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Wound bed preparation has come into sharper focus over the past decade, with strategies identified to improve wound condition. This article focuses on implementing a wound cleansing policy and measuring, through audits, how this change affected rates of wound infection. From 2016 onwards, the Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust took steps to revise and improve wound care practices. This resulted in the introduction of a wound cleansing pathway incorporating a surfactant-based cleanser in place of saline, with subsequent staff training and other changes made to practice. This study details the steps taken to implement the new pathway, which brought a reduction in wound infections of 84.3% between 2017 and 2019.

Acute traumatic wound cleansing is currently a controversial issue demonstrated by the variability in solutions and techniques used to clean wounds in clinical practice. Although there is evidence of improved infection outcomes in wounds cleansed with antiseptics, these observations are often undermined by concurrent use of antibiotics in addition to poor study design. Cleansing techniques including pressurized irrigation have also been investigated indicating potential harms such as edema and inconsistencies in irrigation pressures. The purpose of this article is to provide a narrative review on the contemporary evidence indicating the potential harms and benefits of wound cleansing in the context of acute traumatic wounds.\ud \ud This literature review reveals that acute wound cleansing in clinical practice remains heavily dependent on tradition rather than robust clinical evidence. The evidence base remains limited because of methodological and pragmatic issues in obtaining definitive data on the efficacy of specific agents and techniques. Future studies should focus on establishing the relative benefits of different cleansing solutions and techniques. Establishing the most effective use of antiseptic cleansing solutions may also help reduce further antimicrobial resistance as observed in recent studies. Clinicians responsible for cleansing wounds must consider patient preference when deciding which solution and techniques are used. In addition, a risk assessment considering the potential harms and benefits of different solutions and techniques must be performed.

Background Various solutions have been recommended for cleansing wounds, however, normal saline is favoured as it is an isotonic solution and is less likely to interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. Objectives The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Search strategy Randomised and quasi-randomised controlled trials were identified by electronic searches of Cochrane Wounds Group Specialised Register (June 2004), MEDLINE (1996–2004), EMBASE (1980–2004), CINAHL (1982–2004), and the Cochrane Controlled Trials Register (Issue 2, 2004). Primary authors, company representatives and content experts were contacted to identify eligible studies. Reference lists from included trials were also searched. Selection criteria Randomised and quasi-randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Data collection and analysis Trial selection, data extraction and quality assessment were carried out independently by two reviewers and checked by a third reviewer. Differences in opinion were settled by discussion. Some data were pooled using a fixed effects model. Main results Five trials were identified that compared rates of infection and healing in wounds cleansed with water and normal saline; three compared cleansing with no cleansing and one compared cleansing with procaine spirit with water. There were no standard criteria for the assessment of wound infection across the trials which limited the ability to pool the data. The major comparisons were water versus normal saline, and tap water versus no cleansing. For chronic wounds, the relative risk of developing an infection when cleansed with tap water compared with normal saline was 0.16 (95% CI 0.01–2.96). Use of tap water to cleanse acute wounds in adults was associated with a lower rate of infection than saline (RR 0.55, 95% CI 0.31–0.97). The use of tap water to cleanse acute wounds in children was not associated with a statistically significant difference in infection, when compared with saline (RR 1.07, 95% CI 0.43–2.64). Similarly, no statistically significant differences in infection rates were seen when wounds were cleansed with tap water versus not cleansed at all (RR 0.81, 95% CI 0.31–2.12). Likewise, there was no difference in the infection rate in episiotomy wounds cleansed with water or procaine spirit. The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected. Conclusions Although the evidence is limited one trial has suggested that the use of tap water to cleanse acute wounds reduces the infection rate and other trials conclude that there is no difference in the infection and healing rates between wounds that were not cleansed and those cleansed with tap water and other solutions. In the absence of drinkable tap water, boiled and cooled water as well as distilled water can be used as cleansing agents.

Common treatment for venous leg wounds includes topical wound dressings with compression. At each dressing change, wounds are debrided and washed; however, the effect of the washing procedure on the wound microbiome has not been studied. We hypothesized that wound washing may alter the wound microbiome. To characterize microbiome changes with respect to wound washing, swabs from 11 patients with chronic wounds were sampled before and after washing, and patient microbiomes were characterized using 16S rRNA sequencing and culturing. Microbiomes across patient samples prior to washing were typically polymicrobial but varied in the number and type of bacterial genera present. Proteus and Pseudomonas were the dominant genera in the study. We found that washing does not consistently change microbiome diversity but does cause consistent changes in microbiome composition. Specifically, washing caused a decrease in the relative abundance of the most highly represented genera in each patient cluster. The finding that venous leg ulcer wound washing, a standard of care therapy, can induce changes in the wound microbiome is novel and could be potentially informative for future guided therapy strategies.

Objective. To study the impact of estrogens and liposomes on course of healing process in purulent wounds of soft tissues in experiment. Маterials and methods. Еxperimental investigation was done on 21 sheep. In the laboratory animals purulent-inflammatory process was simulated. Тhe laboratory animals were distributed into two groups: a control - 6 sheep and investigated - 15. All the animals obtained conventional therapy. In laboratory animals of the investigated group estrogens and liposomes were added to complex of the conventional treatment measures. The healing process course was controlled, using cytological, biochemical, planimetric and mathematic-statistical methods of investigation. Results. Application of combined estrogen-liposomal therapy in complex treatment of experimental purulent wound of soft tissues have enhanced the levels of оxyprolene, ribonucleic and deoxyribonucleic acids in the wound area, raised a value of estradiol/testosteronic index, accelerated the wound cleansing, the granulations creation and shortened the wound healing process by (2.12 ± 0.24) days. Conclusion. Including of estrogens and liposomes into the treatment complex for experimental purulent wound of soft tissues enhances cellular biosynthetic activity, activity of reparative processes in the wound area, accelerates the wound cleansing and the granulation creation, shortens the wound healing process and may be applied for improvement of the purulent wounds treatment in elderly and senile patients.

Objective: The burden of wound care within the NHS is estimated at a cost of £5.3 billion per year and is set to rise annually by 30%. This case series describes the results of using polyhexanide (PHMB) and betaine wound irrigation solution and gels (Prontosan, B.Braun Medical Ltd., UK) across the UK in hard-to-heal (also described as chronic) wounds up to 20 years' duration, with an observation period of greater than one month. Over half of the hard-to-heal wounds were healed and vast improvements to all other wounds were observed. Improvements to wound bed condition were reported as early as two days after commencing initial treatment, with decreases in malodour, exudate, slough and pain reported across the case series. In addition to wound bed improvements, a reduction in dressing change frequency of 55% was observed in hard-to-heal wounds under the new treatment regime.

Presence of bacteria in wounds can delay healing. Addition of a regularly instilled topical solution over the wound during negative‐pressure wound therapy (NPWT) may reduce bioburden levels compared with standard NPWT alone. We performed a prospective, randomised, multi‐centre, post‐market trial to compare effects of NPWT with instillation and dwell of polyhexamethylene biguanide solution vs NPWT without instillation therapy in wounds requiring operative debridement. Results showed a significantly greater mean decrease in total bacterial counts from time of initial surgical debridement to first dressing change in NPWT plus instillation (n = 69) subjects compared with standard NPWT (n = 63) subjects (−0.18 vs 0.6 log10 CFU/g, respectively). There was no significant difference between the groups in the primary endpoint of required inpatient operating room debridements after initial debridement. Time to readiness for wound closure/coverage, proportion of wounds closed, and incidence of wound complications were similar. NPWT subjects had 3.1 times the risk of re‐hospitalisation compared with NPWT plus instillation subjects. This study provides a basis for exploring research options to understand the impact of NPWT with instillation on wound healing.

Introducción: Las heridas con defectos de coberturas suponen un gran desafío a la hora de elegir un buen tratamiento que reduzca el riesgo de infección e incremente la capacidad de granulación del tejido. El objetivo de este estudio fue demostrar la utilidad del digluconato de clorhexidina para la granulación de tejidos. Materiales y Métodos: Se incluyeron 18 heridas de 16 pacientes que cumplían con los criterios de inclusión. Se realizaron curaciones ambulatorias con gasas embebidas en digluconato de clorhexidina al 20%, cada 48-72 h, hasta lograr la adecuada granulación de tejido y se tomaron fotografías de la evolución clínica de las heridas. Resultados: Se observó una adecuada granulación de las heridas en una media de 9.2 días (rango 4-25), independientemente del tamaño o de las comorbilidades. Ninguna herida presentó signos clínicos de infección durante el período de curación. Conclusiones: El uso de digluconato de clorhexidina es un adecuado método por tener en cuenta para tratar heridas, de forma ambulatoria, y así disminuir los costos hospitalarios del sistema de salud.

Introduction There is a paucity of randomized trials on nail surgery. Since there are no established guidelines, dermatologists may have false beliefs about best practices in performing nail surgery and post-procedural care. Methods We identified five common myths concerning nail surgery. A PubMed search was performed to refute or support these beliefs. Results We found compelling evidence that refutes these nail surgery myths. We found that epinephrine can be safely used for nail surgery, hydrogen peroxide and tap water is recommended for wound cleansing, prophylactic topical antibiotics should be avoided, calcium alginate, or amniotic membrane dressings are valuable dressing alternatives, and digital dressings have a low risk profile with precise technique. Discussion Randomized controlled trials for nail surgery are lacking. Data from similar fields may guide dermatologists in performing nail surgery. J Drugs Dermatol. 2020;19(3): 230-234 doi:10.36849/JDD.2020.4861.

OBJECTIVE The aim: To conduct an analysis of the complex treatment of severe forms of rectal abscesses complicated by NF. PATIENTS AND METHODS Materials and methods: The results of treatment in 471 patients with deep forms of RA was performed. In 38(8%) the spread of the process and rotten-necrotic affection of the perineal fascia. Patients were treated at the surgical clinic of the medical faculty №2, VNPMMU, and Vinnytsya Clinical Emergency Hospital in the period from 2010-2018. RESULTS Results: Total lethality 8(1,7%). Mortality in GF was 8(19,5%). It is worth noting the reduction of the treatment duration against the background of the modern technologies usage in the period from 2016 to 12 days in relation to the total figure of 15 days. CONCLUSION Conclusions: Early surgical treatment, adequate necrectomy, fasciotomy and antibacterial therapy stop the necrotic process. The active aspiration reduces the timing of wound cleansing and further ensures the accelerated implementation of reconstructive surgical interventions.

The aim of this study was to assess the coverage of studies of collagenolytic enzymes (collagenases) in the sphere of their use in wounds and scars treatment, the resource of their production and the range of collagenase products to identify the areas for their improvement. Materials and methods . The information from retrieval and library databases (eLIBRARY, PubMed, Scopus, ScholarGoogle, ResearchGate), patent information databases (freepatent.ru, ntpo.com, fips.ru), the State register of medicines (GRLS) and the State register of medical devices, as well as technical information provided by manufacturers of medicines and medical devices, was used in the article. Results . The analysis of the information database has shown that collagenolytic enzymes are effective proteolytic complexes because of their ability to provide the breakdown of collagen, the main component of wounds and scars. Hepatopancreas crustaceans is currently one of the available raw resources of collagenases in Russia. It is noted that proteolytic enzymes from the Paralithodes camtschatica hepatopancreas are characterized by a broad specificity: they are able to hydrolyze both native collagen and other protein substrates. There are data confirming the capability of collagenases to accelerate the process of reparation in addition to wound cleansing from a necrosis. The results of clinical studies of collagenases anti-scar properties, indicate the effectiveness of their use for the skin scar correction. The content analysis has shown that there is a small amount of collagenase-based products in the Russian pharmaceutical market: lyophilized powder for preparation of the injection solution "Collalysin", recommended for scars treatment; a medical dressing "Digestol" with collagenase, recommended for wounds and necrotic lesions treatment; "Fermencol" (gel and powder), the "Karipain plus" gel for scars treatment. Drugs are represented by only powder lyophilisate "Collalysin". Conclusion . The development of gel compositions (Aerosil-based oleogels) and atraumatic dressings with collagenase from Paralithodes camtschatica hepatopancreas as the most affordable raw materials can be considered problem number one of practical pharmacy at present. This provides for the creation of the dosage forms, improved in terms of stability and efficiency, as well as ease of use.

Objective:To assess the benefits of negative pressure wound therapy (NPWT) in complex therapy of patients with enterocuta‑ neous fistulas.Methods: From 2014 to 2019 in Saint Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, 24 patients were managed with vacuum assisted techniques. For comparison, a comparable group of 23 observations (control) was formed retrospectively based on an analysis of medical records.Results: When using NPWT, the terms of wound cleansing and the formation of a laparostomy were reduced, and conditions were created for its early closure. With a small laparostomy, the use of NPWT contributed to self-epithelialization of the wound around the fistula.Conclusions: The use of NPWT more than halves the time of formation of a laparostomy, shortens the time for cleansing the wound and creates the conditions for its closure. Surgical tactics using NPWT can more than three times reduce the number of local complications in patients with unformed intestinal fistulas and less often change the combination of antibacterial drugs.

Introduction : Au Mali, de 2015 à 2018, on a recensé 2611 cas de morsures de chiens dont 6 cas de rage humaine confirmés. Durant la même période, les cas de morsures de chiens à Sikasso, s'élèvent à 236 et est en constante augmentation d'année en année. Les objectifs étaient de décrire les cas de morsures en personne, Caractériser les lésions des morsures et apprécier la prise en charge des cas. Méthodologie : Nous avons mené une étude descriptive portant sur les dossiers des sujets mordus par chiens de janvier 2017 à octobre 2019 dans le District Sanitaire de Sikasso. Résultats : Les consultants recensés au nombre de 196 en majorité de sexe masculin (64 %), avaient un âge moyen de 14 ans. Seuls 31/196, soit 15,81 % des chiens étaient vaccinés. Les fesses ont été le site privilégié des morsures de chiens avec 39,80%. Le schéma vaccinal à 5 doses avec lavage de la plaie représentait 52,52%. Parmi les 196 consultants recensés, 15,62 % avaient abandonné le traitement vaccinal. Les chiens mis en observation étaient 41,34% et un grand nombre abattu soit 38,26%. La classification finale des cas fait état de trois (3) cas de rage canine et aucun cas de rage humaine. Conclusion La lutte contre la rage doit mettre l'accent le traitement post exposition précoce, la vaccination des animaux ainsi que sur la sensibilisation de la population vis-à-vis du risque de rage.

Appropriate and effective wound cleaning represents an important process that is necessary for preparing the wound for improved wound healing and for helping to dislodge biofilms. Wound cleaning is of paramount importance to wound bed preparation for helping to enhance wound healing. Surfactant applications in wound care may represent an important area in the cleaning continuum. However, understanding of the role and significance of surfactants in wound cleansing, biofilm prevention and control, and enhancing cellular viability and proliferation is currently lacking. Despite this, some recent evidence on poloxamer‐based surfactants where the surfactants are present in high concentration have been shown to have an important role to play in biofilm management; matrix metalloproteinase modulation; reducing inflammation; and enhancing cellular proliferation, behaviour, and viability. Consequently, this review aims to discuss the role, mode of action, and clinical significance of the use of medically accepted surfactants, with a focus on concentrated poloxamer‐based surfactants, to wound healing but, more specifically, the role they may play in biofilm management and effects on cellular repair.

The goal of wound cleansing and care is the control or removal of tissue infection to allow healing in the most functional, cosmetic, fastest, and least expensive manner possible. This is accomplished through the removal of debris and necrotic tissue while reducing the bacterial load via careful use of mechanical techniques and cleaning agents, accepting that some level of tissue trauma will result. Keep in mind that the benefit of a clean wound must be weighed against the trauma inflicted in the process of cleansing. Veterinary health care professionals should take steps to reduce hospital-acquired infections and zoonotic disease transmission.

SUMMARY The use of negative-pressure wound therapy (NPWT) has become an established therapy for wound management. There have been many advancements in the technology of NPWT including NPWT with instillation and dwell (NPWTi-d). NPWTi-d promotes wound healing by wound cleansing, irrigation, and nonexcisional debridement. NPWTi-d has been shown in comparative clinical studies to decrease the time to definitive wound healing and length of hospitalization. NPWTi-d-using a reticulated open-cell foam dressing with "through" holes (ROCF-CC)-has been postulated to facilitate solubilization, detachment, and elimination of infectious materials, such as slough and thick exudate, before or after operative debridement, and in cases where surgical debridement is not an option. The authors provide an overview on the use of NPWTi-d by reviewing the components of the system, proposed mechanism of action, clinical outcomes, and current consensus guidelines for its utilization.

Cleansing provides an opportunity to remove pathogens from the wound bed, thereby preventing an increase in the bioburden and delayed healing. This article describes the reported efficacy of hypochlorous acid-containing wound cleansers

Objetivo: Produzir e validar um manual sobre cuidados com a ferida pós-pleurostomia aberta para profissionais de saúde. Métodos:Trata-se de um relato de experiência. Inicialmente, foram selecionados artigos em português, espanhol e inglês no período de 2010 a 2018 nas bases de dados bibliográficos e sites de busca da Cochrane, SciELO, LILACS, PubMed e Google Acadêmico para o desenvolvimento do material. Foram utilizados os descritores: “toracotomia”, toracostomias”, “cavidade torácica”, “pleura”, “cavidade pleural”, “ferimentos e lesões”. Após consulta, o texto foi elaborado, seguido das ilustrações e a diagramação. O manuscrito concluído foi encaminhado aos especialistas para validação. O índice de validade de conteúdo (IVC) foi utilizado para validar o manual. Resultados: O manual desenvolvido possui trinta e seis páginas e sete capítulos com os seguintes temas: introdução, cuidados com a ferida pós-pleurostomia aberta, limpeza da ferida/debridamento, coberturas, registro dos cuidados, considerações finais e bibliografia. Conclusão: Foi possível desenvolver e validar um manual de cuidados com a ferida pós-pleurostomia aberta para a consulta de profissionais de saúde

Objective: To determine reliability of primary closure of abscesses verses conventional incision and drainage. Study Design: Comparative study. Settings: DHQ Hospital, Independent University Hospital Faisalabad-Pakistan. Duration: Two years, 2017 to 2019. Conventional incision and drainage with wound packing is still being widely practiced despite innovative broad spectrum antibiotic coverage availability. The purposes of innovative primary closure procedure after incision and drainage and meticulous wound cleansing with normal saline covered by broad-spectrum prophylactic and post-operative antibiotics is to reduce morbidity and cost related to the more conventional procedure. Methodology: Comparison of two procedures that i.e. conventional incision and drainage with wound packing and incision and drainage with primary closure. The results were observed in patients including author's recent practice undergoing primary closure after incision and drainage from December 2017 to July 2019. The data was collected from DHQ Hospital, Independent University Hospital Faisalabad from year 2017 to 2019. Group 1 included patients with primary closure and group 2 included patients undergoing conventional incision and drainage. Results: Results of both procedures were compared in terms of morbidity i.e. recurrence, wound infection, cost and final scar results. In group 1 recurrence was observed in one patient (2%). It was observed that post-operative wound infection occurred in two patients (4%) that settled with antibiotic cover. Lesser number of average hospitals stay which the author found to be just 0- 1 day. The healing time was observed to be 7-10 days. In the group 2, there was no difference in recurrence of abscess which was found to be 2%-3%. The wound infection was observed 4% which was like group 1. On the other hand, the patients had to stay hospital for 4-5 days. Daily painful dressings requiring I.V analgesia and psychological trauma related to open wound. The average healing time was extended to of 4-6 weeks. Conclusion: Primary closure of abscesses versus conventional incision and drainage is more beneficent.

Increasing the number of dogs and cats kept in urban households makes relevant research of new effective methods of treatment of companion animals. We conducted studies of the effect of Bovhyaluronidaze azoximer on the treatment duration of suppurative wounds. The study was carried out on 42 animals (24 cats and 18 dogs) with septic processes in two groups. The animals of the both groups were given conventional therapy; in animals of the experimental group the Bovhyaluronidaze azoximer preparation was additionally included as a part of a complex therapy. The effect of the use Bovhyaluronidaze azoximer preparation was evaluated by three indicators: the wound cleansing from purulonecrotic masses duration, the duration of existence of edema, the number of managements of wound. The median wound cleansing time in the experimental group improve on 2.29 days. The median duration of existence of edema in the experimental group was in less time on 1.57 days in comparison with the control group. The median number of required managements of wound is reduced by 5.00 manipulations in the experimental group in comparison with the control group. The results of our study show that Bovhyaluronidaze azoximer can be recommended for use in the therapy of suppurative wounds.

The purpose of this paper is to provide an overview of the formation of slough on the wound bed. The impact slough has on wound healing will also be explored. There are several wound cleansing products which can be used for the safe removal of slough, and several different methods of debridement - including autolytic, conservative sharp, surgical, ultrasonic, hydrosurgical and mechanical - as well as several therapies which can be used, including osmotic, biological, enzymatic dressings and monofilament fibre pads. These various methods will be described.

Objective: To evaluate if cleansing, using a solution containing the antimicrobial polyhexanide and the surfactant betaine (polyhexanide propylbetaine [PP], Prontosan Solution, B. Braun), can aid effective wound bed preparation (WBP). Method: A solution containing the PP was used in two different treatment regimens. Group A was treated with a single application at different time durations (2, 5, 10 and 15 minutes) to evaluate efficacy in the removal of residues from the wound bed. Group B was treated with PP for 10 minutes, followed by application of an inert dressing, at daily dressing changes for 14 days, to evaluate efficacy of debridement. Results: A total number of 70 patients took part in the study. In Group A (n=40), after the two and five minute application, no change was observed. At 10 minutes, an improvement was seen in 4/10 cases and at 15 minutes the improvement was in 5/10 patients. In Group B (n=30), over the 14 days, an improvement in the condition of the tissue, i.e. the wound bed was cleaned and debrided in 73% of cases, was observed. Patients experienced a reduction in pain and no adverse effect or complication was reported. Periwound skin was improved in 29/30 cases, with only one case where the tissue deteriorated, as determined by the presence of maceration. Conclusion: PP is effective in helping debridement during wound cleansing. Efficacy depends on time of application. However, randomisation and further study is required to confirm these results.

The increasing population of diabetic patients leads to the increasing number of diabetic foot ulcer (DFU) cases. To avoid the expansion of the infection, the wound cleansing is conducted through the irrigation and pressure methods. The aim of this research was to identify the effectiveness of wound cleansing using 0.9% normal saline technique with the pressure of 15 Psi in reducing the number of bacteria. This research used the randomized control trial method with a double blind design which had been approved by the ethnical committee of Muhammadiyah University of akarta with the ethnical committee number 261/PMK-UMJ/IV/2017. There were as many as 31 samples in each group collected through consecutive sampling technique with randomization. It had been found that there was a signi fi cant difference in the number of bacteria before and after wound cleansing. Thus, it could be concluded that from the statistical test and clinical test, wound cleansing with normal 0.9% saline technique with the pressure of 15 Psi could decrease the number of bacteria in diabetic foot ulcers. Wound cleansing with 0.9% normal saline irrigation technique pressurized at 15 Psi was recommended as a safe wound cleansing method for diabetic foot ulcers.

Manuskrip ini sudah dipublikasikan di Journal Advanced Science Letters, Volume 23, No 12 (December 2017)

The aim of this study was to compare different wound-rinsing solutions to determine differences in the efficiency and to evaluate three different in vitro models for wound cleansing. Different wound-rinsing solutions (physiological saline solution, ringer lactate solution for wound irrigation, water and a solution containing polihexanide and the surfactant undecylenamidopropyl-betain) were applied on standardised test models (one- and three-chamber model, flow-cell method and a biofilm model), each challenged with three different standardised wound test soils. In the one-chamber model saline showed a better effect on decontaminating proteins than the ringer lactate solution. In the flow-cell method, water performed better than physiological saline solution, whereas ringer lactate solution demonstrated the lowest cleansing effect. No obvious superiority between the two electrolyte-containing solutions was detectable in the biofilm model. Unfortunately, it was not possible to assess the protein decontamination qualities of the surfactant-containing solution because of the interference with the protein measurement. The flow-cell method was able to detect differences between different rinse solutions because it works at constant flow mechanics, imitating a wound-rinsing procedure. The three-chamber and the less-pronounced modified one-chamber method as well as the biofilm model had generated inhomogeneous results.

Surfactants are widely used as detergents, emulsifiers, wetting agents, foaming agents and dispersants in the cosmetics, hygiene, food and oil industries. Their use in a clinical setting is also common, particularly within the field of wound care. Many wound cleansers contain surfactants and subsequently there is available data that shows the growing potential of these wound cleansers in the enhancement of wound closure. The presence of microorganisms in wounds has been recognised as a significant factor that delay healing. In complex or chronic wounds that are complicated by biofilms, persistent inflammation or the production of non-viable tissue and slough, the use of surfactants has been shown to aid in the removal of these barriers to wound healing. The use of concentrated surfactant(poloxamer) based wound dressings represent an important component of wound management. Consequently, this article will discuss the effect of clinically used surfactants, with specific focus on a concentrated poloxamer for use against wound biofilm.

Background : wound cleansing is part of wound management which performed to remove foreign bodies or pathogens that can cause infections in wounds to improve the wound healing process. Although it has been agreed that wound cleansing aims to reduce the incidence of infection but the reality is still debated among practitioners about the advantages and disadvantages of this implementation, so the selection of wound cleansers must be done wisely. This review literature aims to evaluate the use of available wound cleansers for wound healing. methods: Literatures was sourced from database Google scholar, PubMed, Proquest, ScienDirect, published from January 2011 to July 2018, there 14 articles were identified and after 9 filters were left. Results: from 9 articles that met the criteria, the results that showed the effect of wound cleansing use; Electrolyzed strong acid water, superoxidised, hydrogen peroxide, propylbetaine-polihesanide, povidine-iodine, chlorin dioxide, tap water with normal saline as a comparison group of the effectiveness in inhibiting infection, tissue toxicity, comfortably, timing and improvement of wound healing process. Based on the review results, it is generally stated that there is no significant difference between. Conclusions: There was no significant difference between wound cleanser. Based on this review it is recommended to pay attention to the type of wound before using wound Cleansing. Keywords: wound Cleansing, wound healing, literature review

The care of any wound in the community requires multidisciplinary working between healthcare professionals. In this article, the authors offer five generalisable principles that colleagues providing community care can apply in order to achieve timely wound healing: (1) assessment and exclusion of disease processes; (2) wound cleansing; (3) timely dressing change; (4) appropriate (dressing choice; and (5) considered antibiotic prescription. High-quality wound care is an essential aspect of healthcare practice but lacks an evidence base and standardised practice at present. The practice and teaching of wound care should be more greatly emphasised in healthcare training for all disciplines.

On 20 November 2018, following the International Society for Paediatric Wound Care conference, a closed panel meeting took place in which the use of a surfactant-based gel (PluroGel (PMM), Medline Industries, Illinois, US) in paediatric wound care was discussed. The authors shared their experiences, thoughts, experimental data and clinical results. The panel identified the need for a product that can gently cleanse paediatric wounds and remove devitalised tissue without causing discomfort or skin reactions, as well as potentially promote healing. In adults, PMM has been shown to assist healing by hydrating the wound, controlling exudate and debriding non-viable tissue. Islands of neo-epithelium have also been reported to appear rapidly in different parts of the wound bed. No adverse effects on these proliferating cells have been observed. In vitro data suggest that PMM can remove biofilm, as well as potentially promote healing through cell salvage. The panel, therefore, set out to discuss their experiences of using PMM in the paediatric patients and to establish a consensus on the indications for its use and application in this population. This article will describe the main outcomes of that discussion and present case studies from paediatric patients with a variety of wound types, who were treated with PMM by members of the panel.

Introduction. An important component of the treatment of gunshot wounds is antibiotic therapy. Unfortunately, due to the antibiotic resistance of many strains of microorganisms, there remains a risk of purulent- infectious complications even with prolonged antibiotic therapy. In recent years, methods of physical action, in particular, photodynamic therapy (PDT), have been used to accelerate bacterial decontamination of wounds. Gunshot wounds have their own characteristics that create certain difficulties for the application of the method of photodynamic therapy. Purpose. Аnalyzes the results of the application of the developed PDT method in the complex treatment of gunshot wounds of soft tissues. Materials and methods. A comparison was made of the main indicators of the wound healing process between the wounded of the main group who used PDT (n = 52) and the comparison group (n = 32) who used treatment with complex water-soluble ointments. To increase the effectiveness of the method, the «Photolon» photosensitizer was administered in two ways: by injection infiltration of tissues around the wound and by application directly to the wound surface. The wavelength of laser radiation is 660 nm. The dose of laser energy was 20 J/cm2. Results. The results of the study showed an improvement in the course of the wound process in all respects when using PDT: the period of regression of local edema in the main group on (3.7 ± 0.4) days in the comparison group (6.2 ± 0.5), the period of wound cleansing (4.7 ± 0.6) days (7.3 ± 0.8) days, respectively; the timing of the start of granulation (4.6 ± 0.5) days and (7.8 ± 0.6). At the beginning of treatment, 45 pathogenic strains were isolated in 38 (73.1 %) wounded main groups and 26 strains in 22 (68.7 %) wounded comparison groups. A day after the use of PDT, pathogenic wound microflora was isolated in 5 (9.6 %) wounded main groups — 5 strains and 23 strains in 19 (59.4 %) wounded comparison groups. Conclusions. The effects of PDT were observed: rapid inactivation of pathogenic wound microflora, reduction of edema, pain syndrome and stimulation of granulation growth, which contributes to early closure of wounds.

Background : Diabetic ulcer is a major complication of diabetes and is the main cause of infection. One of the efforts or interventions to reduce infection by doing wound cleansing, but research on the effects of wound cleansing on bacterial colonization is still limited. The purpose of this literature study was to determine the effectiveness of using a type of wound cleansing on changes in bacterial colonization in DM wounds . Methods : The data base used in making this review literature is Pubmed, Science Direct, Google Scholar and Cochrane. there are 144 articles identified and published from 2010-2018. Of the 144 articles 8 articles that met the inclusion criteria. Results : Various wound cleansing solutions are used to optimize the wound healing process and the effect is quite good in decreasing bacterial colonies in DM wounds. Conclusion : wound cleansing type ESWA has a bactericidal effect, is effective in reducing bacterial colonization, and economically it is expected to be a concern in the treatment process injury, research is needed as to whether ESWA washing types can be used to reduce bacterial colonization in DM wounds.

Betaine Polyhexanide (PHMB) is often being used as wound cleansing solution in current clinical practice for wound care. betaine polyhexanide (PHMB) can reduces the surface tension of the biofilm. The aim of this study was to compare the need of betaine plyhexanide (PHMB) solution and the cost effectiveness in the treatment of diabetic foot ulcers using cleansing method of 13 psi and 7 psi. The observation was conducted for 6 days at Fatmawati Hospital in Jakarta on 18 samples of diabetic foot ulcers. The data were analyzed using SPSS version 15.0. The results of this study showed that the need of betaine polyhexanide (PHMB) solution and the cost effectiveness of irrigation pressure method of 13 psi is more effective and more efficient than the irrigation method of 7 psi ( p = 0.006 ; p = 0:02 ; CI 95 % ). The combination of irrigation pressure method of 13 psi using 0.9 % NaCl and betaine polyhexanide (PHMB) is recommended in clinical applications. Keywords: irrigation pressure, 13 psi, 7 psi, prontosan ® , diabetic foot ulcer

Objective: Research into surfactant solutions for the debridement of chronic wounds suggests that surfactants may support wound bed preparation (WBP) in chronic wounds, however their efficacy has not been evaluated in randomised controlled trials (RCTs). Our aim was to assess the clinical efficacy of a propylbetaine-polihexanide (PP) solution versus normal saline (NS) solution in WBP, assessing inflammatory signs and wound size reduction in patients with pressure ulcers (PUs) or vascular leg ulcers. Method: In a single-blinded randomised controlled trial (RCT) patients were randomly allocated to two groups and treated with either propylbetaine-polihexanide (PP) solution (Prontosan) or NS. Wounds were assessed using the Bates-Jensen wound assessment tool (BWAT). Assessments took place at inclusion (T0), day 7 (T1), day 14 (T2), day 21 (T3), and day 28 (T4). Outcomes were analysed using a two-tailed Student's t-test. Results: A total of 289 patients were included. Both groups had similar demographics, clinical status, and wound characteristics. Data analysis showed statistically significant differences between T0 and T4 for the following outcomes: BWAT total score, p=0.0248; BWAT score for inflammatory items, p=0.03; BWAT scores for wound size reduction (p=0.049) and granulation tissue improvement (p=0.043), all in favour of PP. The assessment of pain did not show any significant difference between the two groups. Conclusion: The study results showed significantly higher efficacy of the PP solution versus NS solution, in reducing inflammatory signs and accelerating the healing of vascular leg ulcers and PUs. This evidence supports the update of protocols for the care of chronic wounds. Declaration of interest: The authors have no conflict of interest regarding this research. This is an investigator initiated trial. B. Braun Milano SpA kindly provided the material under investigation for both treatment groups, and paid the Ethics Committees' application fees in all participating centres.

Background: Removal of nonvital tissue is an accepted method to eradicate biofilms and to stimulate wound healing. Debridement using a monofilament polyester fiber pad has clinically been shown to be effective as well as pain and trauma free. Methods: For in vitro determination of the cleansing capacity of this product compared to gauze swabs, a wound debridement model was used with glass plates coated with a bovine serum albumin solution, stained with hematoxylin. Both products were moistened and fixed to a weight connected to a regulated motor and were then pulled over the holding device with the coated glass plate under standardized conditions (power = 0.067 N/cm2, velocity = 1.6 cm/s). Results: At a low coating concentration (0.5%) both products were equally effective, but at a high concentration (1.5%) cleansing did not occur after 5 wipes. When wiping the plates 15 times, the debridement pad cleansed significantly (p < 0.001) better than gauze. When consecutively wiping 4 coated plates with a single debridement pad or swab, the pad exhibited and maintained a significantly higher cleansing capacity while gauze quickly lost its effect. Conclusion: Our in vitro test results indicated a higher cleansing capacity of the debridement pad compared to gauze swabs.

Necrotizing soft tissue infection is a rapidly spreading bacterial infection that can quickly destroy a person’s muscles, skin, and underlying tissue. In this retrospect chart review, we will look at how the utilization of negative pressure wound therapy with instillation and dwell (NPWTi-d) and novel reticulated open cell foam (ROCF-CC) assisted with the healing of a patient’s wound along with decreasing the time spent in the operating room. NPWTi-d provided the benefits of wound healing such as solubilizing the infectious material and removing the devitalized tissue. Using this form of treatment, we were able to improve the patient’s quality of life and decrease her time in the hospital.

We describe our early experience with a novel foam dressing together with negative pressure wound therapy and instillation (NPWTi-d) for cleansing and removal of infectious materials. This is a prospective review of the clinical outcomes of three patients using V.A.C. VERAFLO™ Therapy with the V.A.C. VERAFLO CLEANSE CHOICE™ Dressing. This novel foam dressing has been designed in a unique way to help facilitate the removal of infectious material, thick fibrinous exudate, slough, and other wound bioburden. To our best knowledge, this is the first reported case series using this dressing in the Middle East. Our preliminary results suggest that adjunctive use of NPWTi-d using V.A.C. VERAFLO CLEANSE CHOICE™ Dressing can clean large or complex wounds when complete surgical debridement is not possible or when areas of non-viable tissue remain present on the wound bed after surgical debridement.

The human body is a complex, multisystem organism that can manifest disease processes in a multitude of ways. Over the decades, technological advancements have allowed us to make precise diagnoses so that clinicians can thoroughly treat the underlying cause. Frequently these disease processes require surgical intervention to eliminate the progression and provide the patient with positive outcomes. When surgical intervention is required, the patient is often left with large complex wounds. Just like medical advancements, wound care modalities have made vast technological improvements. Wounds previously being treated with simple but labor-intensive treatments such as gauze packings and return operating room interventions, can now be treated with negative pressure wound therapy combined with instillation and dwell (NPWTi-d). This therapy combines the benefits of negative pressure while cleansing the wound through the instillation of a topical wound cleanser in a controlled environment. In this case review, we will highlight a case of necrotizing fasciitis in which surgical intervention was required and negative pressure wound therapy with instillation and the use of reticulated open cell foam dressing with through holes (ROCF-CC) was utilized. Negative pressure with instillation was used to remove infectious material and other nonviable tissue from the wound base while promoting granulation tissue production. By utilizing this treatment, we were able to decrease the patient's return trips to the operating room (OR), enhance granulation tissue production, and ultimately achieve positive patient outcomes.

Chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) have major financial implications for patients and healthcare professionals. VLUs, in particular, require significant care, can be slow to heal, and have a high rate of recurrence. These factors combine to make VLUs a major burden on the healthcare system. Recent estimates show that the cost of treatment of VLUs per patient in the United States is $10,000 to $12,000 per year, with the average lifetime cost of care greater than $40,000. Infected VLUs often require surgical debridement for the removal of bacterial burden and biofilm. The use of negative pressure wound therapy with instillation and dwell (NPWTi-d) has shown to decrease OR visits, length of hospitalization, and therapy days in lower extremity and trunk wounds. In 2017, a novel reticulated open cell foam dressing with through holes (ROCF-CC) was introduced as a dressing option with NPWTi-d. ROCF-CC assists in removing thick wound exudate and infectious materials. This dressing option is especially helpful for wound cleansing when debridement is not possible or appropriate in patients.

Microbiology diagnostics are frequently performed in patients with chronic wounds. However, there is currently a lack of uniformity with respect to indications as well as the practical implementation of such workup. The fact that diagnostic results may be significantly affected by the sampling technique used as well as the preceding (wound) preparation underscores the need for uniform standards, which have been missing so far. In Germany, bacteriologic wound swabs are routinely performed, particularly with the intent to screen for multiresistant pathogens. For this indication, prior wound cleansing should be avoided, and sampling using the Essen Rotary technique provides a quick and easy-to-use option. If there is clinical suspicion of an infection, wound cleansing with sterile saline solution (0.9 %) and/or sterile cotton gauze should be carried out prior to obtaining bacteriologic swabs. While routine diagnostic biopsies are generally not required in chronic wound patients, they may be useful in case of clinically suspected wound infections, particularly in patients with deep ulcerations, diabetic foot syndrome, severe soft tissue infection, or fistula tissue. Moreover, biopsies are indispensable in the microbiology workup of specific pathogens such as mycobacteria, Leishmania, actinomycetes, Nocardia ssp. or molds.

Background and Aim: Surgical site infection (SSI) remains an important concern in Japan. The Japanese Soci‐ ety for Infection and Prevention Control disclosed that the incidence of SSIs has been lowered only by a fraction over the past 10 years. The importance of taking steps to reduce the occurrence of SSIs is recognized by many hospitals, but to date, no truly effective countermeasures have been reported. We executed a plan to better un‐ derstand the spec fic surveillance needs at St. Marianna University School of Medicine Hospital and then de‐ velop and institute procedures that would reduce the incidence of SSIs. Methods and Results: In 2005, we began development of an enhanced SSI surveillance system. With our basic CDC-based surveillance system in place, we assembled a team of doctors and nurses to oversee surveillance. We practiced strict record keeping and data analysis, gleaned information from staff, and enlisted the coopera‐ tion of other departments. New procedures were established accordingly and implemented in three phases. Be‐ tween 2005 and 2013, we witnessed informative fluctuat ons in the incidence of SSIs. Key components of our new system were standardized postoperative wound cleansing, use of buried absorbable sutures to close surgical wounds, consistent provision of 6 antibacterial agents, each one active against a common organ spec fic patho‐ gen, and establishment of a prophylactic protocol. New methods of information sharing were also instituted. We lowered the incidence of SSIs from 8% in 2006 to approximately 6.9% in 2012. We continue to monitor the number of SSIs occurring and are encouraged by a steady decline. Conclusion: Establishment of the SSI team at our hospital has proven to be a useful multidisciplinary approach to nosocomial infection awareness and control. Gradual introduction of the system to the various departments and step-by-step implementation have decreased the occurrence of SSIs and the nosocomial spread of infectious agents.

Wound cleansing should create an optimal healing environment by removing excess debris, exudates, foreign and necrotic material which are commonly present in the wounds that heal by secondary intention. At present, there is no research evidence for whether pressurised irrigation has better wound healing outcomes compared with conventional swabbing practice in cleansing wound.This study investigated the differences between pressurised irrigation and swabbing method in cleansing wounds that healed by secondary intention in relation to wound healing outcomes and cost-effectiveness.Multicentre, prospective, randomised controlled trial.The study took place in four General Outpatient Clinics in Hong Kong.Two hundred and fifty six patients with wounds healing by secondary intention were randomly assigned by having a staff independent of the study opening a serially numbered, opaque and sealed envelope to either pressurised irrigation (n=122) or swabbing (n=134). Staff undertaking study-related assessments was blinded to treatment assignment. Patients' wounds were followed up for 6 weeks or earlier if wounds had healed to determine wound healing, infection, symptoms, satisfaction, and cost effectiveness. The primary outcome was time-to-wound healing. Patients were analysed according to their treatment allocation. This trial is registered with ClinicalTrials.gov, number NCT01885273.Intention-to-treat analysis showed that pressurised irrigation group was associated with a shorter median time-to-wound healing than swabbing group [9.0 days (95% CI: 7.4-13.8) vs. 12.0 (95% CI: 10.2-13.8); p=0.007]. Pressurised irrigation group has significantly more patients experiencing lower grade of pain during wound cleansing (93.4% vs. 84.2%; p=0.02), and significantly higher median satisfaction with either comfort or cleansing method (MD 1 [95% CI: 5-6]; p=0.002; MD 1 [95% CI: 5-6]; p0.001) than did swabbing group. Wound infection was reported in 4 (3.3%) patients in pressurised irrigation group and in 7 (5.2%) patients in swabbing group (p=0.44). Cost-effectiveness analysis indicated that pressurised irrigation in comparison with swabbing saved per patient HK$ 110 (95% CI: -33 to 308) and was a cost-effective cleansing method at no extra direct medical cost with a probability of 90%.This is the first randomised controlled trial to compare the pressurised irrigation and swabbing. Pressurised irrigation is more cost-effective than swabbing in shortening time that wound heals by secondary intention with better patient tolerance. Use of pressurised irrigation for wound cleansing is supported by this trial.

Several published reviews and recommendations exist for the use of negative pressure wound therapy (NPWT) with instillation and a dwell time (NPWTi-d) in acute and chronic wounds. Specific dressings for use with NPWTi-d have also been developed, including a reticulated open cell foam dressing with through holes (ROCF-CC) that assists in removing thick wound exudate and infectious materials. ROCF-CC is especially helpful for wound cleansing when debridement is not possible or appropriate in patients. We report our initial experiences in using NPWTi-d with ROCF-CC in patients with pressure ulcers. An algorithmic approach was used to determine appropriate treatment to reach the goals of therapy (i.e., wound bed preparation, granulation tissue formation, and removal of infectious materials). Previous therapies included honey and gauze soaked in Dakin’s solution. All patients received antibiotics and debridement when possible. Five patients (3 females and 2 males) received NPWTi-d with ROCF-CC (instillation of saline or a hypochlorous solution with a dwell time of 10 minutes, followed by 2-3 hours of -125 mmHg NPWT). Patient comorbidities included obesity, diabetes mellitus, hypertension, and peripheral artery disease. Mean age of patients was 65.2 years (range: 50-82 years). After an average of 6 days of therapy (range 2-9 days), all wounds treated with NPWTi-d with ROCFCC showed rapid granulation tissue formation. We also noted improved removal of devitalized tissue and subsequent granulation tissue formation in patients receiving hypochlorous solution compared to patients receiving saline during NPWTi-d with ROCF-CC. All patients were eventually transferred to a skilled nursing facility. In our clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of the thick exudate and infectious materials and promoted excellent development of underlying granulation tissue.

This study was necessitated by the international recognition of wound-related pain (WRP) as a must-address issue and patient-centred concerns. The aim of this study was to assess patients' WRP experiences at rest and in relation to dressing change. This descriptive study utilised a WRP questionnaire which incorporated a visual analogue scale of 0-10 for data collection. A total of 109 patients participated in this study; 95·4% of the participants experienced wound pain at rest and during performance of activities of daily living, which were moderate (47·1%) and severe (30·8%) in intensity. Also, 91·7% of the participants experienced wound dressing change-related pain, mostly as moderate (47·0%) and severe (28·0%) pain. The major factors that worsened WRP experiences were touch/handling, change in position/movement, wound cleansing, removal of dressings and usage of honey as a dressing agent, while the use of analgesic and brief rest between dressing change were considered the major strategies that can relieve WRP. WRP experiences have been reported by patients at rest, during performance of activities of daily living and at wound dressing change. A need to incorporate WRP assessment has been observed, which is vital in improving wound care outcome.

a b s t r a c t Introduction: Hydrotherapy is widely used in burns management however there are risks associated with its use, in particular cross-infection. Data regarding indications and tech- niques in common use is deficient. This study aimed to investigate hydrotherapy practices in the UK and Ireland. Methods: A survey of the hydrotherapy practice of major burn care providers was performed by e mail and where necessary, follow up telephone contact. Results: The survey included 28 burn care providers. 27 reported using hydrotherapy. Only 11 (41%) had defined indication criteria with 4 (15%) implementing a specific protocol. Variations in hydrotherapy practice were seen. Conclusion: Hydrotherapy is used nationwide, however considerable variation in practice exists. One area worthy of further consideration is the need for appropriate standards of infection control.

The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and debridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds.

ZusammenfassungEs gibt eine statistisch nicht erfasste Patientenzahl, die über Jahre chronische Wunden an ihren Unterschenkeln haben. Viele dieser Patienten haben eine Odyssee von Krankenhausaufenthalten, Versorgungen in Wundzentren und anderen Versorgungsstrukturen erlebt. In der langen Krankheitsphase steht bei diesen Patienten weniger die Therapie als das Herstellen von „Normalität“ im Alltag und die Symptomkontrolle im Vordergrund. Normalität im Alltag bedeutet für oftmals die Auseinandersetzung mit chronischen Schmerzen und der starken Exsudation. Häufig ist zu beobachten, dass die Wundreinigung und die Sicherstellung der Kausaltherapie, in diesen Fällen also die Durchführung einer komplexen Kompressionstherapie, kaum bis gar nicht toleriert wird. Viele dieser Patienten gelten nicht selten als austherapiert. Anhand eines Fallbeispiels soll aufgezeigt werden, wie es gelingen kann, diesen Patienten nachhaltig zu helfen.

Pet cat bites are common—the most typical patient being a child, and the most typical locality hands and face. The normal flora of a pet cat’s mouth houses very potent pathogens. Therapeutic measures include wound cleansing, prophylaxis against tetanus and possibly rabies. Antibiotic prophylaxis should be administered in the cases of all but the mildest superficial wounds especially if the wound is in the hand or face. We present a review on the medical care of cat bite wounds and a typical case of a patient who developed rapid symptoms and signs of infection after a pet cat bite and nearly required hospitalization. The clinical picture was consistent with a Pasteurella infection.