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Objective: To summarise the findings on the effect of the clinical use of 0.1% polyhexanide-propylbetaine (PHMB/betaine) solution/gel on acute and hard-to-heal (chronic) wound healing., Method: A literature search was conducted in MEDLINE, CINAHL, Embase, Scopus and the CENTRAL Trials Registry of the Cochrane Collaboration. Paired reviewers conducted title and abstract screening and full-text screening to identify experimental, quasi-experimental and observational studies. Study quality and risk of bias were not formally evaluated., Results: A total of 17 studies met the eligibility criteria. The findings from 12 studies indicated that the use of 0.1% PHMB/betaine solution/gel had: a low risk of contact sensitivity; could help debridement during wound cleansing; aided effective wound bed preparation; reduced wound size, odour and exudate; improved pain control; reduced microbial load; and enhanced wound healing. The results of three studies indicated that both 0.1% PHMB and saline solution were effective in reducing bacterial load, while another showed that adding 0.1% PHMB to tie-over dressings had no effect on reducing bacterial loads in wounds. Another study concluded that disinfection and granulation of pressure ulcers with hydrobalance dressing with 0.3% PHMB was faster and more effective than using 0.1% PHMB/betaine., Conclusion: The findings of this literature review showed that 0.1% PHMB/betaine solution/gel appeared to be useful and safe for wound cleansing, was effective in removing soft debris and slough from the wound bed, and created a wound environment optimal for healing. Although these actions cannot be attributed solely to this treatment modality, these results do highlight the unique action of this combined product. However, more robust studies are needed to confirm these results.

A break in skin integrity must be repaired as quickly as possible to avoid excess blood and fluid loss, and to minimise the onset of infection. Hard-to-heal wounds, in which the progression of the wound healing response is compromised, present several challenges to healing (for example, the presence of devitalised tissue acting as a physical barrier to healing and as a focus for bacterial contamination with the potential for subsequent infection). The objective of this article is to present, as a narrative review, the clinical evidence supporting the use of a unique hydro-responsive wound dressing (HydroClean, HRWD1, PAUL HARTMANN AG, Germany). The dressing provides a simple treatment option to address a number of clinical challenges clinicians must overcome in order to facilitate wound healing progression. These studies demonstrated that this product supported successful debridement/cleansing of a wide variety of wounds, including hard-to-heal wounds, enabled wound bed preparation, and lead to positive healing outcomes, including in wounds that previously had failed to heal. The simplicity of using HRWD1 as a single dressing can help clinicians overcome a variety of challenges when treating both acute and hard-to-heal wounds, which, with the benefit of proven patient outcomes, could make it an ideal choice for a first-line treatment.

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.

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., (© 2017 The Authors. International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

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.

Background: Wound cleansing should create an optimal healing environment by removing excess debris, exudates, foreign and necrotic material which are commonly present in the wounds that heal by secondary intention. At present, there is no research evidence for whether pressurised irrigation has better wound healing outcomes compared with conventional swabbing practice in cleansing wound., Objectives: This study investigated the differences between pressurised irrigation and swabbing method in cleansing wounds that healed by secondary intention in relation to wound healing outcomes and cost-effectiveness., Design: Multicentre, prospective, randomised controlled trial., Setting: The study took place in four General Outpatient Clinics in Hong Kong., Methods: Two hundred and fifty six patients with wounds healing by secondary intention were randomly assigned by having a staff independent of the study opening a serially numbered, opaque and sealed envelope to either pressurised irrigation (n=122) or swabbing (n=134). Staff undertaking study-related assessments was blinded to treatment assignment. Patients' wounds were followed up for 6 weeks or earlier if wounds had healed to determine wound healing, infection, symptoms, satisfaction, and cost effectiveness. The primary outcome was time-to-wound healing. Patients were analysed according to their treatment allocation. This trial is registered with ClinicalTrials.gov, number NCT01885273., Results: Intention-to-treat analysis showed that pressurised irrigation group was associated with a shorter median time-to-wound healing than swabbing group [9.0 days (95% CI: 7.4-13.8) vs. 12.0 (95% CI: 10.2-13.8); p=0.007]. Pressurised irrigation group has significantly more patients experiencing lower grade of pain during wound cleansing (93.4% vs. 84.2%; p=0.02), and significantly higher median satisfaction with either comfort or cleansing method (MD 1 [95% CI: 5-6]; p=0.002; MD 1 [95% CI: 5-6]; p<0.001) than did swabbing group. Wound infection was reported in 4 (3.3%) patients in pressurised irrigation group and in 7 (5.2%) patients in swabbing group (p=0.44). Cost-effectiveness analysis indicated that pressurised irrigation in comparison with swabbing saved per patient HK$ 110 (95% CI: -33 to 308) and was a cost-effective cleansing method at no extra direct medical cost with a probability of 90%., Conclusions: This is the first randomised controlled trial to compare the pressurised irrigation and swabbing. Pressurised irrigation is more cost-effective than swabbing in shortening time that wound heals by secondary intention with better patient tolerance. Use of pressurised irrigation for wound cleansing is supported by this trial., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

This study aimed to evaluate the effectiveness of Cocor Bebek (Kalanchoe pinnata) leaves in wound cleaning for diabetic foot ulcers (DFU) and compare it with the use of NaCl solution. Diabetes mellitus (DM) and its complications, such as DFU, pose a global health problem with increasing prevalence. Given the escalating occurrence of DFU, timely and effective treatment is crucial to prevent severe complications, including amputation. This research employed a quasi-experimental design with a pretest-posttest control group and was conducted at Rumah Luka Surabaya, Indonesia. The sample comprised 40 respondents with DFU, divided into an intervention group (using Cocor Bebek leaves) and a control group (using NaCl solution). Respondents' characteristics, including age, sex, occupation, duration of diabetes, and other factors, were assessed to understand their impact on the response to treatment. The results demonstrated a significant improvement in DFU wound healing in the intervention group after using Cocor Bebek leaves (p<0.05), along with reduced scores on Bates Jensen Wound Assessment Tool (BWAT) indicators such as wound edge, tunnel, and necrotic tissue type. Conversely, the control group using NaCl solution also exhibited significant improvement in wound healing (p<0.05), with decreased scores on indicators such as the amount of necrotic tissue and the quantity of exudate. This study underscores the potential of Cocor Bebek leaves in aiding wound healing in DFU, evident from clinical improvements and reduced BWAT scores. However, further research and clinical trials are needed to comprehensively support these findings and understand the mechanism of action, as well as the safety of using Cocor Bebek leaves in diabetic patients. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this study is to compare the healing rate between AP soap and 4% Chlorhexidine solution in superficial second-degree burn wounds. The secondary objectives include the analgesic effect and moisturization of these two products. Materials and Methods: Data was collected between 2019 and 2021. Patients aged 18 years and above, with superficial second-degree burns including at least 20% of TBSA, and admitted to the Burn Unit within 24 hours of injury were included. They were randomly assigned to two groups: Andrographis paniculata with Perilla oil liquid soap group (AP group) and 4% Chlorhexidine group (control group). The measurements included percentage of epithelialization, pain score during wound cleansing, itching score after wound cleansing, and dry skin specified symptoms. All patients received standard care for burn wound treatment. Results: A total enrollment was 23 patients in this study (12 in the AP group and 11 in the control group). The median age was 38.5 years. There were no statistically significant differences in age, %TBSA, and initial wound size between both groups (p > 0.05). Although the healing time was similar in both groups, (18.5 vs. 20.1, p=0.347), the AP group had a significantly lower pain score than the control group (4.7 vs. 5.4, p=0.020). Moreover, the AP group demonstrated significant improvements in itching score and SRRC score at 14 days compared to the control group (5.1 vs. 6.0, p 0.039 and 1.08 vs. 1.55, p 0.020, respectively). There were no adverse effects during this study. Conclusion: Patients treated with Andrographis paniculata with Perilla oil liquid soap experienced less pain and better moisturization compared to those treated with the standard 4% chlorhexidine solution, while achieving a comparable healing rate. A future large-scale prospective trial is recommended. [ABSTRACT FROM AUTHOR]

Background: Use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) using reticulated open cell foam dressings with through holes (ROCF-CC) may help remove barriers to healing by removing thick exudate, infectious materials, and non-viable tissue and promoting granulation tissue development. Aims: Use of NPWTi-d with ROCF-CC dressings was assessed in two patients with diabetic foot wounds and one patient with a non-healing, lower-extremity wound. Methods: Wounds were assessed for osteomyelitis and malignancy, and antibiotics initiated. Surgical debridement was performed followed by application of NPWTi-d with ROCF-CC. Normal saline was instilled with a 1-minute dwell time, followed by negative pressure at -125 mmHg for 2.5 hours. Dressings were changed every 2-3 days. Results: NPWTi-d with ROCF-CC use resulted in granulation tissue development and removal of debris, infectious materials, and non-viable tissue. After NPWTi-d use, two patients underwent a skin graft procedure to facilitate wound closure. The remaining patient underwent further wound care. Conclusions: NPWTi-d with ROCF-CC dressing use helped promote granulation tissue development and remove debris, infectious materials, and non-viable tissue in these three patients. [ABSTRACT FROM AUTHOR]

Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII–WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted. [ABSTRACT FROM AUTHOR]

Wound cleansing agents are routine in wound care and preoperative preparation. Antiseptic activity intends to prevent contaminating microbes from establishing an infection while also raising concerns of cytotoxicity and delayed wound healing. We evaluated the cytotoxicity of five clinically used wound cleaning agents (saline, povidone iodine, Dove® and Dial® soaps, and chlorhexidine gluconate [CHG]) using both an ex vivo and in vivo human skin xenograft mouse model, in contrast to classical in vitro models that lack the structural and compositional heterogeneity of human skin. We further established an ex vivo wound contamination model inoculated with ~100 cells of Pseudomonas aeruginosa or Staphylococcus aureus to evaluate antimicrobial efficacy. Scanning electron microscopy and confocal microscopy were used to evaluate phenotypic and spatial characteristics of bacterial cells in wound tissue. CHG significantly reduced metabolic activity of the skin explants, while all treatments except saline affected local cellular viability. CHG cytotoxicity persisted and progressed over 14 days, impairing wound healing in vivo. Within the contamination model, CHG treatment resulted in a significant reduction of P. aeruginosa wound surface counts at 24 h post‐treatment. However, this effect was transient and serial application of CHG had no effect on both P. aeruginosa or S. aureus microbial growth. Microscopy revealed that viable cells of P. aeruginosa reside deep within wound tissue post‐CHG application, likely serving as a reservoir to re‐populate the tissue to a high bioburden. We reveal concerning cytotoxicity and limited antimicrobial activity of CHG in human skin using clinically relevant models, with the ability to resolve spatial localization and temporal dynamics of tissue viability and microbial growth. [ABSTRACT FROM AUTHOR]

This article describes the wound infection continuum in surgical, acute and chronic wounds. The phases are: contamination, colonisation, local infection and finally spreading and systemic infection. Clinicians need to be familiar with the signs and symptoms of local infection in order to put strategies in place to prevent a 'full blown' wound infection and to recognise how the signs and symptoms differ by wound type. The article looks at the most recent guidance on wound infection management strategies, together with the identification and treatment of suspected biofilms and the two-week challenge, used in clinical practice to disrupt biofilms. Wound cleansing and the use of antimicrobial dressings and topical antiseptics are also discussed. [ABSTRACT FROM AUTHOR]

Background: The short-term application of negative pressure wound therapy with instillation and dwell time (NPWTi-d) enables the delivery of topical wound solutions, the solubilisation of debris and cleansing of the wound bed. The application of NPWTi-d may support the transition of the wound to a more manageable state and minimises the use of more invasive techniques. Method: In this case series, we describe the process of applying NPWTi-d early as part of a contaminated wound treatment plan. Results: The case series included 15 patients in the preoperative setting. Wound types included surgical dehiscence, hard-to-heal wounds, heel pressure ulcers, diabetic foot ulcers, a cat bite and an amputation left open. Normal saline or a 0.125% sodium hypochlorite solution were instilled and allowed to dwell for five minutes, followed by 15 minutes of continuous negative pressure at –125mmHg. NPWTi-d was continued for 4–36 hours, or until the operating room became available. After NPWTi-d, we observed a decreased amount of devitalised tissue in the wound bed and reduced oedema and erythema in the periwound area. Patient white blood cells also significantly decreased in all cases after NPWTi-d (p<0.001). Conclusion: Short-term use of NPWTi-d may be a useful option for supporting the surgical treatment of contaminated lower extremity wounds. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Over the years, there has been a plethora of evidence-based literature on effective and ineffective wound management practices; however, some healthcare professionals continue to manage wounds using outmoded or ritualistic practices. The key areas are: frequency of dressing changes; maintenance of a moist environment to aid healing; when wounds should be cleansed; and which cleaning solutions to use. This article presents the evidence base in these key four areas and aims to dispel some of the myths and misconceptions to ensure that healthcare professionals can be confident that they are delivering upto- date, evidence-based wound care in accordance with the Code of Conduct (Nursing and Midwifery Council [NMC], 2015). [ABSTRACT FROM AUTHOR]

Background. Negative pressure wound therapy (NPWT) is commonly used in wound management of both acute and chronic wounds. As wound care has advanced, traditional NPWT has evolved to include instillation and dwell time (NPWTi-d). To better understand the potential clinical benefits of NPWTi-d, an assessment of the available literature focusing on NPWTi-d mechanisms of action in wound management was conducted. Methods. A literature search was performed for abstracts and articles published between 2010 and 2023. Published studies in English that discussed NPWTi-d mechanisms of action and included a study population larger than 10 patients were examined. Results. A total of 1878 articles were identified through the literature search. After removal of duplicates and article reviews, 29 studies discussing the mechanisms of action for NPWTi-d were found. Study types included case series (n = 20), comparative study (n = 6), randomized controlled trial (n = 2), and retrospective study (n = 1). These studies included approximately 1108 patients who received NPWTi-d as part of a wound care treatment plan. NPWTi-d use was associated with improved wound and clinical outcomes through wound cleansing, removal of exudate and infectious materials, and promotion of granulation tissue development. Conclusions. The mechanisms of action for NPWTi-d helps provide wound management through wound cleansing, removal of exudate and infectious materials, and promoting the development of granulation tissue. Additional studies are warranted to fully assess the potential clinical and health economic benefits of NPWTi-d use. [ABSTRACT FROM AUTHOR]

The burn patient is easily subject to colonization by microorganisms and infection, due to reduced defence capabilities and immune dysfunction. Moreover, burn units and intensive care units are characterized by a selection of resistant bacterial strains. If the burn patient is not adequately cared for in terms of infection prevention and control, sepsis is inevitable. Nowadays, several different antiseptics and antiseptic dressings are used in the topical treatment of burns, each with positive and negative effects. Topical antiseptics allow control of bacterial load, but they can also cause cytotoxicity and reduce healing rate. Choosing the most effective antiseptic is crucial to preventing infection from compromising wound healing. The present study aims to review the available literature in order to highlight evidence on the use of topical antiseptics in burns. [ABSTRACT FROM AUTHOR]

The article focuses on several randomized controlled trials reports which reveals use of tap water as a safer method for cleansing of acute traumatic wounds with lower rate of infection as compared to normal saline water. It highlights three main variables in wound cleansing which includes cleansing solution, solution volume and delivery method. It further highlights benefits of tap water for cleansing of acute traumatic wounds in patients which is cost-effective for health care providers.

The following case studies assess the effects of Octenilin Wound Irrigation Solution and Octenilin Wound Gel (octenilin® range, schülke) on non-healing wounds -- for example, wounds with necrotic tissue, slough, and/or wounds that are critically colonised, or wounds that are locally infected (including with MRSA). A variety of non-healing wounds were assessed, including a venous leg ulcer, diabetic foot ulcer and pressure ulcers. [ABSTRACT FROM AUTHOR]

A number of clinical studies and case reports have shown that HydroClean plus effectively cleanses wounds of necrotic tissue, fibrinous slough and bacteria-laden wound exudates. Due to the innovative technology inherent in the polyacrylate superabsorbent material at the core of these dressings, the wound is actively cleansed by the rinsing and absorbing effect of this pad core. Optimisation of the moist wound environment and promotion of autolytic debridement supports the formation of new granulation tissue and leads to progression of wound healing response. This product focus explores the evidence supporting HydroClean plus and hydro-responsive wound dressings. [ABSTRACT FROM AUTHOR]

Background: Wound cleansing should create an optimal healing environment by removing excess debris, exudates, foreign and necrotic material which are commonly present in the wounds that heal by secondary intention. At present, there is no research evidence for whether pressurised irrigation has better wound healing outcomes compared with conventional swabbing practice in cleansing wound. Objectives: This study investigated the differences between pressurised irrigation and swabbing method in cleansing wounds that healed by secondary intention in relation to wound healing outcomes and cost-effectiveness. Design: Multicentre, prospective, randomised controlled trial. Setting: The study took place in four General Outpatient Clinics in Hong Kong. Methods: Two hundred and fifty six patients with wounds healing by secondary intention were randomly assigned by having a staff independent of the study opening a serially numbered, opaque and sealed envelope to either pressurised irrigation (n = 122) or swabbing (n = 134). Staff undertaking study-related assessments was blinded to treatment assignment. Patients' wounds were followed up for 6 weeks or earlier if wounds had healed to determine wound healing, infection, symptoms, satisfaction, and cost effectiveness. The primary outcome was time-to-wound healing. Patients were analysed according to their treatment allocation. This trial is registered with ClinicalTrials.gov, number NCT01885273. Results: Intention-to-treat analysis showed that pressurised irrigation group was associated with a shorter median time-to-wound healing than swabbing group [9.0 days (95% CI: 7.4-13.8) vs. 12.0 (95% CI: 10.2-13.8); p = 0.007]. Pressurised irrigation group has significantly more patients experiencing lower grade of pain during wound cleansing (93.4% vs. 84.2%; p = 0.02), and significantly higher median satisfaction with either comfort or cleansing method (MD 1 [95% CI: 5-6]; p = 0.002; MD 1 [95% CI: 5-6]; p < 0.001) than did swabbing group. Wound infection was reported in 4 (3.3%) patients in pressurised irrigation group and in 7 (5.2%) patients in swabbing group (p = 0.44). Cost-effectiveness analysis indicated that pressurised irrigation in comparison with swabbing saved per patient HK$ 110 (95% CI: 33 to 308) and was a cost-effective cleansing method at no extra direct medical cost with a probability of 90%. Conclusions: This is the first randomised controlled trial to compare the pressurised irrigation and swabbing. Pressurised irrigation is more cost-effective than swabbing in shortening time that wound heals by secondary intention with better patient tolerance. Use of pressurised irrigation for wound cleansing is supported by this trial. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]

Abstract: The wet-to-dry phase as a basic accompanying measure in dressing changes on secondary healing wounds was first described and instructed 1989 by G. Kammerlander at the university hospital of Zurich. This development traces back to collective years of practical experiences at the Clinic of dermatology of the university hospital Zurich (Prof. U.W. Schnyder/G. Kammerlander). The positive empirical experiences over more than one and a half decade now require underlying this method with scientific facts. Using a literature survey, the importance and significance of this practical experience will be confirmed and supported. This article will show this established and widely-used method in an updated version. [Copyright &y& Elsevier]

Objective: Negative pressure wound therapy (NPWT) can be delivered in continuous or noncontinuous modes, while NPWT with instillation (NPWTi) couples NPWT with automated delivery and removal of topical wound treatment solutions and suspensions. This porcine study compared granulation response of NPWTi (instillation foam dressing with saline) to NPWT(standard foam dressing) in continuous and noncontinuous modes. Methods: Full-thickness dorsal excisional wounds in pigs were treated with continuous NPWT, intermittent NPWT, dynamic (controlled variable) NPWT, and NPWTi with saline (n=10 per group).Wound dimensionswere determined from 3D images collected on days 0, 2, 5, and 7. On day 7, animals were euthanized and specimens were harvested for histopathological review. Results:Average granulation thicknesswas not statistically different among continuous (3.29 ± 0.33 mm), intermittent (3.03 ± 0.47 mm), and dynamic (3.40 ± 0.34 mm) NPWT wounds at day 7. Average granulation thickness of NPWTi wounds (4.75 ± 0.54 mm), however, was statistically greater (P < .05) by 44%, 57%, and 40%, respectively, than that of wounds treated with continuous, intermittent, and dynamic NPWT. Analysis of 3D images revealed a greater reduction in wound area and perimeter in NPWTi wounds compared to all NPWT wounds (P < .05). In addition, the average wound fill rate for NPWTi wounds was faster than that for continuous (40%; P < .05), intermittent (25%; P > .05), and dynamic (65%; P < .05) NPWT wounds. Conclusions: Although not confirmed in humans, these porcine data suggest that NPWTi with saline may stimulate a faster rate of wound granulation than NPWT in continuous and noncontinuous modes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: This cohort study evaluated the clinical efficacy of singlet oxygen, ActiMaris (AM) a hypertonic (3%) ionised (pH 9.8) sea water solution. It was assumed that when used for wound cleansing, disinfection and the reduction of inflammation, AM would be safe and effective. Method: Between May 2008 and May 2009, ambulant patients presenting at one of four wound healing centres were included in the study. Patients had critically colonised and/or infected, malodorous wounds, covered with slough/fibrin or wounds showing inflammation of the periwound skin. Wounds were assessed in terms of percentage changes in fibrin, slough and granulation tissue, they were assessed clinically and high resolution digital photographs were scored by a physician who was blinded to treatment allocation. Results were compared at baseline (week 0) and following 42 days of AM treatment (week 6). Results: Seventy-three patients were included in the analysis. Dressing changes were at 2-day intervals on average, and the median treatment period was 46.04 days (range: 3-197). At 42 days, 33% (n=24) of included wounds had healed, 57% (n=42) had improved and 10% (n=7) remained stagnant. Cleansing and wound disinfection with AM was effective. In 31 patients (42%) wounds had showed clinical signs and symptoms of critical colonisation and/or infection at day 0, whereas at day 42 the infection was completely eradicated. Inflammation was reduced in 60% (n=44) of cases and patients did not report pain or discomfort when using AM. Conclusion: The use of singlet oxygen was shown to be safe and the results of this study indicate AM to be useful for wound cleansing, disinfection, reducing inflammation and promoting wound healing. Conflict of interest: The centres were supplied with the study product by the sponsor. The authors have no financial interest in writing this article. [ABSTRACT FROM AUTHOR]

Over the past two decades a body of evidence has been generated to support the traditional use of water in cleansing wounds, with studies showing that the use of clean water does not increase the risk of infection or delay healing. However, recent advances in the understanding of wound management have encouraged reforms and led to the development of wound cleansing agents that have the potential to improve clinical outcomes. This article draws on in vitro and in vivo evidence including comparative studies of patients with acute and chronic wounds to consider the evidence supporting alternatives to water in wound cleansing. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Wound coatings can severely delay chronic wound healing by inducing ischaemia and degradation of viable tissue and increasing susceptibility to infection. It is, therefore, essential to cleanse wounds gently and thoroughly to remove the detrimental coatings. In this study, an in-vitro model that mimics wound coatings (human plasma dried onto adhesive glass slides) was used to compare the efficacy of four sterile solutions used to cleanse wounds: saline and Ringer's (both salt solutions), a betaine surfactant-containing wound rinsing solution (Prontosan® B. Braun) and an antiseptic solution (Octenisept® Schülke & Mayr). Both salt solutions and the wound rinsing solution were found to remove protein from the test wound coatings, whereas the test coatings became fixed and insoluble when immersed in antiseptic solution. [ABSTRACT FROM AUTHOR]

Objective: To develop an in-vitro model to evaluate the efficiency of wound-rinsing solutions in removing adherent, hydrophobic, denatured proteins. We hypothesised that saline solutions would be less effective than surfactant-containing solutions in removing denatured proteins. Method: Prepared slides containing dried blood plasma or fibrin were incubated for up to one hour in histological troughs filled with one of four test solutions: physiological saline solution, Ringer's solution, a surfactant-containing solution and an antiseptic. The concentration of dissolved proteins was measured using a modified Biuret test. Results were analysed by plotting protein concentration against the incubation time. Results: During the incubation period, the protein concentration increased in all of the test solutions, with the lowest concentration reported in the two saline-based solutions. These stayed clear, while the surfactant-containing solution become opaque, indicating that the surfactant had encased hydrophic substances, such as denatured proteins. Conclusion: Ringer's solution and saline are inappropriate solvents for adhering wound coatings. A sterile, surfactant-containing wound rinsing solution contains the essential properties for thorough and gentle cleansing of chronic wounds. Declaration of Interest: None. [ABSTRACT FROM AUTHOR]