Search

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.

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.

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.

The aim of the research was to study of the effect of metabolites of the culture of Bacillus subtilis 804 on the healing processes of deep linear wounds of rats' skin. Material and methods . The study was performed on 40 Wistar rats, which were made linear skin wounds 1.0 cm in length and depth to the hypodermis under the inhalation ether anesthesia. The animals were divided into 2 groups (20 rats in each). In the 1st experimental group, the area of the skin wound defect was once watered with 1.0 ml of a sterile solution of the Bacillus subtilis 804 metabolites. In the 2nd control group 1.0 ml of saline was applied to the wound. Tissues from the area of the wound defect were studied using light microscopy, histochemistry, and morphometry on days 3, 7, and 11. Results. In the experiment, an earlier migration of macrophages into the damage zone and a higher value of macrophage-neutrophil index were observed, which indicated the initially less pronounced inflammatory process, faster wound cleansing and the transition to the next stages of healing with accelerated proliferation and differentiation of epithelial cells and fibroblasts with the replacement of type III collagen by type I. Conclusions. The metabolites of Bacillus subtilis 804 optimize the function of effector cells of the reparative process, that limits the severity of inflammation and determines the early migration of macrophages to the damaged area, accelerated cleansing of the wound defect, stimulates the migration of fibroblasts and epithelial cells into the wound, contributes to the formation of a functional and morphologically complete epidermal layer on the 7th day, and the dermal component on the 11th day after the alteration, leads to the limitation of sclerosis during remodeling of the forming scar, ensuring its normotrophicity.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

The antibiotic treatment of microbial pathogens of the skin and wounds could so far not fulfil the expectations of an effective and permanent elimination of pathogens so that local treatment with antiseptic agents as a flanking measure to wound cleansing and debridement has become increasingly more established. Because an antiseptic treatment does not actually represent a treatment of infections, the current antimicrobial treatment strategy for infections in skin and wound areas consists of combined antibiotic and flanking antiseptic administration following debridement. However, the combined therapy is not always successful. There is an urgent need for new forms of therapy particularly to combat multiresistant pathogens in biofilms in infections of chronic and other complicated wounds.

We describe our experience with a novel foam dressing architecture in tandem with negative pressure wound therapy and instillation (NPWTi‐d) for removing viscous wound exudate and infectious materials. A retrospective review was conducted of the outcomes of 21 patients who received NPWTi‐d using a reticulated open cell foam instillation dressing with through holes (ROCF‐CC) designed to facilitate the removal of thick wound exudate and infectious materials. NPWTi‐d with ROCF‐CC was used to treat large complex chronic wounds with viscous wound exudate that contained substantial areas of devitalised tissue. Debridement was performed as appropriate or available. NPWTi‐d with ROCF‐CC assisted in loosening, solubilising and detaching viscous exudate, dry fibrin, wet slough and other infectious materials. Percent surface area of black non‐viable tissue and yellow fibrinous slough was reduced to ≤ 10% in 18/21 (85·7%) and 12/21 (57·1%) wounds, respectively, after an average of 1–3 applications (3–9 days) of NPWTi‐d with ROCF‐CC. Preliminary evidence suggests that adjunctive use of NPWTi‐d with ROCF‐CC may help clean large, complex wounds when complete surgical debridement is not possible or appropriate and/or when areas of slough and non‐viable tissue remain present on the wound surface.

Background: Diabetic ulcer is an open wound on the skin layer to the dermis due to hyperglycemia and neuropathy. This condition often causes infection and becomes an inhibitor in the wound healing process. Red fruit oil soap can be used as an alternative cleansing to reduce the number of bacterial colonies and accelerate the wound healing process.Aims: This present study aimed to observe the effect of red fruit oil soap in the cleansing process to reduce the number of bacterial colonies and the wound healing process in grade II Diabetic ulcer patientsMethods: This is a quasi-experimental study with the pre-test post-test non-equivalent control group design. Wound cleansing in the intervention group used 0.9% NaCl solution and red fruit oil soap with a pH of 5.74, while the wound cleansing in the control group used 0.9% NaCl solution. Bacterial colonies were assessed and the type of bacteria was observed by the swab method. The wound healing was assessed with Bates-Jensen Wound Assessment Tool (BWAT) instrument for 14 days with observations every 3 days. Analysis test used Mann Whitney and Repeated Measure ANOVA.Results: There was no difference in the mean of the number of bacterial colonies between the wounds that were cleansed with 0.9% NaCl solution and red fruit oil soap and the wounds which were cleansed by using 0.9% NaCl solution (p> 0.05). The mean of the number of colonies in the intervention group until the 14th day reduced by 3.14x106 and in the control group was reduced h 1.40x106. There was a significant decrease in the wound healing scores in each group, in each assessment for 14 days.Conclusion: This study found that the wound cleansing using red fruit oil soap and 0.9% NaCl solution could reduce the number of bacterial colonies on the wound surface and accelerate the wound healing process among patients with grade II diabetic ulcer.

Infections of contaminated or colonised acute or chronic wounds remain a grave risk for patients even today. Despite modern surgical debridement concepts and antibiotics, a great need exists for new therapies in wound management. Since the late 1990s, advantageous effects of negative pressure wound therapy (NPWT) have been combined with local antiseptic wound cleansing in the development of NPWT with instillation (NPWTi). This article summarises the current scientific knowledge on this topic. MEDLINE literature searches were performed on the subject of negative pressure wound and instillation therapy covering publications from the years 1990 to 2013 (36 peer-reviewed citations) and regarding randomised controlled trials (RCTs) covering wound care with bone involvement (27 publications) or soft-tissue wounds without bone participation (11 publications) from 2005 to 2012. The use of NPWTi in the therapy of infected wounds appears to be not yet widespread, and literature is poor and inhomogeneous. However, some reports indicate an outstanding benefit of NPWTi for patients, using antiseptics such as polyhexanide (concentration 0·005–0·04%) and acetic acid (concentration 0·25–1%) in acute and chronic infected wounds and povidone-iodine (10% solution) as prophylaxis in contaminated wounds with potential viral infection. Soaking times are recommended to be 20 minutes each, using cycle frequencies of four to eight cycles per day. Additionally, the prophylactic use of NPWTi with these substances can be recommended in contaminated wounds that cannot be closed primarily with surgical means. Although first recommendations may be given currently, there is a great need for RCTs and multicentre studies to define evidence-based guidelines for an easier approach to reach the decision on how to use NPWTi.

A new method (V.A.C.ULTA Therapy System, KCI USA, Inc., San Antonio, TX) combines the benefits of negative pressure wound therapy (NPWT; V.A.C. Therapy, KCI USA, Inc.) with regulated, periodic instillation of user-selected topical wound solutions (V.A.C. VeraFlo Therapy, KCI USA, Inc.). In simulated wound model studies comparing solution distribution using NPWT with and without a soak phase, the instillation soak phase allowed for uniform solution distribution across the wound bed, whereas continuous (no soak) irrigation resulted in uneven coverage. Additional in vitro work illustrated that bacterial particle aerosolisation during wound cleansing was significantly decreased using NPWT with instillation (NPWTi) versus commercially available low-pressure wound cleansers (P < 0·05). In porcine studies, NPWT with saline instillation induced 43% more granulation tissue versus NPWT (P < 0·05) and was as effective at wound cleansing as pulsed lavage. These studies have demonstrated that NPWTi may be an effective wound management therapy that provides both wound cleansing and NPWT benefits.

Wound healing is a complex series of events that are interlinked and dependent on one another. Acute wounds usually follow a well-defined process. In the past this model of healing has been applied also to chronic wounds, but it is well known that chronic wound healing is different from acute wound healing. Wound bed preparation as a concept allows the clinician to focus systematically on all of the critical components of a non-healing wound to identify the cause of the problem, and implement a care programme in order to achieve wound healing. To assist with implementing the concept of wound bed preparation, the TIME acronym was developed in 2002 by a group of wound care experts. It is important to understand wound bed preparation and TIME within the context of total patient care. Debridement is an integrated part of wound management, achieving certain goals and, thus, creating a healthy wound bed, margins and peri-wound skin with the objective to promote and accelerate healing. Debridement is defined as the removal of foreign material and necrotic tissue from a wound and it can also help to stimulate wound healing. However, not all methods of debridement are the same. Each method has advantages and disadvantages that must be clearly understood. Wound cleansing loosens and washes away cellular debris such as bacteria, exudate, purulent material and residual topical agents from previous dressings. Failure to use the correct method for a given wound may lead to further delays in wound healing, increase patient suffering, and unnecessarily increase the cost of care. Aim of this review is to give an overview of current standards and definitions concerning wound bed preparation and debridement.

Wound cleansing is considered to be an integral part of wound care, nevertheless wound cleansing is very often said to be a ritualistic procedure that is undertaken with very little thought or rational ( Magson-Roberts 2006 ). Is wound cleansing a procedure that needs to be performed and what is the difference between wound cleansing and debridment. The aim of this article is to consider the need for wound cleansing; the solutions used and the preferred method of cleansing wounds.

Contexto: Existe consenso de que a limpeza de feridas reduz as taxas de infeção. Contudo, há algum debate na praxis clínica sobre as suas potenciais vantagens e desvantagens. Objetivos: Identificar e sintetizar as melhores evidências sobre a eficácia de soluções de limpeza para o tratamento de feridas. Método de Revisão: Seguiu-se a metodologia do Joanna Briggs Institute. Foram incluídos estudos que consideravam doentes com feridas crónicas e agudas. Dois revisores independentes realizaram a avaliação crítica, a extração e a síntese dos dados. Resultados: Foram incluídos 3 ensaios clínicos aleatorizados (n=718) e os resultados da meta-análise mostraram não existirem diferenças nas taxas de infeções quando se compara a água corrente com o soro fisiológico (OR=0,79; lC 95%= 0,36-1,72; p=0,55). Para as feridas agudas, o odds ratio foi de 0,98 (IC 95%= 0,43-2,25). Conclusão: Não há evidências de que a utilização de água corrente para limpar feridas em adultos aumente as taxas de infeção/cicatrização. Pode existir uma diminuição das taxas de infeção quando é utilizada iodopovidona nas feridas de origem cirúrgica. Background: There is a consensus that wound cleansing reduces infection rates. There is, however, some debate in clinical circles about the potential advantages and disadvantages of cleansing wounds. Objectives: To identify and synthesize the best available evidence on the effectiveness of cleansing solutions for wound treatment. Review method: This systematic review followed the Joanna Briggs Institute methodology and included studies that considered patients with chronic and acute wounds. Critical appraisal, extraction and synthesis of data were performed by two independent reviewers. Results: Three randomized clinical trials (n=718) were included and the results of the meta-analysis showed no difference in the wound infection for the Tap Water versus Sterile Saline comparison (OR=0,79; 95% Cl= 0,36-1,72; p=0,55). For acute wounds, the odds ratio was 0,98 (95% CI= 0,43-2,25). Conclusion: There is no evidence that using tap water to cleanse acute and chronic wounds in adults increases infection or healing rates. There may be a trend towards a lower wound infection rate when povidone-iodine is used in surgical wounds. Marco contextual: Existe consenso en que la limpieza de heridas reduce las tasas de infección. Sin embargo, existe un debate sobre sus potenciales ventajas y desventajas en la práctica clínica. Objetivos: Identificar y sintetizar las mejores pruebas sobre la eficacia de las soluciones de limpieza para el tratamiento de heridas. Metodología: Se siguió la metodología del Instituto Joanna Briggs y se incluyeron estudios que consideraron a los enfermos con heridas crónicas y agudas. Dos revisores independientes realizaron el análisis crítico, la extracción y la síntesis de los datos. Resultados: Se incluyeron 3 ensayos clínicos aleatorios (n=718). Los resultados del metanálisis mostraron que no existen diferencias en las tasas de infecciones cuando se compara el agua potable con el suero fisiológico (OR=0,79; lC 95%= 0,36-1,72; p=0,55). Para las heridas agudas, la razón de momios fue 0,98 (IC 95%=0,43-2,25). Conclusión: No hay pruebas de que el uso de agua potable para limpiar heridas en adultos aumente las tasas de infección/cicatrización. Puede existir una reducción en las tasas de infección cuando se utiliza povidona yodada en las heridas quirúrgicas.

The concept of wound bed preparation can be implemented using the TIME paradigm. Chronic wounds are mostly characterised by prolonged inflammation and increased bioburden. Removal of wound biofilm and devitalised tissue, which is an ideal environment for bacterial growth, can help address the I in TIME. Wound cleansing aims to remove contaminants, debris, dressing remnants and superficial slough from the wound. Some wound cleansers contain surfactants, which reduce the surface tension of a liquid, enabling it to spread further over a surface. This article describes how these solutions can be used to debride the wound surface without damaging healthy cells.

Wound cleansing is considered to be an integral part of wound care. Nevertheless, it is often said to be a ritualistic procedure that is undertaken with little thought or rationale ( Magson-Roberts, 2006 ). Is wound cleansing therefore a procedure that needs to be performed? The aim of this article is to consider the need for wound cleansing, the solutions used and the preferred method of cleansing wounds.

Introduction. Wound cleansing for diabetic wound care always used 0.9% of NaCl or other commercial solutions. Currently, the use of guavas leaves extract (Psidium guajava L) as an alternative wound cleansing solution has been started to be introduced as a part of complementary nursing. The aim of this study was to compare the effectiveness of commercially wound cleansing solution of 0.9% NaCl and guavas leaves extract in wound healing process of diabetes mellitus patients. Methods. This study used six respondents as a sample, by using quasi experiment methods of 4 times wound cleansing. In this experiment, the control group used NaCl 0.9% while a group of sample used guavas leaves extract as wound cleansing solutions. Result. The experimental result revealed that there was a significant result between types of wound cleansing solution effectiveness in NaCl 0.9% with an extract guavas leaves for some wound characteristics (Presentation of wound slough P value: 0.043; presentation of wound granulation Pvalue: 0.037 (α=0.05)). However, There were no significant result of effectiveness comparison between wound cleansing solution (NaCl 0.9% and Guavas Leaves Extract) for wound dimension and epithelial tissue characteristics (Wound wide Pvalue:0.184; wound long Pvalue: 0.361; epithelial tissue presentation Pvalue:0.072 (α=0.05). Discussion. These results confirmed that guava leaves extract can serve as an alternative wound cleansing solution as commercial wound cleansing solution such as 0.9% NaCl. Keywords: Guavas leaves extract, Diabetes mellitus, wound care, wound cleansing solution

Atiyeh BS, Dibo SA, Hayek SN. Wound cleansing, topical antiseptics and wound healing. Quality of care is a critical requirement for wound healing and ‘good’ care of wounds has been synonymous with topical prevention and management of microbial contamination. Topical antiseptics are antimicrobial agents that kill, inhibit or reduce the number of microorganisms and are thought to be essential for wounds infection control. However, they have long and commonly been used on wounds to prevent or treat infection, the merits of antiseptic fluid irrigation have received little scientific study. Unlike antibiotics that act selectively on a specific target, antiseptics have multiple targets and a broader spectrum of activity, which include bacteria, fungi, viruses, protozoa and even prions. Although certain skin and wound cleansers are designed as topical solutions with varying degrees of antimicrobial activity, concerns have been raised. Wound cleansers may affect normal human cells and may be antimitotic adversely affecting normal tissue repair. Repeated and excessive treatment of wounds with antiseptics without proper indications may have negative outcomes or promote a microenvironment similar to those found in chronic wounds. However, when applied at the proper times and concentrations, some classes of antiseptics may provide a tool for the clinician to drive the wound bed in desired directions. The present review summarises the various antiseptics in use and their negative impact on the wound healing mechanisms. It is clear that the role of antiseptics on wounds and their role in wound care management need to be reconsidered.

Highly effective means of stopping capillary-parenchymatous bleeding — one of the main causes of death in people from 1 to 34 years of age in traffic accidents — were developed. Biologically active wound dressings that reduce purulent-necrotic wound cleansing time by 3 times, healing time by 2.5 times, and hospital stays by 6 times were developed.

Significance: Traumatic injuries are the leading cause of morbidity and mortality in children. The purpose of this review is to provide an overview of the initial assessment and management of traumatic and burn wounds in children. Special attention is given to wound cleansing, debridement techniques, and considerations for pain management and psychosocial support for children and families. Recent Advances: Basic and translational research over the last 5–7 years has advanced our knowledge related to the optimal care of acute pediatric traumatic and burn wounds. Data concerning methods, volume, solution and timing for irrigation of acute traumatic wounds, timing and methods of wound debridement, including hydrosurgery and plasma knife coblation, and wound dressings are presented. Additionally, data concerning the long-term psychosocial outcomes following acute injury are presented. Critical Issues: The care of pediatric trauma and burn-related wounds requires prompt assessment, pain control, cleansing, deb...

Aim: This evaluation aimed to determine whether the use of a haemoglobin spray solution expedited sloughy wound healing. Method: A descriptive evaluation was undertaken within a community setting exploring 25 patients presenting with sloughy healing and non-healing wounds, and the effects of 8 topically administered haemoglobin treatments over a 4-week period. Standard wound cleansing and dressing management were continued, with no changes to pre-evaluation regimens, and care being provided by the patients themselves or by a carer. Data were collected weekly with regard to primary outcomes of slough reduction, wound surface area reduction, patient ease of use (self-care), and overall product experience. Results: At 4 weeks, all wounds demonstrated positive measured endpoints of slough elimination and continued wound-size reduction. Patients and carers found the product easy to use (self-caring) with an overall positive wound care experience. Conclusion: The administration of a haemoglobin spray solution on patients presenting with sloughy wounds resulted in positive healing outcomes of slough elimination and wound reduction alongside positive self-care and product satisfaction. Continued evaluation is recommended to build upon the evidence of this form of treatment.

Chronic wound management remains challenging in clinical practice, especially in the presence of bacterial bioburden and slough. To resolve these clinical challenges, it is essential clinicians implement the TIME framework (tissue, inflammation/infection, moisture, edge of wound) as a model of effective wound bed preparation. As a result of advances in technology and wound care therapies, on the market today are products that can help reduce the wound bed clinical challenges recommended by the TIME framework. This article looks at a wound cleansing solution that reduces the wound bed bioburden by breaking down biofilms and debriding slough.

A biofilm can be described as a microbial colony encased in a polysaccharide matrix which can become attached to a wound surface. This can affect the healing potential of chronic wounds due to the production of destructive enzymes and toxins which can promote a chronic inflammatory state within the wound. Biofilms can be polymicrobial and can result in delayed wound healing and chronic wound infection resistant to antibiotics, leading to prolonged hospitalisation for some patients. There appears to be a correlation between biofilms and non-healing in chronic wounds. It is suggested that biofilms are a major player in the chronicity of wounds. They are a complex concept to diagnose and management needs to be multifactorial.

Important improvements have been made in wound care over the last decade. However, few data are available on the influence that these have outside their intended use. This study aimed to clarify the effects of the use of wound cleansers on bacterial contamination of the immediate surroundings. Little evidence was found from either laboratory or clinical settings that wound-derived micro-organisms become airborne during wound cleansing. Bacterial dispersion around wounds may be attributed to general activity rather than wound cleansing. If simple precautions are taken, risks for personnel and patients in hospitals and consultation rooms during wound cleansing can be minimized.

Approximately 10 million patients with traumatic wounds are treated in US emergency departments annually. The practice of wound cleansing or antiseptic management has a dichotomous history anchored in tradition and science. The merits of antiseptic fluid irrigation of traumatic wounds have received little scientific study. The purpose of this article is to critically evaluate the potential harm to patient outcome by the use of antiseptics on acute wounds. First, animal and cell culture data that describe the effects of topical antiseptics on wound healing are offered. Second, human case studies are presented to illustrate the potential harm of the indiscriminate use of antiseptics. Finally, data from previously published reviews are presented and evaluated for clinically based evidence to justify the current practice of antiseptic use in acute traumatic wounds. (J Am Podiatr Med Assoc 95(2): 148–153, 2005)

Background This systematic review updates a previous review published in 2001. Cleansing is a vital component of wound management; however; little attention has been give to the solutions and techniques used for cleansing purposes. The objective of this review was to assess the effectiveness of different solutions, pressures and techniques used for wound cleansing to prevent infection and promote wound healing. Search strategy Randomised and clinical controlled trials were identified using the Cochrane Central Register of Controlled Trials (CENTRAL). Additional searches of other databases and hand searches of journals and bibliographies was undertaken to identify further trials. Selection criteria All randomised and clinical controlled trials involving adults and/or children whose wounds were cleaned with commercial cleansers, normal saline, water, chlorhexidine, hydrogen peroxide or povidone-iodine were eligible for inclusion. Studies that utilised solutions for preoperative skin cleansing, compared solutions for burns or dental procedures, and those that compared dressings for patients with ulcers were excluded from this review. Outcomes included rate of healing, incidence of infections or levels of bacterial count. Selection of potential articles, assessment of methodological quality and data abstraction was conducted independently by two reviewers. Trials with similar patients, comparisons, and outcomes were pooled. The data were analysed using Cochrane Review Manager 4.2. Where pooling was inappropriate, trials are discussed in a narrative review. Results Fourteen randomised controlled trials were included that compared various solutions for wound cleansing. The evidence indicates that there is no difference in the infection and healing rates in acute and chronic wounds cleansed with either tap water or normal saline. An irrigation pressure of 13 psi is effective for cleansing wounds and reducing infection without causing tissue trauma. There were no studies comparing common techniques for wound cleansing such as swabbing or scrubbing. Showering postoperative wounds did not demonstrate any difference in infection rates; however, it increased the morale of the patient. Whirlpool therapy was effective in reducing inflammation and pain in surgical wounds. Conclusions These conclusions are based on the best available clinical evidence. However, there is an urgent need to support these findings with rigorous research as some of the conclusions are based on single studies with limited sample sizes. Solutions for wound cleansing: • The evidence supports the use of potable tap water for cleansing lacerations in both adults and children and postoperative wounds in adults only. • Potable tap water as well as boiled and cooled water is also an effective wound cleansing solution. This finding, however, is based on a trial that had a small sample size. • The evidence to support the use of potable tap water is limited (only one study with low power); therefore, further studies are required to confirm that assumption. • Povidone-iodine is an effective cleansing solution for contaminated wounds. Pressure for wound cleansing: • A pressure of 13 psi is effective in reducing infection and inflammation in both adults and children with lacerations and traumatic wounds. Techniques for wound cleansing: • Evidence to support or refute swabbing and scrubbing to cleanse wounds is lacking. • The review demonstrated no evidence of a difference in the wound infection and healing rates between wounds that were showered and those that were not. • The evidence for showering ulcers and other chronic wounds is lacking; therefore, this technique of wound cleansing should be undertaken with caution. • Whirlpool therapy is effective to reduce pain and inflammation in surgical wounds and improve the healing rate in pressure ulcers. • The evidence to support the use of Sitz bath for patients following episiotomy is limited.

WOC nurses may be asked to manage small burn wounds or to follow up with patients who have residual wound care issues after recovering from a major burn injury. Aspects of care include identifying patients who warrant a higher level of burn care expertise, managing small wounds, recognizing the common complications of burns, and determining the needs of patients undergoing burn rehabilitation. Persons managing burn wounds will incorporate a variety of techniques to facilitate wound cleansing and dressing, pain management, psychological support, and minimization of complications. In addition, depending on the setting, extent, and nature of the wounds, the patient's abilities and rehabilitation requirements will need to be determined. The patient and his or her family need to be educated about the normal changes that follow a burn injury and how to manage these issues. (J WOCN 2002;29:76-82.)

Whether to use clean or sterile technique in the management of acute and chronic wounds is a question that researchers and clinicians have been asking and attempting to answer with certainty since the 1800s. Because patient situations are unique, particularly in the home, the structured guidelines one finds for wound cleansing and dressing are not universally applicable. The key to current WOCN practice is to critically examine wound care regimens, remain current in wound care strategies, and base practice on best current evidence along with government policies.

A critical aspect of effective and cost-efficient wound management is infection prevention and actions taken to minimize bacterial levels in the wound. This article describes effective wound cleansing and debridement, appropriate use of advanced dressings, procedures for dressing changes, and the appropriate use and understanding of topical antimicrobial agents.

Wound cleansing is an important component of wound management. When carried out correctly it can improve healing, but when undertaken unnecessarily it can impede wound progress. Literature suggests that nurses continue to rely on ritualistic practice rather than using research or best evidence to inform patient care. The rationale and implications for wound cleansing are examined in relation to cleansing solutions, technique and equipment.

Local treatment with polykatan, a magnesium-containing drug based on bischofite mineral, promoted healing of infected skin wounds. Wound cleansing from bacteria was due to a direct antibacterial effect of the drug.

Wound pain is a common experience in patients with acute and chronic wounds, and also post healing in some cases, with scars (Stavrou et al, 2009). This pain can cause patients considerable suffering and distress, and patients identify that wound pain is an important part of their experience, for example during dressing removal, wound cleansing or debridement. They frequently identify pain management as their most important priority, over and above achieving wound healing. Pain-free dressing removal was also ranked the most highly desired characteristic of a dressing in a survey of 3918 clinicians across 11 countries (Moffatt et al, 2002).

Since commercialisation almost 20 years ago, negative pressure wound therapy (NPWT; V.A.C.® Therapy; KCI USA, Inc., San Antonio, TX) has been used to treat a wide variety of wound types and continues to evolve as research expands understanding of the mechanisms of action that enable this adjunct therapy to facilitate wound closure. In 2010, the educational International Surgical Wound Forum (ISWF) was created to facilitate discussion among experts from all over the world regarding modern wound treatment challenges and techniques. This is the first of two supplements, which are based on the 2012 and 2013 ISWF presentations and demonstrate the evolution of the role of NPWT in wound care. This first supplement provides an overview of current health care challenges and clinical practice and reviews evidence and experience using NPWT with instillation, which combines NPWT with computer‐controlled delivery and removal of topical solutions and suspensions to cleanse and/or treat wounds.

Wound cleansing is an essential component of wound management used to facilitate the wound healing process.1,2 Several methods are available for use by the physical therapist to achieve wound cleansing.1–4 This update reviews the research examining the effects of pulsed lavage in wound cleansing and comparisons with more traditional methods of wound cleansing. Normal wound healing is characterized by 3 overlapping phases: inflammatory, proliferative or fibroplastic, and remodeling.5,6 Vascular and cellular responses to trauma occurring during the inflammatory phase remove infectious microorganisms, foreign materials, and necrotic tissue from the wound's surface. During the proliferative phase, tissue granulation and reepithelialization occur.5,6 Collagen fibers are deposited in the dermis of the skin during the remodeling phase to strengthen the healing wound. If the body's inflammatory response is inadequate to overcome surface microorganisms, a wound is predisposed to infection, delaying wound angiogenesis and granulation.7 In the 1950s, Liedberg et al8 showed that when bacterial concentrations of streptococci, pseudomonas, or staphylococci were greater than 100,000 organisms per gram in tissues, skin grafts on rabbits were destroyed. In 1969, Robson and Heggers9 summarized military and civilian studies examining the critical level of bacterial burden necessary to produce wound sepsis and failure to heal. They concluded that wound healing is possible only when bacterial counts are maintained at a concentration of 100,000 organisms per gram or less. Impediments to healing are not limited to the presence of microorganisms on the wound's surface. Winter,10 for example, suggested that the presence of eschar or scab in a dry wound delays wound epithelialization and contraction. Likewise, Constantine and Bolton11 surmised that the presence of necrotic tissue or eschar, within the wound or at the wound's margin, impedes wound contraction and closure. Elek …