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.

 

Call for Founder's Award Nominees!

The 29th annual Clinical Symposium on Advances in Skin & Wound Care will be held September 28-October 1, 2014, at the Mirage in Las Vegas, Nevada. Preconference workshops will be held September 27 & 28, 2014. An annual event at the symposium is the presentation of the prestigious Sharon Baranoski Founder’s Award. This award recognizes the overall pursuit of excellence in the field of wound management by an individual or group who has enhanced the care of patients with wounds.  

Candidates for the award should be nominated in writing, with supporting data to affirm his/her excellence in innovative educational approaches, cost-benefit approaches to practice, unique treatments that significantly impact patient care, or leadership that has fostered the profession of wound care. The deadline for nominations is July 15, 2014.

Written nominations are now being accepted and should include a letter explaining how the candidate met the award criteria, and any pertinent data, tools, teaching displays, pictures, or other material to support the nomination letter. Letters and supporting materials should be emailed to karyn.cousart@wolterskluwer.com or mailed to Wolters Kluwer Health, Conference Dept, Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103.

The award will be presented in a ceremony at the symposium on September 29, 2014, just before the opening session at The Mirage in Las Vegas, Nevada. The winner will receive a $2,000 grant, 1 complimentary conference registration, 3 nights’ hotel accommodations, and 1 roundtrip airfare to the meeting.

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 1.5 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
 

Bacteria and Wound Healing Success

Researchers from Lawrence Livermore National Laboratory, Livermore, California, found that microorganisms found in war wounds could be associated with normal wound healing. They discovered that certain bacteria, including Pseudomonas species and Acinetobacter baumannii, were frequently observed in wounds that failed to heal, while bacteria typically associated with the gastrointestinal system, such as Escherichia coli and Bacteroides species, were found in wounds that did heal successfully. The microbial populations present in wounds are different between patients and evolve over time with an individual wound milieu emphasizing the need for personalized treatment of individual wounds. Other researchers from the University of Manchester Healing Foundation Centre, Manchester, United Kingdom, suggest that genetic factors can influence the makeup of bacteria on a person's skin, which in turn influences whether the wound is likely to heal quickly or persist.

 

Application of Pulse Electrical Fields for Wound Healing

Overuse of antibiotics has lead to the growing prevalence of antibiotic-resistant bacteria.  Pulsed electrical fields destroy bacteria by inducing the formation of large holes in bacterial membranes. Investigators from the Massachusetts General Hospital Center for Engineering in Medicine documented the use of microsecond-pulsed, high-voltage, non-thermal electric fields to treat full-thickness burns that were infected with multidrug-resistant bacteria in mice. Results indicated a significant reduction in bacterial levels, ranging from a 500-fold reduction after 80 pulses at 250 V/mm volts to a more than 10,000-fold reduction after 80 pulses at 500 V/mm.  Further research is needed to confirm the safety of the tested voltage levels and the treatment's effectiveness against deep infections and other species of resistant bacteria.

 

Surgical Safety Checklist to Reduce Surgical Site Infection

The World Health Organization Surgical Safety Checklist is a patient safety tool used to ensure the safe delivery of anesthesia, prevent surgical errors and complications and promote effective teamwork and communication within surgical teams. A meta-analysis of 7 studies including 37,339 patients was done to evaluate the effect surgical safety checklists had on postoperative complications.  Results indicate the adoption of surgical checklist can reduce overall postoperative complications, such as wound infections by 2.9% (one less wound infection prevented for every 34 patients).

 

Aspirin May Delay Wound Healing

New research describes how aspirin could potentially delay wound healing. The researchers showed that high doses of aspirin delay wound healing by reducing the production of 12-HHT, molecule that promotes the re-formation of the epithelial layer at wound sites by enhancing the migration of keratinocytes.  Results suggest that aspirin should be used with caution in patients with chronic wounds.

 

High-Quality Diabetes Care after Limb Revascularization

High-quality outpatient diabetic care, including regular monitoring of serum lipid and glycated hemoglobin, has been demonstrated to reduce the risk of amputation or mortality by a significant 6% among diabetic patients after undergoing limb revascularization. Ensuring patients are on proper management plan and identifying patients who are poorly managed also reduced the likelihood of 30-day readmission to hospital by a significant 9%.

 

Human Amnion/Chorion Membrane Allograft for Diabetic Foot Ulcers

MiMedx Group has reported results of a prospective, randomized comparative study involving the application of dehydrated human amnion/chorion membrane allograft in the management of diabetic foot ulcers. In the 12-week study period, 37 out of 40 patients, or 92.5%, of the diabetic foot ulcers healed completely. Of these 37 patients, the mean time to complete healing was 2.4 weeks for those patients receiving weekly applications and 4.1 weeks for those receiving biweekly applications.