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Debridement is a core component of chronic wound management. Although various debridement methods exist, each carries a unique patient risk level. This article discusses the different normal tissue components that are critical to safe debridement practice, various methods of wound debridement for nurses, and the importance of an interprofessional team and consulting a wound specialist. [ABSTRACT FROM AUTHOR]

Purpose: Fournier's gangrene (FG) is a serious, aggressive, and often fatal multi-organism infection that affects the soft tissues of the perineum, rectum, and external genitalia. This study aimed to analyse the treatment's strategies of FG.Materials and Methods: This was a retrospective study of 35 patients with a diagnosis of FG admitted between 2016 and 2021. The diagnosis of FG was established on a clinical basis. Data on patient's age, sex, comorbidities, laboratory results (C-reactive protein (CRP), white blood cell (WBC), hematocrit (HCT), platelets (PLT), sodium, potassium, creatinine, procalcitonin, international normalized ratio (INR), and gangrene culture), extent of resection, antibiotics used, and hospitalisation time were obtained. The extent of resection was assessed on a scale of 1-5.Results: The study group consisted of all men (n=35) aged 24-85 (mean, 58) years. In 13/35 (37%) patients, hyperbaric oxygen therapy (HBOT) combined with negative-pressure wound therapy (NPWT) was used as a treatment for wound healing in Fournier's syndrome (group 1), and in 22/35 (63%) patients, open standard wound care was used (group 2). There were no fatalities in group 1, but four deaths (18%) were noted in group 2. The median extent of resection was 3 in group 1 and 2 in group 2. There was a correlation between the extent of resection and use of HBOT combined with NPWT. The hospitalisation time was much shorter in group 2 (mean, 23 days) than in group 1 (mean, 26 days).Conclusion: HBOT and NPWT (group 1) showed advanced wound healing with a high efficiency rate. The longer median hospitalisation time in this group may be related to the severity of injury. [ABSTRACT FROM AUTHOR]

Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community. [ABSTRACT FROM AUTHOR]

Patients with chronic wounds (leg ulcers, decubitus, and diabetic foot ulcers) suffer from marked restrictions in their quality of life and can often no longer adequately carry out their everyday tasks. The need for nursing and medical care increases when other illnesses and complaints are present at the same time. Qualified wound care and the treatment of comorbidities are therefore of particular importance. The treatment of this disease, which is increasing in number, requires a holistic, multimodal treatment approach which, in addition to professional wound care, also includes comorbidities in the treatment. This case study describes an old treatment method for refractory wounds, the so-called “maggot therapy”, and shows how this is integrated into a holistic, multimodal therapeutic approach. [ABSTRACT FROM AUTHOR]

Most acute wounds will heal with good topical care. However, some wounds, especially chronic ones occurring in impaired hosts, are more problematic. To properly manage these types of wounds and optimize healing, there should be an evidence-based approach to wound care in the emergency department. [ABSTRACT FROM AUTHOR]

Background: Mechanisms for military injury have evolved in the past century. Debridement is the gold standard for preparing a clean wound bed, decreasing the bacterial load, and reducing the likelihood of infection. However, bacteria may continue to linger in these wounds. The MolecuLight i:X Imaging Device uses the principle of autofluorescence to detect bacteria under violet light. Thus, visualizing bacteria will not only guide clinicians in their management of the wound but it will also serve as a means of evaluating debridement efforts. We hope to improve traumatic wound management by targeting debridement and assessing its quality.Methods: We describe the use of the MolecuLight i:X to photograph wounds under standard and violet light in three patients. Images were captured before and after debridement. Microbiology swabs were collected to correlate the bacteria found in the images to the wounds.Results: The post-debridement images demonstrate a marked decrease or complete removal of bacteria. The microbiology swabs confirmed the pre-debridement presence of bacteria.Conclusions: The MolecuLight i:X shows promise for debridement evaluation. The use of the MolecuLight i:X may reduce the likelihood of infection, thus having positive implications for military and trauma wounds. [ABSTRACT FROM AUTHOR]

Abstract: Research to quantify the potency of larval excretion/secretion from Lucilia sericata using liquid culture assays has produced contradictory results. In this study, viable counting was used to investigate the effectiveness of excretion/secretion against three marker bacterial species (Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli) and the effects of varying growing conditions in assays. Results demonstrate that factors such as number of larvae, species of bacteria and addition of nutrient influence its antibacterial potency. Therefore a standardised method should be employed for liquid culture assays when investigating the antibacterial activity of larval excretion/secretion from L. sericata. [ABSTRACT FROM AUTHOR]

Objectives: Commercially produced sterile green bottle fly Lucilia sericata maggots are successfully employed by practitioners worldwide to clean a multitude of chronic necrotic wounds and reduce wound bacterial burdens during maggot debridement therapy (MDT). Secretions from the maggots exhibit antimicrobial activity along with other activities beneficial for wound healing. With the rise of multidrug-resistant bacteria, new approaches to identifying the active compounds responsible for the antimicrobial activity within this treatment are imperative. Therefore, the aim of this study was to use a novel approach to investigate the output of secreted proteins from the maggots under conditions mimicking clinical treatments. [ABSTRACT FROM PUBLISHER]

The correct assessment and early management of wounds is vital in achieving a good outcome in both the acute and chronic setting. A robust management plan for the trauma patient depends upon accurate and timely assessment of all injuries and evaluation of key features such as mechanism of injury, pre-hospital findings and intervention, zone of injury, patient characteristics and structures damaged. This article describes the general principles of wound assessment and management, discussing mechanism and zone of injury, debridement techniques, types of irrigation and the use of antibiotic prophylaxis. Particular attention is given to the management of open tibial fractures, fasciotomy wounds, pretibial lacerations and haematomas and bite wounds. [ABSTRACT FROM AUTHOR]

Clinicians involved in the conservative care of chronic wounds have many treatment interventions from which to choose, including debridement/irrigation, dressings and pressure-relieving devices, to name a few. All are physical treatments that create an ideal wound healing environment. Unfortunately, many wounds heal very slowly, do not heal, or worsen. This situation relates to the woman in this case study who had a non-healing leg ulcer for 12 months. One of the interventions commonly used to treat chronic wounds is bio-electrical stimulation therapy (BEST), and the rationale for use of this method is based on the fact that the human body has an endogenous bioelectric system that enhances healing of bone fractures and soft-tissue wounds. When the body's endogenous bioelectric system fails and cannot contribute to wound repair processes, therapeutic levels of electrical current may be delivered into the wound tissue from an external source. [ABSTRACT FROM AUTHOR]

Sterile larvae of the common green bottle, Lucilia sericata, have been shown to be a highly cost-effective alternative to conventional treatments for the debridement and cleansing of all types of chronic wounds (Thomas, 2006). One or two treatment cycles each lasting approximately 3 days are often sufficient to achieve complete debridement of such wounds, provided sufficient numbers of maggots are applied on each application. Maggots are less commonly used in traumatic injuries, although in these wounds their remarkable wound cleansing properties could be of considerable value. [ABSTRACT FROM AUTHOR]

The article presents a case study of Bowen's disease in wound care. The patient's condition upon admission at the leg ulcer clinic is presented. The common symptom of Bowen's disease is stated. It explains why the possibility of malignancy could not be excluded.