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Aims To present recent evidence for the antimicrobial effect of a non-medicated wound dressing in wounds. Methods: An electronic search of key terms ("HydroClean" and "HRWD") was undertaken in articles published between 1 January 1990 and 31 March 2024. Results: In all, seven articles met the inclusion criteria. Two articles were related to experimental studies, and the remaining five articles described clinical studies featuring non-medicated wound dressings. Conclusions: Non-medicated wound dressings' (HydroClean®) effectiveness in exudate management includes the absorption and sequestration of damaging exudate components such as matrix metalloproteinases. Hydro-responsive wound dressings (HRWD™) promote removal of devitalised tissue which is a focus of microbial growth (such as wound biofilm), and results in a reduction in the clinical signs of infection. Non-medicated wound dressings that contain no active antimicrobial agent may be used to treat infected wounds via the physical characteristics of the dressing. [ABSTRACT FROM AUTHOR]

The purpose of wound dressings is to support the local wound environment to facilitate wound healing. Dressings range from simple or passive dressings that essentially provide a contact layer to protect the wound bed from further damage and maintain a moist environment, to more advanced or interactive dressings that can modify the physiology of the wound milieu to optimize healing by, for example, promoting debridement, enhancing granulation tissue formation and re-epithelialization, managing exudate levels and bacterial load. There are also bioactive dressings which can change the cellular or biological aspects of the wound, an example of this would be a topical antimicrobial product. Hence a fundamental prerequisite to choosing the most appropriate dressing is having a clear objective in mind. Essential to this is an accurate assessment of the wound. This article will describe the features of the clinical assessment process as a basis for understanding the principles of wound management and provide details of various dressings and devices together with the indications and limitations of their use. [ABSTRACT FROM AUTHOR]

Background and Objectives: Wound healing is a complex process involving cellular, anatomical, and functional repair, often hindered in chronic wounds associated with diseases like diabetes and vascular disorders. This study investigated the efficacy of conventional and regenerative wound healing approaches in a sheep surgical wound model. Materials and Methods: Six female Bergamasca sheep underwent five full-thickness skin lesions treated with various methods: sterile gauze (control), chlorhexidine, sodium hypochlorite, micronized dermis system application, and dermal matrix. Wound healing progression was monitored over 42 days through wound dimension measurements, exudate analysis, and histopathological evaluations. Results: The results indicated that all wounds healed completely by day 42, with significant reductions in wound size and exudate over time. Notably, Micronized dermis system application and dermal matrix treatments showed a faster evolution in exudate characteristics and improved collagen reorganization compared to other treatments. Histological analysis revealed earlier neovascularization and better reconstitution of hair follicles in these groups. Despite the lack of significant differences in healing time, both regenerative approaches enhanced wound healing phases, contributing to exudate control, angiogenesis promotion, and reduced scar formation. Conclusions: The findings suggest that while micronized dermis system application and dermal matrix do not accelerate acute wound healing compared to conventional methods, they offer potential benefits in managing exudate and improving tissue regeneration, warranting further investigation in chronic wound scenarios. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) and antibiotic‐loaded bone cement (ALBC) are commonly used treatments for diabetic foot ulcers (DFUs). However, the combined efficacy of these two modalities remains unclear. This clinical study aimed to assess the effectiveness and underlying mechanisms of NPWT&ALBC in the management of DFUs. A total of 28 patients were recruited, 16 of whom served as controls and received only NPWT, whilst 12 received NPWT&ALBC. Both groups underwent wound repair surgery following the treatments. Blood samples were obtained to detect infections and inflammation. Wound tissue samples were also collected before and after the intervention to observe changes in inflammation, vascular structure and collagen through tissue staining. Compared with the NPWT group, the NPWT&ALBC group exhibited a superior wound bed, which was characterised by reduced inflammation infiltration and enhanced collagen expression. Immunostaining revealed a decrease in IL‐6 levels and an increase in α‐SMA, CD68, CD206 and collagen I expression. Western blot analysis demonstrated that NPWT&ALBC led to a decrease in inflammation levels and an increase in vascularization and collagen content. NPWT&ALBC therapy tends to form a wound bed with increased vascularization and M2 macrophage polarisation, which may contribute to DFUs wound healing. [ABSTRACT FROM AUTHOR]

Introduction: In severe extremity trauma involving large tissue defects, early closure (e.g., free-flap surgery) of the defects is an essential step for good functional reconstruction; however, in some cases, early closure may be difficult. Highly concentrated carbon dioxide bathing, used to improve blood flow in ischemic limbs and skin ulcers, can also be applied in wound bed preparation for severe limb trauma. Patients and Methods: The three cases in this study required an average of 13 weeks of highly concentrated carbonated bathing, which led to significantly better wound bed preparation, even in the exposed bone and tendon regions. Results: We successfully achieved good functional limb reconstruction in patients with deep burns and severe open fractures by reducing wound infection and facilitating good wound bed preparation. Conclusions: Highly concentrated carbon dioxide bathing was sufficient to prevent frequent wound infections, even in severe extremity trauma involving large soft-tissue defects such as deep crush burns and Gustilo Anderson classification ≥3b open fractures of the extremities. To our knowledge, such interventions have not been reported in the past and are valuable as new procedures for wound bed preparation in severe extremity trauma from both cost and wound infection control perspectives.

Patients with chronic wounds present a growing challenge to community practitioners. Adding to this growing burden is the fact that inconsistent and sub-optimal wound care is delivered in some cases resulting in hard-to-heal wounds that could heal with evidence-based care. Holistic patient assessment is an important first step in establishing the cause of the wound and identifying any barriers to healing. Wound bed preparation is a concept which prepares the wound for closure by systematically identifying potential barriers to non-healing within the wound, including the presence of devitalised tissue, excess exudate, increased wound bioburden, infection, inflammation and biofilm. Dressings are a key part of wound bed preparation in the community setting, and it is important that community practitioners are mindful of the properties and mode of action of products they use, so that optimal outcomes can be achieved. Suprasorb® Liquacel Pro is a hydroactive gelling fibre dressing and Suprasorb® Liquacel Ag is a hydroactive dressing with silver nanoparticles that can be used as part of wound bed preparation to promote a moist wound healing environment. [ABSTRACT FROM AUTHOR]

Objective: This work explores concurrent optical and magnetic stimulation (COMS) effects on hard-to-heal wounds in real-world settings. Method: In this case series, participants received COMS 1–3 times per week for up to 12 weeks alongside standard wound care. Results: A total of 27 patients (18 female and nine male) were included. Mean age was 72 years. Participants' wounds that were unresponsive to standard wound care included: venous leg ulcers (VLUs, n=13); mixed leg ulcers (MLUs, n=4); diabetic foot ulcers (DFUs, n=1); pressure ulcers (PUs, n=5); and traumatic wounds (TWs, n=4). On average, COMS was applied twice a week, resulting in an overall mean wound area reduction of 69%. In 24 participants, COMS was used primarily to achieve wound closure by the end of the 12-week period, of which: 12 were classified as complete wound closure (50%; VLUs=8, PUs=3 and TW=1); four as likely-to-heal (17%; VLUs=2 and MLUs=2); four as 'improved' (17%; MLU=1, DFU=1 and TWs=2); and four as 'non-responding' (17%; VLUs=3 and MLU=1). The best results were achieved in PUs and VLUs (respectively 100% and 62% categorised as completely healed). When used in participants where its purpose was other than that of achieving wound closure, COMS was successfully used to debride two PUs, and for wound bed preparation in one TW. Conclusion: In this case series, COMS showed positive effects and appeared to be beneficial in healing different types of hard-to-heal wounds in community health and homecare settings. Novel COMS therapy aspects emerged: (1) positive outcomes for PU and VLU treatment; (2) COMS as a potential debridement tool when sharp debridement is unfeasible; and (3) COMS as a promising method to prepare wound beds for subsequent skin grafting or skin replacement procedures. [ABSTRACT FROM AUTHOR]

Background: Debridement is key to removing devitalised tissue, debris and biofilm as part of wound-bed preparation. Unlike many other methods of debridement, mechanical debridement with a pad is effective enough to be used independently without an adjunctive method of debridement, while being more accessible than other standalone options. Objective: To explore the clinical performance and safety of a debridement pad with both abrasive and non-abrasive surfaces in daily clinical practice. Methods: This was a prospective, non-controlled, non-randomised, single-arm, open-label, multicentred observational evaluation. Inclusion criteria were wounds >4 cm2 covered with at least 30% debris, necrotic tissue or slough in patients aged ≥18 years. The treatment protocol comprised a single application of the debridement pad. The primary outcome measure was the amount of necrotic tissue, slough or debris in the wound bed. Secondary outcomes included the appearance of the wound bed, edges and periwound skin; self-reported pain scores; foreseeable negative impacts; and clinician satisfaction. Results: A total of 62 participants with a variety of wound types were included in the analysis. Most wounds (87%) had been present for over 3 months and had high or moderate exudate levels (90%). A significant reduction was observed in all three parameters: necrotic tissue (p=0.043), slough (p<0.001) and debris (p<0.001). Necrotic tissue, slough and debris showed mean relative reductions of 40%, 72% and 40%, respectively. Of participants, 84% did not experience an increase in pain during the debridement procedure. Conclusion: This clinical real-world data shows the debridement pad to be an effective and well-tolerated device for debridement and wound bed preparation. [ABSTRACT FROM AUTHOR]

Objective: There are several methods of treating hard-to-heal (chronic) wounds, each differing in terms of efficiency, selectivity, speed, cost and pain. The objective is to activate a wound to initiate the healing cascade. For this pilot study we assessed the feasibility of a new microjet wound therapy technology compared to standard sharp debridement in wound outcomes. Method: A randomised, controlled, open-label pilot study was conducted in one outpatient wound clinic in Western Switzerland from March 2022 to May 2023. Results: A total of 13 consecutive patients were randomly assigned to receive either microjet wound therapy (n=5) or standard mechanical debridement with instruments (n=8). As a feasibility study, there was insufficient power to detect significant differences between the groups. However, in the intervention group, our analysis may indicate a modestly faster reduction in wound area. Microjet wound therapy appears to alleviate patient anxiety and offer cost savings due to the potential for reduced time, as well as the number of required treatments. This meant fewer overall consultations. Conclusion: This study highlights a trend that may indicate that microjet therapy holds value in promoting faster healing of hard-to-heal wounds, and it provides a feasibility basis for a sufficiently powered multicentre trial. [ABSTRACT FROM AUTHOR]

Background and Objectives: Wound healing is a complex process involving cellular, anatomical, and functional repair, often hindered in chronic wounds associated with diseases like diabetes and vascular disorders. This study investigated the efficacy of conventional and regenerative wound healing approaches in a sheep surgical wound model. Materials and Methods: Six female Bergamasca sheep underwent five full-thickness skin lesions treated with various methods: sterile gauze (control), chlorhexidine, sodium hypochlorite, micronized dermis system application, and dermal matrix. Wound healing progression was monitored over 42 days through wound dimension measurements, exudate analysis, and histopathological evaluations. Results: The results indicated that all wounds healed completely by day 42, with significant reductions in wound size and exudate over time. Notably, Micronized dermis system application and dermal matrix treatments showed a faster evolution in exudate characteristics and improved collagen reorganization compared to other treatments. Histological analysis revealed earlier neovascularization and better reconstitution of hair follicles in these groups. Despite the lack of significant differences in healing time, both regenerative approaches enhanced wound healing phases, contributing to exudate control, angiogenesis promotion, and reduced scar formation. Conclusions: The findings suggest that while micronized dermis system application and dermal matrix do not accelerate acute wound healing compared to conventional methods, they offer potential benefits in managing exudate and improving tissue regeneration, warranting further investigation in chronic wound scenarios.

Background Chronic wound management in low-resource settings deserves special attention. Rural or underresourced settings (ie, those with limited basic needs/healthcare supplies and inconsistent availability of interprofessional team members) may not be able to apply or duplicate best practices from urban or abundantly resourced settings. Objective The authors linked world expertise to develop a practical and scientifically sound application of the wound bed preparation model for communities without ideal resources. Methods A group of 41 wound experts from 15 countries reached a consensus on wound bed preparation in resource- limited settings. Results Each statement of 10 key concepts (32 substatements) reached more than 88% consensus. Conclusions The consensus statements and rationales can guide clinical practice and research for practitioners in low-resource settings. These concepts should prompt ongoing innovation to improve patient outcomes and healthcare system efficiency for all persons with foot ulcers, especially persons with diabetes. [ABSTRACT FROM AUTHOR]

Background: Chronic wounds have a significant impact on patients' lives and are challenging for healthcare professionals to treat. Failure to implement evidence-based practice can prolong patient suffering and lead to wound complications such as infection. Effective dressing selection is important to ensure wound bed preparation (WBP) and removal of the barriers to healing, such as devitalised tissue, infection, and excess exudate. Multidimensional products such as UrgoClean Ag have a combined action of continuous cleansing, debridement, and treatment of infection, and can effectively prepare the wound bed and advance wound healing. This paper discusses the importance of WBP, with a focus on infection and biofilm management using a multidimensional product (UrgoClean Ag), with clinical practice examples. [ABSTRACT FROM AUTHOR]

Background: The rapidity of wound bed preparation is determined in part by the type of dressing agent employed. The extension phase in which the wound is characterized by the presence of sloughs and eschar and microbial invasion could be managed nonsurgically. Objective: The objective of this study was to compare the rapidity of wound bed preparation using unripe papaya versus honey. Materials and Methods: Sixty-four patients were assigned into two equal groups, each dressed, respectively, with unripe papaya or honey. All selected patients were monitored for eschar separation and bacterial clearance time. Data obtained with a pro forma were analyzed with SPSS version 25. Results: Unripe papaya dressing had a mean eschar separation time of 5.53 ± 2.20 days and bacterial clearance time of 6.81 ± 3.64 days compared to the honey group which had an eschar separation time of 30.09 ± 27.90 days and bacterial clearance time of 15.33 ± 13.62 days. P <0.001 and P < 0.001, respectively, in comparing both outcome measures between the two groups. There was a statistically significant difference in both eschar/slough separation time and bacterial clearance time both in favor of the group prepared with unripe papaya. Conclusion: The use of unripe papaya was superior to honey in wound bed preparation with respect to eschar/slough separation, bacterial clearance ultimately resulting in reduced length of hospital stay. [ABSTRACT FROM AUTHOR]

Wounds cost £8.3 billion per year in the United Kingdom (UK) annually. Venous leg ulcers (VLUs) account for 15% of wounds and can be complicated to heal, increasing nurse visits and resource costs. Recent wound bed preparation consensus recommends wound cleansing and biofilm disrupting agents. However, inert cleansers such as tap water or saline are inexpensive, an evaluation of evidence is required to justify the higher upfront costs of treatment with active cleansers. We undertook a cost-effectiveness analysis of the use of a biofilm disrupting and cleansing solution and gel, Prontosan® Solution and Gel X, (PSGX) (B Braun Medical), as compared to the standard practice of using saline solution, for treating VLUs. A Markov model was parameterised to one-year costs and health-related quality of life consequences of treating chronic VLUs with PSGX versus saline solution. Costs are viewed from a UK healthcare payer perspective, include routine care and management of complications. A systematic literature search was performed to inform the clinical parameters of the economic model. Deterministic univariate sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were undertaken. For PSGX an Incremental Net Monetary Benefit (INMB) of £1,129.65 to £1,042.39 per patient (with a Maximum Willingness to Pay of £30k and £20k per QALY respectively), of which cost savings are £867.87 and 0.0087 quality-adjusted life years (QALYs) gain per patient. PSA indicates a 99.3% probability of PSGX being cost-effective over saline. PSGX for the treatment of VLUs is dominant compared with saline solution in the UK with expected cost-savings within a year and improved patient outcomes. • Prontosan® Solution and Gel X, (PSGX) in VLUs is dominant compared to saline in the UK with cost-savings within a year. • PSGX for VLUs compared to saline saves £867.87 and gaining 0.0087 quality-adjusted life years (QALYs) per patient. • In a UK region with 250,000 people 7,753 chronic wounds are estimated, PSGX could return a cost saving of £6.7M to the NHS. • The time for PSGX to become cost saving is estimated at 0.57 months. [ABSTRACT FROM AUTHOR]

Wound bed preparation is essential for treatment of chronic and hard to heal wounds and clinicians have several options depending on skill and availability of equipment. There is growing evidence of benefit and usage of low frequency ultrasound contact debridement (LFUCD) across the globe but few studies that explore what the best sonotrode, technique using that sonotrode, intensity of ultrasound, or level of flow of irrigation have on the outcome of treatment or the patient experience. This observational case series study of 114 treatments of a convivence sample of 45 patients explored the use of three different sonotrodes / handpieces and five different techniques - mainly 100% ultrasound intensity and irrigation flow greater than 40% - to determine any variation in outcome or patient experience. The minimum data set (MDS) captured information regarding percent of tissue type and size of the wound before and after treatment, level of pain before, during and after treatment, technique(s), analgesia, length of treatment, aetiology and demographics. The results indicate LFUCD assisted in removing non-viable tissue and fibrin within minutes, while sparing granulation tissue, and was well tolerated regarding pain. This study did not find any significant difference in the type of techniques, but the type of sonotrode did. [ABSTRACT FROM AUTHOR]

The wound dressings market in South Africa follows the worldwide growth of products, and healthcare practitioners must acquire knowledge of the basics of wound healing and wound bed preparation for a cost-effective indication of those products. Based on the Wound Bed Preparation (WBP) paradigm, the author suggests a framework comprising most of the products in the basic classification, which has been updated yearly for the Wound Healing Association of Southern Africa (WHASA). [ABSTRACT FROM AUTHOR]

Approximately 3.8 million people in the UK are affected by acute or chronic wounds each year and it is essential that nurses are equipped with the knowledge and skills to assess and manage these patients. This article covers the main aspects that nurses need to consider to provide evidence-based care to patients with a wound, including skin anatomy, normal wound healing physiology and the factors that can delay healing. The author also discusses holistic wound assessment, including wound healing risk factors, wound bed preparation and wound management products, providing nurses with a practical overview of the complex topic of wound care., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

examines the treatment of the cause and patient-centred concerns to determine if a wound is healable, a maintenance wound, or non-healable (palliative). For healable wounds (with adequate blood supply and a cause that can be corrected), moisture balance is indicated along with active debridement and control of local infection or abnormal inflammation. In maintenance and non-healable wounds, the emphasis changes to patient comfort, relieving pain, controlling odour, preventing infection by decreasing bacteria on the wound surface, conservative debridement of slough, and moisture management including exudate control. In this fourth revision, the authors have re-formulated the WBP model into 10 statements. This article will focus on the literature in the last 5 years or new interpretations of older literature. This process is designed to facilitate knowledge translation in the clinical setting and improve patient outcomes at a lower cost to the healthcare system. [ABSTRACT FROM AUTHOR]

The purpose of wound dressings is to support the local wound environment in order to facilitate wound healing. Dressings range from simple or passive dressings that essentially provide a contact layer to protect the wound bed from further damage and maintain a moist environment, to more advanced or interactive dressings that are capable of modifying the physiology of the wound milieu to optimize healing by, for example, promoting debridement, enhancing granulation tissue formation and re-epithelialization, managing exudate levels and bacterial load. There are also bioactive dressings which can change the cellular or biological aspects of the wound, an example of this would be a topical antimicrobial product. Hence a fundamental prerequisite to choosing the most appropriate dressing is having a clear objective in mind. Essential to this is an accurate assessment of the wound. This article will describe the features of the clinical assessment process as a basis for understanding the principles of wound management and provide details of various dressings and devices together with the indications and limitations of their use. [ABSTRACT FROM AUTHOR]

Objective: Over the course of a wound's healing trajectory, whether the wound is acute or hard-to-heal, management is likely to involve the use of several different dressing types. Minimising the complexity of treatment (in terms of dressing usage) would aid clinicians in providing effective wound care but excellent clinical outcomes must remain the primary goal. Method: This study was an open-labelled, non-comparative study assessing the clinical effectiveness of a coordinated wound dressing treatment regimen. After an initial phase of using a hydro-responsive wound dressing (HydroClean, HRWD-1, PAUL HARTMANN AG, Germany) to cleanse and debride hard-to-heal wounds, the wounds were subsequently treated with either HydroTac (HRWD-2, PAUL HARTMANN AG, Germany) (to maintain healing progression and re-epithelialisation) or RespoSorb (a superabsorbent dressing, PAUL HARTMANN AG, Germany) (to manage moderate-to-high levels of exudate). The Pressure Ulcer Scale for Healing (PUSH) assessment tool was used to measure the wound status over the course of the treatment period and to assess several wound status parameters (for example, wound area, exudate levels and wound characteristics such as level of re-epithelialisation). Results: The results from this study demonstrated that wounds treated with HRWD-2 showed a positive healing response when using the PUSH score assessment tool with a significant mean reduction (p<0.0001) in the PUSH score of wounds treated with HRWD-2, with >75% of wounds being closed by the end of the study. This result underlines the effectiveness of HRWD-2 in supporting healing progression. Conclusion: The results from this study support the coordinated use of HRWDs for the effective management and treatment of a variety of hard-to-heal wounds. Declaration of interest: This study was funded by PAUL HARTMANN AG, Germany. [ABSTRACT FROM AUTHOR]

Wound healing is a highly complex natural process, and its failure results in chronic wounds. The causes of delayed wound healing include patient-related and local wound factors. The main local impediments to delayed healing are the presence of nonviable tissue, excessive inflammation, infection, and moisture imbalance. For wounds that can be healed with adequate blood supply, a stepwise approach to identify and treat these barriers is termed wound bed preparation. Currently, a combination of patient-related and local factors, including wound debridement, specialty dressings, and advanced technologies, is available and successfully used to facilitate the healing process., Competing Interests: Disclosure None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Significance : Burns result in irretrievable cell damage, which can occur upon exposure to hot surfaces, liquids, gases, ultraviolet or ionizing radiation, and through friction. Standard of care in burn management involves protecting the patient, limiting burn progression, and achieving wound closure. Negative pressure wound therapy (NPWT) and NPWT with instillation and dwell time (NPWTi-d) are two wound management options that have been shown to improve outcomes for burn patients in recent years. This work provides a general review of NPWT and NPWTi-d use in burn wound management. A literature search was performed using PubMed and Embase for peer-reviewed publications and conference abstracts written in English and reporting on burn management using NPWT and/or NPWTi-d from a single manufacturer between 2000 and 2021. All burn types were included. Recent Advances: Thirteen studies and 308 patients were available for assessment. Use of NPWT was reported in a majority of studies ( n  = 11). When conventional NPWT was applied, graft take of >90% was observed and consistent final wound closure was achieved. Two studies described NPWTi-d use for burn wound management. NPWTi-d use promoted granulation tissue development in burn wounds. Critical Issues: Limited high-level prospective evidence exists for use of NPWT and NPWTi-d in burn wound management. Future Directions: Available literature on the use of NPWT and/or NPWTi-d in burn care has reported improved outcomes in wound bed preparation, which can ultimately lead to final wound closure. The use of these modalities should be considered in management of burn care patients.

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. [ABSTRACT FROM AUTHOR]

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

The overall goal of wound bed preparation (WBP) is to create an optimal wound healing environment and enhance the effectiveness of therapeutic measures (Falanga, 2000; Schultz et al, 2003). All WBP should be based on holistic patient assessment, utilising a systematic approach to evaluate and eliminate barriers to healing (Dowsett and Newton, 2005). Debridement is a key focus that needs to be considered in all wounds. [ABSTRACT FROM AUTHOR]

Objective: Immediately following a two-year prospective case series in which the wounds of 60 patients with hard-to-heal ulcers were treated with a hypochlorous acid oxidising solution (AOS) in addition to standard of care (SoC) for 70 days (T0–T70), a subset of 31 patients (51.7%) whose wounds had not fully healed by T70 opted to continue with treatment for a further 22 weeks (days T70–T224, a total treatment time of 32 weeks (224 days). The objective was to provide long-term evidence on the clinical performance and safety of AOS when used in association with the usual SoC in patients with stalled, hard-to-heal ulcers of various aetiologies. Method: As per the main study, wounds were formally assessed by the study lead at 28 days (±14 days, depending on patient attendance). Parameters assessed at fortnightly visits included area, depth and duration of ulcer; pain; wound bed preparation (WBP) score; and infection status. Wounds were managed in accordance with the SoC protocol. Results: By T224, 35.5% (n=11) of wounds healed completely and 83.9% showed some types of improvement. All wounds were free of infection and colonisation, the WBP score improved (100% A1–A2 at T196), and pain scores fell. Use of AOS in combination with several types of dressing (SoC) for such a long period confirmed a good safety profile. Conclusion: This follow-up evaluation, coupled with the primary study, suggests that AOS might represent a valuable therapeutic addition for the management of hard-to-heal ulcers for long periods of treatment. Declaration of interest: ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest. [ABSTRACT FROM AUTHOR]

Objective: This prospective case series aims to evaluate the clinical impact of a hypochlorous acid oxidising solution (AOS) in association with usual standard of care (SoC) on wound bed preparation (WBP) in patients with hard-to-heal ulcers of various aetiologies. The AOS (Nexodyn, APR Applied Pharma Research S.A., Switzerland) comprises three main features: highly pure and stabilised hypochlorous acid, acidic pH and high reduction–oxidation potential. Method: Between February 2015 and February 2017, patients who met the inclusion criteria were treated with AOS and usual SoC. Data collection ran for 70 days: T0–T70. A baseline assessment was undertaken at T0; parameters assessed at fortnightly visits included: WBP score, area and depth of ulcer, duration, pain, Bates–Jensen score and infection status. Results: A total of 60 patients took part in the study. By T70, 68.3% of wounds had healed or improved and a significant wound size reduction of 21% was observed (p<0.001), despite a mean wound duration of 20.6 months. All wounds were free of local infection and cellulitis; 10% were colonised. WBP scores improved, while Bates–Jensen and pain scores fell significantly over time. Conclusion: This evaluation suggests that AOS might represent a valuable therapeutic addition for an optimal WBP in the routine management of hard-to-heal ulcers of different aetiologies. Declaration of interest: ER worked as a consultant for APR Applied Pharma Research S.A. The authors have no other conflicts of interest. [ABSTRACT FROM AUTHOR]

Radiation wounds are very difficult to manage due to poor vascular status, excessive matrix metalloproteinases, and abnormal myofibroblast function. Such wound beds do not adequately support conventional resurfacing as do nonradiate beds. We present a 46-year-old female with a sacral radiation ulcer, which had earlier failed to support flap cover on two instances after bed preparation with conventional honey dressing and negative pressure dressing, but was subsequently successfully managed with unripe pawpaw wound bed preparation. A re-elevation of the right gluteal myocutaneous flap proved successful and satisfactory. The finding may have resulted from both enzymatic properties of unripe pawpaw and its ability to break the biofilms and to locally supply the ascorbic acid necessary for collagen synthesis and granulation tissue formation.

Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community. [ABSTRACT FROM AUTHOR]

Wound Bed Preparation is a paradigm to optimize chronic wound treatment. This holistic approach examines the treatment of the cause and patient-centered concerns to determine if a wound is healable, a maintenance wound, or nonhealable (palliative). For healable wounds (with adequate blood supply and a cause that can be corrected), moisture balance is indicated along with active debridement and control of local infection or abnormal inflammation. In maintenance and nonhealable wounds, the emphasis changes to patient comfort, relieving pain, controlling odor, preventing infection by decreasing bacteria on the wound surface, conservative debridement of slough, and moisture management including exudate control. In this fourth revision, the authors have reformulated the model into 10 statements. This article will focus on the literature in the last 5 years or new interpretations of older literature. This process is designed to facilitate knowledge translation in the clinical setting and improve patient outcomes at a lower cost to the healthcare system. [ABSTRACT FROM AUTHOR]

Agata Janowska,1 Valentina Dini,1 Teresa Oranges,1,2 Michela Iannone,1 Barbara Loggini,3 Marco Romanelli1 1Department of Dermatology, University of Pisa, Pisa, Italy; 2Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy; 3Department of Pathology, University of Pisa, Pisa, ItalyCorrespondence: Agata JanowskaDepartment of Dermatology, University of Pisa, Via Roma 67, Pisa 56126, ItalyTel +39 050 992436Fax +39 050 992556Email dottoressajanowska@gmail.comAbstract: Atypical ulcers show atypical clinical features, histology, localization, and resistance to standard therapies. The persistence of a chronic ulcer despite treatment with standard therapies requires a more specific diagnostic investigation. Diagnosis involves obtaining the history and performing clinical examination and additional tests. A skin biopsy is frequently used to confirm unclear diagnosis. In difficult cases, microbiological and immunohistochemical examinations, laboratory blood tests, or instrumental tests should be evaluated. The treatment of atypical wounds is characterized by local systemic therapy and pain control. Our results highlight the need for early diagnosis, and standardized and targeted management by a multidisciplinary wound healing center.Keywords: atypical ulcers, wound healing, wound bed preparation, wound management

Recent literature has shown that negative pressure wound therapy with instillation and dwell time (NPWTi-d) is a valid method of managing complex wounds and gained increasingly wider interest due in part to the increasing complexity of wounds. The purpose of this case study was to obtain information on the profile of NPWTi-d in necrotizing fasciitis patients, investigate the role it play in wound bed preparation, length of hospital stay and number of debridement operations. NPWTi-d has been used in patients with necrotizing fasciitis with either normal saline or Prontosan® solution and complete the treatment were involved in the present study. Following aggressive surgical debridement, NPWTi-d was initiated by instilling solution with a set dwell time of 5–10 min, followed by continuous NPWT of −125 mm Hg for 3–5 h. The system was changed on a 3–5 days schedule until sufficient granulation tissue was evident. Patients received systemic antibiotics and underwent wound debridement as indicated. Data of wound bed preparation, length of hospital stay, duration of NPWTi-d therapy, number of surgical interventions were collected retrospectively from patient medical records. A total of 32 patients with diagnosis of necrotizing fasciitis received NPWTi-d were included. Granulation tissue was found to be sufficient in 9–16 days. The mean duration of NPWTi-d therapy was 12.5 days prior to wound closure by split-thickness autograft (n = 21), suture (n = 9), or flap transplantation (n = 2).Patients received NPWTi-d treatment over a period of 8–16 days. The mean length of hospitalization was 22.8 days. All wounds were successfully closed and no recurrence of infection or adverse event was observed during NPWTi-d treatment. In these patients, NPWTi-d facilitates wound cleansing and wound bed preparation and offers the clinician an additional tool for the management of necrotizing fasciitis. Further well designed prospective investigations with low risk of bias are needed to confirm these findings in the future work. • Necrotizing fasciitis is a life-threatening soft tissue infection and management of this condition remains challenging. • Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has showed clinical advantages. • However, there is a paucity of literature regarding the role of NPWTi-d in management of necrotizing fasciitis. • We assessed the clinical outcomes of NPWTi-d in treating of necrotizing fasciitis in a relatively larger patients samples. • NPWTi-d facilitates wound cleansing and wound bed preparation and serves a new modality for managing necrotizing fasciitis. [ABSTRACT FROM AUTHOR]

Wound bed preparation (WBP) often incorporates debridement, which removes debris, slough and, importantly, biofilm from the wound bed, to facilitate healing. The Prontosan® Debridement Pad (B. Braun) is a microfibre mechanical debridement pad with a uniquely tapered design, facilitating access into awkward and hard-to-reach wounds. Fifty-six healthcare professionals (HCPs) from a range of settings reported their experience using the Prontosan Debridement Pad via a feedback questionnaire. During the response period, 111 responses were completed by these 56 HCPs. Over 90% of the questionnaires scored the pad as 'good' or 'excellent' for overall usability and debridement action. The majority of the questionnaire responses (87%) found accessing all areas of a wound 'easy' or 'very easy' when using the Prontosan Debridement Pad. Irrespective of wound type, over 95% of the responses completed by the HCPs perceived that patient comfort whilst using the pad was 'as expected' or 'better than expected'. The unique tapered end of the Prontosan Debridement Pad was used in the majority of wounds (60%; n=46/77). Finally, results revealed that, in the HCPs' opinion, the pad was preferred over other available debridement products in the UK. [ABSTRACT FROM AUTHOR]

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Objective: Management of any wound, either acute or hard-to-heal, might involve the use of multiple and different wound dressings in its treatment. This approach is necessary to overcome the myriad of clinical challenges the wound presents, as well as any underlying comorbidities that might affect the clinical outcomes. This article describes the clinical effectiveness of a coordinated wound dressing treatment regimen. Method: This was an open-labelled non-comparative study involving patients with a variety of hard-to-heal and acute wounds of differing levels of severity, but all of which required removal of devitalised tissue to enable wound healing to progress. The first phase used the hydroresponsive wound dressing HydroClean (PAUL HARTMANN AG, Germany). The PUSH score was used as the primary measurement parameter. Results: A total of 86 patients (38 male/48 female), with a mean age of 67.7±21.7 years, took part in the study. The results showed that the hydroresponsive dressing was effective in managing wound exudate production and promoting wound cleansing and debridement, supporting good wound bed preparation. Wound closure was observed in 16/86 (18.6%) wounds at the end of the study (20 weeks). This enabled clinicians to switch to alternative wound dressings to promote subsequent clinical healing outcomes. Conclusion: In this study, the hydroresponsive wound dressing was highly effective in preparing a clean wound bed such that the next stage of wound healing could be supported. [ABSTRACT FROM AUTHOR]

Introduction: In severe extremity trauma involving large tissue defects, early closure (e.g., free-flap surgery) of the defects is an essential step for good functional reconstruction; however, in some cases, early closure may be difficult. Highly concentrated carbon dioxide bathing, used to improve blood flow in ischemic limbs and skin ulcers, can also be applied in wound bed preparation for severe limb trauma., Patients and Methods: The three cases in this study required an average of 13 weeks of highly concentrated carbonated bathing, which led to significantly better wound bed preparation, even in the exposed bone and tendon regions., Results: We successfully achieved good functional limb reconstruction in patients with deep burns and severe open fractures by reducing wound infection and facilitating good wound bed preparation., Conclusions: Highly concentrated carbon dioxide bathing was sufficient to prevent frequent wound infections, even in severe extremity trauma involving large soft-tissue defects such as deep crush burns and Gustilo Anderson classification ≥3b open fractures of the extremities. To our knowledge, such interventions have not been reported in the past and are valuable as new procedures for wound bed preparation in severe extremity trauma from both cost and wound infection control perspectives., Competing Interests: The authors declare no conflicts of interest in association with the present study., (© 2024 The Author(s).)

Background. Wound preparation and cleanliness represent the first steps towards effective healing. Debridement can be the most traumatic procedure for the patient when wound dressing is being carried out. It is important to choose appropriate techniques that aid the selective removal of non-viable tissue thereby reducing patients’ physical and psychological trauma. Hydrodebridement with oxygenated saline solution is a selective mechanical debridement procedure, that exploits oxygen pressure in order to deliver a micro jet of solution which cleanses the wound bed and removes devitalized tissue. Subjects and Methods: The JetoxTM-HDC  system was teamed with a sterile saline solution (0.9%) and compressed medical oxygen with adjustable flow (9-15 L/min). The device is sterile, latex free, and simultaneously sucks up tissue residues. Three skin lesions with different etiology in two clinical cases were treated: Case 1 (male, age 55, diabetic) with one(1) ischemic lesion (20x11cm); Case 2 (female, age 87, diabetic, and bedridden) with two(2) pressure ulcers, (10x10cm and 4x7cm). We gauged any improvement in tissue oxygenation locally around the wound by monitoring the trans-cutaneous tissue oxygen pressure (TcPO2) before and during hydro-debridement. Conclusions: The procedure was easy to use and generally well tolerated by patients. The device was suitable for outpatient treatment as well as for homecare. The debridement was capable of selectively removing of non-viable tissue and did not cause other vital tissue damage. In addition to improved wound bed preparation and better overall decongestion of the injured area, the use of the system was associated with an overall improvement in tissue oxygenation in the surrounding wound area. (TcPO2-30mmHg, start of hydro-debridement – TcPO2-44mmHg, end of hydro-debridement). This technique could be advantageous in the treatment of both ischemic wounds and pressure ulcers. The extent of tissue oxygenation produced by this procedure deserves further investigation in a statistically more relevant number of studies.

Connie Harris,1 Patricia Coutts,2 Rose Raizman,3,4 Niki Grady5 1Perfuse Medtec Inc., London, ON, Canada; 2Toronto Regional Wound Healing Clinic, Mississauga, ON, Canada; 3Professional Practice Scarborough and Rouge Hospital Centenary Site, Scarborough ON, Canada; 4Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; 5Advanced Wound Healing Clinic, Windsor, ON, Canada Abstract: Conservative sharp wound debridement, as part of the wound bed preparation paradigm, can be performed in a wide variety of settings including the patients’ home or community clinic settings, by health care professionals who perform within their scope of practice and have been certified to be competent. This paper reviews the components that must be in place to ensure safe delivery of conservative sharp wound debridement for an increased number of clinicians, with organizational support, based on practices in a Canadian context. Expected goals are a cleaner wound bed, with an increased percentage of viable tissue, decreased amount of wound exudate, corresponding decreased risk of wound infection and malodor, and improved periwound skin. Keywords: wound bed preparation, competency, non-viable tissue, scope of practice, CSWD

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]

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis which may be rapidly progressive. Standard guidelines for local treatment are lacking. Through our experience, we suggested a local treatment algorithm based on the tissue, infection, moisture balance, and epithelization (TIME) concept. The clinical and histopathological features of 52 patients with PG, the duration, and the evolution of the lesions were retrospectively evaluated. Systemic therapies, local treatments, and standard wound treatments were reported. We observed ulcerative PG in the majority of the patients (82.6%), followed by the pustular form (9.6%), the peristomal type (3.8%), the vegetative form (1.9%), and the bullous type (1.9%). The lower leg was the most commonly area affected (90.4% of cases). Pathergy was reported in 15.3% of cases. The first‐line treatment was the use of oral glucocorticosteroids (GCSs). We observed healing after 3 weeks of GCS in 17.3% of cases. In 25% of all cases, we obtained complete healing with long‐term low doses (<0.5 mg/kg) of GCS in the range of 2 to 6 months. We used second‐line treatments in 57.6% of patients. Local, systemic treatment, and correct wound management can be associated with better clinical results. We suggest a new local therapeutic algorithm in both the inflammatory and noninflammatory healing phases. [ABSTRACT FROM AUTHOR]

Yuliya Yarets Clinical Laboratory Medicine Department, The Republican Scientific Centre for Radiation Medicine and Human Ecology, Gomel, Belarus Abstract: The aim of the study was to evaluate the efficacy of ultrasonic-assisted wound debridement (UAW) used for wound bed preparation of chronic wounds prior to skin grafting. Initially, 140 patients were enrolled into study. Group 1 patients (n=53) with critically colonized wounds underwent a single UAW procedure before skin grafting. Group 2 patients (n=87) with colonized wounds received two UAW sessions, skin grafting followed by the second UAW treatment. Initial wound classification in colonized and critically colonized wounds did not correlate with results from microbiological analysis of wound swab samples. Hence, comparison of efficacy of one or two debridement sessions was conducted solely for a similar group of patients, that is, patients with colonized wounds of group 1 (n=40) and group 2 (n=47). In wounds of group 1 patients, a single debridement session resulted in reduction of bacteria from >104 to

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

The use of a comprehensive wound assessment tool and appropriate selection of dressing products can aid clinicians in the management of complex wounds. This paper describes the care of two patients presenting with head wounds. The first case is a patient who suffered from a right temporalis flap failure and exposed periosteum after wide excision. The second case explores the management of a sternocleidomastoid abscess that developed during radiotherapy for head and neck cancer. The paper outlines how the choice of healing by secondary intention can prevent patients from undergoing additional surgeries where outcomes may not be favourable. [ABSTRACT FROM AUTHOR]