Ostomy/wound management
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Ostomy/wound management · Jun 2009
Case ReportsUsing low pressure, NPWT for wound preparation & the management of split-thickness skin grafts in 3 patients with complex wound.
The use of negative pressure wound therapy (NPWT) is well established in the management of hard-to-heal wounds. One institution, familiar with NPWT's capabilities as well as its shortcomings (eg, pain at dressing changes and pain with the maximum recommended setting of 125 mm Hg), sought a viable alternative. A low pressure, negative pressure wound therapy (LP-NPWT) system, using subatmospheric pressure levels of 75 mm Hg and a low-adherence dressing, was evaluated to prepare the wound bed for split-thickness skin graft (STSG) on three patients. ⋯ In all cases, STSGs, followed by 4 days of LP-NPWT were applied and all wounds healed. The results from these three cases suggest that the LP-NPWT system is a useful healing adjunct for complex wound bed preparation and graft management. Clinical studies to quantify the effects of LP-NPWT technology and compare its safety and efficacy to other negative pressure systems are needed.
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Race/ethnicity, immigration, health insurance, and literacy--along with patient-provider communication and understanding of and adherence to treatment protocols--are societal factors that affect the provision of optimal healthcare. Wound care practitioners should be aware of the need to address these factors in vulnerable groups, including the effects of racial/ethnic care disparities, immigration, low income, uninsured or underinsured status, and literacy/health literacy on health and wound care. The literature shows that care is not always perceived to be or equitably provided across different ethnic and economically diverse populations. ⋯ Each patient's physical and psychosocial concerns must be assessed without malice and clinicians must work with community, state, and federal agencies to enhance access to necessary services. Wound care patient teaching materials need to be developed that consider the literacy and language skills of the community served. Once the type of wound and its appropriate treatment are determined, wound care practitioners must consider patient teaching, vulnerability, cultural, and economic constraints of care, along with strategies for prevention of complications and hospitalizations.
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Ostomy/wound management · Feb 2009
Randomized Controlled Trial Multicenter StudyA prospective, randomized clinical trial to assess the cost-effectiveness of a modern foam dressing versus a traditional saline gauze dressing in the treatment of stage II pressure ulcers.
Modern dressings such as hydrocolloids, gels, and foams are typically more expensive than traditional dressings such as gauze. However, if modern dressings require fewer changes, the overall cost of treatment may be lower despite the higher initial purchase price. If healing rates are comparable or better, modern dressings also may be cost-effective. ⋯ Total cost over the study period was lower by $466 per patient (P = 0.055) and spending on dressings was lower by $92 per patient in the foam group (P = 0.025). Cost per ulcer healed was lower by $1,517 and cost per ulcer-free day was lower by $80 for patients in the foam group. On the evidence of this study, the foam dressing is a more cost-effective treatment than saline-soaked gauze for the treatment of Stage II pressure ulcers.
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Ostomy/wound management · Jan 2009
Multicenter Study Controlled Clinical TrialThe impact of noncontact, nonthermal, low-frequency ultrasound on bacterial counts in experimental and chronic wounds.
Preventing wound infection and the development of resistant bacteria are important concerns in wound management. To determine if noncontact, nonthermal, low-frequency ultrasound therapy is effective in controlling wound bacterial colony counts, a series of four related experiments was conducted. First, ultrasound penetration in both wounded and intact skin was assessed in vitro. ⋯ None of the wounds exhibited signs of a clinical infection during the treatment period and no adverse events were observed. Taken together, these four studies indicate that noncontact ultrasound can be used to reduce bacterial quantity. Controlled clinical studies are warranted to ascertain the efficacy of this treatment and to further elucidate its effects on various Gram-negative and Gram-positive bacteria.