Search

The wound process is a set of stages that successively replace each other and as a result lead to epithelization of the skin and closure of the wound defect. The development of the wound process is influenced by the pH value of the wound contents, which determines the rate of all biochemical reactions occurring in the wound. In the course of the study, patients were measured for wound exudate in the postoperative period. It was noted that in patients with the initial values of the hydrogen index, which was 7, a more effective healing process of the postoperative wound was observed, while in patients with the initial pH value of 8, the wound process took a protracted character.

Amniotic tissues have been long utilised to treat chronic wounds; however, there are few studies evaluating how the wound microenvironment responds to these therapies. The goal of this study was to evaluate the changes in wounds treated with a hypothermically stored amniotic membrane (HSAM). In this prospective single‐arm study, 15 female patients with venous leg ulcers were treated with HSAM from male donors and standard of care for 12 weeks. Over the course of the study, wound exudate was collected and evaluated using proteomic microarrays. Biopsies were collected during the course of treatment to detect the presence of HSAM tissue. By 4 weeks, 60% of subjects achieved 50% or greater reduction in wound size, and by 12 weeks, 53% of subjects achieved 100% re‐epithelialization. HSAM DNA was detected in 20% of biopsies as determined by the detection TSPY4, indicating HSAM was no longer present within the wound bed approximately 7 days from the last treatment for the majority of wounds. Proteomic analysis of wound exudate found that wounds on a healing trajectory had significantly higher levels of MMP‐10, MMP‐7, and TIMP‐4 and significantly lower levels of CX3CL1, FLT‐3 L, IL‐1ra, IL‐1a, IL‐9, IL‐2, IL‐3, MCP‐1, and TNF‐b compared with other wounds.

Controlling wound pain, absorption of wound exudate, and minimizing the frequency of changing the dressing are necessary parameters to facilitate wound-healing process. Hence, stable hydrophilic hy...

The antimicrobial efficacy of antiseptics used in wound management is tested in vitro under standardised conditions according to DIN EN 13727, with albumin and sheep erythrocytes used as organic challenge. However, these testing conditions do not adequately simulate the wound bed environment. Thus, the aim of this study was to compare the efficacy of different antiseptics such as octenidine dihydrochloride (OCT), chlorhexidine digluconate (CHX), polyhexamethylene biguanide (PHMB), and povidone‐iodine under challenge with human wound exudate instead of standardised organic load in an in vitro setting according to DIN EN 13727. Moreover, protein contents, pH, and temperature were compared with standardised testing conditions. The tested antiseptic agents were reduced to different extents based on their bactericidal efficacy, when challenged with human wound exudate compared with standardised conditions. Overall, 0.10% OCT showed the highest effects reaching full efficacy after 30 seconds. CHX and PHMB were the least efficient. Next to the protein content, other components of wound exudate, such as the microflora, seem to influence the efficacy of antiseptics. In summary, the optimisation of in vitro testing conditions in future applications, to more adequately simulate the wound bed environment, will allow a more realistic picture on the potential performance of antiseptics in clinical practice.

It has been demonstrated that wound dressings provide a protective effect against pressure injuries. However, no method exists to measure either the life or performance of dressings used in prevention; testing dressings in a clinical setting or a research environment has typically been based on measuring its moisture absorption capacity. This article examines the changes that occur in the structural and mechanical properties of a prophylactic dressing based on conditions of use when wound exudate is not present.A clinically relevant method was developed to simulate the loading, friction-inducing shear, and moisture transpiration present in a typical hospitalization where a dressing is applied for prevention. Single-use dressings were tested using this method to evaluate their ability to protect patients from pressure injuries throughout the typical 5 to 7 days of use. Following this aging process, researchers measured the physical, structural, and mechanical changes in prophylactic dressings over time.This innovative method provides guidance for clinicians on dressing use and replacement intervals. For bioengineers, the method generates important empirical data for computer modeling of dressing performance, which can then reveal the consequences of changes in dressing structure and function on sustained tissue loads. It is the authors' hope to generate discussion about the creation of industry-wide standards for testing dressings to improve patient care.

Wound healing is an intrinsic and dynamic process. Wound exudate is a normal feature of wound healing; however, when there is insufficient or excessive production, or the composition of the exudate is harmful, wound healing may be compromised with resulting psychosocial and financial implications. Therefore, the management of exudate is essential for improved patient outcomes and in the prevention of future complications. The purpose of these studies, carried out in Germany and Poland, was to observe and to evaluate the clinical performance of Cutimed® Siltec® and Cutimed Siltec B on patients' wounds. Three visits (initial visit, dressing change visit and final visit) were scheduled and documented. In all, 129 patients took part in these studies and 150 wounds were treated. The results were pooled. Positive attributes of using these dressings included a decrease in exudate, intact wound margins and a decrease in pain during dressing changes. Clinicians and patients were satisfied with the product and rated the following parameters as ‘good’ to ‘very good’: wearing comfort, ease of application and removal, absorption and retention capacity, adaptability to the affected body part, absorption and retention capacity under compression. The results from this study suggest that Cutimed Siltec and Cutimed Siltec B absorbent dressings are beneficial in wound management due to the positive attributes, and clinicians and patients showed satisfaction with these dressings.

Aim: The aim of this study was to investigate the relationship between CXCL-6 levels in wound exudates and healing of diabetic foot ulcers (DFU). Materials & methods: One hundred patients with neuropathic DFU were recruited. Wound exudate CXCL-6 levels were measured by enzyme-linked immunosorbent assay. Patients were followed for 24 weeks and divided into rapidly healing and nonhealing groups. Results: Compared with the NH group, the mean CXCL-6 levels in the wound exudates of the rapidly healing group were significantly higher. After adjusting for traditional risk factors, wound exudate CXCL-6 levels were still significantly associated with wound healing. Conclusion: CXCL6 is an independent predictor of wound healing in DFU patients and may be a potentially novel therapeutic target for the treatment of DFU.

By default, antimicrobial efficacy of antiseptics used in wound management is tested in vitro under standardized conditions according to DIN EN 13727, with albumin and sheep erythrocytes used as organic challenge. However, it is not clear whether these testing conditions do adequately reflect the wound bed environment. Therefore, the aim of this study was to compare the efficacy of different antiseptic products based on octenidine dihydrochloride (OCT), polyhexamethylene biguanide (PHX), and povidone-iodine under challenge with human wound exudate instead of standardized organic load in an in vitro setting according to DIN EN 13727. Bactericidal efficacy of the tested products was reduced to different extend when challenged with human wound exudate compared to standardized conditions. Overall, OCT-based products showed the necessary germ count reductions at the shortest exposure times (e.g., 15 seconds for octenisept®). PHX-based products were the least efficient. In addition to the protein content, other components of wound exudates, such as the microflora, seem to influence the efficacy of antiseptics. This study demonstrates that standardized in vitro test conditions only partly reflect actual wound bed conditions. Consequences for an amendment of existing test methods adapting organic load requirements and the feasibility of standardization of wound exudates are to be discussed.

An integrated smart microfluidic dressing with a multibiomarker immunosensor can provide in situ wound status profiling on site., Chronic wounds arise from interruption of normal healing due to many potential pathophysiological factors. Monitoring these multivariate factors can provide personalized diagnostic information for wound management, but current sensing technologies use complex laboratory tests or track a limited number of wound parameters. We report a flexible biosensing platform for multiplexed profiling of the wound microenvironment, inflammation, and infection state at the point of care. This platform integrates a sensor array for measuring inflammatory mediators [tumor necrosis factor–α, interleukin-6 (IL-6), IL-8, and transforming growth factor–β1], microbial burden (Staphylococcus aureus), and physicochemical parameters (temperature and pH) with a microfluidic wound exudate collector and flexible electronics for wireless, smartphone-based data readout. We demonstrate in situ multiplexed monitoring in a mouse wound model and also profile wound exudates from patients with venous leg ulcers. This technology may facilitate more timely and personalized wound management to improve chronic wound healing outcomes.

Cysteiniphilum litorale is a Gram-negative coccobacillus first isolated from the seawater of Wailingding Island near the estuary of Pearl River in southern China. This organism was previously not considered to cause disease in animals or humans. We report a case of a 19-year-old female patient infected with abscess caused by C. litorale in the middle digit of her right hand after minor trauma during the handling of estuarine shrimps at home. C. litorale was cultured from the wound exudate of the patient and identified by 16S rRNA gene sequencing. Whether C. litorale may be transmitted to humans via other channels requires further exploration.

The absorption capacity of cotton dressings is a critical factor in their widespread use where they help absorb wound exudate. Cotton wax dressings, in contrast, are used for wounds where care is taken to avoid adhesion of dressings to sensitive wounds such as burn injuries. Accordingly, we explored the loading of 2‐deoxy‐D‐ribose (2dDR), a small sugar, which stimulates angiogenesis and wound healing in normal and diabetic rats, into both types of dressings and measured the release of it over several days. The results showed that approximately 90% of 2dDR was released between 3 and 5 days when loaded into cotton dressings. For wax‐coated cotton dressings, several methods of loading of 2dDR were explored. A strategy similar to the commercial wax coating methodology was found the best protocol which provided a sustained release over 5 days.\ud \ud Cytotoxicity analysis of 2dDR loaded cotton dressing showed that the dressing stimulated metabolic activity of fibroblasts over 7 days confirming the non‐toxic nature of this sugar‐loaded dressings. The results of the chick chorioallantoic membrane (CAM) assay demonstrated a strong angiogenic response to both 2dDR loaded cotton dressing and to 2dDR loaded cotton wax dressings. Both dressings were found to increase the number of newly formed blood vessels significantly when observed macroscopically and histologically.\ud \ud We conclude this study offers a simple approach to developing affordable wound dressings as both have the potential to be evaluated as pro‐active dressings to stimulate wound healing in wounds where management of exudate or prevention of adherence to the wounds are clinical requirements.

This article reports on a product evaluation of KytoCel, an absorbent wound dressing used in the treatment of 30 wounds treated in community care and 10 split-thickness skin-graft donor sites treated in acute care. Within the community-treated cohort, unspecified leg wounds were the most common wound type (n=6) with the mean wound area of the 30 wounds being 17.6 cm2 (standard deviation (SD) 31.7) and mean volume being 8.4 cm3 (SD 21.4). Most community treated wounds (27/30; 90%) were reported to have moderate to high levels of wound exudate with the majority (n=19) either healed or improved during treatment. All ten split-thickness skin graft donor sites healed during the evaluation. A semi-structured focus group consisting of 17 nurses provided their opinions on KytoCel, with positive comments offered on the dressing during the focus group and of the 17 participants, 10 commented that the KytoCel dressing was available on their local wound care formulary.

Diabetic wounds are difficult to heal, which increases the difficulty of treatment and aggravates the suffering of patients. Especially its intractable large amount of exudate puts forward more stringent requirements for dressings. The accumulation of excessive exudate would prolong inflammation phase and delay wound healing. To manage wound exudate in time and get through the inflammatory phase smoothly, we developed a Janus nanofibrous aerogel with asymmetric wetting properties. The Janus nanofibrous aerogel has a micropattern obtained from cellular nanofibrous structure, which does not require external force to realize the autonomous, rapid and unidirectional transportation of exudate. Benefiting from its structure and fluid gating characteristics, it can not only absorb high-volume liquid but also effectively prohibit liquid penetration in reverse. Besides, the Janus nanofibrous aerogel has excellent antibacterial and antioxidant properties to synergistically promote wound healing. Experiments in diabetic mice model showed that Janus nanofibrous aerogel can prevent maceration of peri-wound tissue, shorten the inflammation phase, and promote diabetic wound healing. Its good elasticity and easy production characteristics are friendly for clinical application.

Pain management during and following disbudding procedures has been studied extensively, though few studies have evaluated wound healing following cautery disbudding in dairy calves. The purpose of this study was to observe wound healing following cautery disbudding with or without treatment using a topical aluminum-based aerosol bandage (ALU) in preweaned dairy calves. Dairy calves were disbudded within the first 3 wk of life using a standard cautery disbudding protocol. The ALU treatment was randomly allocated to the right or left horn bud within each animal. The outcomes measured were lesion score (LS) and wound diameter (WD). The LS was evaluated on a scale of 1 to 3, with LS = 1 representing normal healing without a scab or exudate, LS = 2 having the presence of a scab, and LS = 3 showing the presence of wound exudate. Lesion score and WD were evaluated on a weekly basis following dehorning for 3 wk. A total of 209 animals completed the study. No difference was observed in LS between groups during the first 2 wk postdisbudding, but the proportion of LS = 3 on wk 3 postdisbudding was greater for the control group when compared with ALU (17 vs. 8%, respectively). During wk 1 and 2 postdisbudding, the odds of having delayed healing, or a LS ≥2, were similar for both groups. However, the odds tended to be different at wk 3 postdisbudding with control disbudding sites being 1.42 times more likely to have delayed healing than ALU. In wk 3, WD was 1 mm smaller in the treatment group compared with the control, and treatment decreased diameter over time compared with controls. Overall, once abnormal wound healing was observed, the likelihood of having abnormal wound healing the following week was increased. However, treatment with ALU diminished this effect on delayed healing during the follow-up period. Based on these results, the use of ALU improved wound healing following cautery disbudding of preweaned dairy calves.

Wound healing is a multipart and dynamic process of replacing devitalized and damaged cellular structures and tissue layers. Numerous conventional wound dressings are employed for the management of wounds but there is a lack of absolute and versatile choice. An ideal wound healing modality should provide a moist environment, offer protection from secondary infections, eliminate wound exudate, and stimulate tissue regeneration. Hyaluronic acid (HA) has been known to promote angiogenesis, granulation tissue formation, remodeling of extracellular matrix (ECM), and wound healing. Accumulation and turnover of ECM is a hallmark of tissue injury, repair, and remodeling in wound healing. HA is a major component of ECM and plays an important role in regulating tissue injury, accelerating tissue repair, and controlling disease outcomes. A wide range of in vitro, in vivo, and clinical studies have demonstrated the wound healing efficacy of HA-based biomaterials not only in the treatment of wound in the tympa...

Purpose Effective management of wound pain is essential for optimal wound healing. Nevertheless, the outcomes of wound pain interventions are based on subjective measures, which can prove problematic in patients with cognitive impairment. Identification of biomarkers associated with wound pain and wound healing can be used to more objectively estimate wound pain and contribute to the development of precise management options to reduce wound pain and promote wound healing. This scoping review aimed to identify wound pain and wound healing biomarkers from wound exudates and to describe different wound collection methods to identify these biomarkers. Methods We searched the literature (PROSPERO database registration number: CRD42018103843) via a scoping review. Search strategy The PubMed database was searched for articles that explored relationships between cutaneous wound pain, wound healing, and biomolecules. Inclusion criteria were articles that reported original data, used adult human samples, and were published in English. Findings Twenty-one articles were retrieved: 17 investigated molecules from wound exudate associated with wound healing status, and 4 reported molecules associated with wound pain. The most frequently observed wound pain biomarkers were proinflammatory cytokines; the most frequently observed wound healing biomarkers were proteases including those in the matrix metalloproteinase family. Six wound exudate collection methods were identified to extract potential wound pain and wound healing biomarkers from wound exudate. Implications The results can guide future wound exudate research to validate these wound pain and wound healing biomarkers and to develop therapies targeting these biomarkers to reduce wound pain and promote wound healing.

Objective: The number of hip and knee replacement performed is rising, causing increased pressure for the timely management of these patients. A dry incision is considered a prerequisite for discharge. This is a retrospective cohort study comparing two treatments for skin closure during elective hip and knee arthroplasty. Methods: A barbed monofilament absorbable 3.0 subcuticular suture (Quill), with the additional surface application of n-butyl-2-cyanoacrylate glue, was used for the study group and metal clips or a smooth monofilament absorbable 3.0 subcuticular suture (Monocryl) for the control group. Each group comprised 46 hip and 27 knee replacement patients and data on predisposing risk factors for prolonged wound exudate were collected. We have calculated the proportion of patients who have exceeded their expected length of stay due to a wound exudate, the additional days required for the wound to dry and the derived cost. Results: No significant differences were identified with regards to risk factors. The study group demonstrated a significantly lower incidence of exudating wounds of excessive duration (1% versus 14%, p=0.005, relative risk: 10; 95% confidence interval: 1.31–76.13). The combined additional stay was 22 days more for the control group, producing an average financial benefit of £80 per patient for the study group. There were seven knee replacement and two hip replacement patients treated with a nozzled glue applicator who presented with delayed (> 2 weeks) wound healing issues. Conclusion: Barbed subcuticular suture with surface glue application is a viable option for skin closure after elective lower limb joint arthroplasty and can reduce the incidence of prolonged wound discharge. A brushed glue applicator should be preferred over the nozzled one.

The spread of antimicrobial resistance calls for chronic wound management devices that can engage with the wound exudate and signal infection by prompt visual effects. Here, the manufacture of a two-layer fibrous device with independently-controlled exudate management capability and visual infection responsivity was investigated by sequential free surface electrospinning of poly(methyl methacrylate-co-methacrylic acid) (PMMA-co-MAA) and poly(acrylic acid) (PAA). By selecting wound pH as infection indicator, PMMA-co-MAA fibres were encapsulated with halochromic bromothymol blue (BTB) to trigger colour changes at infection-induced alkaline pH. Likewise, the exudate management capability was integrated via the synthesis of a thermally-crosslinked network in electrospun PAA layer. PMMA-co-MAA fibres revealed high BTB loading efficiency (&gt, 80 wt.%) and demonstrated prompt colour change and selective dye release at infected-like media (pH &gt, 7). The synthesis of the thermally-crosslinked PAA network successfully enabled high water uptake (WU = 1291 &plusmn, 48 &minus, 2369 &plusmn, 34 wt.%) and swelling index (SI = 272 &plusmn, 4 &minus, 285 &plusmn, 3 a.%), in contrast to electrospun PAA controls. This dual device functionality was lost when the same building blocks were configured in a single-layer mesh of core-shell fibres, whereby significant BTB release (~70 wt.%) was measured even at acidic pH. This study therefore demonstrates how the fibrous configuration can be conveniently manipulated to trigger structure-induced functionalities critical to chronic wound management and monitoring.

Products that provide a protective skin barrier play a vital role in defending the skin against the corrosive effect of bodily fluids, including wound exudate, urine, liquid faeces, stoma output and sweat. There are many products to choose from, which can be broadly categorised by ingredients. This article describes the differences in mechanisms of action between barrier products comprising petrolatum and/or zinc oxide, silicone film-forming polymers and cyanoacrylates, and compares the evidence on them. The literature indicates that all types of barrier product are clinically effective, with little comparative evidence indicating that any one ingredient is more efficacious than another, although film-forming polymers and cyanoacrylates have been found to be easier to apply and more cost-effective. However, laboratory evidence, albeit limited, indicates that a concentrated cyanoacrylate produced a more substantial and adherent layer on a porcine explant when compared with a diluted cyanoacrylate and was more effective at protecting skin from abrasion and repeated exposure to moisture than a film-forming polymer. Finally, a silicone-based cream containing micronutrients was found to significantly reduce the incidence of pressure ulceration when used as part of a comprehensive prevention strategy.

The rapid detection of pathogens in infected wounds can significantly improve the clinical outcome. Wound exudate, which can be collected in a non-invasive way, offers an attractive sample material for the detection of pathogens at the point-of-care (POC). Here, we report the development of a nucleic acid lateral flow immunoassay for direct detection of isothermally amplified DNA combined with fast sample preparation. The streamlined protocol was evaluated using human wound exudate spiked with the opportunistic pathogen Pseudomonas aeruginosa that cause severe health issues upon wound colonization. A detection limit of 2.1 × 105 CFU per mL of wound fluid was achieved, and no cross-reaction with other pathogens was observed. Furthermore, we integrated an internal amplification control that excludes false negative results and, in combination with the flow control, ensures the validity of the test result. The paper-based approach with only three simple hands-on steps has a turn-around time of less than 30 min and covers the complete analytical process chain from sample to answer. This newly developed workflow for wound fluid diagnostics has tremendous potential for reliable pathogen POC testing and subsequent target-oriented therapy.

This common feature of wound care presents a challenge to clinicians, writes Edwin Chamanga

Aim. To evaluate the effectiveness of using ozonated solutions combined with decamethoxin solution in the treatment of purulent wounds.Methods. 101 patients with purulent wounds were under observation. In the treatment of all patients, the first stage was surgical debridement, which removes exudate and non-viable tissue. Also the conditions for wound drainage and good drainage of wound exudate were created, and then the treatment of wounds under a bandage was performed. In the main group (51 people) in addition to the basic treatment ozonated 0.9% sodium chloride solution with a concentration of ozone 8-10 μg/mL and 0.02% decamethoxin solution were used. The general condition of patients and the wound condition were evaluated over time.Results. The duration of fever and pain syndrome did not differ in the groups. A statistically significant difference between groups in the terms of symptoms disappearance and wounds healing was found, indicating the advantages of using the decamethoxin solution in combination with ozonated 0.9% sodium chloride solution in treatment of purulent wounds. The length of stay in hospital statistically significantly decreased compared to the control group. Positive dynamics was observed on the wounds cytology: starting from 3 days of treatment in the main group neutrophil count decreased, number of lymphocytes and polyblasts increased. With the increase in terms from the beginning of the treatment, there was even greater reduction in the number of neutrophils, the increase in the number of lymphocytes and the appearance of macrophages and fibroblasts.Conclusion. The study results demonstrated the benefits of using combination of ozonated solutions with decametoxine solution in the treatment of purulent wounds; method is available to any surgical wards and outpatient clinics.

The aim of our research was to analyze the results of bacteriologic examination in patients with local and disseminated chronic osteomyelitis. We performed retrospective analysis of the results of bacteriologic examination of wound exudate in 80patients who were admitted to the clinic of Irkutsk Scientific Center of Surgery and Traumatology for operative treatment of shinbone shaft fractures complicated with local and disseminated chronic osteomyelitis. We used common methods of mono- and bilocal osteosynthesis which resulted in different terms of fracture union and bone defect replacement. Bacteriologic examination of exudate from bone and soft-tissue wounds was performed in all patients at their admission to the clinic. In patients with local chronic osteomyelitis and with usual terms of fracture union, the most common were pure cultures (93.%) with dominant S.aureus (60%). In patients with delayed fracture union, the most common were microorganism associations (55.5±11.7%). In patients with disseminated chronic osteomyelitis with usual terms of defect replacement, pure cultures were registered in 90% of cases. In patients with delayed defect replacement pure cultures were found in 57,2% of cases. Comparative analysis showed that in patients with delayed fracture union and defect replacement, bacterial associa-tions were more common than in patients with usual terms of defect replacement. Preoperative bacteriologic examination showed that S.aureus was the dominant flora of wound exudate in patients with local and disseminated chronic osteomyelitis. Bacterial associations in wound exudate of patients with delayed fracture union and defect replacement is associated with significant circulation failure in affected extremity and is an unfavorable factor for reparative process disorder at chronic osteomyelitis.

A D-optimal design was used to identify and model variables that affect the transit time of wound exudate through an illustrative dressing used for negative pressure wound therapy. Many authors have addressed the clinical benefits of negative pressure wound therapy, but limited information is available on how to assess performances of dressings. In this paper, the transit time of wound exudate through a dressing was chosen as a model parameter to show how experimental design (DOE) can be used for this purpose. Results demonstrated that rate of exudate production, temperature and dressing thickness were the variables with the largest impact on transit time. The DOE approach could be used to model other dressing properties, like for example capability of absorbing excess exudate or breathability.

An assessment of the effectiveness of integrated technology cesarean section using the methods of broadband radio wave surgery (SHRH) was taken, argon-plasma coagulation, namely (APC) in tissue anterior abdominal wall and uterus to prevent chronic inflammatory, and other intra-and postoperative complications. The study included analysis of cesarean section outcomes, these results are about women operated without the use of argon-plasma coagulation and the use of APC. Studies have shown that the proposed modification of the cesarean section using methods SHRH reduces the amount of wound exudate and helps to improve microcirculation and tissue repair, formation of a wealthy uterine scar.

SummaryClinical diagnostics of venous leg ulcers set the course for efficient therapy. Precise clinical findings with an objectification of signs and symptoms of chronic venous insufficiency are essential. Duplex ultrasound investigations of the leg veins are necessary in the very early stages after the appearance of leg ulcers. Furthermore, not only a clinical investigation of the arterial perfusion but also the determination of the ankle-brachial-index is obligatory. Microbiological diagnostics are currently seen as useful in Germany, due to discussions on MRSA, even though they don´t have an immediate therapeutic consequence without the presence of clinical signs of infection. Therapeutic achievements can be objectified by a continuous documentation of the wound size, the wound bed, the wound exudate and signs of infection as well as the life quality of patients with chronic wounds.

In clinical practice, point-of-care diagnostic testing has progressed rapidly in the last decade. For the field of wound care, there is a compelling need to develop rapid alternatives for bacterial identification in the clinical setting, where it generally takes over 24 hours to receive a positive identification. Even new molecular and biochemical identification methods require an initial incubation period of several hours to obtain a sufficient number of cells prior to performing the analysis. Here we report the use of an inexpensive, disposable electrochemical sensor to detect pyocyanin, a unique, redox-active quorum sensing molecule released by Pseudomonas aeruginosa, in wound fluid from patients with chronic wounds enrolled in the WE-HEAL Study. By measuring the metabolite excreted by the cells, this electrochemical detection strategy eliminates sample preparation, takes less than a minute to complete, and requires only 7.5 μL of sample to complete the analysis. The electrochemical results were compared against 16S rRNA profiling using 454 pyrosequencing. Blind identification yielded 9 correct matches, 2 false negatives, and 3 false positives giving a sensitivity of 71% and specificity of 57% for detection of Pseudomonas. Ongoing enhancement and development of this approach with a view to develop a rapid point-of-care diagnostic tool is planned.

This updated volume provides the current knowledge on the diagnosis, treatment, management, and prevention of pressure ulcers. Chapters on the early detection of pressure ulcers, negative pressure therapy, pressure ulcers in pediatric patients, adjunctive therapies, surgical management of pressure ulcers, and innovation in pressure ulcer research and practice are included. This second edition aims to be the primary reference for pressure ulcers from diagnosis and prevention to management and treatment options. The book is relevant to dermatology clinicians, vascular surgeons, and dermatology nurses.

Objective:To evaluate the safety and performance of a gelling fibre dressing, with respect to wound exudate management, maceration and periwound skin conditions.Method:Complex (non-healing) surgical or chronic wounds healing by secondary intention were treated with a gelling fibre dressing (Biosorb, Acelity) as part of a prospective, two-centre case series product evaluation study. Dressing performance was evaluated at each change, and weekly for up to four weeks or until the wound healed, if this was in less than four weeks. The main outcome measure was dressing performance, wound bed and periwound skin condition.Results:A total of 15 patients, aged 26–87 years, were enrolled; 10 patients (66.7%) presented with chronic wounds including venous leg ulcers (VLUs), arterial leg ulcer, one mixed leg ulcer, pressure ulcer (PU), and diabetic foot ulcers (DFUs). The remaining wounds (33.3%) were postsurgical complex wounds healing by secondary intention, located in the upper leg, foot, abdomen, and sacrum. Mean wound area was 22.6±36.6cm2(range: 1.3–144.0cm2). Treated wounds showed complete granulation in eight (53.0%) wounds, 75% granulation coverage in two (13.3%) wounds, 50% coverage in three (20.3%), and 25% coverage in two (13.3%) wounds. Patients evaluated the dressing effectiveness as ‘excellent’ or ‘very good’ in 45% of cases, ‘moderate’ in 45%, and ‘poor’ in 10% of cases. Results of Visual Analogue Scale (VAS) showed 70% of patients rated their pain as ‘low’ and 30% as ‘moderate’ at dressing removal. Clinicians' evaluation of dressing ability to absorb and retain wound exudate was rated ‘excellent’ or ‘very good’ in 80% of cases, and moderate in 20% and poor in 10% of cases. Overall, clinicians' impression of the dressing performance was reported as ‘excellent’ or ‘very good’ in 80% of cases and ‘moderate’ in 20% of cases. No patient had to be removed from the study due to adverse events directly related to the dressing or its performance.Conclusion:These clinical findings suggest the new gelling fibre dressing to be safe and effective in wound treatment of complex (non-healing) surgical or chronic wounds, to manage exudate effectively, and to optimise the conditions of wounds healing by secondary intention

A survey was undertaken with the aim of identifying health professionals' understanding of wound exudate and their ability to assess and manage it. The survey was carried out at Wound Expo, which is a large annual event that provides generalist nurses with interactive education on the core aspects of wound care, including wound exudate. The sample comprised 223 delegates. Almost all delegates (89%) included exudate in every wound assessment, but only 20% based assessment of excess exudate on colour, viscosity and malodour, with the majority (67%) basing it on leakage and increased frequency of dressing changes. While almost all (94%) delegates said they always assess exudate colour and most (80%) that they always assess its viscosity, 18% did not understand the clinical significance of exudate colour and 29% were unable to correctly identify the characteristics of low-viscosity exudate. Furthermore, one quarter of the sample did not always take absorbency into account when selecting a wound dressing. The results indicate that exudate assessment is often subjective, and there is scope for greater use of wound exudate assessment tools and exudate descriptors.

The wound contact layer of UrgoTul Absorb Border (Urgo Medical) foam dressing contains a Technology Lipido Colloid (TLC) Healing Matrix, which includes hydrocolloid and lipophilic substances designed to stimulate fibroblast proliferation and thus promote granulation tissue formation. A multicentre, noncomparative, clinical evaluation of UrgoTul Absorb Border investigated whether use of the dressing promoted granulation tissue formation and the management of wound exudate. Other parameters evaluated included: pain-free dressing changes, protection and improvement of surrounding tissue, ease of application, conformability, ability to remain in place, wear time, effect on peri-wound skin, durability, ease of removal, and patient comfort. There were 43 patients recruited into the evaluation. Results show that 8 wounds (19%) achieved full epithelialisation and 34 (81%) improved. All participating clinicians rated the dressing's overall performance, including its ability to manage exudate, as excellent, very good, or good.

Current concepts in wound management are summarized. The emphasis is on selection of the contact layer of the bandage to promote a moist wound environment. Selection of an appropriate contact layer is based on the stage of wound healing and the amount of wound exudate. The contact layer can be used to promote autolytic debridement and enhance wound healing.

Good quality wound dressings should have exceptional properties for usage, such as being able to remove excess wound exudates, having rapid dehydration, and providing optimal water vapour permeability. This study evaluated and compared the morphological and physical properties of six different commercially absorbent wound dressings in Thailand: two hydrocolloids, two alginates, and two foams. These wound dressings are available in a variety of components and structures, some of which have a multilayer structure. The results showed that the calcium sodium alginate dressings had better absorption properties than the calcium alginate dressings, hydrocolloid dressings, hydrocolloid with foam layer dressings, foam with polyurethane film layer dressings, and foam with hydrogel and polyurethane film layer dressings. Furthermore, the calcium sodium alginate dressings had the highest rate of dehydration and provided an optimal water vapour transmission rate. However, the calcium sodium alginate dressings could not retain the original structure after being submerged with a wound exudate.

Because the genus Corynebacterium colonize the human skin, detection of Corynebacterium striatum in a sterile blood specimen is sometimes considered as contamination. An 80-year-old man who underwent cardiovascular operation presented with high-grade fever postoperatively. Corynebacterium striatum was detected in the blood and wound exudate, and the patient was diagnosed with mediastinitis due to Corynebacterium striatum. One month earlier, a patient with similar symptoms due to C. striatum-related mediastinitis died in our care. The Corynebacterium striatum isolates from both patients had identical biochemical and genetic characteristics, suggesting that Corynebacterium striatum was acquired nosocomially. We have learnt a lesson from this negative experience: early diagnosis of Corynebacterium striatum-related infection and early administration of glycopeptide antibiotics could have saved this patient. It is notable that C. striatum can cause life-threatening infection after cardiovascular operation.

Objective: The wound bed score is a validated tool to monitor wound healing in chronic wounds, and depends on visual examination by trained personnel. This study describes the feasibility of adding some biochemical and immunohistochemical parameters to increase the objectivity and specificity of the wound bed score Method: Patients with chronic wounds on the lower leg with different durations were enrolled to assess the correlation between the wound bed score and specific wound-related biomarkers, namely MMP-9, MMP-2, NGAL, albumin, integrin α2/β1, and other histochemical (CD68, PK1, CD32, fractalkine, periostin) and immunocytochemical markers from biopsies and smears taken from wound edges and bed. Results: The study examined samples from 10 patients. Patients with an unfavourable wound bed score had a low expression of periostin and fractalkine in the wound bed tissue. CD68 PK1 showed a low or negative expression in the majority of the samples. Patients negative for CD68 PK1 were also negative for CD32. Principal component analysis revealed that the albumin level and the amount of proteins were associated with a high wound bed score. Two different subsets of patients could be discriminated either by integrin α2/β1 and albumin percentages or the MMP-9 and MMP-2 activities Conclusion: These preliminary results pave the way towards an improved wound status diagnosis and an advanced quality of wound care and management. These findings need confirming with a large number of patients and at different time points.

There are a number of physiological changes that occur with aging that make the older adult more susceptible to traumatic wounds, as well as pressure ulcers following a traumatic injury. Nursing care of wounds in the older adult trauma patient should include control of comorbidities, particularly those that may inhibit wound healing. Additional risk factors for the older adult that can impair the wound-healing process include dehydration, malnutrition, unresolved pressure/shear and friction, excessive skin moisture, pruritus and dry skin, increased levels of wound exudate, and inappropriate management of wound exudate [1].

Studying influence of remaxol on reparative process of tissue reparation in a laparotomy wound.90 patients with the acute appendicitis complicated by local peritonitis in the early postoperative period are examined. 50 patients received traditional therapy. Therapy of other 40 patients included Remaxol (intravenous introduction, daily within 5 days, of 400 ml).It is established that Remaxol optimizes the course of reparative process in laparotomy wound that was confirmed with data of tenziomety and wound exudate cytological research. Efficiency of a Remaxol is based on its capability to improve microcirculation, antiedematous action and its capability to reduce excessive intensity peroxide oxidation of membrane lipids, phospholipase activity and the phenomena of a hypoxia.Цель исследования - изучение влияния Ремаксола на репаративный процесс тканевых структур лапаротомной раны. Материал и методы. Обследованы 90 больных с острым аппендицитом (ОА), осложненным местным перитонитом, в раннем послеоперационном периоде. Традиционную терапию получали 50 пациентов, остальные 40 - Ремаксол (ежедневное в течение 5 сут по 400 мл внутривенное введение). Результаты и заключение. Установлена способность Ремаксола оптимизировать течение репаративного процесса лапаротомной раны, что подтверждено данными ранотензиометрии и цитологическим исследованием раневого экссудата. В основе индукторной регенераторной эффективности Ремаксола лежит его способность улучшать микроциркуляцию, противоотечное действие, а также способность уменьшать избыточную интенсивность перекисного окисления мембранных липидов, фосфолипазную активность и явления гипоксии.

Objective: To identify the clinical empirical evidence for identifying, managing and preventing skin maceration in human subjects. Method: A rapid review of the current literature was undertaken between 5 September and 19 September 2016 using the electronic databases CINAHL, MEDLINE, PUBMED and Cochrane, with the key words: skin macerat*, wound macerat*, moisture associated skin damage, wound exudate and hyper-hydration of skin, Results: Of 526 papers found using an electronic database search, four were identified as fitting the search parameters, and a further two were retrieved from a manual search of reference lists. There were three themes that emerged: how to identify and measure maceration, how to manage and reduce maceration once it has already occurred, and how to prevent skin maceration. Hyper-hydration can reach greater skin depths than previously thought, thus engendering more extensive damage potential, which in turn can impact on treatments and healing time. Realistically, the deeper the hyper-hydration issue, the more extensive the damage and it will take longer to recover—a problem compounded if the hyper-hydration is due to incontinence and skin is also exposed to urine and/or faeces. In relation to wound management, the authors advocate the removal of moisture away from the wound or skin, either through superabsorbent dressings, or by allowing the excess moisture to evaporate through semi-permeable dressings to reduce maceration, enhance patient comfort and encourage healing. However, we found no evidence regarding the limits of hydration of the dermis and epidermis and thereby the optimal conditions for managing exuding wounds and promoting skin health. Each of the six papers in this review calls for further research to help identify, treat and prevent maceration. Conclusion: Maceration causes patients' discomfort and pain as well as prolonging healing time and deserves more focused research. This rapid review highlights how limited the clinical empirical research is on identifying and managing skin maceration from an early stage so that health professionals may be better equipped to prevent it. Further clinical research is also needed to determine when levels of hydration in the skin become damaging. The small number of studies within this review show that skin maceration can be avoided, but clearer guidance is needed.

A polypeptide nanofilm made by layer-by-layer (LbL) self-assembly was built on a surface that mimics nonwoven, a material commonly used in wound dressings. Poly-L-lysine (PLL) and poly-L-glutamic acid (PLGA) are the building blocks of the nanofilm, which is intended as an enzymatically degradable lid for release of bactericides to chronic wounds. Chronic wounds often carry infection originating from bacteria such asStaphylococcus aureusand a release system triggered by the degree of infection is of interest. The dry nanofilm was studied with ellipsometry. The thickness of the nanofilm was 60% less in its dry state than in its wet state. The measurements showed that a primer was not necessary to build a stable nanofilm, which is practically important in our case because a nondegradable primer is highly unwanted in a wound care dressing. Added V8 (glutamyl endopeptidase) enzymes only showed adsorption on the nanofilm at room temperature, indicating that the PLL/PLGA “lid” may remain intact until the dressing has been filled with wound exudate at the elevated temperature typical of that of the wound.

The management of wound exudate remains a clinical challenge despite technological advances in products with better exudate-handling capacities. This clinical challenge is occasionally encountered when thick exudate (viscous exudate) is present, and when most modern dressings do not possess the capabilities to manage the viscosity while enabling exudate absorption. Maceration to the peri-wound area poses another challenge, irrespective of the number of topical barrier application products on the market and the innovation of dressing products that lock exudate away or those that encourage vertical wicking. In addition to all the above, in clinical practice, the assessment and documentation of wound exudate remains sporadic, leading to the challenges of effective wound exudate dressing selection and cost-effective dressings.

Purpose Patients with malignant breast wounds (MBWs) have multiple symptoms. In particular, care for exudates or peri-wound moisture-associated dermatitis (MAD) is difficult. However, MAD has not been distinguished from peri-wound dermatitis. Therefore, care for patients with MAD has not been well established. The aim of this study was to describe morphological characteristics of MAD in MBWs and link morphological characteristics of MAD to related factors. Methods We conducted a qualitative descriptive study and a cross-sectional study. Data were collected by qualitative participant observation and structured interviews. The qualitative descriptive study was conducted using the ‘morphoqualitative analysis' method. Data analyses were performed using qualitative research methods. In the cross-sectional study, the participants were classified into 2 groups for comparison: with MAD (MAD group) and without MAD (non-MAD group). Results Characteristics of 24 MBWs were examined. Morphoqualitative analyses of data generated 17 subcategories and 3 categories. We could morphologically define MAD by findings of ‘radial shape matching the dressing' and ‘half-fusiform shape over the dressing'. Regarding factors related to MAD, necrotic tissue type was significantly more severe in the MAD group than in the non-MAD group ( p = 0.048). Wound exudate leakage was significantly more frequent in the MAD group than in the non-MAD group ( p = 0.013). Conclusion Our study provides several points for nursing MBWs. Morphoqualitative analyses of MAD are quite important for evaluating possible causes of MAD as well as selecting effective interventions.

Controlling wound exudate is a common problem that has traditionally been managed by changing dressings frequently—and using dressings that were not designed for highly exuding wounds. Wound exudate can have a significant impact on a patient's quality of life and can delay wound healing ( World Union of Wound Healing Societies (WUWHS), 2007 ). It is also challenging for clinicians and can be costly in terms of clinical time and dressing cost ( Dowsett, 2011 ). Use of appropriate absorbent dressings for effective exudate management can reduce time to healing, reduce exudate-related problems such as periwound skin damage and infection, improve patients' quality of life, reduce dressing change frequency and clinician input, and so, overall, improve healthcare efficiency ( Romanelli, et al, 2009 ).

Exudate and infection are two of the key challenges facing clinicians in the management of wounds, especially chronic wounds. The associated increased use of healthcare resources and nursing time are also important consequences. What we cannot underestimate, however, is the challenge for patients and their carers of living with wounds that impact on the quality of their daily lives, causing misery and distress. This article focuses on the importance of exudate as a marker of infection and the link between the two. It looks at infection and the difficulties confronting clinicians in managing wound bioburden when sometimes the wound appears not to give any clues, or at the least, very subtle ones that could easily be missed. The pivotal role of ongoing patient assessment and wound assessment is discussed; timely intervention is seen as the key to management.

Objective: The aim of this study was to quantify blood cells and inflammatory markers, involved in the healing process, in exudates from wounds in different healing phases, to assess these markers in order to identify the inflammatory phase of the wounds. Method: Patients who presented with postsurgical wounds, which closed by first and second intention, and those who presented with pressure ulcers (PUs), which were closed by second intention, were included in the study. Results: We examined wounds from 37 patients and collected samples from 52 wounds in the inflammatory phase, 30 in the proliferative phase and 29 in the maturation phase. The number of neutrophils and platelets in the exudate collected from wounds in the inflammatory phase was significantly higher (pConclusion: Our findings suggest that the combination of the markers, percentage of neutrophils and monocytes, platelets, CRP and IgG levels could be useful prognostic indicators of the inflammatory phase.

This study compared moisture vapour transmission rate (MVTR) and wear time or fluid-handling capacities of six adhesive foam dressings to a reformulated control dressing. Standardised in vitro MVTR methodology and a previously published in vivo artificial wound model (AWM) were used. Mean inverted MVTR for the reformulated dressing was 12 750 g/m(2) /24 hours and was significantly higher than four of the six comparator dressings (P 7·0 days, compared with 1·0 to 3·5 days for the comparator dressings (P = 0·0012 to P 87 ml compared with 13·0 to 44·5 ml for the comparator dressings (P = 0·0007 to P < 0·001). Interestingly, inverted MVTR did not correspond well to the AWM. These results suggest that marked differences exist between the dressings in terms of both MVTR and wear time or fluid-handling capacity. Furthermore, high inverted MVTR does not necessarily predict longer wear time or fluid-handling capacities of absorbent dressings.

Objective: There are no well-defined criteria for assessing the efficacy and quality of wound dressings, and evaluation is often simplistic and based on the subjective opinion of the health-care professional. The aim of this study was to identify specific parameters suitable for measuring dressings' performance, and to recommend laboratory tests able to evaluate these specific criteria in an objective manner. Method: After reviewing all tests currently used in Italy and examining the criteria for evaluating the quality of dressings, the authors selected 12 clinically significant parameters. These parameters were measured using standard and non-standard tests, and in some cases, these tests were modified and improved to simulate real-life conditions more accurately. Results: Most of the tests used were able to discriminate well between dressings belonging to different brands, with some tests being more suitable than others for the assessment of specific dressings. Conclusion: These results highlighted some issues in the standard testing procedures, such as the need of a suitable fluid that mimics the real exudate, and the importance of standard temperature and humidity conditions during testing. Our study paves the way for a larger project aimed at a systematic evaluation of dressing quality able to assess every wound dressing on the market.