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Aims: Exemplify the potential of using health economy modeling and simulations to support and optimize wound dressing purchasing decisions., Materials and Methods: We developed a Markov cost-effectiveness modeling framework fusing clinical and industry sources of healing and cost outcomes for evaluating dressings, focusing on polymeric membrane dressings compared to passive foam dressings without active inflammation modulation components. We calculated the wound care costs for patients with and without diabetes, as well as for infected and non-infected wounds, to illustrate the effectiveness of this model in supporting decision-making., Results: The model results demonstrated that polymeric membrane dressings reduce the cumulative treatment costs compared to passive foam dressings, due to fewer dressing changes and lower associated labor costs, regardless of the initial product price differences., Conclusion: Cost-effectiveness calculations should be performed in healthcare facilities to support purchasing decisions based on true cost analyses. Making purchasing decisions focusing on the dressing price alone may provide wrong estimates of the real cost differences., Competing Interests: Declaration of competing interest This work was partially supported by the Israeli Ministry of Science & Technology (Medical Devices Program Grant no. 3-17421, awarded to Professor Amit Gefen in 2020) and by an unrestricted educational grant from Ferris Mfg. Corp. (Fort Worth, TX, USA)., (Copyright © 2024 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

Objective: The aim of this study is to determine the effect of evidence-based skin care and hydrocolloid dressing in the prevention of nasogastric (NG) tube-related pressure injuries (PIs)., Design: This study was a three-arm parallel-group randomized controlled clinical trial registered on Clinicaltrials.gov (NCT04682925)., Methods: The study was conducted with 102 patients who underwent NG tube insertion immediately after admission to the anesthesiology and reanimation intensive care unit of a university hospital in Turkey. Patients were randomly assigned to three groups: a control arm (n = 34), a hydrocolloid dressing arm (n = 34), and a skin care arm (n = 34). Patients in the hydrocolloid dressing arm received daily application of hydrocolloid dressing to the nasal mucosa and alae nasi where the NG tube was inserted. Patients in the skin care arm received skin care interventions in preventing PIs twice daily. No interventions were administered to the control group., Results: No NG tube-related PIs occurred in any patients in the hydrocolloid dressing arm. However, PIs occurred in 97.1 % of patients in the control arm and 94.1 % of patients in the skin care arm. According to the results of regression analysis, failure to apply hydrocolloid dressing increased the risk of NG tube-related PIs by 20.3 times [OR = 20.301, 95 % CI = 6.335-65.053, p < 0.001]. Additionally, a one-unit increase in the duration of ventilation days reduced the risk of NG tube-related PIs by 17.7 % (1-0.823) [OR = 0.823 (95 % CI = 0.684-0.989), p = 0.038]., Conclusion: Results revealed that hydrocolloid dressing is effective in preventing of NG tube-related PIs, whereas skin care did not demonstrate the same effectiveness., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

Objectives: To estimate the cost-effectiveness of sacrum multilayer silicone foam dressings as an adjuvant prophylactic therapy compared to standard pressure ulcer prevention in a hospital population at high risk for pressure ulcer development., Methods: An economic evaluation is performed from a healthcare payer's perspective. This evaluation is based on a Belgian publicly funded pragmatic randomized controlled trial (RCT), linked with real-world data from administrative claims database and a Belgian cost analysis. A cost-consequences analysis with a one-year time horizon is performed., Results: The RCT has shown that the risk of developing a new pressure ulcer on the sacrum was statistically significantly reduced by 41 % in the treatment group (RR = 0.59, 95 % CI 0.35-0.98, p = 0.04). The absolute risk reduction of 2.0 % (95 % CI -0.1-4.1 %) coincides with a number needed to treat of 50.0 to prevent one new pressure ulcer of category II or worse. The evolution of quality of life is on average negative for patients who developed a pressure ulcer before day 3, while it is positive for patients without pressure ulcers. In a scenario with conservative assumptions, i.e. without inclusion of price discounts for the multilayer silicone foam dressings and only including costs during the hospitalization, pressure ulcer prevention with dressings on the sacrum was already cost-neutral., Conclusions: The preventive use of silicone adhesive multilayer foam dressings on the sacrum for a population similar to the pragmatic trial population can be supported both from a clinical and economic point of view., Competing Interests: Declaration of competing interest MN, CDM, SD and EM are members of the KCE Expert Team. KCE is a federal institution. KCE's mission is to advise policymakers on decisions relating to health care and health insurance on the basis of scientific and objective research. KCE has no interest in companies (commercial or non-commercial, i.e. hospitals and universities), associations (e.g. professional associations, unions), individuals or organisations (e.g. lobby groups) that could be positively or negatively affected (financially or in any other way) by the implementation of the recommendations. MN, CDM, SD and EM have no relevant interests to declare. DB has the following interests to declare: Membership of the European Pressure Ulcer Advisory Panel (EPUAP), European Wound Management Association (EWMA), and International Skin Tear Advisory Panel (ISTAP)). Participation in pressure ulcer research (investigator initiated) funded by industry developing prophylactic multi-layer foam dressings. Research grant provided by Mölnlycke Healthcare (Core Outcome Sets in clinical studies on bordered foam dressings). Member of International Wound Dressing Technology Expert Panel (IWDTEP) - Mölnlycke Healthcare. Fees for speaking at scientific meetings by companies in this sector (Mölnlycke Healthcare, Smith & NephewSmith & Nephew, 3M Healthcare, Flen Pharma)., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Aim: Senescent cells, inducing a senescence-associated secretory phenotype (SASP), lead to chronic inflammation in hard-to-heal wound tissue. However, eliminating senescent cells may impede normal wound healing due to their important role in the wound healing mechanism. Accordingly, we focused on wound exudates in hard-to-heal wounds, which contain many inflammation biomarkers consistent with SASP. Therefore, we hypothesized that senescent cells might be present in the exudates and induce chronic inflammation. This study investigated the relationship between gene expression associated with cellular senescence in exudates from pressure injuries and wound healing status., Methods: This retrospective cohort study involved patients treated by a pressure injury team. We collected viable cells from wound dressings and analyzed gene expression. Pearson's correlation coefficient was calculated between cellular senescence and SASP expression. The relationship between the gene expression of cellular senescence and the wound area reduction rate by the following week was examined using a mixed-effects model., Results: CDKN1A-related to cellular senescence-was expressed in 96.3 % of 54 samples, and CDKN1A expression and SASPs positively correlated (PLAU: r = 0.68 and TNF: r = 0.34). Low CDKN1A expression was statistically associated with a large wound area reduction rate (β = 0.83, p < 0.01)., Conclusions: Gene expression of both cellular senescence and SASP factor in wound dressings suggests the presence of cellular senescence. Senescent cells in wound dressings could be associated with delayed wound healing in the following week., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: this study was undertaken to evaluate the efficacy of multilayer polyurethane foam with silicone (MPF) compared to transparent polyurethane film (TPF) dressings in the control of heel skin microclimate (temperature and moisture) of hospitalized patients undergoing elective surgeries., Method: the study took of a secondary analysis of a randomized self-controlled trial, involving patients undergoing elective surgical procedure of cardiac and gastrointestinal specialties in a university hospital in southern Brazil, from March 2019 to February 2020. Patients served as their own control, with their heels randomly allocated to either TPF (control) or MPF (intervention). Skin temperature was measured using a digital infrared thermometer; and moisture determined through capacitance, at the beginning and end of surgery. The study was registered in the Brazilian Registry of Clinical Trials: RBR-5GKNG5., Results: significant difference in the microclimate variables were observed when the groups (intervention and control) and the timepoint of measurement (beginning and end of surgery) were compared. When assessing temperature, an increase (+3.3 °C) was observed with TPF and a decrease (-7.4 °C) was recorded with MPF. Regarding skin moisture, an increase in moisture (+14.6 AU) was recorded with TPF and a slight decrease (-0.3 AU) with MPF., Conclusions: The findings of this study suggest that MPF is more effective than TPF in controlling skin microclimate (temperature and moisture) in heels skin of hospitalized patients undergoing elective surgeries. However, this control should be better investigated in other studies., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest., (Copyright © 2024 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

Aim of the Study: The aim of the current study was to develop collagen-based bi-layered composite dressings with antibacterial property and evaluate the efficiency for wound healing., Materials and Methods: A bi-layered composite wound dressing was fabricated using two marine biomacromolecules (collagen and chitosan or carboxymethyl chitosan). Non-crosslinked and N-Ethyl-N'-(3-dimethylaminopropyl) carbodiimide/N-Hydroxy succinimide (EDC/NHS) cross-linked collagen sponges fabricated by vacuum freeze-drying technology was used as the inner layer. The medical spun-laced nonwoven coated with chitosan and carboxymethyl chitosan was used as the outer layer. The antibacterial activities against E. coli and S. aureus were evaluated by the inhibition zone assay. Deep second-degree scald model was performed to evaluate the efficiency of bi-layered composite dressings for wound healing., Results: In view of comprehensive evaluation of appearance and in vitro antibacterial activity, medical spun-laced nonwoven coated with 3% of chitosan solution was chosen to be used as the optimized preparation conditions to produce the outer layer of composite dressing, which acted as a barrier against microorganisms and provided mechanical support. Furthermore, the results of wound closure and histopathological analysis indicated that EDC/NHS cross-linked collagen-based bi-layered composite dressing was superior to non-crosslinked and commercial products, which stimulated the wound healing process and accomplished deep second-degree scalded skin healing within a time span of 28 days., Conclusion: The EDC/NHS cross-linked collagen-based bi-layered composite dressing had immense potential to be applied for an ideal wound dressing for more efficient and faster wound healing. Therefore, the findings provided the essential theoretical basis for great potential of collagen-based composite dressing used in wound healing applications., (Copyright © 2021. Published by Elsevier Ltd.)

Aim: While the scientific evidence in favour of negative pressure wound therapy (NPWT) dressings on sutured incisions in the prevention of surgical site infections (SSIs) has increased, the cost-effectiveness after vascular surgery has not been evaluated. The aim of this study was to evaluate the cost-effectiveness of NPWT compared to standard dressings for the prevention of SSIs after open inguinal vascular surgery., Materials and Methods: Patient data were retrieved from the randomised INVIPS-trial's open arm, which included patients randomised to either NPWT or standard dressings. The patients were surveyed for SSIs for 90 days postoperatively. The patients' individual cost data were included and analysed from a healthcare perspective. The patients' quality of life was measured using the Vascuqol-6 questionnaire pre- and 30 days postoperatively. Cost-effectiveness of NPWT was determined by decreased or equal total costs and a significant reduction in SSI incidence., Results: The mean vascular procedure-related costs at 90 days were €16,621 for patients treated with NPWT (n = 59) and €16,285 for patients treated with standard dressings (n = 60), p = 0.85. The SSI incidence in patients treated with NPWT was 11.9% (n = 7/59) compared to 30.0% (n = 18/60) with standard dressings, p = 0.015. This corresponds to an increased mean cost of €1,853 per SSI avoided. The cost-effectiveness plane of incremental vascular procedure-related costs and difference in Vascuqol-6 score showed that 42% of estimates were in the quadrant where NPWT was dominant., Conclusion: NPWT is considered cost-effective over standard dressings in patients undergoing open inguinal vascular surgery due to reduced SSI incidence at no higher costs., (Copyright © 2020 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Pain caused by wounds of different etiology is usually treated with oral analgesics. New topical use of products such as the ether anesthetic sevoflurane shows good results for pain control and has additional benefits. Pressure ulcers are painful and patients may benefit from the use of sevoflurane. We present the case of a double-lung transplant patient with a long-standing sacral pressure ulcer with poor pain control, for which sevoflurane dressings were used. The number of pain-free hours after application, the amount of daily analgesics and the size of the wound were monitored with the mobile wound application MOWA. After several days of sevoflurane application, the patient reduced analgesic consumption, remained longer free of pain, and the size of the wound decreased. Unfortunately, the patient had serious complications due to multiple comorbidities and died before the wound healed completely. Topical use of sevoflurane in pressure ulcers may be a good option to treat pain and improve patient quality of life., (Copyright © 2020 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Aim: The purpose of the study was to evaluate clinical safety and effectiveness of Oasis ® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care., Methods: A total of 130 adults with Stage III or Stage IV pressure ulcers were randomly assigned, received either multiple topical treatments of SIS plus standard care (n = 67), or standard care alone (n = 63), and were subsequently evaluated. Ulcer size was determined at enrollment and weekly throughout treatment. Healing was assessed at each visit for a period of up to 12 weeks, with incidence of complete healing and 90% reduction in ulcer area being the primary outcome measures., Results: The proportion of complete healing in the SIS group was 40% as compared to 29% in the standard of care group (p = 0.111); the percentage of patients having a 90% reduction in ulcer surface area was 55% in the SIS group versus 38% in the standard of care group (p = 0.037)., Conclusions: The results of this study suggest that within the setting of a comprehensive wound care program, weekly treatment of chronic pressure ulcers with SIS wound matrix increases the incidence of 90% reduction in wound size versus standard of care alone., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Wound healing is a complicated process that begins at the onset of injury and a continued process till complete healing. The emergence of nanotechnology has provided a new therapeutic modality to silver nanoparticles in treatment of wounds. However, the safety of these silver nanoparticles in the process of wound healing is yet to be elucidated; nevertheless, biocompatibility is the primary concern. Biosynthesis of silver nanoparticles was synthesized using aqueous clove extract and silver nitrate solution under microwave and the obtained particles size were 30-60 nm and roughly spherical in shape. The present study focused on the efficacy of biocompatible silver nanoparticles in vivo wound healing process. Consequently, this study supported the incorporation of biosynthesized silver nanoparticles in wound dressings as a cream formulation for improved healthcare., (Copyright © 2018 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Background: It is current practice for physicians to use the Prontosan ® range of products in children based on their personal clinical experience, despite the lack of safety data in this population. This retrospective data review was designed to obtain information on the safety profile of the Prontosan ® range of products in children in routine clinical practice., Methods: Data from newborns, infants and children with burns treated with the Prontosan ® range were collected retrospectively from patient medical records., Results: The majority of children treated for burns (80.1%) were under the age of four. More boys than girls were subject to burn injury (58.1% vs. 41.9%). The majority of burns (74.7%) were partial thickness burn (IIa and IIb). Safety was analysed based on the adverse events/reactions, infections and interactions/symptoms related to Prontosan ® reported in the CRFs. AEs were reported in five children after the use of Prontosan ® products: itching (3 cases), rash (1 case) and hypergranulating tissue (1 case). No event was severe and all events resolved favourably with good healing results. In addition, 11 patients developed clinical signs of infection during treatment (mainly Staphylococcus aureus)., Conclusions: The Prontosan ® range of products is demonstrated as safe and tolerable for use in children as part of burn treatment. Inclusion of this range of products in the protocol of paediatric burn care allows a good healing process starting with appropriate wound cleansing and maintaining moist wound environment., (Copyright © 2018 Tissue Viability Society. All rights reserved.)

Background: Perforator flap techniques with conventional wound dressing have being extensively used in the management of soft-tissue defects. However; the flap's survival rate is not always guaranteed and the wound healing time always long. The aim of this study was to investigate the clinical effectiveness use of a freshly transplanted perforator flap in conjunction with Vacuum-assisted closure (VAC) for better clinical outcomes., Methods: A prospective, randomized, effectiveness study comparing the clinical outcomes of VAC versus traditional wrap and bandages for the treatment of open wounds that required hospital admission and operative debridement using perforator flaps, was carried out from March 1, 2014 to March 31, 2016 at Wuhan University Zhongnan Hospital. Fifty-one eligible patients were randomized into two groups; study group (perforator flaps covered by VAC) and control group (perforator flaps covered by traditional wrap and bandages). The measured clinical endpoints included the time of the first post-operative dressing change, pain visual analogical scale, perforator flap infection rate, 95% perforator flap healing time and percentage of survived perforator flap., Results: There was no statistically significant difference in the demographic profiles in the two cohorts. There were statistically significant differences in the clinical endpoints in the two groups (p < 0.001; p < 0.05, Table 2)., Conclusions: In summary, VAC combining with perforator flap technique, can diminish accumulated exudation of the transferring flap, protect against postoperative infection, prolong the interval between perforator flap relocation and first postoperative dressing change, decrease pain during removal of dressing, increase perforator flap survival rate, and shorten wound healing time, with a good aesthetic outcome, a good mobility and a satisfactory therapeutic result., (Copyright © 2017 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

This abstract highlights the work undertaken by the Bedfordshire and Hertfordshire Tissue Viability Nurses Forum (BHTVNF) to select a super absorbent dressing for local formularies. A range of super absorbent dressings was selected to be included in the evaluation based on their accessibility via FP10 or NHS Supply chain. Dressings were evaluated in the hospital setting, community setting and leg ulcer clinics. Table top evaluations were also undertaken. Performance of dressings both clinically and via table top were considered along with costs. It was interesting to find out that hospital patients had different needs to community patients and as such three recommendations were made. The acute sector has added one super absorbent which is different from the community selected one. The community has also selected a lower performing super absorbent which the acute sector has not chosen., (Published by Elsevier Ltd.)

Aim of the Study: It is important to reduce potential wound complications in total hip and total knee arthroplasty procedures. The purpose of this study was to compare the jubilee dressing method to a standard adhesive dressing., Method: 124 patients (62 total hip replacements and 62 total knee replacements) were randomly selected to have either a standard adhesive dressing or jubilee method dressing. The number of dressing changes, incidence of blistering, leakage, appearance of inflammation, infection rate and the average stay in hospital was recorded for each patient., Results: The jubilee dressing significantly reduced the rate of blistering, leakage and number of dressing changes when compare to a traditional adhesive dressing (p < 0.05). The rate of inflammation and average length of stay in hospital was not significantly different between the two groups., Conclusion: The authors recommend the use of this dressing for total hip and total knee arthroplasty procedures due to the associated lower complication rate., (Copyright © 2012 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

This study investigated the reduction in lower limb oedema achieved when different combinations of intermittent pneumatic compression (IPC) pump settings were used. Twenty-seven individuals aged between 22 and 96 years, with ankle oedema of venous origin, were randomised to either a treatment or control group. Treatment was delivered via a Flowpac pump (Huntleigh Healthcare Ltd, Luton, UK) possessing variable controls. The control group were 'treated' by elevating both lower limbs. The average difference in limb volumes was compared, for each combination of pump setting, to changes in limb volume in the control group. These comparisons revealed that the highest mean reduction in limb volumes was recorded for a pressure of 40 mmHg (p = 0.02), 10 second deflation time (p = 0.0002) and 15 second inflation time (p = 0.0096). Other significant results were obtained by the 30 mmHg pressure (p = 0.017), 35 second deflation time (p = 0.018), and 5 and 45 second inflation times (p = 0.012, 0.013 respectively). For many setting combinations no significant differences were observed between the limb oedema seen in the control and experimental groups. The results should be interpreted with caution because of the large number of tests performed. In addition adverse effects were observed in six out of nine subjects at 70 mmHg pressure and this pressure was discontinued. One subject suffered cramp at 60 mmHg pressure. Lower pressures together with shorter inflation and deflation times appear to be more efficient than higher pressures and long inflation/deflation times. In addition the lack of significant reduction in oedema at pressures above 40 mmHg suggests that the higher pressures cause a tourniquet effect.

Wound dressings guidelines promote rational prescribing. The development of such guidelines is described, including how to get started, the collection of data, format, contents and avoiding the pitfalls. After implementation, the guidelines require on-going monitoring, review, updating and audit.