June 2017 - Volume 30 - Issue 6

  • Richard "Sal" Salcido, MD
  • 1527-7941
  • 1538-8654
  • 12 issues per year
  • 1.337

Current Issue Highlights


Editorial


Payment Strategies


Practice Points



New Products


Association News



Original Investigations


Clinical Management Extra


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

Q.  A 76-year-old retired school teacher developed a skin tear on the dorsal surface of her left hand. What is the best approach to manage skin tears?

 

 Skin tears 2017.jpg

A. According to the International Skin Tear Advisory Panel (ISTAP), a skin tear often results from trauma on the extremities, such as the arms, hands, pretibial areas and feet. Significant friction or shear forces the epidermis to be detached from the underlying dermal layer exposing deeper structure. As with other injuries, patients develop exquisite pain and fear further injury. This affects their quality of life and mobility. More than 1 in 4 patients within the healthcare system has evidence of skin tears at any given time. The ISTAP created a classification system to describe skin tears based on the amount of tissue loss. Skin tears can be described as type 1 with an intact skin flap and no tissue loss; type 2 involves partial tissue loss; and type 3 with complete tissue loss.

 

The ISTAP system is simple to easy and has been translated and validated in various languages, including Dutch, French, and Portuguese to date. The purpose is to create a universal language to describe skin tears that can match different treatment approaches. In the photos here, the patient suffered from a type 1 skin tear. She was at risk because of her age, dry skin, falls risk, and chronic use of a steroid, making her skin paper thin. The key to managing this type of skin tear is to ensure the skin flap is rolled back into its original position to approximate the edges and cover the exposed tissue; sterile strips and sutures should be avoided. Alternatively, acrylate type agents can be applied or sprayed on the edges of the skin tear to keep the flap in place. Dressing selection is based on the volume of drainage from the skin tear. In general, atraumatic nonadherent dressings are preferred to cover and leave in place for 7 days. Whatever dressing material that is chosen to cover the skin tear, it is advisable to draw an arrow to indicate the direction from which the dressing should be removed. If the dressing is removed in the opposite direction, the skin flap will likely be ripped off completely, causing more extensive damage. To prevent recurrence, daily moisturization is crucial.

 

For further information, readers are encouraged to review the following article published in this journal: LeBlanc K, Baranoski S, Christensen D, et al. The Art of Dressing Selection: A Consensus Statement on Skin Tears and Best Practice. Adv Skin Wound Care 2016;29:32-46.

http://bit.ly/2jeaZs2

 

 

 

 

 

 

 

Mobile App for Burn Patients

In 2016, more than 200,000 burn patients were admitted to regional burn centers in the US for specialized intensive care treatment for burn injuries, according to the National Institutes of Health. The University of Tennessee, Knoxville's College of Social Work has developed the first mobile phone app designed to support burn patients. The new app will offer instructional videos for dressing changes and range of motion, answer patient questions, offer health-related reminders and provide encouraging daily messages that are appropriate to each burn patient's stage of recovery. It also will capture feedback from burn survivors related to pain, mood, anxiety, patient self-efficacy, goal setting and achievement, social participation, wound healing, medication and pressure garment compliance, and will offer tips on returning to work.  The goal is to decrease hospital readmissions and support the patient's healing, quality of life and resilience.

Comparison of Skin Closure at Cesarean Delivery Using Glue versus Intra-Cuticular Sutures

Cesarean delivery rates have increased during the last few decades and it has become the most common surgery during a woman's reproductive years. There is currently no definite evidence regarding the best method for skin closure after a cesarean surgery. Safety of the operation, healing, and cosmetic outcomes are important considerations that determine the choice of skin closure methods.

In a recent randomized controlled trial, pregnant women undergoing a scheduled cesarean delivery were randomly assigned to skin closure with glue (Dermabond, Ethicon) or with a monofilament synthetic suture (Monocryl, Ethicon). Scars were evaluated after 8 weeks. Primary outcome measures were Patient and Observer Scar Assessment Scale (POSAS) scores. Secondary outcome measures were surgeon satisfaction, duration of surgery, duration of hospitalization after the cesarean delivery, and complications of surgical site infection or wound complications at the incision. Both surgeons and patients were blinded to the skin closure method.

The researchers found no significant differences found between the 2 groups in blood loss, infections, and length of postpartum hospitalization or wound disruption. Glue and suture skin closure scores using POSAS were similar 8 weeks after surgery.

Antibiotic Synthetic Spider Silk for Wound Healing

An interdisciplinary team of scientists at The University of Nottingham has developed a technique to produce spider silk that can be tailored to applications used in drug delivery, regenerative medicine, and wound healing. Spider silk is strong, biocompatible, and biodegradable. It is a protein-based material that does not appear to cause a strong immune, allergic, or inflammatory reaction.  The team use "click-chemistry" to attach molecules, such as antibiotics or fluorescent dyes, to artificially produced spider silk synthesized by Escherichia coli bacteria. These fibers function as a temporary scaffold and can replace the extra cellular matrix to accelerate growth of the new tissue.  The team has also shown that these silk fibers are coated with the antibiotic levofloxacin that render its anti-bacterial activity for at least 5 days.

Patient Perceptions of Pain Treatment with Use of Transdermal Formulations

The institutional review board-approved OPERA (Optimizing Patient Experience and Response to Topical Analgesics) study was designed to evaluate patient perceptions of pain treatment with the use of FDA-approved topical/transdermal formulations alone or in combination with neuropathic supplements via a patient-reported survey.  The study includes 100 clinician investigators and more than 1000 patients, both men and women, ranging in age from 18 to 64. Latest analysis indicates participants continue to see a reduction of 45% of opioid usage and a significant reduction of nonopioid drugs to treat chronic pain.

Anti-adhesion Molecules to Combat Multidrug Resistance Bacteria

A research team from the University of Texas Southwestern Medical Center identified a new way to prevent bacteria from binding to host tissue.  The study done in rats targeted one of the most lethal pathogens: multidrug-resistant Pseudomonas aeruginosa, which is found in approximately 33% of all burn cases and in 59% of extensive burns. A group of adhesion molecules called adhesins that are created by bacteria to bind, or stick to cells in an early and crucial step in causing infection. The researchers showed that topical application of an engineered adhesion inhibitor molecule—Multivalent Adhesion Molecule 7, or MAM7—substantially decreased the bacterial levels in wounds in the first 24 hours after administration and prevented the spread of the infection to adjacent tissue for 3 more days. In addition, the experimental molecule aided wound healing and maintained normal inflammatory responses to the burn, the researchers report.