Diabetic foot ulcer wound management Quick Guide
The Diabetic Foot Ulcer Wound Management Quick Guide comprises: A review of the TIME framework to optimise wound management A management plan for each step of DFU care to avoid amputation A visual guide to DFU classification and decision-making overview for local wound treatment. Supported by B Braun
Ten Top Tips… Using negative pressure wound therapy effectively
<p>Negative pressure wound therapy (NPWT) has revolutionised the approach to complex wounds, enabling a breakthrough in wound management.Drawing on current research-based evidence and expert consensus opinion, the following top 10 tips can be used to aid appropriate use for optimal outcomes.</p>
Adapting policies and guidelines makes good sense
<p>It has been an absolute pleasure to work with the members of the International Wound Infection Institute (IWII) committee who have produced two of the articles included this issue of Wounds International.</p>
International Wound Infection Institute: Leaders in wound infection understanding, prevention, and management
<p>Wound infection is a source of morbidity and mortality the world over; be it in acute wounds, or the ever-growing number of chronic wounds. Much remains to be done by the clinicians in the field and researchers in the lab to better understand and manage wound infection. Though common, the nuances of many of the […]
New Zealand’s 2013 STOP Pressure Injury Day Campaign: Successes of the New Zealand Wound Care Society
<p>New Zealand faces many of the same issues as other countries around the world with an aging population, increasing numbers of chronically sick patients, and tight health care cost constraints. This is true of wound care, and here the authors report a campaign to address avoidable pressure injuries.</p>
Ten Top Tips… Preventing orthopaedic surgery-related wound blisters
<p>Superficial wound blisters are an abnormal swelling (i.e. filling with fluid) in the epidermal layer of the skin in response to trauma. Blistering in postoperative wounds may be caused by skin stripping from removal of medical tape, or prolonged exposure of the skin to adhesive contact layers of dressings and associated with the presence of […]
Ten Top Tips… Understanding and managing wound biofilm
<p>Our understanding of the factors that delay wound healing continues to improve through advances in research into the microenvironment. There is now strong evidence that biofilm is present in the majority of chronic wounds. The pathogenesis of biofilms continues to be evaluated, but current knowledge suggests they are detrimental to wound healing and degrade the […]
Pyoderma gangrenosum associated with melanoma
<p>Pyoderma gangrenosum – a rare, neutrophilic dermatosis – is associated with diseases including inflammatory bowel disease, arthritis and haematologic disease. This case story describes an unusual association between pyoderma gangrenosum and malignant melanoma. Clinicians should consider malignant melanoma in all patients with pyoderma gangrenosum.</p>
Sciatic nerve block: A useful procedure for diabetic foot surgery
<p>The range of comorbidities experienced by people who require lower-limb surgery to manage diabetic foot disease are many. These comorbidites make the undertaken of general anaesthesia both difficult and places them at high risk of complications during surgery or in the immediate postoperative period. In this article the authors present a description of a peripheral […]
Best practice guidelines: Effective skin and wound management in non-complex burns
This document is a practical guide to the management of burn injuries for healthcare professionals everywhere who are non-burns specialists. With an emphasis on presenting hands-on and relevant clinical information, it focuses on the evaluation and management of non-complex burn injuries that are appropriate for treatment outside of specialist burns units.
Best practice guidelines: Effective skin and wound management in non-complex burns
This document is a practical guide to the management of burn injuries for healthcare professionals everywhere who are non-burns specialists. With an emphasis on presenting hands-on and relevant clinical information, it focuses on the evaluation and management of non-complex burn injuries that are appropriate for treatment outside of specialist burns units.
Infographic on pressure ulcer prevention
Ten Top Tips… Promoting your wound care centre
<p>In many countries, health care is largely provided by private sector businesses. Elsewhere, traditionally state-run health services are currently undergoing a shift – not least due the burden of providing care for aging populations – towards the provision of specific health services by the private sector (see, for example, physiotherapy and podiatry in the UK).</p>
Biatain® Silicone dressings: A case series evaluation
<p>A multicentre case series was performed as a product evaluation of two new silicone wound dressings, Biatain® Silicone and Biatain® Silicone Lite (Coloplast A/S, Humlebaek, Denmark). This addressed the dressings’ overall usability (focusing on comfort for the patients and dressing handling for the healthcare practitioners) in a total of 39 patients who fulfilled the evaluation […]
Ten top tips from Wounds International in 2014
<p>Wounds International is delighted to announce that we are now averaging over 50 000 visitors to the website each month from 150 different countries. In October and November 2013, we recorded a large jump in our figures, mainly due to the interest created around the International Wound Care Conference held in Kuala Lumpur, Malaysia in […]
February 2014 Volume 5 Issue 1: Full Issue
An online practice-based journal for clinicians worldwide
Ten Top Tips… The management of burn wounds
<p>Many people will experience a burn injury in their lifetime. Burn injuries range from the most severe – requiring high levels of critical care and surgical intervention – to simple burns, for which self-treatment may suffice. Burn injuries pose a considerable burden to heathcare resources across the globe.[1] In the UK, the figures are considerable, […]
Book review: A Closer Look At Silver: A Clinical Information Tool (CIT) To Help You Choose The Right Silver Wound Dressing For Your Patient!
<p>The cost-effective, efficient management of individuals with wounds is a key factor in providing quality wound management services. Whereas this espoused principle may seem relatively straightforward, in reality it is not. A lack of evidence to support dressing use, along with a lack of sustained availability of the right dressing for the right patient, often […]
Implementing evidence-based leg ulcer care in an Azorean healthcare centre
<p>The Azores are a Portuguese territory and comprise nine volcanic islands situated in the North Atlantic Ocean. The largest and most populous island in this archipelago is São Miguel, which is famous for its beautiful lakes and green mountains.</p>
Ten Top Tips… Taking high-quality digital images of wounds
<p>"Use a picture. It's worth a thousand words."</p>
Haemodynamics of lymphoedema
<p>The Starling hypothesis and available data on the physiology of the microcirculation provide a clear model for understanding how arterial, capillary and venous haemodynamics may affect the production of lymphatic fluid. This review considers the studies that have focused on venous and arterial haemodynamics and calf muscle pump function. Although the evidence base available is […]
Field experience of Handicap International
<p>Even if around 180 million people suffer from lymphoedema worldwide (Casley-Smith et al, 1997), its impact as a public health problem is underestimated. The main reason for this being the lack of epidemiology. Both in developed and developing countries, the prevalence and incidence of lymphoedema is unknown. In developing countries, lymphatic filariasis (LF) is seen […]
Lymphologists, phlebologists, veins and lymphatics
<p>No matter who we are, clinician, allied healthcare professional, scientist, patient or carer, we often focus only on what we know, what we find comfortable and what we have learnt (or been told). In reality, that is not good, we stagnate, our chances for different and perhaps better outcomes are reduced, and strangely, we often […]
Using exercise classes to reduce arm lymphoedema
<p>Background: Arm lymphoedema is a chronic condition affecting multiple aspects of patients’ daily lives but quality of life can be improved with excess volume reduction. Treatment consists of infection prevention, lymphatic massage, compression therapy and special exercises. However, there is little evidence regarding the effect of exercise in a group framework. Aims: Using a series […]
Implementation of a BCRL management programme
<p>Background: Breast cancer-related lymphoedema (BCRL) is a growing concern with the increased survival rate following breast cancer (Smith et al, 2011). However, limited data is available on prospective management designed to reduce the morbidity of BCRL.</p>n<p>Aims: To evaluate the impact of the development of a BCRL programme on the management of women with breast cancer.</p>n<p>Methods: […]
Screening for morbidity following breast cancer
<p>Background: A screening tool was developed to identify morbidity emerging in the years after breast cancer treatment.</p>n<p>Aims: This project aimed to investigate patient responses to a newly developed screening tool for lymphoedema, reduced arm function, fatigue and pain.</p>n<p>Methods: Interviews were conducted following completion of the screening tool by 40 women attending review appointments post-treatment for […]
The skin as a barrier: What does it mean when it fails when lymphoedema is present?
<p>The skin is a barrier and a primitive immunosurveillance organ. When in good health at rest, the skin has no reason to undergo repair. Stretching, compression or stimuli such as stripping with tape or exposure to UVB switch on the repair mode (Ryan, 2004). After a short period, often measured in hours, mitoses appear and […]
Exercise for limb lymphoedema: evidence that it is beneficial
<p>Exercise has been shown to improve lymphatic propulsion, clearance and venous drainage from the limbs. However, awareness of the positive benefits of different exercise regimens for those with lymphoedema of the limb has been slow to emerge. Despite this, studies have demonstrated that various exercise regimens can have a positive impact on limb size, subjective […]
Lymphoedema in Japan: current issues
<p>Lymphoedema is a worldwide problem, and yet, until recently it has been considered a relatively unimportant health concern. In developed countries, it mainly occurs following surgical treatment for cancer. Recent studies have helped to raise awareness of this condition and have indicated that it can lead to a decrease in quality of life (McWayne and […]
Hosiery in lower limb lymphoedema
<p>As part of its work to establish a national provision of lymphoedema services in the UK, the Lymphoedema Framework project has developed guidelines for the use of compression hosiery in lower limb lymphoedema. The guidelines, to be presented in two parts, have drawn together existing hosiery classifications and linked a new classification with clinical descriptions […]
German Society of Lymphology
<p>The German Society of Lymphology (DGL) has existed since 1976, developing as an offshoot from the Society for Manual Lymph Drainage (Dr Vodder) and Related Therapies (GfMLV) that was founded in 1967. It is a membership organisation, recognised as a non-profit society. The goal of the society is to promote research and teaching in the […]
10 years of global efforts to eliminate LF: where are we?
<p>Lymphatic filariasis (LF) is a mosquito-borne parasitic infection responsible for long-term chronic morbidity in the form of lymphoedema, genital pathology (especially hydroceles), recurrent disabling fevers (lymphangitis) and elephantiasis in over 40 million people around the world (Ottesen et al, 2008). Currently, over one billion people are exposed to infection in 81 endemic countries in Asia, […]
Imaging of lymphatics, LE and lymphatic function
<p>Despite our best imaging techniques and technologies, many are still far from perfect. However, they can give us valuable information about the structural and functional status of the tissues and systems, and specifically about the lymphatic system and the diagnosis of lymphoedema.</p>
We need to help patients to help themselves
<p>Performing the same task day after day, week after week is not only predictably routine, there is also a danger that we may avoid doing it altogether. Perhaps worse, fear of losing face may result in us telling people we have been performing the task when, in fact, we haven’t.</p>
Historical review of lymphatic studies in the head and neck
<p>The discovery of the lymphatic system occurred later than the other vascular systems. Early studies only observed lymphatics of the viscera in mammals. Lymphatics of the head and neck were not revealed until the mercury injection technique was introduced, which detailed in books of Mascagni (1787) and Sappey (1874) that were largely referred by later […]
So, this is lipoedema
<p>I find it hard to remember when I first began to realise that my legs looked different to others. Being obese from the age of six hid the fact that my body was showing signs of other problems. I have always been singled out as being different, and when my knee-high nylon school socks only […]
Lymphoedema and delusional parasitosis
<p>The false and fixed belief of being infected/infested by one or many different living organisms, such as insects or parasites, is not a common condition. Although several cases have been recorded since the end of the nineteenth century, it was the Swedish psychiatrist Karl-Axel Ekbom who first systematically studied the presenile syndrome of delusional dermatozoid […]
Use of laser therapy in the management of lymphoedema
<p>The use of laser therapy has been slow to develop and not without controversy along the way. Forty years have passed since initial research reported positive biological effects from laser light (Carney et al, 1967). Despite the publication of over 2,500 titles relating to therapeutic light, there is still debate over its clinical use particularly […]
Learning from traditional healers in South Africa
<p>In 1999 the South African Ministry of Health (1999) reported that breast cancer was the leading cancer diagnosis among South African women in 1999. More recently, Mqoqi et al (2004) found one in 12 white women and one in 18 ethnically-diverse women were at risk of being diagnosed with breast cancer in South Africa. The […]
Haddenham Healthcare: children with lymphoedema
<p>The treatment of lymphoedema in the UK is predominantly based on the needs of adults with cancer-related lymphoedema (Robertson Squire, 2000). This paper aims to look at the different treatment options available from Haddenham Healthcare and their suitability for children with lymphoedema. Factors such as age, parents’ attitude and severity of oedema all need to […]
Being true to your specialism, is being true to your patient
<p>As we are at the infancy of 2012, we too are at the infancy of the plethora of change within the NHS in the UK. Although the idealism was set out in 2011, it is this year where we will experience the impact of what the reforms truly mean to both patients and those involved […]
Non-compliance? It’s easy for you to say…
<p>Recently, I was delighted to receive an invitation to attend the 20th birthday celebration of the Lymphoedema Practitioners Education Group of Victoria (LPEGV), which I gladly accepted, looking forward to catching up with some old friends from my time with the Lymphoedema Association of Victoria (LAV). I was not disappointed. It was a great evening, […]
Lipoedema management: Gaps in our knowledge
<p>Lipoedema is a condition characterised by abnormal, symmetrical fat deposits in the legs, resulting in a disproportion between a smaller upper body and a larger lower body. Since its first use, the term “lipoedema” devised by Allen and Hines (1940) has been broadened to incorporate patterns of limb adiposity differing from the original pattern, which […]
The facts about liposuction as a treatment for lymphoedema
<p>There is some controversy regarding liposuction for late-stage lymphoedemas. While it is clear that conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema that is not responding to treatment is not so clear. Liposuction has been used […]
Lymphoedema and sexual relationships in mid/later life
<p>Background: Women with breast cancer-related lymphoedema (LE) can experience physical, psychological, and sexual problems as a result of both physical limitations and appearance associated with this condition. Aims: This study investigated the effect on quality of life of the sexual relationships with intimate partners for women with LE. Methods: Participants were 11 women with LE. […]
An overview of lower limb lymphoedema and diabetes
<p>The prevalence for individuals diagnosed with lower limb lymphoedema and coexisting diabetes is unknown. However, both conditions cause significant problems that can compromise the viability of the lower limbs. An extensive search of the literature including medical databases (MEDLINE, PubMed and CINAHL), plus hand searching through diabetes journals, podiatry journals and wound care journals, was […]
BCRL questionnaires: climate and indigenous groups
<p>Valid and reliable subjective questionnaires are essential to enable research regarding the effect of breast cancer-related lymphoedema (BCRL) on quality of life (QoL). This review was undertaken to determine the reliability and validity of four current subjective questionnaires for the evaluation of BCRL, particularly with respect to climate and ethnic or indigenous groups. Searches were […]
Audit of the use of kinesiology tape for breast oedema
<p>Background: Lymphoedema developing in the breast and truncal area after treatment for breast cancer can be challenging to manage and distressing for patients. Kinesiology tape has traditionally been used in sports injuries and is considered effective at improving lymph drainage (Kase et al, 2003). It offers potential as a self-care option for managing swelling in […]
A new treatment for soft tissue fibrosis in the breast
<p>Background: Soft tissue fibrosis is a common consequence of breast cancer treatment and chronic lymphoedema. It can compromise function and quality of life, but research regarding interventions is limited.</p>n<p>Aims: To assess the efficacy of using JoViPitPak® (JoviPak Corporation) to influence soft tissue fibrosis change by looking at tissue density, perceived cosmesis and perceived breast pain.</p>n<p>Methods: […]
Using honey in post-excision malignant melanoma ulcers
<p>Malignant melanomas are extremely difficult to treat conservatively at primary care level since the precise diagnosis requires a skin biopsy, which then undergoes dermatoscopy or epiluminescence microscopy. The treatment also varies according to the stage of melanoma and whether it is a superficial spreading melanoma or a melanoma in situ (Lorentzen et al, 1999). For […]
