Niinikoski et al, 1991; Gottrup, 2004a). One of the most urgent requirements is oxygen, as it is critically important for the reconstruction of new vessels and connective tissue, and also enables resistance to infection.</p>
Evaluation of the WIfI classification system in older patients with diabetes
<p>In January 2014, the Society for Vascular Surgery published its new threatened limb classification system based on Wound extent, degree of Ischemia and foot Infection (WIfI). This classification represents a summary of multiple previously published classifications focused on diabetic foot ulcers and pure ischaemia or infection models. Despite the new system, patient-centred functional outcomes — such […]
The status of wound care units in Spain
<p>The paucity of published studies to date has made it difficult to assess wound care provision in Spain. This paper reports the outcomes of the first census of units specialising in the treatment of chronic wounds in this country. Results indicate that wound units have very heterogeneous and diverse characteristics, varying according to region and […]
Closed surgical incision management:Understanding the role of NPWT
Substantial numbers of patients develop surgical site infections and other incisional complications worldwide each year. The social, healthcare and wider economic implications are considerable. As the average age of the population increases and multi-morbidity becomes more common, the number and complexity of surgical procedures performed is rising. As a result, reducing the risk and burden […]
Local management of the diabetic foot Made Easy
Diabetic foot ulcers are a major issue globally, with considerable economic and human cost. Ensuring the most appropriate treatments are used, and taking a multidisciplinary team approach, is essential in improving patient outcomes and preventing serious and expensive complications, such as infection and amputation. Supported by Acelity
International consensus: Making the case for cost-effective wound management
Clinicians who treat patients with wounds need access to the resources that will enable them to deliver the best and most appropriate treatments. With economic constraints on healthcare budgets, in addition to challenges to prove efficacy, budget holders and payors are increasingly asking for financial justification for the provision of treatment. Clinicians therefore need to […]
Biofilm-based wound care with cadexomer iodine: Made Easy
Evidence suggests that biofilms are present in most, if not all, chronic, non-healing wounds with a recent in vivo study suggesting prevalence could be at least 78% (Malone et al, 2017a). This Made Easy informs clinicians about the role of cadexomer iodine, an effective anti-biofilm dressing, as an early intervention within the T.I.M.E (Schultz, 2003) […]
Improving outcomes in hard-to-heal wounds with single-use negative pressure: Part 1
This webcast, broadcast in October 2017 explores how implementing the PICO pathway in hard-to-heal wounds supports clinical decision making, improves patient outcomes, lowers the cost of treatment and reduces the cost burden on the health economy1. The first part of the webcast is presented by Caroline Dowsett, Clinical Nurse Specialist Tissue Viability, East London NHS […]
Improving outcomes in hard-to-heal wounds with single-use negative pressure: Part 2
This webcast, broadcast in October 2017 explores how implementing the PICO pathway in hard-to-heal wounds supports clinical decision making, improves patient outcomes, lowers the cost of treatment and reduces the cost burden on the health economy1. The second part of the webcast is presented by Jane Hampton, Consultant Wound Nurse, Aarhus Municipality, Denmark and focuses […]
A rose by any other name …
<p>When Juliet Capulet turns to Romeo Montague and exclaims “that which we call a rose by any other word would smell as sweet”, she could well have been referring to the National Pressure Ulcer Advisory Panel (NPUAP)’s decision to amend its terminology from “pressure ulcer” to “pressure injury”. Although William Shakespeare’s play was not, as we know, a […]
Inelastic compression by bandages: effective, but requiring education
<p>Based on experimental work, a practical definition of inelastic material is provided and some superior effects concerning an improvement of the venous haemodynamics are emphasised in this article. In contrast to elastic compression, this material can narrow the veins in the upright position and to exert beneficial haemodynamic effects by abolishing reflux and improving the […]
Ten top tips: improving outcomes from flap reconstruction
<p>Pressure ulcers are estimated to be present in more than one-third of patients with spinal cord injury (McKinley et al, 1999). Flap reconstruction of a pressure injury is aimed at improvement of patient hygiene and appearance, prevention or resolution of osteomyelitis and sepsis, reduction of fluid and protein loss through the wound, and prevention of future […]
Evaluation of a device combining electrostimulation and ultrasound in the treatment of non-healing chronic leg ulcers
<p>For many years, ultrasound and electrostimulation have been used in the treatment of injuries such as muscle sprains and in wound care. The BRH-A2 is a device combining ultrasound and electrostimulation. This study evaluated the effect of BRH-A2 on healing chronic leg ulcers and the device’s impact on pain, wellbeing and mobility. </p>
The diabetic foot: how to assess the risk?
<p>Patients with diabetic foot infections present a challenge beyond the expertise of a single field of medicine. Collaboration between multiple specialties is necessary, as well as rapid assessment of the diabetic foot. In 2014, an interdisciplinary team of vascular and podiatric surgeons put forth the new classification focusing on the Wound, Ischemia and Foot Infection (WIFI). […]
Treating venous leg ulcers with Extracorporeal Shockwave Technology (ESWT)
<p>Treating venous leg ulcers with Extracorporeal Shockwave Technology (ESWT)Aims: Extracorporeal shockwave technology (ESWT) delivers high-energy acoustic shock waves to the body. With clinical applications in urolithiasis and orthopaedics, there is emerging evidence for its use to facilitate healing for diabetes related foot ulcers and burns. This study sought to examine the benefit of ESWT therapy on venous […]
Meeting report: no compromise on quality: is ‘good enough’ really good enough?
<p>This article is based on a symposium held at the European Wound Management Association (EWMA) in Amsterdam on May 4, 2017, which was sponsored by Mölnlycke.</p>
Meeting report: the Triangle of Wound Assessment: implementing a simple and structured approach to wound management
<p>A symposium entitled ‘The Triangle of Wound Assessment: Implementing a simple and structured approach to wound management’ was held by Coloplast at the European Wound Management Association (EWMA) conference in Amsterdam, The Netherlands, 2017. The symposium highlighted the ease-of-use in clinical practice of the Triangle of Wound Assessment: a systematic framework that provides a holistic […]
Meeting report: pressure ulcer prevention and management: do we all agree?
<p>This article is based on an expert panel discussion held at the European Wound Management Association (EWMA) in Amsterdam on 5th May 2017, which was sponsored by 3M.</p>
Meeting report: pressure injury prevention: clinical outcomes explained by robust scientific evidence: a panel discussion
<p>This meeting report summarises the proceedings of a panel-led symposium that took place at the European Wound Management Association (EWMA) Conference, Amsterdam in May 2017. It looks at the crucial role of pressure injury prevention and the importance of robust clinical data in proving the positive impact — for patients, clinicians and the healthcare economy […]
Wounds digest 8-3
<p>In this section, a brief synopsis is presented of a range of recently published articles that may be of interest to health professionals working in the wound care setting. The aim of this round-up is to provide an overview, rather than a detailed summary and critique, of the research papers selected. Full references are provided […]
Identification and management of infection in diabetic foot ulcers
Diabetic foot ulcers (DFUs) are rising in prevalence globally, and particularly in the Gulf region. Infection remains a common and serious complication in managing DFUs. A need was identified for local guidelines that considered cultural and religious practices in the Gulf region, as well as clinical issues. This consensus document aims to provide practitioners with […]
Making the case: BIOSORB Gelling Fibre Dressing
BIOSORBTM Dressing (Acelity) is a unique gelling fibre dressing, which is designed to manage exudate effectively and create an optimal environment for wound healing. When the absorbent dressing comes into contact with wound exudate, it forms a gel. This facilitates autolytic debridement and ensures that any wound debris retained in the fibre dressing is removed […]
Two-component compression: Concordance, evidence and clinical use
In the absence of corrective surgery, compression therapy has been found to be the most effective treatment for venous leg ulcers (VLUs) (Nelson et al, 2000; WUWHS, 2008; O’Meara et al, 2012). Achieving healing rests on patients’ adherence to treatment. However, a large body of evidence shows they do not always do so (Bland, 1996; […]
Hydrotherapy Made Easy-wint
Rapid cleansing, early granulation and sustained epithelialisation are important requirements for efficient chronic wound healing. This Made Easy discusses HydroTherapy, an innovative approach to wound treatment where a two-step therapy harnesses optimised hydration at all stages of the healing response to promote wound progression and healing. Supported by HARTMANN
The rise of the robots and AI — their impact on lymphoedema diagnosis and treatment
<p>We see automation and robots wherever we look and go — at the airport, in our cars and in our homes. Automation and robots are already in medicine being most prominent in the surgery area, but will they spread into the diagnosis and treatment arenas for lymphoedemas? </p>
The lymphatic system and skin conditions, old age and the impact of medications
<p>Here, the editor answers some readers’ questions and invites you to share thoughts and experiences</p>
A patient-based self-examination survey for staging the severity of lymphoedema
<p>Background: A lymphoedema self-assessment tool can help therapists deliver appropriate advice, and prioritise patients who are on waiting lists or who cannot access a lymphoedema clinic. Aims: This pilot study aims to assess the validity and reliability of the Lymphoedema Self-Examination Survey (LYSES) and the relationship between outcomes obtained through LYSES and healthcare professionals’ lymphoedema […]
Bibliometric analysis of breast cancer-related lymphoedema research published from 2007–2016
<p>Background: Breast cancer–related lymphoedema (BCRL) has been a poorly-researched topic; however, research productivity related to BCRL has increased within the last decade. Aims: Conduct a bibliometric analysis to characterise recent BCRL research. Methods: A search for indexed English abstracts was performed in PubMed using search terms of “(“lymphedema”[tiab] OR “lymphoedema”[tiab]) AND “breast cancer”[tiab]” from 2007–2016. […]
Health insurance coverage for conservative lymphoedema treatment in Japan
<p>Petitioning for the necessity of complex physical therapy started in the early 2000s and led to the provision of one-time prophylactic guidance for the management of lymphoedema for cancer patients and a partial reimbursement for compression garments in 2008. In 2016, complex physical therapy itself became part of the national health insurance system. This change […]
Quantitative study of the subcutaneous needle drainage of lymphoedema in advanced malignancy
<p>Background: Lymphoedema is an often-neglected symptom of advanced malignancy. Subcutaneous needle drainage is a procedure that drains the fluid externally in refractory lymphoedema. It has the potential to improve quality of life but little objective data exist about its efficacy or adverse outcomes. This study used validated tools to objectively assess subcutaneous lymphoedema drainage. Methods: […]
Muscle strength and functional exercise capacity in patients with lipoedema and obesity: a comparative study
The use of compression wraps in the management of lymphoedema
<p>There is increasing interest in the potential value of compression wraps in the management of lymphoedema and other disorders of the circulatory system. Given the significant unit cost of these materials, the All Wales Medical Devices Strategy Group commissioned an independent review of the literature to determine if these devices represent a cost-effective option for the […]
Compression garments for managing lymphoedema
<p>Lymphoedema is a chronic condition due to a compromised lymphatic system and results in the accumulation of oedema. It can affect patients who have undergone cancer treatments that involve removal of lymph nodes and radiotherapy. It can also present from a congenital defect of the lymphatic system and as a complication of a venous disorder […]
Obesity-related lymphoedema and hospice charities: considerations for the future
<p>The Leicestershire Organisation for the Relief of Suffering (LOROS), a hospice-based charity, runs a lymphoedema service and is facing an increase in the number of referrals for the treatment of obesity-related lymphoedema. This article highlights the issues involved and questions the appropriateness of providing treatment for this cohort of patients when the majority of funding […]
The adverse impact of strenuous exercise on breast cancer–related lymphoedema: a case report
<p>Background: Exercise is an essential part of lymphoedema treatment; however, it’s important to consider the level of exercise intensity in lymphoedema patients. Aim: To examine the effects of one session of strong exercise, which included extreme weight-bearing to the limb affected by lymphoedema. Methods: A 66-year-old female patient with breast cancer–related lymphoedema (BCRL) attended the oncological […]
Our interest is swelling — but what’s in a name?
<p>We seem to have made strides in our ability to differentiate between lipoedemas and myxoedemas on the basis of clinical testing and presentation, but there is still a lot of uncertainly it seems when it comes to defining the boundaries between chronic oedema and lymphoedema. </p>
AQUACEL® Ag+ Extra Made Easy
While there are a number of barriers to wound healing, addressing exudate, infection and biofilm is particularly important when managing slow-healing, static or deteriorating wounds. These barriers combine to increase the chronicity of a wound and must be tackled with innovative technologies that manage the microbial load and ensure an optimum moist wound healing environment. […]
IAD Made Easy
Incontinence-associated dermatitis (IAD) describes skin damage associated with exposure to urine or faeces. It causes patients significant discomfort and can be difficult and timeconsuming to treat. It is a significant health challenge and a well-documented risk factor for development of pressure injury. Supported by Medline Industries
Best Practice Guidelines: Skin and wound care in Epidermolysis Bullosa
Epidermolysis bullosa (EB) describes a rare complex group of inherited skin fragility disorders. Ideally patients should be managed in a specialist centre. EB is a lifelong disorder that requires specialist intervention and considerations to minimise complications and improve quality of life. EB can be inherited autosomal recessively or autosomal dominantly; in general, recessive forms tend […]
Aquacel Extra dressing in practice: Quick Guide
This Quick Guide outlines how using a partnership of tried and tested AQUACEL dressings can provide effective wound management. The focus is on AQUACEL Extra dressing, which is designed to lock in harmful bacteria, micro-contour to the wound bed to maintain optimal moisture balance and reduce ‘dead space’ where bacteria can grow, and respond to […]
PHMB Made Easy
This Made Easy focuses on the challenge of dealing with infection, and how the use of polyhexamethylene biguanide (PHMB) can help. A new mode of delivery means that PHMB can now be delivered via foam dressing, combining the benefits of a traditional foam dressing with the antimicrobial properties of PHMB. Supported by Advanced Medical Solutions
Soring UAW Made Easy
Soring UAW is an effective tool for wound debridement that can be easily integrated into treatment pathways for various chronic wound aetiologies as an integral part of wound bed preparation. This Made Easy outlines this unique approach to debridement, describing how it works to protect healthy tissues at the wound site whilst targeting biofilm or […]
