Editor-in-Chief: Richard "Sal" Salcido, MD
ISSN: 1527-7941
Online ISSN: 1538-8654
Frequency: 12 issues per year
Ranking: Nursing 17/103
Impact Factor: 1.5

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Wound CSI: Can You Solve the Case?

Welcome to Wound Clinical Solutions Investigation (CSI). See if you can make the diagnosis.

Q. This is a young patient with a history of spina bifida resulting in paralysis of both legs.  He spends most of his time in a powered wheelchair and continues to enjoy a very busy social life. The wound care team was asked to examine this wound that developed on the ankle area.  What is the cause of this wound?

What is your diagnosis? 

  

A. The wound is linear in shape with smooth, even edges, which suggests this is most likely caused by external trauma, such as an abrasion or laceration. He was recently prescribed with compression bandages to control pedal edema due to the loss of calf muscle pump function and the extended time he spent in a chair with his legs in a dependent position. A short-stretch compression bandaging system was applied daily with a figure 8 wrap-style around the ankle. After investigating, the wound care team concluded that the wound was caused by the compression bandage. The following recommendations were made:

1.   Provide education and training to staff to ensure safe application of compression.

2.     Document a plan of care and application method to ensure consistency and discourage “personal” modification.

3. Use appropriate tension to apply the short-stretch bandage: Snug, no tug, to avoid the excessive pressure to the area.

4.   Ensure dorsiflexion of the foot while the bandages are applied to prevent slippage.

5. Use an ankle-foot orthosis to keep his feet in a normal position and prevent excessive passive movements due to weakness of the feet.

6. Apply an atraumatic dressing to cover the open lesion.

7.  Customize a piece of foam to the ankle area to reduce friction.

8.  Pad the ankle to reduce the angle of flexion between the leg and the foot. This will help distribute pressure evenly to minimize trauma to the skinfold and the Achilles tendon.

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CME Connection Now Live
ATTENTION PHYSICIANS: Do you need CME STAT? The Lippincott CME Connection website is now live, offering a variety of educational activities for physicians to receive continuing medical education credit. Articles on a variety of topics that have been published in 2014 are available. Visit http://cme.lww.com for immediate results, other CME activities, and your personalized CME planner tool.
New Supplement Available

A supplement to the March 2014 issue, titled "Wound Bed Preparation Meets Dressing Form and Function: The Role of Hydrofera Blue and Endoform," is now available free of change. Read the full supplement articles.

 

Still Time to Register!

It's almost time for the 29th annual Clinical Symposium on Advances in Skin & Wound Care, and you won't want to miss it! This year's Polynesian-themed destination is The Mirage Hotel, Las Vegas, Nevada. Preconference workshops will be held September 27 to 28, and the main conference will be held September 28 to October 1, 2014.

Keynote speakers, a prestigious faculty of wound care thought and content leaders, exhibits, poster presentations, and a broad range of lecture topics are among the many features of this year's event.

By attending the symposium, you'll be able to apply basic to advanced concepts in the science of wound healing to your practice or role in preventing and managing wounds; discuss current clinical practice, plus how to integrate cutting-edge treatments, emerging technologies, and research breakthroughs; identify credible, balanced, and relevant clinical practice issues; and network with faculty and colleagues to maintain and grow relationships. In addition, don't miss this opportunity to earn continuing education credits, which are available to nurses, physicians, podiatrists, physical therapists and assistants, and dietitians.

Be sure to register today! Early registration fees are in effect for registrations postmarked by September 14. Walk-in registrations will be accepted on site. Visit http://www.symposiumonwoundcare.com for complete details and registration information.

See you at the conference!

 

 

Words on Wounds
Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA
A forum to discuss the latest news and ideas in skin and wound care.

Latest Entry: 4/21/2014 Managing Wound Infection

HBO Nuggets of the Week
Frank L. Ross, MD, FACS
A forum to discuss interesting aspects of hyperbaric medicine.

Latest Entry: 4/16/2014 HBO Nugget 12

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WANTED: Online Exclusive Content!

Advances in Skin & Wound Care is going to offer authors the opportunity to have their article posted online only with free access to all readers. We are seeking a specific scope of article for this special section. Under the heading of “Wound Care around the World,” we’d like to invite articles that detail innovative and resourceful ways that clinicians are helping to heal patients’ wounds in all corners of the globe. Articles should have a “this is how we do it” approach, not present a research study. For example, an article might illustrate how clinicians fashion wound dressings in a remote region where current products and technology may be sparse or unavailable. Send your manuscript ideas to Kathleen Greaves, Senior Managing Editor, at Kathleen.Greaves@wolterskluwer.com. Articles invited for submission will go through the standard peer review and acceptance process. We hope to hear from you!

 

 

ASWC Impact Factor
Advances in Skin & Wound Care has received an Impact Factor Ranking of 1.6 in the current Journal Citation Report.  We extend our thanks to all the authors, editorial board members, and peer reviewers who contribute to the success of the journal!
In the News
New Dressing Material to Reduce Bacteria Adherence

Researchers have developed a new matrix structure called zwitterions that prevent bacteria and blood cells from sticking to the dressing surface that interfaces with the wound bed. More research is required to determine if this material could minimize trauma and pain upon dressing removal. What remains unclear is whether this material is beneficial for infection management. It is considered to be an important function for wound dressings to be able to attract and remove harmful bacteria from wound surface.

Point-of-Care Tests to Identify Wound Infection

WOUNDCHEK Laboratories announced that it is partnering with the Serena Group to complete 2 clinical trials in 2014 aimed at gaining FDA clearance of both WOUNDCHEK Protease Status and WOUNDCHEK  Bacterial Status. WOUNDCHEK Protease Status detects elevated protease activity in chronic wounds. WOUNDCHEK Bacterial Status is being developed to assess bacterial protease activity that is indicative of an early stage of the wound infection, which would necessitate attention and special treatment. These point-of-care diagnostic tests will help early detection and correction of wound environment.

Wound Closure with Sutures to Reduce Complications

C-sections are a common procedure accounting for about a third of all deliveries in the United States. Stapling is a preferred closure method for ease of use, speed of the procedure, and for closing deeper incisions, such as those in overweight women. A new study examined wound complications including infection, wounds dehiscence, and accumulation of blood or lymphatic fluid around the scar comparing incisions that were closed with sutures (stitches) versus surgical staples. The investigators observed that complications were 57% less likely to occur in patients whose incisions were closed with suture. Results indicate a need to modify existing care approach to patients who have to undergo C-sections.

Zinc and Iron Nanoparticles for Healing

A research team from University of Duisburg-Essen has developed a wound dressing containing zinc oxide and iron oxide nanoparticles in a sponge-like carrier material, called microgel. The microgel structure allows antibacterial ions to be gradually released into the wound environment. Future studies are underway to determine the dose of nanoparticles to optimize wound healing.

Anti-Biofilm Dressing to Promote Healing

Biofilm is a key cause of delayed wound healing and a precursor to infection. A multi-country clinical evaluation shows improvement in wound healing using AQUACEL  Ag+ wound dressings to destroy biofilm and kill infection-causing bacteria in the wound dressing. The dressing has been shown to possess sustained antimicrobial activity and enhance silver penetration in a multispecies biofilm.

Skin Olfactory Receptor for Wound Healing

Researchers at the Ruhr-Universität Bochum have discovered olfactory receptor that occurs in the skin. These receptors were activated with a synthetic sandalwood scent, so-called Sandalore, leading to a cascade of physiological events including increased proliferation and migration of keratinocytes. This mechanism constitutes a possible target for the development of new modality for wound healing.

High Prevalence of Smoking in People with Disability

Researchers from The Miriam Hospital conducted an analysis of 13,308 adults aged 21-85 years old to determine the relationship between smoking and disability. Results showed that smoking was more prevalent among individuals with mobility impairments requiring the use of special ambulatory equipment and having difficulty walking one-quarter mile without equipment than those without mobility problems. Smokers with mobility impairments were also less likely to attempt quitting than smokers without mobility impairments. Although the study is not designed to address causality, further studies are needed to shed some light on the intricate relationships among smoking, depression, stress, underlying medical conditions, unemployment, poverty, and disability. Many people smoke to cope with stress in relation to physical disability that could be worsened by smoking due to exacerbation of underlying medical conditions. Target treatment program should be developed to help people with mobility impairments quit smoking.