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Journal of Wound, Ostomy & Continence Nursing:
doi: 10.1097/WON.0b013e31825dd62a
Wound Care Literature Review

Wound Care Literature Review 2011

Collins, Patricia S. RN, MSN, ACNS-BC, CWOCN; Contributor; Evans, Sharon MS, RN, CWOCN; Contributor; Falconio-West, Margaret BSN, RN, APN/CNS, CWOCN, DAPWCA; Contributor; Jacobs, Julia A. BSN, RN, CWOCN; Contributor; Miner, Kimberly J. ND, RN, CNS, CWCN, FAPWCA; Contributor

Section Editor(s): Doughty, Dorothy

Free Access
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General Concepts in Wound Management

W1. Moisture-Associated Skin Damage: Overview and Pathology

Gray M, Black JM, Baharestani MM, Bliss DZ, Colwell JC, Goldberg M, et al. Journal of Wound, Ostomy and Continence Nursing. 2011;38(3):233–241.

Article Type: Integrative Review

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Description/Results:

* Reports results of consensus conference on moisture-associated skin damage (MASD) that includes overall definition of MASD and the 4 defined subcategories of MASD: incontinence-associated dermatitis (IAD), intertriginous dermatitis (ITD), periwound moisture-associated dermatitis, and peristomal moisture-associated dermatitis.

* Provides in-depth review of skin physiology and characteristics of intact barrier; etiology and pathology of MASD; and general principles for prevention and treatment.

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What does this mean for me and my practice?

Provides essential information for any wound care clinician caring for patients at risk for or presenting with moisture-associated skin damage.

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W2. MASD Part 2: Incontinence-Associated Dermatitis and Intertriginous Dermatitis

Black JM, Gray M, Bliss DZ, Kennedy-Evans KL, Logan S, Baharestani M, et al. Journal of Wound, Ostomy and Continence Nursing. 2011;38(4):359–370.

Article Type: Integrative Review

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Description/Results:

* Provides an in-depth review of the pathology, risk factors, clinical presentation, prevention, and management of incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD).

* This article is the result of a consensus conference.

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What does this mean for me and my practice?

This article provides critical information regarding differential assessment and management of IAD and ITD and would be helpful to clinicians in accurately differentiating wound etiology (MASD vs pressure ulcers, and specific types of MASD).

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W3. MASD Part 3: Peristomal Moisture-Associated Dermatitis and Periwound Moisture-Associated Dermatitis

Colwell J, Ratliff C, Goldberg M, Baharestani M, Bliss D, Gray M, et al. Journal of Wound, Ostomy and Continence Nursing. 2011;38(5):541–553.

Article Type: Integrative Review

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Description/Results:

* Provides in-depth definitions and discussion of peristomal moisture-associated dermatitis and periwound moisture-associated dermatitis to include pathology, prevention, presentation, and management.

* Discussion also includes pseudoverrucous lesions, peristomal pyoderma gangrenosum, and categories of absorptive dressings.

* This article is the result of a consensus panel discussion.

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What does this mean for me and my practice?

A very helpful article for any clinician caring for individuals with periwound moisture-associated lesions and peristomal moisture-associated lesions; provides guidelines for accurate terminology and differential assessment.

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W4. Preclinical Evaluation of Antimicrobial Efficacy and Biocompatibility of a Novel Bacterial Barrier Dressing

Mikhaylova A, Liesenfeld B, Moore D, Toreki W, Vella J, Batich C, Schultz G. Wounds. 2011;23(2):24–31.

Article Type: Research Study

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Description/Results:

* Preclinical in vitro study to test the efficacy of a new antimicrobial dressing (polyDADMAC) as compared to silver; gauze dressings were used as a control.

* In the laboratory, the new antimicrobial was effective against all organisms against which tested (strains of gram + and gram − organisms).

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What does this mean for me and my practice?

Provides evidence that less-expensive alternatives to silver dressings may be equally effective. The dressing tested in this study (Bioguard) is now Food and Drug Administration-approved and commercially available.

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W5. “Homemade” Negative Pressure Wound Therapy: Treatment of Complex Wounds Under Challenging Conditions

Gill NA, Hameed A, Sajjad Y, Ahmad Z, Rafique AM. Wounds. 2011;23(4):84–92.

Article Type: Case Study/Series

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Description/Results:

* Authors address alternatives to commercially available options for negative pressure wound therapy (NPWT) when standard systems are not feasible due to financial or practical reasons.

* Authors evaluate the use of homemade system adherent to principles of “standard” NPWT systems in 44 patients with 51 wound and demonstrated positive outcomes in 47 of the wounds.

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What does this mean for me and my practice?

Provides evidence that nonstandard NPWT systems can be used effectively so long as the established principles are followed in device construction.

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W6. An Appraisal of Potential Drug Interactions Regarding Hyperbaric Oxygen Therapy and Frequently Prescribed Medications

Smith RG. Wounds. 2011;23(6):147–158.

Article Type: Integrative Review

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Description/Results:

* Describes the mechanisms underlying hyperbaric oxygen therapy (HBOT) and drug interactions, and data regarding potential interactions between the most commonly prescribed drugs and HBOT.

* Thirty-eight of the 69 most commonly prescribed drugs had reported drugs interactions/side effects.

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What does this mean for me and my practice?

Provides a helpful overview of potential interactions between HBOT and commonly prescribed drugs; includes very helpful tables specifying drugs that have been documented to interact with HBOT.

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W7. Caring for Persons With Bariatric Health Care Issues: A Primer for the WOC Nurse

Blackett A, Gallagher S, Dugan S, Gates J, Henn T, Kennedy-Evans K, Lutze J. Journal of Wound, Ostomy and Continence Nursing. 2011;38(2):133–137.

Article Type: Integrative Review

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Description/Results:

* Addresses increasing prevalence of obesity among US population and implications for health care providers.

* Provides specific recommendations for equipment to prevent injury to patients and providers, measures to maintain skin integrity, and promote incisional healing, and psychosocial care to promote the patient's privacy and dignity.

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What does this mean to me and my practice:

A very helpful article for any wound care clinician involved in bariatric patient care or development of bariatric patient care protocols.

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W8. Negative Pressure Wound Therapy—A Descriptive Study

Wallin A, Bostrum L, Ulfvarson J, Ottosson C. Ostomy Wound Management. 2011;57(6):22–29.

Article Type: Research Study

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Description/Result:

* Retrospective descriptive study conducted to identify patients most likely to respond to negative pressure wound therapy (NPWT).

* Of the 87 patients who received NPWT, the majority demonstrated significant improvement with a median treatment time of 17 days; 20% discontinued treatments due to either complications or negative impact on quality of life.

* Wound healing rates were significantly higher for infectious wounds, postoperative wounds, and traumatic wounds as opposed to pressure ulcers or vascular wounds (P = .001).

* Limitations included lack of a control group and small numbers of patients in various subgroups.

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What does this mean for me and my practice?

Findings suggest that outcomes with NPWT may be impacted by wound etiology; this may be helpful to wound care clinicians utilizing NPWT for wounds of varied etiologies.

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W9. Individualizing the Use of Negative Pressure Wound Therapy for Optimal Wound Healing: A Focused Review of the Literature

Borgquist O, Ingemansson R, Malmsjo M. Ostomy Wound Management. 2011;57(4):44–54.

Article Type: Integrative Review

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Description/Results:

* Provides a summary of publications on negative pressure wound therapy (NPWT) from 2005 to 2010; addresses the mechanisms of action and factors to be considered when selecting specific NPWT systems and individualizing the therapy to optimize outcomes for an individual patient.

* Provides specific guidance in terms of level of negative pressure, type of filler dressing, and mode of delivery (intermittent vs continuous vs variable).

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What does this mean for me and my practice?

Provides guidance to clinicians in optimal use of available NPWT systems.

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W10. Scar Management Practice and Science: A Comprehensive Approach to Controlling Scar Tissue and Avoiding Hypertrophic Scarring

Widgerow A, Chait L. Advances in Skin and Wound Care. 2011;24(12):555–561.

Article Type: Research Study

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Description/Results:

* A concise summary of current evidence related to the pathology of hypertrophic scarring and the implications for prevention: scar support provided by micropore tape applied longitudinally along the incision (to reduce tension); hydration of the scar tissue (to prevent signaling of dermal fibroblasts that stimulates collagen production); control of inflammation, which is a known precursor to excessive scarring; and promotion of rapid movement through the remodeling phase and a shift from a predominance of type 3 to type 1 collagen.

* Reports on a study comparing scar support alone to scar support combined with application of a gel containing extracts of the Centella asiatica plant and olive oil compounds, which have been shown to have anti-inflammatory properties and to promote collagen remodeling. The study involved 120 patients undergoing a variety of procedures; patients treated with the gel had consistently and statistically significantly improved outcomes in terms of scar pain, itching, thickness, pliability, and pigmentation when compared to those managed with scar support alone (P < .0001 and P < .005).

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What does this mean for me and my practice?

Provides an extremely helpful review of the pathology of hypertrophic scar formation with clear clinical implications and provides initial report on topical agent that may be beneficial in prevention of hypertrophic scarring. Authors do acknowledge that further study is needed, specifically a study comparing the active gel to a placebo gel.

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W11. The Clinical Relevance of Treating Chronic Wounds With an Enhanced Near-Physiological Concentration of Platelet-Rich Plasma Gel

DeLeon J, Driver V, Fylling C, Carter M, Anderson C, Wilson J, et al. Advances in Skin and Wound Care. 2011;24(8):357–368.

Article Type: Case Study/Series

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Description/Results:

* Addresses common characteristics of nonhealing wounds, and the potential benefits of platelet-rich plasma (PRP) gel in treatment of these wounds.

* Study was conducted by reviewing data from a multicenter registry database that included information regarding all wounds treated with PRP gel; 39 centers contributed data, and the analysis involved 200 patients with 285 wounds (pressure ulcers, diabetic ulcers, venous ulcers, dehisced wounds, and wounds of other etiologies).

* 96.5% of wounds demonstrated positive response within an average of 2.2 weeks (positive response was indicated by reduction in wound area and/or volume, and/or reduction in undermining and tunneling). Authors provide detailed statistical analysis of response by wound type.

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What does this mean for me and my practice?

This was not a controlled study but does provide evidence that PRP gel can be used to promote healing in a variety of refractory wounds. Study was funded by Cytomedix.

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W12. Use of Platelet-Rich Plasma in the Treatment of Recalcitrant Sinus Tracts: A Case Series

Allam RC, Partain R. Wounds. 2011;23(11):322–327.

Article Type: Case Series

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Description/Results:

* Series involved 12 patients; platelet-rich plasma (PRP) was used to fill sinus tracts. Basis for therapy was potential release of growth factors and sealant properties of activated fibrin.

* In straight sinus tracts < 5 cm length, 9 of the 12 healed.

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What does this mean for me and my practice?

While this was a small case series, finding suggest that PRP may be effective in promoting healing of selected recalcitrant sinus tracts.

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W13. Special Considerations in Wound Bed Preparation 2011: An Update

Sibbald G, Goodman L, Woo K, Krasner D, Smart H, Tariq G, et al. Advances in Skin and Wound Care. 2011;24(9):415–438.

Article Type: Integrative Review

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Description/Results:

* In-depth review of all aspects of chronic wound management, with specific attention to the following: identification and treatment of etiologic factors; evaluation of ability to heal; correction (to extent possible) of systemic factors affecting ability to heal; attention to patient concerns such as wound-related pain and quality of life; wound assessment; management of necrotic tissue, infection, and inflammation; appropriate use of dressings; and appropriate use of advanced therapy options.

* Provides a number of “tools” such as Quick Reference Guide for Wound Bed Preparation, NERDS and STONEES for assessment of clinical signs of infection, moisture balance dressing chart, and Sibbald cubes for superficial and deep infections.

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What does this mean for me and my practice?

A comprehensive review of current guidelines for chronic wound management.

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W14. Skin Tears: State of the Science: Consensus Statements for the Prevention, Prediction, Assessment, and Treatment of Skin Tears

LeBlanc K, Baranoski S, Campbell K, Carville K, Christensen D, et al. Advances in Skin and Wound Care. 2011;24(9S):S2-S15.

Article Type: Integrative Review

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Description/Results:

* Provides a comprehensive review of current information regarding skin tear pathology, risk factors, classification, prevention, and treatment.

* Includes 12 consensus statements with brief discussion of each; includes specific recommendations for topical therapy (lipido-colloid–based mesh and foam dressings, soft silicone–based mesh or foam dressings, calcium alginate dressings, absorbent clear acrylic dressings, and cyanoacrylate skin glue) and clear statements that hydrocolloids and transparent film dressings are not recommended.

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What does this mean for me and my practice?

Relevant for any clinician who manages patients with skin tears or at risk for skin tears.

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W15. Wound Bed Preparation and Complementary and Alternative Medicine

Laforet K, Woodbury G, Sibbald G. Advances in Skin and Wound Care. 2011;24(5):226–236.

Article Type: Integrative Review

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Description/Results:

* Addresses reasons many patients elect complementary or alternative therapies and provide clear definitions of each. Presents a model for use with patients who desire complementary or alternative therapies as opposed to conventional wound care (therapeutic double-blind approach).

* Authors provide specific information about the potential benefits of acupuncture, aromatherapy such as lavender, energy work, plant extracts such as capsicum and turmeric, use of honey and aloe vera for debridement and anti-inflammatory effects, and herbal antimicrobials such as tea tree oil, calendula, hypericum, and quercus albus.

* Authors provide a number of resources for additional information as well as practice pearls for safely and effectively incorporating complementary and alternative therapies.

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What does this mean for me and my practice?

Provides a concise overview of complementary and alternative therapies that may be encountered by wound care nurses.

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W16. The Haiti Earthquake: The Provision of Wound Care for Mass Casualties Utilizing Negative Pressure Wound Therapy

Gabriel A, Gialich S, Kirk J, Edwards S, Beck B, et al. Advances in Skin and Wound Care. 2011;24(10):456–462.

Article Type: Case Study/Series

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Description/Results:

* Authors describe prevalence and most common types of wounds following natural disasters such as earthquakes and also address common outcomes and complications related to wound management in a field environment with very limited resources and limited follow-up (high incidence of serious infections and high rate of amputations).

* Authors address benefits of negative pressure wound therapy in management in suboptimal wound care conditions and also address the challenges in ensuring an adequate supply of products in postearthquake situations.

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What does this mean for me and my practice?

Provides helpful insights for any wound care provider who provides volunteer care in postdisaster situations.

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W17. Reduction of Bacterial Burden and Pain in Chronic Wounds Using a New Polyhexamethylene Biguanide Antimicrobial Foam Dressing—Clinical Trial Results

Sibbald G, Coutts P. Advances in Skin and Wound Care. 2011;24(2):78–83.

Article Type: Research Study

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Description/Results:

* Provides a review of terms—contamination, colonization, critical colonization, and infection—along with implications and guidelines for treatment.

* Compared wound healing rates, bacterial loads, and pain in patients with leg and foot ulcers managed with foam dressings impregnated with polyhexamethylene biguanide (PHMB) (N = 19) and plain foam (N = 21). Subjects were randomly assigned to treatment groups and there were no statistically significant differences in the 2 groups in terms of comorbidities and characteristics. All subjects underwent baseline vascular assessment to ascertain sufficient perfusion to promote healing.

* There was no significant difference in healing rates between the 2 groups; there was a significant reduction in pain among the PHMB group (P = .0006) and reduction of bacterial load (P = .04).

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What does this mean for me and my practice?

Provides additional evidence that antimicrobial dressings can reduce bacterial loads and wound pain and specifically supports the efficacy of PHMB as a topical antimicrobial agent.

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W18. Negative Pressure Wound Therapy for Musculoskeletal Tumor Surgery

Sakellariou V, Mavrogenis A, Papagelopoulos P. Advances in Skin and Wound Care. 2011;24(1):25–30.

Article Type: Research Study

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Description/Results:

* Comparison of outcomes for patients undergoing musculoskeletal tumor surgery who were managed with standard care and those who were managed with negative pressure wound therapy (NPWT).

* Statistically better outcomes in the NPWT group in terms of length of hospitalization (P = .036), complication rates (P = .034), and soft tissue infection rate (P = .028).

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What does this mean for me and my practice?

Provides data supporting the use of NPWT in management of patients undergoing major musculoskeletal surgery. Limitations include small sample size (N = 32) and the fact that this was not a randomized controlled trial.

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W19. Use of Honey in Wound Care: An Update

Song J, Salcido R. Advances in Skin and Wound Care. 2011;24(1):40–47.

Article Type: Integrative Review

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Description/Results:

* Provides a brief review of current data regarding efficacy of honey-based dressings in wound management.

* Authors point out that data to date do not show any significant difference in outcomes with honey-based dressings as compared to other advanced wound dressings.

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What does this mean for me and my practice?

Provides a helpful summary of current data related to honey dressings that would be relevant to any wound care provider.

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W20. Significant Reduction of Wound Infections With Daily Probing of Contaminated Wounds

Towhigh S, Clarke T, Yacoub W, Pooli AH, Mason RJ, Katkhouda N, et al. Archives of Surgery. 2011;146(4):448–452.

Article Type: Research Study

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Description/Results:

* Clinical outcomes of daily incisional probing of loosely closed appendectomy wounds to decrease postoperative infection were explored in 76 patients who underwent surgery for perforated appendix.

* 50% of patients were assigned to loose closure and daily cotton tip applicator swabs; 50% were assigned to control group with primary staple closure and povidone-iodine daily swabbing.

* Test group had a shorter hospital stay and lower likelihood of infection.

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What does this mean for me and my practice?

While more study is warranted, a simple gentle probing to maintain free drainage could reduce the incidence of surgical site infections following surgery for a ruptured appendix.

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Pressure Ulcers

W21. Beds: Practical Pressure Management for Surfaces/Mattresses

Norton L, Sibbald G. Advances in Skin and Wound Care. 2011;24(7):324–332.

Article Type: Integrative Review

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Description/Results:

* Provides a review of currently accepted terminology (according to National Pressure Ulcer Advisory Panel) related to support surfaces, that is, reactive versus active surface, alternating pressure, and lateral rotation; also provides current definitions of terms such as pressure, shear, and friction.

* Provides 3 decision trees that can be used to guide selection of the best surface for a specific patient: validated risk assessment decision-making tree; active support surface decision tree; and reactive support surface decision tree.

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What does this mean for me and my practice?

Provides current information and practical tools that may be beneficial to wound care clinicians dealing with pressure ulcer prevention and management.

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W22. Leveraging Certified Nursing Assistant Documentation and Knowledge to Improve Clinical Decision Making: The On-Time Quality Improvement Program to Prevent Pressure Ulcers

Sharkey S, Hudak S, Horn S, Spector W. Advances in Skin and Wound Care. 2011;24(4):182–188.

Article Type: Quality Improvement Report

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Description/Results:

* Reports on a quality improvement project involving 75 long-term care facilities across the United States. Key elements of the program include the use of a software program that includes key elements of certified nursing assistant (CNA) documentation (meal intake, bowel and bladder function, change in behavior, and skin status); a monitoring program to assure consistency in CNA documentation of these key elements; routine short focused “huddles” for reporting changes in resident status that increase their risk of pressure ulcer development; and implementation of pressure ulcer prevention programs for at-risk residents.

* In 21 facilities with a high level of implementation, there was a 42% reduction in pressure ulcer incidence. CNAs report feeling that their contributions/observations are valued by other team members.

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What does this mean for me and my practice?

Provides an overview of comprehensive quality improvement project that focuses on enhancing and promoting the role and involvement of frontline caregivers.

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W23. Risk Factors for Pressure Ulceration in an Older Community-Dwelling Population

Takahashi P, Chandra A, Cha S. Advances in Skin and Wound Care. 2011;24(2):72–77.

Article Type: Research Study

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Description/Results:

* Prospective cohort study conducted among individuals > 60 years of age in primary care, to determine risk factors associated with development of a pressure ulcer within 40 months.

* Incidence rate was 2.9% (N = 366 of 12650) The 2 most significant risk factors for pressure ulcer development were prior history of pressure ulcer and long-term care facility placement. Additional risk factors were increasing age and comorbidities.

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What does this mean for me and my practice?

Provides additional support for previous ulceration and comorbidities as risk factors for future pressure ulcer development.

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W24. A Pilot Study Providing Evidence for the Validity of a New Tool to Improve Assignment of National Pressure Ulcer Advisory Panel Stage to Pressure Ulcers

Young D, Estocado N, Landers M, Black J. Advances in Skin and Wound Care. 2011;24(4):168–175.

Article Type: Research Study

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Description/Results:

* Discusses challenges in accurate staging of pressure ulcers and reports on a pilot study evaluating the efficacy of a structured tool to improve accuracy of pressure ulcer staging (the N.E.O.C.S.—AnyOne Can Stage) tool. The NEOCS tool provides both narrative and pictorial guidance to the clinician.

* The study involved 101 clinicians (MDs, RNs, RN students, LPNs, PTs, PT students, PTAs, and 1 OT). They were asked to stage 10 wounds, using photographs with brief case descriptions; 8 of the 10 wounds were pressure ulcers of various stages, and 2 were other wound types. Subjects staged the wounds 3 times on one day: the first time with no specific instruction; the second time with the NEOCS but no further instruction; and the third time following 5 minutes of scripted instruction on the use of the NEOCS. They were given the same test a fourth time 1 week later to determine test-retest reliability. The correct stage for each wound had been determined by a panel of wound experts.

* Average accuracy on the first test was 31.9% as compared to 60.2% on the second test and 69.6% on the third test (P < .001).

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What does this mean for me and my practice?

Provides objective data regarding lack of accuracy in pressure ulcer staging and also provides objective evidence that accuracy can be significantly improved with the use of a structured tool and education.

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W25. Pressure Ulcers: Avoidable or Unavoidable? Results of the National Pressure Ulcer Advisory Panel Consensus Conference

Black J, Edsburgh L, Baharestani M, Langemo D, Goldberg M, McNichol L, et al. Ostomy Wound Management. 2011;57(2):24–37.

Article Type: Integrative Review

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Description/Results:

* Consensus conference held in 2010 to address avoidable versus unavoidable pressure ulcers and pressure ulcers versus end-of-life skin changes.

* There was consensus that some pressure ulcers are unavoidable, and that major risk factors for unavoidable ulcers include hemodynamic instability, terminal status, utilization of selected medical devices, and nonadherence with repositioning or refusal of nutritional intervention.

* Unavoidable ulcers were identified as ulcers that developed despite comprehensive prevention measures.

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What does this mean for me and my practice?

Provides support for fact that some ulcers are unavoidable and reinforces critical importance of comprehensive preventive care for all patients.

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W26. Pressure Ulcer Staging Revisited: Superficial Skin Changes and Deep Pressure Ulcer Framework

Sibbald RG, Krasner D, Woo K. Advances in Skin and Wound Care. 2011;24(12):571–580.

Article Type: Integrative Review (Expert Panel Recommendations)

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Description/Results:

* Provides a summary of recommendations of SOPE Panel (Shifting the Original Paradigm Expert) in regard to pressure ulcer causation and classification.

* Addresses the multiple problems associated with current pressure ulcer classification systems and recommends changing to the following terminology: superficial skin changes (as opposed to stage II pressure ulcer) and deep pressure ulcers (stage III, IV, unstageable, and sDTI). Addresses the fact that current evidence indicates that partial thickness lesions are usually due to moisture and friction (“top down” injuries) whereas pressure ulcers are ischemic lesions (“bottom up” injuries).

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What does this mean for me and my practice?

A critical article for any clinician involved in classification and management of pressure ulcers and skin breakdown caused by other etiologic factors; decisions regarding wound classification have clinical, legal, and regulatory implications. Addresses many unresolved issues related to wound classification.

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W27. Preventing Pressure Ulcers in People With Spinal Cord Injury: Targeting Risky Life Circumstances Through Community-Based Interventions

Vaishampayan A, Clark F, Carlson M, Blanche E. Advances in Skin and Wound Care. 2011;24(6):275–284.

Article Type: Research Study

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Description/Results:

* Provides an analysis of data gathered as part of Pressure Ulcer Prevention Study–Randomized Controlled Trial, a study designed to individualize pressure ulcer prevention for high-risk spinal cord–injured patients through intensive supportive counseling and education provided by OTs with additional training.

* Data obtained through analysis of weekly team meetings revealed major challenges related to lifestyle changes (such as loss of caregiver or insurance), problems communicating effectively with health care professionals, equipment problems, and personality issues interfering with pressure ulcer prevention.

* Therapists found that individualization of standard preventive care education was essential to success.

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What does this mean for me and my practice?

Provides insights into issues affecting pressure ulcer prevention in the spinal cord—injured population, and potentially beneficial approaches to educating and counseling these patients.

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W28. Pressure Ulcer Prevention Program: A Journey

Delmore B, Lebovits S, Baldock P, Suggs B, Ayello E. Journal of Wound, Ostomy and Continence Nursing. 2011;38(5):505–513.

Article Type: Quality Improvement Report

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Description/Results:

* Reports on a quality improvement project in a 500-bed tertiary academic medical center with goal of reducing hospital-acquired pressure ulcers (HAPU).

* Authors report a very comprehensive approach to pressure ulcer prevention to include involvement of perioperative and nonnursing services, appropriate use of equipment such as support surfaces, focus on staff and patient education, use of wristbands to identify at-risk patients, reporting and handoffs, and accuracy in data collection

* Provides a number of very helpful tools developed during the project.

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What does this mean for me and my practice?

Provides objective data regarding impact of a comprehensive and multidisciplinary prevention program and also provides very specific examples of effective strategies for reducing pressure ulcer incidence.

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W29. Hospital-Acquired Pressure Ulcer Prevalence: Evaluating Low-Air-Loss Beds

Johnson J, Peterson D, Campbell B, Richardson P, Rutledge D. Journal of Wound, Ostomy and Continence Nursing. 2011;38(1):55–60.

Article Type: Research Study

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Description/Results:

* Prospective comparative cohort study in a 500-bed hospital looking at “matched pair” med-surg and ICU units. One ICU and one med-surg unit had regular hospital mattresses and one ICU and one med-surg unit had various low air loss mattresses; nursing staff was the same for each of the “matched pairs.”

* Data regarding HAPUs were collected for 3 quarters of 2008; the overall HAPU prevalence was 2.4%.

* Results: 63% of patients with HAPUs were on low air loss beds as compared to 47% on standard mattresses. (These results were not statistically significant.) Investigators hypothesized that nurses caring for patients on low-air-loss mattresses were less vigilant in providing preventive care.

* An unexpected result was that 50% of the patients with HAPU were rated not at risk or low risk on the Braden Scale.

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What does this mean for me and my practice?

Reinforces the importance of a comprehensive prevention program and the dangers of relying on high-level support surfaces to compensate for deficits in routine preventive care. Limitations of the study were the lack of random assignment to bed type and lack of data on preventive care provided.

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W30. Adjunctive Use of Noncontact Low-Frequency Ultrasound for Treatment of Suspected Deep Tissue Injury

Honaker J, Forston M. Journal of Wound, Ostomy and Continence Nursing. 2011;38(4):394–403.

Article Type: Case Series

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Description/Results:

* Series involved 6 patients with suspected deep tissue injury (sDTI) who were treated with noncontact low-frequency ultrasound (NLFU) in combination with the institution's standard sDTI protocols. These included standard preventive care (repositioning, pressure redistribution surfaces; dietary consult; heel offloading boots) as well as topical application of ointment with optional use of silicone foam dressings.

* In this series, the use of NLFU prevented progression of sDTI lesions to higher-pressure ulcer (PU) stages.

* Provides a review of pathologic processes thought to result in PU development and hypotheses regarding mechanisms of action for NLFU.

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What does this mean for me and my practice?

Provides preliminary data that the addition of NLFU may help prevent the progression of sDTI lesions to deeper pressure ulcers. Authors note that further study is needed.

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W31. Longitudinal Study of Stage III and Stage IV Pressure Ulcer Area and Perimeter as Healing Parameters to Predict Wound Closure

Edsberg L, Wyffels J, Ha D. Ostomy Wound Management. 2011;57(10):50–62.

Article Type: Research Study

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Description Result:

* Longitudinal, repeated-measurements study to calculate healing parameters using wound area and perimeter measurements and evaluate their potential to predict closure in stage III and stage IV pressure ulcers.

* Wound length, width, and perimeter were measured at 15 time points or until healing. The following healing parameters were calculated: absolute area, percent area reduction, mean percent area reduction, trajectory, and 3 variations of the linear healing parameter.

* Percent area reduction and linear healing parameters were all predictive of wound outcomes; reduction in wound size at 4 weeks was predictive of healing for stage III and IV pressure ulcers.

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What does this mean for me and my practice?

Provides additional data to support the importance of response to initial therapy as a predictor of healing. Wounds that fail to demonstrate measurable reduction in size at 2 to 4 weeks despite appropriate therapy are unlikely to heal.

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Lower Extremity Ulcers

W32. Managing Lower-Extremity Osteomyelitis Locally With Surgical Debridement and Synthetic Calcium Sulfate Antibiotic Tablets

Gauland C. Advances in Skin and Wound Care. 2011;24(11):515–523.

Article Type: Research Study

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Description/Results:

* Provides a review of current approaches and challenges in treatment of osteomyelitis, specifically the difficulty in establishing therapeutic concentrations of the antibiotic in the affected bone without exceeding safe dosage levels. Also addresses issues related to antibiotic therapy and biofilm, that is, evidence that high local levels of antibiotics can penetrate biofilm (if there was a delivery system that provided high local levels and safe systemic levels).

* Provides a retrospective review of 323 patients treated over 5 years with surgical debridement of infected bone followed by implantation of calcium sulfate tablets impregnated with antibiotics (most commonly vancomycin and gentamicin). Subjects had positive perfusion as evidenced by pulses, ABI > 0.7, or TcPo2 of > 40 mm; confirmed osteo; and ability to offload the area.

* 279 (86.4%) healed with no additional antibiotic therapy; 24 (7.4%) healed with the addition of IV antibiotics; 20 (6.2%) required amputation, but 12 were limited to the affected digit and 2 to the affected ray. Only 6 (1.9%) required below-knee amputation.

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What does this mean for me and my practice?

Findings suggest that local application of antibiotics may be effective in treatment of osteomyelitis; valuable article for any clinician dealing with wounds complicated by osteomyelitis.

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W33. Prevalence Analysis of Fungi in Chronic Lower Extremity Ulcers

Foroozan M, Contet-Audonneau N, Granel-Brobaud A, Schmults JL. Wounds. 2011;23(3):68–75.

Article Type: Research Study

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Description/Results:

* Study involved 152 patients with lower extremity (LE) wounds of varied etiologies; periwound and wound cultures were obtained to determine the presence of fungal organisms and fungal infections.

* 6% of wound cultures and 27.6% periwound cultures were positive for fungi, but only 2% of the ulcers and 8.5% of the periwound skin were clinically infected.

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What does this mean for me and my practice?

Results suggest that clinicians should consider the possibility of fungal infection in patients with clinically infected LE wounds that are unresponsive to appropriate antimicrobial therapy.

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W34. The Use of Pulsed Radio Frequency Energy Therapy in Treating Lower Extremity Wounds: Results of a Retrospective Study of a Wound Registry

Frykberg R, Driver V, Lavery L, Armstrong D, Isenberg R. Ostomy Wound Management. 2011;57(3):22–29.

Article Type: Research Study

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Description/Results:

* Retrospective descriptive study conducted to evaluate effect of pulsed radio frequency energy (PRFE) therapy on healing of long-standing lower extremity wounds that were refractory to standard therapy. PRFE therapy was provided twice daily for 30 minutes and all standard care was continued.

* A total of 113 patients with 128 wounds were evaluated at baseline and after 4 weeks of therapy, and 46% of the wounds exhibited more than 50% reduction in wound size.

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What does this mean for me and my practice?

Results suggest that PRFE therapy may be beneficial in promoting healing in some wounds refractory to standard therapy. In assessing the results of this study, it should be noted that some of the authors are employees or consultants for Regenesis, the company that provides PRFE therapy.

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W35. Overcoming Lower-Extremity Wound Defects Using Hydrocolloid Framing

Goldstein B. Advances in Skin and Wound Care. 2011;24(5):221–224.

Article Type: Case Study/Series

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Description/Results:

* Describes a unique approach to reducing depth of venous ulcers and other lower extremity wounds that can be managed with compression therapy. Technique involves protection of periwound skin with skin sealant followed by application of hydrocolloid dressing “frame” right around the ulcer, followed by application of compression wrap. The hydrocolloid frame acts as a slight pressure dressing right around the ulcer, which helps eliminate edema of the periwound tissue and thus to “flatten” the tissue surrounding the wound, thus facilitating epithelial resurfacing.

* Authors include contraindications and considerations.

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What does this mean for me and my practice?

Provides a novel approach to promoting closure of refractory venous ulcers characterized by significant wound “depth.”

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W36. Retrospective Comparison of Diabetic Foot Ulcer and Venous Stasis Ulcer Healing Outcome Between a Dermal Repair Scaffold (PriMatrix) and a Bilayered Living Cell Therapy (Apligraf)

Karr J. Advances in Skin and Wound Care. 2011;24(3):119–125.

Article Type: Research Study

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Description/Results:

* Provides a brief review of PriMatrix (acellular dermal matrix derived from fetal bovine dermis) and Apligraf (bilayered matrix populated with fibroblasts and keratinocytes harvested from neonatal foreskin), and reports on a single-center retrospective review of clinical outcomes.

* Data were reviewed for 20 patients with diabetic foot ulcers (DFUs) and 14 patients with venous ulcers (VUs) treated with PriMatrix and an equivalent number of patients with each type of ulcer treated with Apligraf. (The database was searched beginning with the most recent patients until the required number of patients meeting the inclusion/exclusion criteria was obtained for each treatment modality.)

* Inclusion criteria: Ulcer not responding to standard therapy; ulcer extending at least to subcutaneous tissue; viable wound base; adequate perfusion for healing; and adherence to offloading (diabetic ulcer) or compression (VU).

* DFUs: time to complete healing averaged 87 days with Apligraf and 37 days with PriMatrix. Hgb A1C levels were lower in the PriMatrix group (7.8 vs 9.3). VUs: time to complete healing averaged 63 days with Apligraf and 32 days with PriMatrix. (Average wound area was larger in the PriMatrix group: 10.2 cm2 for DFUs and VU in PriMatrix group, vs 6.4 cm2 for DFUs and 5.4 cm2 for VUs in Apligraf group). Both products were effective in achieving healing in ulcers that were refractory to standard treatment.

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What does this mean for me and my practice?

Findings suggest that advanced wound care products should be used for ulcers that do not respond to standard therapy and provides preliminary data, suggesting that PriMatrix may be more cost-effective than Apligraf in healing these wounds, although more study is clearly indicated.

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W37. A Prospective Study of the PUSH Tool in Diabetic Foot Ulcers

Gardner S, Hilis S, Frantz R. Journal of Wound, Ostomy and Continence Nursing. 2011;38(4):385–393.

Article Type: Research Study

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Description/Results:

* The study examines the predictive validity of Pressure Ulcer Scale for Healing (PUSH v.3.0) in patients with neuropathic foot ulcers with a convenience sample of 18 patients with neuropathic ulcers on the plantar surface of the foot, which healed completely over a 13-week period.

* The findings indicate that PUSH scores accurately reflect healing in neuropathic DFUs.

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What does this mean for me and my practice?

Provides objective data that PUSH tool can be used to reflect progress in healing of neuropathic DFUs.

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W38. Measuring Toe Pressures Using a Portable Photoplethysmograph to Detect Arterial Disease in High-Risk Patients: An Overview of the Literature

Bonham P. Ostomy Wound Management. 2011;57(11):36–44.

Article Type: Integrative Review

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Description/Results:

* Provides a thorough review of literature on diagnosis of asymptomatic LEAD (lower extremity arterial disease).

* Addresses benefits and limitations of ABI (Ankle Brachial Index) testing, and potential benefit of toe photoplethysmography testing for individuals with high ABI values indicating calcified vessels.

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What does this mean for me and my practice?

Reviews of options for diagnosis of LEAD in patients with calcified vessels and provides evidence that portable PPG toe measurements may be of benefit for these patients.

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W39. A Prospective Comparison of Diabetic Foot Ulcers Treated With Either a Cryopreserved Skin Allograft or a Bioengineered Skin Substitute

Didomenico L, Emch KJ, Landsman AR, Landsman A. Wounds. 2011;23(7):184–189.

Article Type: Research Study

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Description/Results:

* Study involved comparison of 2 commercially available products (cryopreserved skin allograft and bioengineered skin substitute) in patients with nonhealing DFUs (N = 29).

* Twelve wounds were treated with allograft and 17 wounds treated with skin substitute; 66.7% of wounds treated with allograft closed at 12 weeks compared to 41.3% of wounds treated with skin substitute (not statistically significant).

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What does this mean for me and my practice?

Results suggest that allografts may be used effectively in management of refractory DFUs.

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W40. A Matched Cohort Study of the Risk of Cancer in Users of Becaplermin

Ziyadeh N, Walker A, Wilkinson G, Seeger J. Advances in Skin and Wound Care. 2011;24(1):31–39.

Article Type: Research Study

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Description/Results:

* Investigators used health insurance database to compare cancer incidence among individuals receiving becaplermin and a matched cohort who did not receive becaplermin (1622 individuals who were treated with becaplermin and 2809 matched “comparators”).

* In this study, there was no statistical difference in the incidence of cancer among those individuals treated with becaplermin and the matched comparators, regardless of dose.

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What does this mean for me and my practice?

Provides valuable data for any wound clinician who is involved in recommending or prescribing becaplermin for nonhealing diabetic foot ulcers. These data seem to contradict the FDA “black box” warning related to becaplermin and cancer.

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W41. Use of Platelet-Rich Plasma and Hyaluronic Acid in the Loss of Substance With Bone Exposure

Cervelli V, Lucarini L, Spallone D, Palla L, Colicchia G, et al. Advances in Skin and Wound Care. 2011;24(4):176–181.

Article Type: Research Study

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Description/Results:

* Authors compared wound healing outcomes for 9 patients with lower extremity wounds with bone exposure managed with a combination of platelet-rich plasma and hyaluronic acid dressings to 6 patients with comparable wounds managed with hyaluronic acid dressings alone. Wound size was comparable in both groups; all wounds were managed with debridement prior to dressing application.

* Wound healing was complete in an average of 5.8 weeks for the group managed with PRP in addition to hyaluronic acid, as compared to 10.8 weeks for the group managed with hyaluronic acid alone (P < .001).

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What does this mean for me and my practice?

Provides preliminary data supporting the use of combination therapy (PRP and hyaluronic acid) in management of wounds with bone exposure.

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W42. Mixed Arterial and Venous Ulcers

Marston W. Wounds 2011;23(12):351–356.

Article Type: Integrative Review

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Description/Results:

* Comprehensive review and updated guidelines for management of lower extremity mixed etiology (arterial and venous) ulcers.

* Provides options for management and specific discussions of compression and revascularization.

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What does this mean for me and my practice?

A valuable review for wound care specialists caring for patients with mixed arterial/venous disease.

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Burns, Malignant, and Other Wounds

W43. Recognizing Hospital-Acquired Burn Injury in Patients After Coronary Artery Bypass Surgery

Jones EG. Journal of Wound, Ostomy and Continence Nursing. 2011;38(2):193–195.

Article Type: Case Series

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Description/Results:

* Minimal information exists on intraoperatively acquired burns and pressure ulcers.

* 4 postoperative CABG patients (postoperative time 5–6 hours) were identified with perineal lesions; all patients had a preoperative Braden Risk Scale categorized as less than moderate risk.

* OR practice changes included discontinuation of isopropyl alcohol and lowering warming device temperatures. This resulted in no skin breakdown in 3 months.

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What does this mean for me and my practice?

Intraoperative skin lesions may be inaccurately documented as hospital-acquired pressure ulcers. It is important for all wound care specialists to accurately identify atypical wounds.

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W44. Assessment and Management of Fungating Wounds

Bergstrom KJ. Journal of Wound, Ostomy and Continence Nursing. 2011;38(1):31–37.

Article Type: Integrative Review

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Description/Results:

* Discusses challenges commonly associated with fungating wounds: odor and bleeding control, pain and exudate management, periwound irritation, and psychosocial issues.

* Provides a variety of options for each of the commonly encountered challenges.

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What does this mean for me and my practice?

A comprehensive review of fungating wound management; would be beneficial for any wound care clinician caring for these patients.

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W45. A Case of Refractory Pyoderma Gangrenosum Treated With a Combination of Apligraf and Systemic Immunosuppressive Agents

Duchini G, Itin P, Arnold A. Advances in Skin and Wound Care. 2011;24(5):217–220.

Article Type: Case Study/Series

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Description/Results:

* Authors report on the use of systemic immunosuppressive agents (steroids and immunomodulators such as infliximab) along with Apligraf application to stimulate closure of refractory pyoderma gangrenosum (PG) ulcers in a patient who had failed all standard therapies.

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What does this mean for me and my practice?

Provides clinicians with another potential approach to management of refractory PG ulcers, although this was not a controlled study.

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W46. Use of Platelet-Derived Growth Factor in Delayed Healing in Perineal Wound Healing in Patients With Inflammatory Bowel Disease: A Case Series

Kurtz M, Svensson E, Heimann T. Ostomy Wound Management. 2011;57(4):24–31.

Article Type: Case Study/Series

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Description/Results:

* Describes a series of 10 inflammatory bowel disease (IBD) patients with nonhealing perineal wounds 3 months postoperatively; standard care involved sterile gauze dressings, sitz baths, and irrigations as needed.

* With the addition of becaplermin to standard care, 6 of 10 wounds healed in an average of 80 days.

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What does this mean for me and my practice?

Provides initial data supporting possible benefit of platelet-derived growth factor for nonhealing perineal wounds in IBD patients.

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W47. Assessment and Management of Children With Abdominal Wall Defects

Rasma S. Journal of Wound, Ostomy and Continence Nursing. 2011;38(1):22–28.

Article Type: Integrative Review

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Description/Results:

* Describes abdominal wall defects (gastroschisis and omphalocele) in the newborn; diagnosis, pre- and postnatal considerations, and medical and surgical management are outlined.

* Specific therapies relevant to WOC nursing practice are reviewed: silo therapy, serial surgical procedures, grafts, and wound care. Also addresses critical psychosocial needs.

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What does this mean for me and my practice?

A helpful review for wound care clinicians managing these patients.

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W48. Evidence-Based Interventions for Radiation Dermatitis

Feight D, Barney T, Bruce S, McQuestion M. Clinical Journal of Oncology Nursing. 2011;15(5):481–492.

Article Type: Integrative Review

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Description/Results:

* PEP (Putting Evidence into Practice) Group conducted a thorough review of current evidence regarding prevention and management of radiodermatitis and summarized their findings.

* Provides concise information regarding factors that have been shown to reduce the incidence of radiodermatitis. Evidence-based practice interventions are included.

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What does this mean for me and my practice?

Provides updates for any wound clinician caring for patients with potential or actual radiodermatitis.

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W49. Buerger Disease (Thromboangiitis Obliterans): A Clinical Diagnosis

Highlander P, Southerland C, VonHerbulis E, Gonzalez A. Advances in Skin and Wound Care. 2011;24(1):15–17.

Article Type: Case Report

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Description/Results:

* Case report illustrating the risk factors, pathology, clinical presentation, and management of Buerger's disease, with focus on the critical role of nicotine by-products in pathology and treatment.

* A concise summary of current guidelines for diagnosis and treatment of Buerger's disease.

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What does this mean for me and my practice?

Provides a summary of current thinking regarding pathology, presentation, and management of Buerger's disease; would be beneficial to clinician caring for young and middle-aged adults with lower extremity ulcers.

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Legal/Regulatory Issues

W50. Did You Implement the 2011 Skin Substitute/Dermal Substitute Changes: Coding, Payment, and Coverage?

Schaum K. Advances in Skin and Wound Care. 2011;24(1): 11–14.

Article Type: Regulatory Review

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Description/Results:

* Provides updated information regarding coding and reimbursement issues related to the use of skin and dermal substitutes in the outpatient setting.

* Provides current Medicare payment rates for many of the most commonly used skin and dermal substitutes.

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What does this mean for me and my practice?

Provides critical information for any wound clinician involved in coding and billing in the outpatient setting.

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W51. Can You Pass the Surgical Dressing Ordering and Documentation Test?

Schaum K. Advances in Skin and Wound Care. 2011;24(3):112–117.

Article Type: Regulatory Update

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Description/Results:

* Provides answers to commonly asked questions regarding coverage of wound care products for outpatients covered by Medicare Part B and provides current data regarding information that is required in the MD order for wound care products, and required supporting documentation.

* Emphasizes the importance of current knowledge regarding durable medical equipment, Medicare Administrative Contractors' Local Coverage Determinations, and Surgical Dressing Policy, and provides Web sites that clinicians can utilize as resources for current information.

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What does this mean for me and my practice?

Beneficial to any wound care clinician who is responsible for assuring that physician orders for wound dressings and documentation of wound status are consistent with current Medicare Part B requirements.

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W52. 2011 Medicare Payment Changes, Part 2: Hospital-Owned Outpatient Wound Care Services and Procedures

Schaum K. Advances in Skin and Wound Care. 2011;24(5):204–206.

Article Type: Regulatory Review

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Description/Results:

* An overview of changes in Medicare reimbursement for surgical and medical debridement, to include deletion of the 11040 and 11041 codes, and appropriate use of the 97597, 97598, and 97602 codes.

* Also provides guidance for coding of skin and dermal substitutes, compression bandages, NPWT, HBOT, and low-frequency, noncontact, nonthermal ultrasound.

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What does this mean for me and my practice?

Provides critical information for clinicians in outpatient wound clinics who have any responsibility for coding and billing.

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W53. How Does a Skilled Nursing Facility Get Reimbursed by Medicare?

Schaum K. Advances in Skin and Wound Care. 2011;24(9):394–402.

Article Type: Regulatory Update

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Description/Results:

* Provides an overview of Medicare reimbursement for skilled nursing facilities (SNFs) including explanation of MDS and RUGs.

* Provides explanation of payment for NPWT, specialty beds, and offloading devices for Medicare patients in SNFs; also provides explanation regarding payment for SNF patients who are Medicare Part A and being seen at a HOPD (hospital outpatient department).

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What does this mean for me and my practice?

Helpful information for any wound care clinician caring for patients in SNFs or providing outpatient wound care for patients in SNFs.

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W54. Why Should Wound Care Providers Pay Attention to Medicare Payment Indicators?

Schaum K. Advances in Skin and Wound Care. 2011;24(7):300–305.

Article Type: Regulatory Update

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Description/Results:

* Provides a review of status indicators and their impact on payment in hospital outpatient departments; differentiates between Status Code A (active code), which indicates that MDs can be paid separately, and Status Code B (bundled code), which indicates that the professional fee has been “bundled” into the procedure code (nonselective debridement is an example of a “bundled code”).

* Also provides specific guidance regarding procedures that are coded as “S” (significant) procedures, meaning that more than 1 of these procedures can be billed during a single visit when applicable. (Bilateral compression wraps are one example.)

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What does this mean for me and my practice?

Provides helpful information for wound care clinicians working in hospital-based outpatient departments.

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W55. How Does a Home Health Agency Get Reimbursed by Medicare?

Schaum K. Advances in Skin and Wound Care. 2011;24(8):348–354.

Article Type: Regulatory Update

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Description/Results:

* Reviews Home Health Regulatory Guidelines (HHRG) system and role of OASIS-C data in determining HHRG category and payment; also identifies therapies that are reimbursed separately (over and above the HHRG payment), such as NPWT supplies.

* Provides specific wound-related examples of HHRG categories and payments (pressure ulcer stages II and IV, venous insufficiency and ulceration, and abdominal wound dehiscence).

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What does this mean for me and my practice?

Reviews information helpful to any wound care clinician providing care in the home health setting and outpatient setting.

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W56. Who's Minding the Charge Description Master?

Schaum K. Advances in Skin and Wound Care. 2011;24(11):500–502.

Article Type: Regulatory Update

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Description/Results:

* Provides clear definition and description of charge description master (database used to create bills); in addition, the author clearly articulates responsibilities of wound care clinicians in relation to maintenance of a current database.

* The author uses clinical examples to illustrate factors to be considered when deciding how to report and determine costs for wound care procedures and advanced wound care products.

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What does this mean for me and my practice?

Provides critical information for assuring appropriate billing in the hospital-based outpatient wound department.

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Professional Practice

W57. Telemedicine in a Rural Community Hospital for Remote Wound Care Consultations

Clegg A, Brown T, English D, Griffin P, Simonds D. Journal of Wound, Ostomy and Continence Nursing. 2011;38(3):301–304.

Article Type: Integrative Review

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Description/Results:

* Provides a review of 2 major types of telemedicine (asynchronous and “real-time”) and potential advantages in rural and underserved areas.

* Provides a review of experience of one wound care team who provided consultations for 5 acute care facilities and a remote facility; demonstrated significant cost savings with real-time consults.

* Provides a synopsis of current advantages, disadvantages, and unresolved issues with telemedicine approach to wound care.

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What does this mean for me and my practice?

Valuable article for any nurse who is contemplating the use of telemedicine.

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W58. The Implementation of the Chronic Care Model With Respect to Dealing With the Biopsychosocial Aspects of the Chronic Disease of Diabetes

Zinszer K, Mulhern J, Kareem A. Advances in Skin and Wound Care. 2011;24(10):475–484.

Article Type: Integrative Review

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Description/Results:

* Authors address the link between diabetes mellitus, depression, and the complications of diabetes, and advocate the use of the Diabetes Empowerment Scale as a rapid method for assessing a patient for evidence of depression and ability to participate in self-care and diabetes management.

* Authors suggest the Chronic Care Model as a valuable tool in the management of patients with diabetes, depression, or both, and emphasize the importance of ongoing conversations with the patient to assure that care plans are realistic and patient-centered.

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What does this mean for me and my practice?

Provides helpful insights into the relationship between diabetes and depression, and a valuable model for promoting patient-centered care; would be beneficial for any clinician caring for patients with diabetes.

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W59. Collaboration in Wound Photography Competency Development: A Unique Approach

Bradshaw L, Gergar M, Holko G. Advances in Skin and Wound Care. 2011;24(2):85–92. (CE Article)

Article Type: Quality Improvement Report

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Description/Results:

* Authors implemented a systemwide program to assure consistency and accuracy in wound photography based on a literature review and assessment of current practice.

* Clinical practice guideline developed that addressed legal issues (patient consent, photograph labeling, and deletion of photographs from memory card), infection control issues, strategies for obtaining high-quality consistent photos, downloading and digital storage processes, and photograph retrieval procedure.

* Authors address educational and staff support strategies utilized to promote adherence to the new guideline and provide a copy of their Wound Photography Performance checklist.

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What does this mean for me and my practice?

A helpful article for any clinician who uses wound photography as an adjunct to wound measurements and narrative descriptions of wound status.

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W60. Leading Wound Care Technology: The ARANZ Medical Silhouette

Kieser D, Hammond C. Advances in Skin and Wound Care. 2011; 24(2):68–70.

Article Type: Research Study

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Description/Results:

* Wound measurements obtained using handheld PDA-based wound imaging device compared to acetate tracings; measurements were performed on premeasured standardized wound models.

* With PDA-based imaging device, largest average error and SD of surface area measurements were 1.5% and 0.5%, as compared to 2.6% and 2.7% for acetate tracings.

* Users learned how to operate the device with less than 1 hour of training, and the time required to evaluate each wound (including measurements and photography) averaged 2 to 3 minutes.

* A limitation of the device is the inability to measure undermining or tunneling.

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What does this mean for me and my practice?

Results suggest that imaging devices can be used effectively to measure wound surface area; however, to date, imaging devices do not have the ability to measure undermined or tunneled areas.

Copyright © 2012 by the Wound, Ostomy and Continence Nurses Society

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